Continuity of care to optimize chronic disease management in the community setting: an evidence-based analysis.

PubMed

2013-01-01

This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. There is low quality evidence that: Higher continuity of care is associated with decreased health service utilization.There is insufficient evidence on the relationship of continuity of care with disease-specific outcomes.There is an association between high continuity of care and patient satisfaction, particularly among patients with chronic diseases.

Mobile integrated health to reduce post-discharge acute care visits: A pilot study.

PubMed

Siddle, Jennica; Pang, Peter S; Weaver, Christopher; Weinstein, Elizabeth; O'Donnell, Daniel; Arkins, Thomas P; Miramonti, Charles

2018-05-01

Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. This was a retrospective cohort analysis of a quality improvement pilot of patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90days before MIH intervention to 90days after. Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p=0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p=0.98; observation stays 95 to 106, p=0.30) Primary care visits increased 15% (p=0.11). In this pilot before/after study, MIH significantly reduces acute care hospitalizations. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of a hand hygiene campaign in outpatient health care clinics.

PubMed

Kukanich, Kate Stenske; Kaur, Ramandeep; Freeman, Lisa C; Powell, Douglas A

2013-03-01

To improve hand hygiene in two outpatient health care clinics through the introduction of a gel sanitizer and an informational poster. In this interventional study, health care workers at two outpatient clinics were observed for frequency of hand hygiene (attempts versus opportunities). Gel sanitizer and informational posters were introduced together as an intervention. Direct observation of the frequency of hand hygiene was performed during baseline, intervention, and follow-up. A poststudy survey of health care workers was also distributed and collected. In both clinics, the frequency of hand hygiene was poor at baseline (11% and 21%) but improved significantly after intervention (36% and 54%) and was maintained through the follow-up period (32% and 51%). Throughout the study, postcontact hand hygiene was observed significantly more often than precontact hand hygiene. In both clinics, health care workers reported a preference for soap and water; yet observations showed that when the intervention made gel sanitizer available, sanitizer use predominated. Fifty percent of the surveyed health care workers considered the introduction of gel sanitizer to be an effective motivating tool for improving hand hygiene. Hand hygiene performance by health care workers in outpatient clinics may be improved through promoting the use of gel sanitizer and using informational posters. Compared with surveys, direct observation by trained observers may provide more accurate information about worker preferences for hand hygiene tools.

Managed care plan performance since 1980: another look at 2 literature reviews.

PubMed Central

Sullivan, K

1999-01-01

OBJECTIVES: This article compares the quality of care provided by managed care plans (MCPs) and indemnity (or fee-for-service [FFS]) plans since 1980. METHODS: The 44 studies examined are the studies that Miller and Luft cited in their 1994 and 1997 reviews of the literature comparing MCPs with FFS plans. These studies are examined to determine how well they met Miller and Luft's selection criteria and, in addition, whether they controlled for differences in the breadth of insurance coverage. RESULTS: The 44 studies generated 57 observations. MCPs scored better than FFS plans on 10 of these, equally well on 25, and worse on 22. However, only 44 of these observations met the Miller-Luft criteria plus the coverage criterion. Four of these indicated that MCP care was better, 19 that MCP and FFS care were equivalent, and 21 that MCP care was worse. CONCLUSIONS: The small body of reliable studies comparing the quality of MCP care with that of FFS care indicates that the quality of care provided by MCPs tends to be equal or inferior to that provided by FFS plans. PMID:10394307

Primary care nursing role and care coordination: an observational study of nursing work in a community health center.

PubMed

Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret

2012-05-31

Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.

Interprofessional primary care team meetings: a qualitative approach comparing observations with personal opinions.

PubMed

van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia; Daniëls, Ramon; Lenzen, Stephanie Anna; van der Weijden, Trudy; Beurskens, Anna

2017-02-01

The number of people with multiple chronic conditions requiring primary care services increases. Professionals from different disciplines collaborate and coordinate care to deal with the complex health care needs. There is lack of information on current practices regarding interprofessional team (IPT) meetings. This study aimed to improve our understanding of the process of interprofessional collaboration in primary care team meetings in the Netherlands by observing the current practice and exploring personal opinions. Qualitative study involving observations of team meetings and interviews with participants. Eight different IPT meetings (n = 8) in different primary care practices were observed by means of video recordings. Experiences were explored by conducting individual semi-structured interviews (n = 60) with participants (i.e. health care professionals from different disciplines) of the observed team meetings. The data were analysed by means of content analysis. Most participants expressed favourable opinions about their team meetings. However, observations showed that team meetings were more or less hectic, and lacked a clear structure and team coordinator or leader. There appears to be a discrepancy between findings from observations and interviews. From the interviews, four main themes were extracted: (1) Team structure and composition, (2) Patient-centredness, (3) Interaction and (4) Attitude and motivation. IPT meetings could benefit from improvements in structure, patient-centredness and leadership by the chairpersons. Given the discrepancy between observations and interviews, it would appear useful to improve team members' awareness of aspects that could be improved before training them in dealing with specific challenges. © The Author 2016. Published by Oxford University Press.

"Lies, damned lies ..." and observational studies in comparative effectiveness research.

PubMed

Albert, Richard K

2013-06-01

A new federal initiative has allocated $1.1 billion to comparative effectiveness research, and many have emphasized the importance of including observational studies in this effort. The rationale for using observational studies to assess comparative effectiveness is based on concerns that randomized controlled trials (RCTs) are not "real world" because they enroll homogeneous patient populations, measure study outcomes that are not important to patients, use protocols that are overly complex, are conducted in specialized centers, and use study treatments that are not consistent with usual care, and that RCTs are not always feasible because of a lack of equipoise, the need to assess delayed endpoints, and concerns that they take years to complete and are expensive. This essay questions the validity of each of these proposed limitations, summarizes concerns raised about the accuracy of results generated by observational studies, provides some examples of discrepancies between results of observational studies and RCTs that pertain to pulmonary and critical care, and suggests that using observational studies for comparative effectiveness research may increase rather than decrease the cost of health care and may harm patients.

Comparing methods for estimation of heterogeneous treatment effects using observational data from health care databases.

PubMed

Wendling, T; Jung, K; Callahan, A; Schuler, A; Shah, N H; Gallego, B

2018-06-03

There is growing interest in using routinely collected data from health care databases to study the safety and effectiveness of therapies in "real-world" conditions, as it can provide complementary evidence to that of randomized controlled trials. Causal inference from health care databases is challenging because the data are typically noisy, high dimensional, and most importantly, observational. It requires methods that can estimate heterogeneous treatment effects while controlling for confounding in high dimensions. Bayesian additive regression trees, causal forests, causal boosting, and causal multivariate adaptive regression splines are off-the-shelf methods that have shown good performance for estimation of heterogeneous treatment effects in observational studies of continuous outcomes. However, it is not clear how these methods would perform in health care database studies where outcomes are often binary and rare and data structures are complex. In this study, we evaluate these methods in simulation studies that recapitulate key characteristics of comparative effectiveness studies. We focus on the conditional average effect of a binary treatment on a binary outcome using the conditional risk difference as an estimand. To emulate health care database studies, we propose a simulation design where real covariate and treatment assignment data are used and only outcomes are simulated based on nonparametric models of the real outcomes. We apply this design to 4 published observational studies that used records from 2 major health care databases in the United States. Our results suggest that Bayesian additive regression trees and causal boosting consistently provide low bias in conditional risk difference estimates in the context of health care database studies. Copyright © 2018 John Wiley & Sons, Ltd.

Parental Values and Behavior in the Outer Fiji Islands.

ERIC Educational Resources Information Center

West, Mary Maxwell

1988-01-01

Observations from a 1977-78 study of children's cognitive development in Kadavu, Fiji, are discussed in terms of setting, adult work and education, medical care, marriage and residence patterns, infant birth and mortality, and, extensively, cultural values and infant care. It is argued that the observed pattern of infant care fulfills important…

Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study

PubMed Central

van der Eem, Lisette; Nyanza, Elias C.; van Pelt, Sandra; Ndaki, Pendo; Basinda, Namanya; Sundby, Johanne

2017-01-01

Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria. PMID:29236699

Palliative care team visits. Qualitative study through participant observation

PubMed Central

Bueno Pernias, Maria José; Hueso Montoro, César; Guardia Mancilla, Plácido; Montoya Juárez, Rafael; García Caro, Maria Paz

2016-01-01

Objectives: To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. Methods: A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. Results: The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Conclusion: Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources. PMID:27226663

Understanding the treatment of attention deficit hyperactivity disorder in newly diagnosed adult patients in general practice: a UK database study

PubMed Central

Bushe, Christopher; Wilson, Bernard; Televantou, Foula; Belger, Mark; Watson, Louise

2015-01-01

Background Adult attention deficit hyperactivity disorder (ADHD) has been largely ignored in psychiatric and general practice guidance until recently. Adult ADHD has a high social and medical burden, but health care is not well described in the UK. The main study objective was to evaluate a primary care adult ADHD population in terms of prescribing and health care contact rates. Methods This was a retrospective observational study using data from the Clinical Practice Research Database from January 1, 2002 to July 31, 2011. Adult patients with an incident ADHD diagnosis or ADHD medication were identified as having been free of ADHD medication or diagnoses in the previous 2 years. Patients were followed for 12–24 months after diagnosis. Results Of the 663 patients with ADHD in the cohort, 54.1% were prescribed ADHD medication during the observation period. During the first 6 months, 34.2% of patients initiated methylphenidates and 14.0% atomoxetine. In total, 36.3% patients were referred to secondary care psychiatry during observation, with the remaining population (63.7%) never having a referral. Most of the referrals were before diagnosis in primary care. At the end of the observation period, 16.2% of patients were on antipsychotics, 17.3% hypnotics, and 34.8% antidepressants or anxiolytics; however, some patients appeared to be prescribed antipsychotic or antidepressant medications even if they did not have an observable diagnosis in their records. Health care contact rates (general practitioner or hospital) increased by 39.2% post-diagnosis (incidence rate ratio: 1.39; 95% confidence interval: 1.32, 1.47), which may be related to the need for medication monitoring and titration. Conclusion This study has shown in primary care that there is relatively low use of ADHD medication, low referrals into secondary care, high rates of usage of psychiatric non-ADHD medications for different indications, and an increasing burden in terms of health care contacts in adult ADHD patients post-diagnosis. PMID:27774030

Clinical information transfer and data capture in the acute myocardial infarction pathway: an observational study.

PubMed

Kesavan, Sujatha; Kelay, Tanika; Collins, Ruth E; Cox, Benita; Bello, Fernando; Kneebone, Roger L; Sevdalis, Nick

2013-10-01

Acute myocardial infarctions (MIs) or heart attacks are the result of a complete or an incomplete occlusion of the lumen of the coronary artery with a thrombus. Prompt diagnosis and early coronary intervention results in maximum myocardial salvage, hence time to treat is of the essence. Adequate, accurate and complete information is vital during the early stages of admission of an MI patient and can impact significantly on the quality and safety of patient care. This study aimed to record how clinical information between different clinical teams during the journey of a patient in the MI care pathway is captured and to review the flow of information within this care pathway. A prospective, descriptive, structured observational study to assess (i) current clinical information systems (CIS) utilization and (ii) real-time information availability within an acute cardiac care setting was carried out. Completeness and availability of patient information capture across four key stages of the MI care pathway were assessed prospectively. Thirteen separate information systems were utilized during the four phases of the MI pathway. Observations revealed fragmented CIS utilization, with users accessing an average of six systems to gain a complete set of patient information. Data capture was found to vary between each pathway stage and in both patient cohort risk groupings. The highest level of information completeness (100%) was observed only in the discharge stage of the MI care pathway. The lowest level of information completeness (58%) was observed in the admission stage. The study highlights fragmentation, CIS duplication, and discrepancies in the current clinical information capture and data transfer across the MI care pathway in an acute cardiac care setting. The development of an integrated and user-friendly electronic data capture and transfer system would reduce duplication and would facilitate efficient and complete information provision at the point of care. © 2012 John Wiley & Sons Ltd.

Home health care nurses' perceptions of empowerment.

PubMed

Williamson, Kathleen M

2007-01-01

This exploratory study involved the triangulation of qualitative (interview and observation) and quantitative methods (Psychological Empowerment Instrument). This study examined the individual home care nurses' perception of empowerment and how it influences decisions in the home clinical setting. Fifteen nurses were self-selected to participate. All completed an interview, and were observed and given Likert Instrument to complete. A framework analysis was performed to identify mutually exclusive and exhaustive emergent themes and patterns within the data. Home care nurses described that enpowerment is in the interaction between nurse and patient, and nurse and health care provider. Empowered is defined as being independent, confident, trusting, and comfortable with providing quality care. Home health care nurses believe that having the ability to practice collaboratively and build professional relationships was essential. Nurses in this study perceived empowerment as having meaning, choice, and competence in their job.

Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection.

PubMed

Lam, Barbara C C; Lee, Josephine; Lau, Y L

2004-11-01

Health care-associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However, hand hygiene compliance among health care workers (HCWs) remains low. The objective of this study was to assess the frequency and nature of patient contacts in neonatal intensive care units and observe the compliance and technique of hand hygiene among HCWs before and after the implementation of a multimodal intervention program. The nature and frequency of patient contacts, the hand hygiene compliance, and hand-washing techniques of HCWs were observed unobtrusively to reflect the baseline compliance and to investigate factors for noncompliance. The intervention consisted of problem-based and task-orientated hand hygiene education, enhancement of minimal handling protocol and clustering of nursing care, liberal provision of alcohol-based hand antiseptic, improvement in hand hygiene facilities, ongoing regular hand hygiene audit, and implementation of health care-associated infection surveillance. The observational study was repeated 6 months after the completion of the intervention program, which extended over 1-year period. Overall hand hygiene compliance increased from 40% to 53% before patient contact and 39% to 59% after patient contact. More marked improvement was observed for high-risk procedures (35%-60%). The average number of patient contacts also decreased from 2.8 to 1.8 per patient per hour. There was improvement in most aspects of hand-washing technique in the postintervention stage. The health care-associated infection rate decreased from 11.3 to 6.2 per 1000 patient-days. A problem-based and task-orientated education program can improve hand hygiene compliance. Enhancement of minimal handling and clustering of nursing procedures reduced the total patient contact episodes, which could help to overcome the major barrier of time constraints. A concurrent decrease in health care-associated infection rate and increase in hand hygiene compliance was observed in this study. The observational study could form part of an ongoing audit to provide regular feedback to HCWs to sustain the compliance.

Health care workers' hand decontamination practices: an Irish study.

PubMed

Creedon, Sile A

2006-02-01

The primary purpose of this quasi-experimental research is to observe health care workers' compliance with hand-hygiene guidelines during patient care in an intensive care unit in Ireland before (pretest) and after (posttest) implementation of a multifaceted hand-hygiene program. Health care workers' attitudes, beliefs, and knowledge in relation to compliance with handwashing guidelines were also investigated. A convenience sample of nurses, doctors, physiotherapists, and care assistants (n = 73 observational participants, n = 62 questionnaire respondents) was used. Data (N = 314 observations, 62 questionnaires) were analyzed descriptively and cross-tabulated using chi-square (Pearson's) and Mann-Whitney statistical tests. Results revealed that a significant shift (32%) occurred in health care workers' compliance with handwashing guidelines (pretest 51%, posttest 83%, p < .001) following the interventional hand-hygiene program. Significant changes were also found in relation to health care workers' attitudes, beliefs, and knowledge (p < .05).

Learning to Care during Storytime in the Current Context: Moral Education from the Perspective of Care Ethics

ERIC Educational Resources Information Center

Rabin, Colette

2011-01-01

Through an examination of storytelling in the present context, this study addresses the teaching of moral education from the standpoint of care ethics. Through observations, interviews, and surveys in one school committed to care ethics, this study aims to show how the philosophical perspective of care ethics can inform practice. Teachers engaged…

Development and reliability of an observation method to assess food intake of young children in child care.

PubMed

Ball, Sarah C; Benjamin, Sara E; Ward, Dianne S

2007-04-01

To our knowledge, a direct observation protocol for assessing dietary intake among young children in child care has not been published. This article reviews the development and testing of a diet observation system for child care facilities that occurred during a larger intervention trial. Development of this system was divided into five phases, done in conjunction with a larger intervention study; (a) protocol development, (b) training of field staff, (c) certification of field staff in a laboratory setting, (d) implementation in a child-care setting, and (e) certification of field staff in a child-care setting. During the certification phases, methods were used to assess the accuracy and reliability of all observers at estimating types and amounts of food and beverages commonly served in child care. Tests of agreement show strong agreement among five observers, as well as strong accuracy between the observers and 20 measured portions of foods and beverages with a mean intraclass correlation coefficient value of 0.99. This structured observation system shows promise as a valid and reliable approach for assessing dietary intake of children in child care and makes a valuable contribution to the growing body of literature on the dietary assessment of young children.

Resident choice and the survey process: the need for standardized observation and transparency.

PubMed

Schnelle, John F; Bertrand, Rosanna; Hurd, Donna; White, Alan; Squires, David; Feuerberg, Marvin; Hickey, Kelly; Simmons, Sandra F

2009-08-01

To describe a standardized observation protocol to determine if nursing home (NH) staff offer choice to residents during 3 morning activities of daily living (ADL) and compare the observational data with deficiency statements cited by state survey staff. Morning ADL care was observed in 20 NHs in 5 states by research staff using a standardized observation protocol. The number of observations in which choice was not offered was documented for 3 morning ADL care activities and compared with deficiency statements made by surveyors. Staff failed to offer choice during morning ADL care delivery for at least 1 of 3 ADL care activities in all 20 NHs. Observational data showed residents were not offered choice about when to get out of bed (11%), what to wear (25%), and breakfast dining location (39%). In comparison, survey staff issued only 2 deficiencies in all 20 NHs relevant to choice in the targeted ADL care activities, and neither deficiency was based on observational data. Survey interpretative guidelines instruct surveyors to observe if residents are offered choice during daily care provision, but standardized observation protocols are not provided to surveyors to make this determination. The use of a standardized observation protocol in the survey process similar to that used by research staff in this study would improve the accuracy and transparency of the survey process.

Use of a hand-held computer observational tool to improve communication for care planning and psychosocial well-being

PubMed Central

Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.

2013-01-01

Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behaviors may worsen nursing staff relationships. PMID:19182546

Observing the work of the Clinical Nurse Specialist: a pilot study.

PubMed

Darmody, Julie V

2005-01-01

The Clinical Nurse Specialist (CNS) is an advanced practice nurse (APN) with graduate preparation as a clinical expert within a specialty area of nursing practice. There is a need for information about the work of the CNS in order to link CNS activities to outcomes and costs of care. To describe the work of the CNS in the acute care setting using the National Association of Clinical Nurse Specialists (NACNS) model as an organizing framework. Descriptive pilot study of the work of the CNS in acute care. A 500-bed academic medical center located in the Midwestern United States. Five masters-prepared APNs in a unit-based CNS role. Direct observation and time study were used to record activities and time for 4 hours with each CNS (n = 5) for a total of 20 hours of observation. CNS activity and time within each practice domain included patient/client (30%), nursing (44%), organization/system (10%), and other activities (16%). Specific activities observed were linked to possible outcomes in the NACNS framework. The NACNS model provided a useful framework for developing a data collection tool that can be used in a larger study that analyzes the work of the acute care CNS. Describing the work of the CNS is an important preliminary step to measuring outcomes and costs of care.

Patient participation in palliative care decisions: An ethnographic discourse analysis

PubMed Central

Bélanger, Emmanuelle; Rodríguez, Charo; Groleau, Danielle; Légaré, France; MacDonald, Mary Ellen; Marchand, Robert

2016-01-01

The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team. This qualitative study combined ethnographic observations of a palliative care team with discourse analysis. Eighteen palliative care patients with cancer diagnoses, six family physicians, and two nurses were involved in the study. Multiple interactions were observed between each patient and health care providers over the course of 1 year, for a total of 101 consultations, 24 of which were audio-recorded. The analysis consisted in looking for the interpretive repertoires (i.e., familiar lines of argument used to justify actions) that were used to justify patient participation in decision-making during clinical interactions, as well as exploring their implications for decision roles and end-of-life care. Patients and their health care providers seldom addressed their decision-making roles explicitly. Rather, they constructed patient participation in palliative care decisions in a covert manner. Four interpretive repertoires were used to justify patient participation: (1) exposing uncertainty, (2) co-constructing patient preferences, (3) affirming patient autonomy, and finally (4) upholding the authority of health care providers. The results demonstrate how patients and health care providers used these arguments to negotiate their respective roles in decision-making. In conclusion, patients and health care providers used a variety of interpretive repertoires to covertly negotiate their roles in decision-making, and to legitimize decisions that shaped patients’ dying trajectories. Discourse analysis encourages awareness of the role of language in either promoting or hindering patient participation in decision-making. PMID:27882864

Patient participation in palliative care decisions: An ethnographic discourse analysis.

PubMed

Bélanger, Emmanuelle; Rodríguez, Charo; Groleau, Danielle; Légaré, France; MacDonald, Mary Ellen; Marchand, Robert

2016-01-01

The participation of patients in making decisions about their care is especially important towards the end of life because palliative care decisions involve extensive uncertainty and are heavily influenced by personal values. Yet, there is a scarcity of studies directly observing clinical interactions between palliative patients and their health care providers. In this study, we aimed to understand how patient participation in palliative care decisions is constructed through discourse in a community hospital-based palliative care team. This qualitative study combined ethnographic observations of a palliative care team with discourse analysis. Eighteen palliative care patients with cancer diagnoses, six family physicians, and two nurses were involved in the study. Multiple interactions were observed between each patient and health care providers over the course of 1 year, for a total of 101 consultations, 24 of which were audio-recorded. The analysis consisted in looking for the interpretive repertoires (i.e., familiar lines of argument used to justify actions) that were used to justify patient participation in decision-making during clinical interactions, as well as exploring their implications for decision roles and end-of-life care. Patients and their health care providers seldom addressed their decision-making roles explicitly. Rather, they constructed patient participation in palliative care decisions in a covert manner. Four interpretive repertoires were used to justify patient participation: (1) exposing uncertainty, (2) co-constructing patient preferences, (3) affirming patient autonomy, and finally (4) upholding the authority of health care providers. The results demonstrate how patients and health care providers used these arguments to negotiate their respective roles in decision-making. In conclusion, patients and health care providers used a variety of interpretive repertoires to covertly negotiate their roles in decision-making, and to legitimize decisions that shaped patients' dying trajectories. Discourse analysis encourages awareness of the role of language in either promoting or hindering patient participation in decision-making.

Child Care Quality in Different State Policy Contexts

ERIC Educational Resources Information Center

Rigby, Elizabeth; Ryan, Rebecca M.; Brooks-Gunn, Jeanne

2007-01-01

Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a…

A Quasi-experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse-related posttraumatic stress.

PubMed

Rowe, Heather; Sperlich, Mickey; Cameron, Heather; Seng, Julia

2014-01-01

To test the effectiveness of a trauma-specific, psychoeducational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes. Quasi-experimental study comparing women from a single-group, pretest-posttest pilot intervention study with women matched from a prospective observational study. Rural and university-based prenatal clinics. Pregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants. Participants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized, self-study program supported by weekly phone tutoring sessions with a health professional. The National Women's Study PTSD Module, the Peritraumatic Dissociation Experience Questionnaire, the Perception of Care Questionnaire, the Postpartum Depression Screening Scale, the Postpartum Bonding Questionnaire, and a semantic differential appraisal of the labor experience. Participants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor and small effect sizes for postpartum posttraumatic stress disorder (PTSD) symptoms, postpartum depression symptoms, and motherinfant bonding. This trauma-specific intervention reaches and benefits pregnant women with a history of childhood maltreatment. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

A quasi-experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse-related posttraumatic stress

PubMed Central

Rowe, Heather; Sperlich, Mickey; Seng, Julia S.

2015-01-01

Objective To test the effectiveness of a trauma-specific psycho-educational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes. Design Quasi-experimental study comparing women from a single-group pretest-posttest pilot intervention study with women matched from a prospective observational study. Setting Rural and university-based prenatal clinics. Participants Pregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants. Interventions Participants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized self-study program supported by weekly phone tutoring sessions with a health professional. Main Outcome Measures The National Women’s Study PTSD Module; The Peritraumatic Dissociation Experience Questionnaire); The Perception of Care Questionnaire; The Postpartum Depression Screening Scale; The Postpartum Bonding Questionnaire; and a semantic differential appraisal of the labor experience. Results Participants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor, and small effect sizes for postpartum PTSD symptoms, postpartum depression symptoms, and mother-infant bonding. Conclusion This trauma-specific intervention reaches and benefits pregnant women with a history of childhood maltreatment. PMID:24754455

Comparative effectiveness research in cancer with observational data.

PubMed

Giordano, Sharon H

2015-01-01

Observational studies are increasingly being used for comparative effectiveness research. These studies can have the greatest impact when randomized trials are not feasible or when randomized studies have not included the population or outcomes of interest. However, careful attention must be paid to study design to minimize the likelihood of selection biases. Analytic techniques, such as multivariable regression modeling, propensity score analysis, and instrumental variable analysis, also can also be used to help address confounding. Oncology has many existing large and clinically rich observational databases that can be used for comparative effectiveness research. With careful study design, observational studies can produce valid results to assess the benefits and harms of a treatment or intervention in representative real-world populations.

Nursing praxis, compassionate caring and interpersonal relations: an observational study.

PubMed

Fry, Margaret; MacGregor, Casimir; Ruperto, Kate; Jarrett, Kate; Wheeler, Janet; Fong, Jacqueline; Fetchet, Wendy

2013-05-01

The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised. Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.

Disinfection of reusable elastomeric respirators by health care workers: a feasibility study and development of standard operating procedures.

PubMed

Bessesen, Mary T; Adams, Jill C; Radonovich, Lewis; Anderson, Judith

2015-06-01

This was a feasibility study in a Department of Veterans Affairs Medical Center to develop a standard operating procedure (SOP) to be used by health care workers to disinfect reusable elastomeric respirators under pandemic conditions. Registered and licensed practical nurses, nurse practitioners, aides, clinical technicians, and physicians took part in the study. Health care worker volunteers were provided with manufacturers' cleaning and disinfection instructions and all necessary supplies. They were observed and filmed. SOPs were developed, based on these observations, and tested on naïve volunteer health care workers. Error rates using manufacturers' instructions and SOPs were compared. When using respirator manufacturers' cleaning and disinfection instructions, without specific training or supervision, all subjects made multiple errors. When using the SOPs developed in the study, without specific training or guidance, naïve health care workers disinfected respirators with zero errors. Reusable facial protective equipment may be disinfected by health care workers with minimal training using SOPs. Published by Elsevier Inc.

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes.

PubMed

Bonvicini, Laura; Candela, Silvia; Evangelista, Andrea; Bertani, Daniela; Casoli, Morena; Lusvardi, Annarella; Messori, Antonella; Giorgi Rossi, Paolo

2014-02-17

In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Observational population-based study. Reggio Emilia Province. 5957 women resident in the province who delivered between October 2010 and November 2011. CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.

Features of everyday life in psychiatric inpatient care for self-harming: an observational study of six women.

PubMed

Lindgren, Britt-Marie; Aminoff, Carina; Hällgren Graneheim, Ulla

2015-02-01

This study aimed to describe the features of everyday life in psychiatric inpatient care as experienced by women who self-harm. Participant observations and informal interviews were conducted with six women and were subjected to qualitative content analysis. The major feature of everyday life in psychiatric inpatient care was 'being surrounded by disorder', which consisted of 'living in a confusing environment, being subject to routines and rules that offer safety but lack consistency' and 'waiting both in loneliness and in togetherness'. The nursing staff spent minimal time with the patients and the women turned to each other for support, care and companionship.

Pilot Study for Managing Complex Chronic Care Medicaid Patients With Diabetes Using a Mobile Health Application Achieves "Triple Aim" Improvement in a Primary Care Setting.

PubMed

Bovbjerg, Marit L; Lee, Jenney; Wolff, Rosa; Bangs, Bobby; May, Michael A

2017-10-01

IN BRIEF Cost-effective innovations to improve health and health care in patients with complex chronic diseases are urgently needed. Mobile health (mHealth) remote monitoring applications (apps) are a promising technology to meet this need. This article reports on a study evaluating patients' use of a tablet device with an mHealth app and a cellular-enabled glucose meter that automatically uploaded blood glucose values to the app. Improvements were observed across all three components of the Patient Protection and Affordable Care Act's "triple aim." Self-rated wellness and numerous quality-of-care metrics improved, billed charges and paid claims decreased, but no changes in clinical endpoints were observed.

Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.

PubMed

Deschepper, Mieke; Waegeman, Willem; Eeckloo, Kristof; Vogelaers, Dirk; Blot, Stijn

2018-05-09

Chlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population. In this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012-2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme). The study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32-2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51-6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96-2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90-1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2-49.1). These data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.

Caring and technology in an intensive care unit: an ethnographic study.

PubMed

Price, Ann M

2013-11-01

Critical care practice is a mixture of caring and technological activities. There is debate about whether the balance between these two elements is correct and a concern that critical care units can dehumanize the patient. This research sought to examine aspects that might affect this balance between the caring and technology within the critical care setting. What aspects affect registered health care professionals' ability to care for patients within the technological environment of a critical care unit? A qualitative approach using ethnography was utilized as this methodology focuses on the cultural elements within a situation. Data collection involved participant observation, document review and semi-structured interviews to triangulate methods as this aids rigour for this approach. A purposeful sample to examine registered health care professionals currently working within the study area was used. A total of 19 participants took part in the study; 8 nurses were observed and 16 health care professionals were interviewed, including nurses, a doctor and 2 physiotherapists. The study took place on a District General Hospital intensive care unit and ethical approval was gained. An overarching theme of the 'Crafting process' was developed with sub themes of 'vigilance', 'focus of attention, 'being present' and 'expectations' with the ultimate goal of achieving the best interests for the individual patient. The areas reflected in this study coincide with the care, compassion, competency, commitment, communication and courage ideas detailed by the Department of Health (2012). Thus, further research to detail more specifically how these areas are measured within critical care may be useful. Caring is a complex concept that is difficult to outline but this article can inform practitioners about the aspects that help and hinder caring in the technical setting to inform training. © 2013 British Association of Critical Care Nurses.

Family Day Care: Some Observations.

ERIC Educational Resources Information Center

Saunders, Minta M.; Keister, Mary Elizabeth

A study comparing family and group day care was conducted. Data were collected over a two-year period on 12 children in a Greensboro, N. C., family day care program and 10 children in the UNC-G Demonstration Center for Infant-Toddler Care, a group day care center. Results, which disproved many assumptions cited as advantages of family day care,…

A randomised controlled trial of clinics in secondary schools for adolescents with asthma.

PubMed Central

Salisbury, Chris; Francis, Caia; Rogers, Chris; Parry, Kate; Thomas, Huw; Chadwick, Stephanie; Turton, Pat

2002-01-01

AIM: To compare a nurse-led clinic in schools versus care in general practice for adolescents with asthma. DESIGN OF STUDY: Randomised controlled trial in four schools; parallel observational study in two schools. SETTING: Six comprehensive schools. METHOD: In the randomised trial, pupils were invited to attend asthma review at a nurse-led clinic either in school, or in general practice. The parallel observational study compared pupils invited to practice care within and outside the randomised trial. Primary outcome measures were attendance for asthma review, symptom control, and quality of life. Secondary outcomes were knowledge, attitudes, inhaler technique, use of steroids, school absence, peak flow rate, preference for future care, health service utilisation, and costs. RESULTS: School clinic pupils were more likely to attend an asthma review than those randomised to practice care (90.8% versus 51.0% overall [P < 0.001, not consistent across schools]). No differences were observed in symptom control (P = 0.42) or quality of life (P = 0.63). Pupils attending school clinics had greater knowledge of asthma (difference = +0.38, 95% CI = 0.19 to 0.56), more positive attitudes (difference = +0.21, 95% CI = 0.05 to 0.36), and better inhaler technique (P < 0.001, not consistent across all schools). No differences were observed in school absence or peak flow rate. A majority (63%) of those who had received care at school preferred this model in future. Median costs of providing care at school and at the practice were 32.10 Pounds and 19.80 Pounds, respectively. No differences were observed between the groups in the observational comparison on any outcome. CONCLUSIONS: The schools asthma clinic increased uptake of asthma reviews. There were improvements in various process measures, but not in clinical outcomes. PMID:12528584

Factors contributing to the process of intensive care patient discharge: an ethnographic study informed by activity theory.

PubMed

Lin, Frances; Chaboyer, Wendy; Wallis, Marianne; Miller, Anne

2013-08-01

Patient flow from intensive care to acute care units is often problematic and many discharges from intensive care to acute care are unsuccessful on the first attempt. The aim of this study was to explore the factors that influence intensive care patient discharge. This ethnographic study was undertaken in an Australian metropolitan tertiary hospital that had a 14-bed level 3 intensive care unit. Intensive care and acute care unit medical and nursing staff, and other hospital staff who were involved in the intensive care patient discharge process participated in this study. A total of 28 discharges were observed, and 56 one on one interviews were conducted. Data collection techniques including direct observations, semi-structured interviews, and collection of existing documents were used. Activity theory was the theoretical framework that underpinned this study. Three patient activity systems were identified: intensive care patient discharge activity, acute care unit accepting patient activity, and hospital bed management activity. Analysis of the interactions among these activity systems revealed conflicting objects (goals), communication breakdowns, and teamwork issues. Discharge delay was found to be a significant problem, which was associated with limited acute care unit bed availability. Strategies to improve acute care unit bed availability are needed. Routine after-hours ICU discharge could raise patient safety concerns which need to be considered. All team members' input in discharge decision making should be encouraged. Problems identified in clinical handover call for actions to change the handover practice. Activity theory successfully guided the study by providing a practical and descriptive framework for the study, facilitating the understanding of the interrelationships among the activity systems. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessment of delirium using the PRE-DELIRIC model in an intensive care unit in Argentina

PubMed Central

Sosa, Fernando Ariel; Roberti, Javier; Franco, Margarita Tovar; Kleinert, María Mercedes; Patrón, Agustina Risso; Osatnik, Javier

2018-01-01

Objective To describe the incidence of and risk factors for delirium in the intensive care unit of a tertiary care teaching hospital in Argentina and to conduct the first non-European study exploring the performance of the PREdiction of DELIRium in ICu patients (PRE-DELIRIC) model. Methods Prospective observational study in a 20-bed intensive care unit of a tertiary care teaching hospital in Buenos Aires, Argentina. The PRE-DELIRIC model was applied to 178 consecutive patients within 24 hours of admission to the intensive care unit; delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Results The mean age was 64.3 ± 17.9 years. The median time of stay in the intensive care unit was 6 (range, 2 - 56) days. Of the total number of patients, 49/178 (27.5%) developed delirium, defined as a positive CAM-ICU assessment, during their stay in the intensive care unit. Patients in the delirium group were significantly older and had a significantly higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score. The mortality rate in the intensive care unit was 14.6%; no significant difference was observed between the two groups. Predictive factors for the development of delirium were increased age, prolonged intensive care unit stay, and opioid use. The area under the curve for the PRE-DELIRIC model was 0.83 (95%CI; 0.77 - 0.90). Conclusions The observed incidence of delirium highlights the importance of this problem in the intensive care unit setting. In this first study conducted outside Europe, PRE-DELIRIC accurately predicted the development of delirium. PMID:29742219

I-Hydrate training intervention for staff working in a care home setting: An observational study.

PubMed

Greene, Carolynn; Canning, Deebs; Wilson, Jennie; Bak, Aggie; Tingle, Alison; Tsiami, Amalia; Loveday, Heather

2018-05-23

Dehydration is a complex and well-recognised problem for older people residing in care homes. Within the social care sector support staff provide the majority of direct care for residents, and yet receive minimal training. To design, deliver and evaluate a hydration specific training session for care home staff to develop their knowledge and skills in supporting the hydration of care home residents. An observational study comprising a pre-test post-test survey of staff knowledge following a training intervention. Training of care home staff took place in two care homes in North West London. An interactive training session was developed and delivered, with content informed by observations of hydration care within the two homes and evaluated using CIRO model. Participant self-evaluation forms were used to collect data after the session regarding satisfaction and usefulness of the session, and pre and post levels of self-reported knowledge across six facets of hydration care. Training facilitators captured qualitative data in the form of field notes. Observations of hydration care explored the impact of training on practice. Eighteen training sessions were delivered. A total of 161 participant evaluation forms were returned. There was a significant increase in self-reported knowledge across all six facets of hydration care (p = 0.000). The majority of participants found the training enjoyable and useful, and expressed an expected change in their practice. Participants enjoyed the interactive components of the training. A lack of reflective practice skills meant participants were unable to reflect realistically about the hydration care provided in the home. Focused training on hydration in the care home environment benefits from being interactive and experiential. Although such training can be effective in increasing staff knowledge, inclusion of skills in reflective practice is required if this knowledge is to be translated into practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

PubMed

Aléx, Jonas; Gyllencreutz, Lina

2018-02-05

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

Hidden Criteria for Out-of-Home Day-Care Centre Admission in Pokhara, Nepal: A Longitudinal Observational Study

ERIC Educational Resources Information Center

Nakahara, Shinji; Poudel, Krishna C.; Lopchan, Milan; Ichikawa, Masao; Poudel, Om R.; Poudel-Tandukar, Kalpana; Yoshida, Katsumi

2010-01-01

This longitudinal observational study evaluated whether admission priorities given to children on waiting lists for out-of-home day-care centres (DCCs), determined as being either an early or late admission to DCCs, are determined by actual childcare needs and are assigned to children of disadvantaged families, in public DCCs in Pokhara, Nepal,…

Patient financial responsibility for observation care.

PubMed

Kangovi, Shreya; Cafardi, Susannah G; Smith, Robyn A; Kulkarni, Raina; Grande, David

2015-11-01

As observation care grows, Medicare beneficiaries are increasingly likely to revisit observation care instead of being readmitted. This trend has potential financial implications for Medicare beneficiaries because observation care-although typically hospital based-is classified as an outpatient service. Beneficiaries who are readmitted pay the inpatient deductible only once per benefit period. In contrast, beneficiaries who have multiple care episodes under observations status are subject to coinsurance at every stay and could accrue higher cumulative costs. We were interested in answering the question: Do Medicare beneficiaries who revisit observation care pay more than they would have had they been readmitted? We used a 20% sample of the Medicare Outpatient Standard Analytic File (2010-2012) to determine the total cumulative financial liability for Medicare beneficiaries who revisit observation care multiple times within a 60-day period. Participants were fee-for-service Medicare beneficiaries who had Part A and Part B coverage for a full calendar year (or until death) during the study period. Our primary measure was beneficiary financial responsibility for facilities fees. On average, beneficiaries with multiple observation stays in a 60-day period had a cumulative financial liability of $947.40 (803.62), which is significantly lower than the $1100 inpatient deductible (P < 0.01). However, 26.6% of these beneficiaries had a cumulative financial liability that exceeded the inpatient deductible. More than a quarter of Medicare beneficiaries with multiple observation stays in a 60-day time period have a higher financial liability than they would have had under Part A benefits. © 2015 Society of Hospital Medicine.

Osteoporosis therapies: evidence from health-care databases and observational population studies.

PubMed

Silverman, Stuart L

2010-11-01

Osteoporosis is a well-recognized disease with severe consequences if left untreated. Randomized controlled trials are the most rigorous method for determining the efficacy and safety of therapies. Nevertheless, randomized controlled trials underrepresent the real-world patient population and are costly in both time and money. Modern technology has enabled researchers to use information gathered from large health-care or medical-claims databases to assess the practical utilization of available therapies in appropriate patients. Observational database studies lack randomization but, if carefully designed and successfully completed, can provide valuable information that complements results obtained from randomized controlled trials and extends our knowledge to real-world clinical patients. Randomized controlled trials comparing fracture outcomes among osteoporosis therapies are difficult to perform. In this regard, large observational database studies could be useful in identifying clinically important differences among therapeutic options. Database studies can also provide important information with regard to osteoporosis prevalence, health economics, and compliance and persistence with treatment. This article describes the strengths and limitations of both randomized controlled trials and observational database studies, discusses considerations for observational study design, and reviews a wealth of information generated by database studies in the field of osteoporosis.

Providing Opportunities to Learn in Home-Based Child Care Settings: Observations of Learning Contexts and Behavior

ERIC Educational Resources Information Center

Rusby, Julie C.; Crowley, Ryann; Jones, Laura B.; Smolkowski, Keith

2017-01-01

Research Findings: This observation study investigated the prevalence and correlates of learning contexts provided to preschool-age children in 133 registered child care homes in below-average-income neighborhoods in the U.S. Pacific Northwest. On average, 30% of the observed proportion of time was spent in structured teacher-led activities, 51%…

Screening of Infants at Eight Months for Atypical Development in Primary Health Care in Southern Sweden

ERIC Educational Resources Information Center

Sivberg, Bengt; Lundqvist, Pia; Johanson, Ingmarie; Nordström, Berit; Persson, Bengt A.

2016-01-01

Screening studies of a population in primary health care are sparsely reported. The aim was to describe observed atypical behaviours that may be associated with autism spectrum conditions, in a population (n?=?4,329) of infants at eight months. Observations were performed by paediatric nurses. An observational instrument, named SEEK developed for…

Evaluating skin care problems in people with stomas.

PubMed

Williams, Julia; Gwillam, Brandon; Sutherland, Norma; Matten, Jane; Hemmingway, Julie; Ilsey, Helen; Somerville, Mary; Vujnovich, Angela; Day, Stephanie; Redmond, Caroline; Cowin, Caroline; Fox, Kathy; Parker, Theresa

This study aimed to identify actual and potential peristomal skin problems in relation to the use of different types of stoma appliances and accessories. It also compared ostomists' perceptions of their peristomal skin condition with those of stoma care nurse specialists. Maintaining skin integrity is a basic skill that ensures good stoma management. It is widely accepted that from time to time a patient with a stoma will seek clinical advice about a peristomal skin problem. Little is known about how often patients present with these problems, the clinical course of peristomal skin problems, and how patients manage them. A multi-centred descriptive study was conducted among 80 ostomists. Fieldwork took place over 13 months. The sample was drawn from a UK home care delivery database. Using structured questionnaires, ostomists were interviewed by a stoma care nurse specialist. A digital photograph was taken of their peristomal skin and their answers compared with nurse assessment using the Stoma Care Ostomy Research index scoring system. Of the interviewees 32% had healthy peristomal skin both via questionnaire and at observation. At observation, 68% were observed to have peristomal skin problems, of whom 44% had irritated skin, 12% had ulcerated skin, 9% had an apparent allergy and 3% had macerated/eroded skin. In addition, 21% had an ill-fitting appliance at observation. Half (50%) were observed to have a parastomal hernia, although only 24% reported having one. These findings demonstrate significant differences between the perception of skin problems among ostomists and actual skin problems observed by stoma care nurse specialists. Peristomal skin problems are common among ostomists. The difference between ostomists' and nurses' perceptions of peristomal skin condition led to the identification of educational needs for the new ostomist. Education and regular follow-up by the stoma care nurse specialist is imperative.

Syllabus Outline on Child Care for Day Care Teachers at Family Life Teacher Training Centre in Somalia. African Studies in Curriculum Development and Evaluation No. 103.

ERIC Educational Resources Information Center

Ahmed, Mumina M.

Five day care centers in Mogadiscio, the capital city of Somalia, were studied to (1) identify problems encountered in teaching a course in child care; (2) observe teaching methods and assess their effectiveness; (3) ascertain reasons for the lack of preservice training for day care teachers; and (4) develop a new syllabus for a course in child…

Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

PubMed

Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

2016-03-01

Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study

PubMed Central

de Bont, Eefje G P M; Lepot, Julie M M; Hendrix, Dagmar A S; Loonen, Nicole; Guldemond-Hecker, Yvonne; Dinant, Geert-Jan; Cals, Jochen W L

2015-01-01

Objective Even though childhood fever is mostly self-limiting, children with fever constitute a considerable workload in primary care. Little is known about the number of contacts and management during general practitioners’ (GPs) out-of-hours care. We investigated all fever related telephone contacts, consultations, antibiotic prescriptions and paediatric referrals of children during GP out-of-hours care within 1 year. Design Observational cohort study. Setting and patients We performed an observational cohort study at a large Dutch GP out-of-hours service. Children (<12 years) whose parents contacted the GP out-of-hours service for a fever related illness in 2012 were included. Main outcome measures Number of contacts and consultations, antibiotic prescription rates and paediatric referral rates. Results We observed an average of 14.6 fever related contacts for children per day at GP out-of-hours services, with peaks during winter months. Of 17 170 contacts in 2012, 5343 (31.1%) were fever related and 70.0% resulted in a GP consultation. One in four consultations resulted in an antibiotic prescription. Prescriptions increased by age and referrals to secondary care decreased by age (p<0.001). The majority of parents (89.5%) contacted the out-of-hours service only once during a fever episode (89.5%) and 7.6% of children were referred to secondary care. Conclusions This study shows that childhood fever does account for a large workload at GP out-of-hours services. One in three contacts is fever related and 70% of those febrile children are called in to be assessed by a GP. One in four consultations for childhood fever results in antibiotic prescribing and most consultations are managed in primary care without referral. PMID:25991452

Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh.

PubMed

Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

2015-01-01

Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as 'go-betweens' patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an 'enabling environment' for SBA. We highlight the need to ensure quality obstetric care prior to increasing coverage of facility births if cash transfer programmes like the JSY are to improve health outcomes.

Family participation in care plan meetings: promoting a collaborative organizational culture in nursing homes.

PubMed

Dijkstra, Ate

2007-04-01

In this study, the author evaluated a project in The Netherlands that aimed to promote family members' participation in care plan meetings at a psychogeriatric nursing home. The small-scale pilot project, which was conducted in four wards of the nursing home, was designed to involve families in health care decisions by allowing family members to participate in care plan meetings. Both qualitative (participant observation and interview) and quantitative (observation matrix and index analysis) approaches were used to evaluate the project. Findings showed family members were involved in approximately half of the interactions, and many of the questions family members asked were not about the illness, but about its effects. This study indicates there is a need for family members to participate in the multidisciplinary care plan meeting.

Do palliative care interventions reduce emergency department visits among patients with cancer at the end of life? A systematic review.

PubMed

DiMartino, Lisa D; Weiner, Bryan J; Mayer, Deborah K; Jackson, George L; Biddle, Andrea K

2014-12-01

Frequent emergency department (ED) visits are an indicator of poor quality of cancer care. Coordination of care through the use of palliative care teams may limit aggressive care and improve outcomes for patients with cancer at the end of life. To systematically review the literature to determine whether palliative care interventions implemented in the hospital, home, or outpatient clinic are more effective than usual care in reducing ED visits among patients with cancer at the end of life. PubMed, EMBASE, and CINAHL databases were searched from database inception to May 7, 2014. Only randomized/non-randomized controlled trials (RCTs) and observational studies examining the effect of palliative care interventions on ED visits among adult patients with cancer with advanced disease were considered. Data were abstracted from the articles that met all the inclusion criteria. A second reviewer independently abstracted data from 2 articles and discrepancies were resolved. From 464 abstracts, 2 RCTs, 10 observational studies, and 1 non-RCT/quasi-experimental study were included. Overall there is limited evidence to support the use of palliative care interventions to reduce ED visits, although studies examining effect of hospice care and those conducted outside of the United States reported a statistically significant reduction in ED visits. Evidence regarding whether palliative care interventions implemented in the hospital, home or outpatient clinic are more effective than usual care at reducing ED visits is not strongly substantiated based on the literature reviewed. Improvements in the quality of reporting for studies examining the effect of palliative care interventions on ED use are needed.

Green Care Farms as Innovative Nursing Homes, Promoting Activities and Social Interaction for People With Dementia.

PubMed

de Boer, Bram; Hamers, Jan P H; Zwakhalen, Sandra M G; Tan, Frans E S; Beerens, Hanneke C; Verbeek, Hilde

2017-01-01

Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes. Longitudinal observation study. Nursing homes in the Netherlands (green care farms, traditional nursing homes, and regular small-scale living facilities). A total of 115 nursing home residents at baseline, 100 at follow-up. Ecological momentary assessments (n = 16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool. Residents living at green care farms were compared with residents living in traditional nursing homes and regular small-scale living facilities. The following aspects were collected for this study: the activity performed by the participant or occurring in his or her vicinity, the engagement in the activity, the level of physical activity during the activity, the physical environment (location where the activity occurred), and the level of social interaction during the activity. In total, 9660 baseline observations and 7200 follow-up observations were conducted. Analyses showed that residents of green care farms significantly more often participated in domestic activities (P = .004, SE = 1.6) and outdoor/nature-related activities (P = .003, SE = 0.9), and significantly less often engaged in passive/purposeless activities (P < .001, SE = 1.7) compared with residents of traditional nursing homes. Furthermore, residents of green care farms had significantly more active engagement (P = .014, SE = 0.9), more social interaction (P = .006, SE = 1.1), and came outside significantly more (P = .010, SE = 1.1) than residents of traditional nursing homes. Residents of green care farms were significantly more physically active (P = .013, SE = 0.8) than were residents of regular small-scale living facilities. No other significant differences were found. Green care farms can be a valuable alternative to traditional nursing homes. They provide an attractive, homelike environment and activities that positively influence engagement and social interaction. Research is needed to study how successful elements of green care farms can be implemented in existing nursing homes. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Aggregation and the Measurement of Health Care Costs

PubMed Central

Getzen, Thomas E

2006-01-01

Objective This study evaluated the extent to which the causes of variation in health care costs differ by the level at which observations are made. Methods More than 40 U.S. and international studies providing empirical estimates of the sources of variation in health care costs were reviewed and arrayed by size of observational units. A simplified graphical analysis demonstrating how estimated correlation coefficients change with the level and type of aggregation is presented. Results As the unit of observation becomes larger, association between health care costs and health status/morbidity becomes weaker and smaller in magnitude, while correlation with income (per capita GDP) becomes stronger and larger. Individual expenditure variation within a particular health care system is largely due to differences in health status, but across systems, morbidity has almost no effect on costs. For nations, differences in per capita income explain over 90 percent of the variation in both time series and cross section. Conclusions Units of observation used for analysis of health care costs must be matched to the units at which decision making occurs. The observed pattern of empirical results is consistent with a multilevel allocative model incorporating aggregate capacity constraints. To the extent that macro constraints determine total budgets at the national level, policy interventions at the micro level (substitution of generic pharmaceuticals, use of CEA for allocation of treatments, controls on construction and technology, etc.) can act to improve efficiency, equity and average health status, but will not usually reduce aggregate average per capita costs of medical care. PMID:16987309

Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus.

PubMed

Morgan, Sonya J; Pullon, Susan R H; Macdonald, Lindsay M; McKinlay, Eileen M; Gray, Ben V

2017-06-01

Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin's 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.

Prenatal care in Oregon and Washington: policy and utilization for vulnerable women.

PubMed

Docherty, Angie; Johnston, Alison L

2015-01-01

In the prenatal period, women can have sustained contact with nurses and other clinicians, forming relationships that are likely to be health enhancing for both the woman and her unborn child. Yet, first trimester care use in Oregon dropped noticeably over the past decade. In comparison with Washington state, Oregon has not shown substantial recovery. The aim of this study was to explore potential reasons for the declining prenatal trend in Oregon. We collated county-level birth data from all Oregon and Washington counties from 2000 to 2010. A descriptive, observational, time-series regression analysis for both states assessed the influence of maternal determinants known to impact first trimester care utilization. In Oregon, two factors were significantly associated with declining first trimester care: Medicaid funding (p<.01) and maternal Hispanic ethnicity (p=.02). In Washington, there was no significant association between any assessed determinant and first trimester care. In Oregon, over the period of our study, women dependent on Medicaid and women of Hispanic origin were less likely to utilize first trimester care. A similar trend for these variables was not observed in Washington. At the time of our study, both states had different policy approaches, which may explain some of the observable patterns. Amid current healthcare reforms and rising immigration, our findings suggest the need for strong advocacy for those less able to access or utilize care.

Direct observation of weight-related communication in primary care: a systematic review.

PubMed

McHale, Calum T; Laidlaw, Anita H; Cecil, Joanne E

2016-08-01

Primary care is ideally placed to play an effective role in patient weight management; however, patient weight is seldom discussed in this context. A synthesis of studies that directly observe weight discussion in primary care is required to more comprehensively understand and improve primary care weight-related communication. To systematically identify and examine primary care observational research that investigates weight-related communication and its relationship to patient weight outcomes. A systematic review of literature published up to August 2015, using seven electronic databases (including MEDLINE, Scopus and PsycINFO), was conducted using search terms such as overweight, obese and/or doctor-patient communication. Twenty papers were included in the final review. Communication analysis focused predominantly on 'practitioner' use of specific patient-centred communication. Practitioner use of motivational interviewing was associated with improved patient weight-related outcomes, including patient weight loss and increased patient readiness to lose weight; however, few studies measured patient weight-related outcomes. Studies directly observing weight-related communication in primary care are scarce and limited by a lack of focus on patient communication and patient weight-related outcomes. Future research should measure practitioner and patient communications during weight discussion and their impact on patient weight-related outcomes. This knowledge may inform the development of a communication intervention to assist practitioners to more effectively discuss weight with their overweight and/or obese patients. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Evaluation of postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning: a descriptive study.

PubMed

Currey, Judy; Oldland, Elizabeth; Considine, Julie; Glanville, David; Story, Ian

2015-02-01

The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL). A descriptive pre and post interventional design was used. Study data were collected by surveys and observation. University postgraduate critical care nursing programme. Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports). Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing. Postgraduate critical care nursing students responded positively to the introduction of TBL and showed increased engagement with learning. In turn, these factors enhanced nurses' professional skills in teamwork, communication, problem solving and higher order critical thinking. Developing professional skills and advancing knowledge should be core to all critical care nursing education programmes to improve the quality and safety of patient care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patient-centered variables in primary and team nursing.

PubMed

Hamera, E; O'Connell, K A

1981-03-01

Patient-centered variables and their relationship to primary and team nursing have rarely been studied. In the present study the investigation focused on the following patient-centered variables: nurturance received, patient involvement, and frequency of nurse-patient contacts. Baseline observational data were collected on 12 adult medical patients experiencing team nursing care. A primary nursing care approach was then implemented on the same nursing unit, and 6 months later 12 patients were observed under this system. Patients were directly observed 24 hours a day for 5 days of hospitalization and audiotaped, using a specimen record method. This method produced transcripts that were coded for nurturance, involvement, and nurse-patient contacts. Results of the study showed that there were no differences between primary and team nursing care groups in the number of contacts, nurturance, or patient involvement with all nursing personnel or with professional nurses. However, when the primary group was adjusted to include only those patients for whom primary nursing care was fully implemented, the primary group received more nurturance (p less than .05) and had a tendency to be more active involved than did the team group (p less than .10). These findings indicate that the institution of primary nursing care is related to increased quality of nursing care.

Family Selection and Child Care Experiences: Implications for Studies of Child Outcomes.

ERIC Educational Resources Information Center

Burchinal, Margaret R.; Nelson, Lauren

2000-01-01

Discusses family selection issues that should be considered in child care research, and evidence demonstrating why each should be considered. Issues include whether causal inferences can be made from observational studies and the impact on conclusions from regression analyses that include highly correlated measures of child care experiences,…

The importance of standardized observations to evaluate nutritional care quality in the survey process.

PubMed

Schnelle, John F; Bertrand, Rosanna; Hurd, Donna; White, Alan; Squires, David; Feuerberg, Marvin; Hickey, Kelly; Simmons, Sandra F

2009-10-01

Guidelines written for government surveyors who assess nursing home (NH) compliance with federal standards contain instructions to observe the quality of mealtime assistance. However, these instructions are vague and no protocol is provided for surveyors to record observational data. This study compared government survey staff observations of mealtime assistance quality to observations by research staff using a standardized protocol that met basic standards for accurate behavioral measurement. Survey staff used either the observation instructions in the standard survey process or those written for the revised Quality Improvement Survey (QIS). Trained research staff observed mealtime care in 20 NHs in 5 states during the same time period that survey staff evaluated care in the same facilities, although it could not be determined if survey and research staff observed the same residents during the same meals. Ten NHs were evaluated by government surveyors using the QIS survey instructions and 10 NHs were evaluated by surveyors using the standard survey instructions. Research staff observations using a standardized observation protocol identified a higher proportion of residents receiving inadequate feeding assistance during meals relative to survey staff using either the standard or QIS survey instructions. For example, more than 50% of the residents who ate less than half of their meals based on research staff observation were not offered an alternative to the served meal, and the lack of alternatives, or meal substitutions, was common in all 20 NHs. In comparison, the QIS survey teams documented only 2 instances when meal substitutes were not offered in 10 NHs and the standard survey teams documented no instances in 10 NHs. Standardized mealtime observations by research staff revealed feeding assistance care quality issues in all 20 study NHs. Surveyors following the instructions in either the standard or revised QIS surveys did not detect most of these care quality issues. Survey staff instructions for observation of nutritional care are not clearly written; thus, these instructions do not permit accurate behavioral measurement. These instructions should be revised in consideration of basic principles that guide accurate behavioral measurement and shared with NH providers to enable them to effectively implement quality improvement programs.

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina.

PubMed

Fraser, Angela; Wohlgenant, Kelly; Cates, Sheryl; Chen, Xi; Jaykus, Lee-Ann; Li, You; Chapman, Benjamin

2015-02-01

Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized. Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility. Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children's clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high-touch surfaces (ie, light switches, handrails, doorknobs) were touched the least. General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

[Immigrants' access to health care in Spain: a review].

PubMed

Llop-Gironés, Alba; Vargas Lorenzo, Ingrid; Garcia-Subirats, Irene; Aller, Marta-Beatriz; Vázquez Navarrete, María Luisa

2014-01-01

An important proportion of the population in Spain is immigrant and the international literature indicates their inadequate access to health services. The objective is to contribute to improving the knowledge on access to health care of the immigrant population in Spain. Review of original papers published (1998-2012) on access to health services of the immigrant population in Spain published in Medline and MEDES. Out of 319 studies, 20 were selected, applying predefined criteria. The results were analyzed using the Aday and Andersen framework. Among the publications, 13 quantitative studies analysed differences in health care use between the immigrant and the native population, and 7 studied determinants of access of immigrants. Studies showed less use of specialized care by immigrants, higher use of emergency care and no differences in the use of primary care between groups. Five quantitative articles on determinants of access focused on factors related to the immigrant population (sex, age, educational level and holding private health insurance), but without observing clear patterns. The two qualitative studies analyzed factors related to health services, describing access to healthcare barriers such as the limited provision of information or the requirements for personal health card. Access to health care in immigrants has been scarcely studied, using different approaches and the barely analysed factors related to the services. No clear patterns were observed, as differences depend on the classification of migrants according to country of origin and the level of care. However, studies showed less use of specialized care by immigrants, higher use of emergency care and the existence of determinants of access different to their needs.

Clinical research on postoperative trauma care: has the position of observational studies changed?

PubMed

Smeeing, D P J; Houwert, R M; Kruyt, M C; van der Meijden, O A J; Hietbrink, F

2017-02-01

The postoperative care regimes of ankle fractures are studied for over 30 years and recommendations have shifted only slightly in the last decades. However, study methodology might have evolved. The aim of this study was to evaluate the changes in time in the design, quality and outcome measures of studies investigating the postoperative care of ankle fractures. The MEDLINE and EMBASE database were searched for both RCTs and cohort studies. The original studies were divided into decades of publication over the last 30 years. The methodological quality of the studies was assessed using the 'traditional' risk of bias assessment tool provided by The Cochrane Collaboration and the 'newer' MINORS criteria. The percentage of RCTs on this subject declined from 67 to 38 % in the last decades. According to the Cochrane tool, the reported quality of RCTs has improved in the last three decades whereas the reported quality of observational studies has remained unchanged. However, when quality was evaluated with the MINORS criteria, equal improvement was observed for both RCTs and observational studies. In the 80s, 67 % of all studies used the range of motion as the primary outcome measure, which decreased to 45 % in the 90s. In the 00s, none of the studies used the range of motion as the primary outcome. For postoperative care of ankle fractures, results of this study showed a relative decrease in the published number of RCTs. The overall quality of the published articles did not decline. In addition, a gradual shift from physician measured to patient-reported outcome variables was observed. However, it should be borne in mind that the findings are based on a small sample (n = 25).

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes

PubMed Central

2014-01-01

Background In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common. The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Methods Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group. Results Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. Conclusions The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes. PMID:24533853

Feasibility and clinical utility of the Japanese version of the Abbey pain scale in Japanese aged care.

PubMed

Takai, Yukari; Yamamoto-Mitani, Noriko; Chiba, Yumi; Kato, Ayako

2014-06-01

Active usage of observational pain scales in Japanese aged-care facilities has not been previously described. Therefore, to examine the feasibility and clinical utility of the Abbey Pain Scale-Japanese version (APS-J), this study examined the interrater reliability of the APS-J among a researcher, nurses, and care workers in aged-care facilities in Japan. This study also aimed to obtain nurses' and care workers' opinions on use of the scale. The following data were collected from 88 residents of two aged-care facilities: demographics, Barthel Index, Folstein Mini-Mental Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and APS-J for pain. The researchers, nurses, and care workers independently assessed the residents' pain by using the APS-J, and intraclass correlation coefficients (ICC) for interrater reliability and Cronbach alpha for internal consistency were examined. The ICC between researchers and nurses, researchers and care workers, and nurses and care workers were 0.68, 0.74, and 0.76, respectively. Nurses and care workers were invited for focus group interviews to obtain their opinions regarding APS-J use. During these interviews, nurses and care workers stated that the observational points of APS-J subscales were the criteria they normally used to evaluate residents' pain. Several nurses and care workers reported a gap between the estimated pain intensity and APS-J score. Unclear APS-J criteria, difficulties in observing residents, and insufficient practice guidelines were also reported. Our findings indicate that the APS-J has moderate reliability and clinically utility. To facilitate APS-J usage, education and clinical guidelines for pain management may be required for nurses and care workers. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Balancing the Evidence: How to Reconcile the Results of Observational Studies vs. Randomized Clinical Trials in Dialysis.

PubMed

Shen, Jenny I; Lum, Erik L; Chang, Tara I

2016-09-01

Because large randomized clinical trials (RCTs) in dialysis have been relatively scarce, evidence-based dialysis care has depended heavily on the results of observational studies. However, when results from RCTs appear to contradict the findings of observational studies, nephrologists are left to wonder which type of study they should believe. In this editorial, we explore the key differences between observational studies and RCTs in the context of such seemingly conflicting studies in dialysis. Confounding is the major limitation of observational studies, whereas low statistical power and problems with external validity are more likely to limit the findings of RCTs. Differences in the specification of the population, exposure, and outcomes can also contribute to different results among RCTs and observational studies. Rigorous methods are required regardless of what type of study is conducted, and readers should not automatically assume that one type of study design is superior to the other. Ultimately, dialysis care requires both well-designed, well-conducted observational studies and RCTs to move the field forward. © 2016 Wiley Periodicals, Inc.

Balancing the Evidence: How to Reconcile the Results of Observational Studies vs. Randomized Clinical Trials in Dialysis

PubMed Central

Shen, Jenny I.; Lum, Erik L.; Chang, Tara I.

2016-01-01

Because large randomized clinical trials (RCTs) in dialysis have been relatively scarce, evidence-based dialysis care has depended heavily on the results of observational studies. However, when results from RCTs appear to contradict the findings of observational studies, nephrologists are left to wonder which type of study they should believe. In this editorial we explore the key differences between observational studies and RCTs in the context of such seemingly conflicting studies in dialysis. Confounding is the major limitation of observational studies, while low statistical power and problems with external validity are more likely to limit the findings of RCTs. Differences in the specification of the population, exposure, and outcomes can also contribute to different results among RCTs and observational studies. Rigorous methods are required regardless of what type of study is conducted, and readers should not automatically assume that one type of study design is superior to the other. Ultimately, dialysis care requires both well-designed, well-conducted observational studies and RCTs to move the field forward. PMID:27207819

Influence of Structural Features on Portuguese Toddler Child Care Quality

ERIC Educational Resources Information Center

Pessanha, Manuela; Aguiar, Cecilia; Bairrao, Joaquim

2007-01-01

Whereas child care quality has been extensively studied in the U.S., there is much less information about the quality of child care in other countries. With one of the highest maternal employment rates in Europe, it is important to examine child care in Portugal. Thirty toddler classrooms in child care centers were observed. The purpose of this…

A Comparison of Three Types of Day Care and Nursery School-Home Care.

ERIC Educational Resources Information Center

Prescott, Elizabeth

A study was conducted comparing young children's experiences in three types of day care--closed structure, open structure and family--with their experiences in home care supplemented by part-time nursery school. A total of 112 children, aged 2 to 5, were observed, each for 180-200 minutes. Eighty-four were selected from 15 day care centers, half…

Describing and Modeling Workflow and Information Flow in Chronic Disease Care

PubMed Central

Unertl, Kim M.; Weinger, Matthew B.; Johnson, Kevin B.; Lorenzi, Nancy M.

2009-01-01

Objectives The goal of the study was to develop an in-depth understanding of work practices, workflow, and information flow in chronic disease care, to facilitate development of context-appropriate informatics tools. Design The study was conducted over a 10-month period in three ambulatory clinics providing chronic disease care. The authors iteratively collected data using direct observation and semi-structured interviews. Measurements The authors observed all aspects of care in three different chronic disease clinics for over 150 hours, including 157 patient-provider interactions. Observation focused on interactions among people, processes, and technology. Observation data were analyzed through an open coding approach. The authors then developed models of workflow and information flow using Hierarchical Task Analysis and Soft Systems Methodology. The authors also conducted nine semi-structured interviews to confirm and refine the models. Results The study had three primary outcomes: models of workflow for each clinic, models of information flow for each clinic, and an in-depth description of work practices and the role of health information technology (HIT) in the clinics. The authors identified gaps between the existing HIT functionality and the needs of chronic disease providers. Conclusions In response to the analysis of workflow and information flow, the authors developed ten guidelines for design of HIT to support chronic disease care, including recommendations to pursue modular approaches to design that would support disease-specific needs. The study demonstrates the importance of evaluating workflow and information flow in HIT design and implementation. PMID:19717802

Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice.

PubMed

Serrano Santos, Jose Manuel; Poland, Fiona; Wright, David; Longmore, Timothy

2016-10-30

In the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes. A convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs). Overall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (p<0.001). PWD were more likely to experience inappropriate prescribing (IP). Signs of aspiration were more frequently observed in PWD when IP occurred (p<0.001). Observation of medication administration practices by independent pharmacists may enable the identification of potentially dangerous practices and be used as a method of staff support. Unidentified signs of aspiration suggest that nurses require training in dysphagia and need to communicate its presence to the resident's GP. Further research should explore the design of an effective training for nurses. Copyright © 2016 Elsevier B.V. All rights reserved.

Explaining variation in hospice visit intensity for routine home care.

PubMed

Stearns, Sally C; Sheingold, Steven; Zuckerman, Rachael B

2014-01-01

Medicare pays a flat per diem rate by level of hospice service without case-mix adjustment, although previous research shows that visit intensity varies considerably over the course of hospice episodes. Concerns pertain to the inherent financial incentives for routine home care, the most frequently used level, and whether payment efficiency can be improved using case-mix adjustment. The aim of this study was to assess variation in hospice visit intensity during hospice episodes by patient, hospice, and episode characteristics to inform policy discussions regarding hospice payment methods. This observational study used Medicare claims for hospice episodes in 2010. Multiple observations were constructed per episode phase (eg, days 1-14, 15-30, etc.). Episode phase and observed characteristics were regressed on average routine home care visit intensity per day; patient and hospice fixed effects controlled for unobserved characteristics. Visit intensity was constructed using national wages to weight visits by provider type. Observed patient characteristics included age, sex, race, diagnoses, venue of care, use of other hospice levels of care, and discharge status; hospice characteristics included ownership, affiliation, size, and urban/state location. Visit intensity varied substantially by episode phase. This pattern was largely invariant to observed patient and hospice characteristics, which explained <4% of variation in visit intensity per day after adjusting for episode phase. Unobserved patient characteristics explained approximately 85% of remaining variation. These results show that case-mix adjustment based on commonly observed factors would only minimally improve hospice payment methodology.

Acute care nurses' views on family participation and collaboration in fundamental care.

PubMed

Mackie, Benjamin R; Marshall, Andrea; Mitchell, Marion

2018-06-01

To understand the beliefs, attitudes and perceptions of nurses regarding family participation and collaboration in the care of their hospitalized adult relative. Family participation in care is known to enhance the quality of patient care. Nurses are uniquely placed to support such participation, including the delivery of fundamental care. However, nurses' attitudes and beliefs may help or hinder participation. A mixed methods approach with an exploratory sequential design was used. A regional referral hospital in Australia. Nurses were eligible to participate in the study if they were permanent staff of the hospital, and who in their day-to-day work had direct contact with adult patients and their families on acute care wards. Observer-as-participant observation data and semi-structured interviews were undertaken. 30 hr of observational data were gathered, and 14 nurses were interviewed. Data collection occurred between September and December 2016. Following separate analysis, data were triangulated. Analysis uncovered two contrasting categories: (i) enacting family participation (four themes); and (ii) hindering family participation (five themes). The findings of our study demonstrated that the practices of nurses do not always align with healthcare policies, and strategies to support nurses to enact patient- and family-centred practices are needed. Nurses can use these findings to make informed evidence-based changes to the way they practice and communicate with families to ensure fundamental care is delivered. © 2017 John Wiley & Sons Ltd.

Quality of Care in Creches for Disadvantaged Children: A Brazilian Case Study.

ERIC Educational Resources Information Center

Ferreira, M. C. Rossetti; And Others

A study was conducted to critically assess the developmental conditions of 187 children (ages 1 month to 6 years) in eight creches (day nurseries) located in and around Ribeirao Preto, Brazil. Data were collected through informal interviews of day care staff and from 20 hours of direct observations of day care units. Findings indicated inadequate…

Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis

PubMed Central

Devereaux, P.J.; Heels-Ansdell, Diane; Lacchetti, Christina; Haines, Ted; Burns, Karen E.A.; Cook, Deborah J.; Ravindran, Nikila; Walter, S.D.; McDonald, Heather; Stone, Samuel B.; Patel, Rakesh; Bhandari, Mohit; Schünemann, Holger J.; Choi, Peter T.-L.; Bayoumi, Ahmed M.; Lavis, John N.; Sullivan, Terrence; Stoddart, Greg; Guyatt, Gordon H.

2004-01-01

Background It has been shown that patients cared for at private for-profit hospitals have higher risk-adjusted mortality rates than those cared for at private not-for-profit hospitals. Uncertainty remains, however, about the economic implications of these forms of health care delivery. Since some policy-makers might still consider for-profit health care if expenditure savings were sufficiently large, we undertook a systematic review and meta-analysis to compare payments for care at private for-profit and private not-for-profit hospitals. Methods We used 6 search strategies to identify published and unpublished observational studies that directly compared the payments for care at private for-profit and private not-for-profit hospitals. We masked the study results before teams of 2 reviewers independently evaluated the eligibility of all studies. We confirmed data or obtained additional data from all but 1 author. For each study, we calculated the payments for care at private for-profit hospitals relative to private not-for-profit hospitals and pooled the results using a random effects model. Results Eight observational studies, involving more than 350 000 patients altogether and a median of 324 hospitals each, fulfilled our eligibility criteria. In 5 of 6 studies showing higher payments for care at private for-profit hospitals, the difference was statistically significant; in 1 of 2 studies showing higher payments for care at private not-for-profit hospitals, the difference was statistically significant. The pooled estimate demonstrated that private for-profit hospitals were associated with higher payments for care (relative payments for care 1.19, 95% confidence interval 1.07–1.33, p = 0.001). Interpretation Private for-profit hospitals result in higher payments for care than private not-for-profit hospitals. Evidence strongly supports a policy of not-for-profit health care delivery at the hospital level. PMID:15184339

Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study.

PubMed

Merriweather, Judith; Smith, Pam; Walsh, Timothy

2014-03-01

To compare and contrast current nutritional rehabilitation practices against recommendations from National Institute for Health and Excellence guideline Rehabilitation after critical illness (NICE) (2009, http://www.nice.org.uk/cg83). Recovery from critical illness has gained increasing prominence over the last decade but there is remarkably little research relating to nutritional rehabilitation. The study is a qualitative study based on patient interviews and observations of ward practice. Seventeen patients were recruited into the study at discharge from the intensive care unit (ICU) of a large teaching hospital in central Scotland in 2011. Semi-structured interviews were conducted on transfer to the ward and weekly thereafter. Fourteen of these patients were followed up at three months post-ICU discharge, and a semi-structured interview was carried out. Observations of ward practice were carried out twice weekly for the duration of the ward stay. Current nutritional practice for post-intensive care patients did not reflect the recommendations from the NICE guideline. A number of organisational issues were identified as influencing nutritional care. These issues were categorised as ward culture, service-centred delivery of care and disjointed discharge planning. Their influence on nutritional care was compounded by the complex problems associated with critical illness. The NICE guideline provides few nutrition-specific recommendations for rehabilitation; however, current practice does not reflect the nutritional recommendations that are detailed in the rehabilitation care pathway. Nutritional care of post-ICU patients is problematic and strategies to overcome these issues need to be addressed in order to improve nutritional intake. © 2013 John Wiley & Sons Ltd.

Long-term Clinical and Cost Outcomes of a Pharmacist-managed Risk Factor Management Clinic in Singapore: An Observational Study.

PubMed

Tan, She Hui; Kng, Kwee Keng; Lim, Sze Mian; Chan, Alexandre; Loh, Jason Kwok Kong; Lee, Joyce Yu-Chia

2017-12-01

Few studies have determined the benefits of pharmacist-run clinics within a tertiary institution, and specifically on their capability to improve clinical outcomes as well as reduce the cost of illness. This study was designed to investigate the effectiveness of a pharmacist-managed risk factor management clinic (RFMP) in an acute care setting through the comparison of clinical (improvement in glycosylated hemoglobin level) and cost outcomes with patients receiving usual care. This single-center, observational study included patients aged ≥21 years old and diagnosed with type 2 diabetes mellitus (DM) who received care within the cardiology department of a tertiary institution between January 1, 2014, and December 31, 2015. The intervention group comprised patients who attended the RFMP for 3 to 6 months, and the usual-care group comprised patients who received standard cardiologist care. Univariate analysis and multiple linear regression were conducted to analyze the clinical and cost outcomes. A total of 142 patients with DM (71 patients in the intervention group and 71 patients in the usual-care group) with similar baseline characteristics were included. After adjusting for differences in baseline systolic blood pressure and triglyceride levels, the mean reduction in glycosylated hemoglobin level at 6 months from baseline in the intervention group was significantly lower by 0.78% compared with the usual-care group. Patients in the usual-care group had a significantly higher risk of hospital admissions within the 12 months from baseline compared with the intervention group (odds ratio, 3.84 [95% CI, 1.17-12.57]; P = 0.026). Significantly lower mean annual direct medical costs were also observed in the intervention group (US $8667.03 [$17,416.20] vs US $56,665.02 [$127,250.10]; P = 0.001). The pharmacist-managed RFMP exhibited improved clinical outcomes and reduced health care costs compared with usual care within a tertiary institute. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Comparison of Ramadan-specific education level in patients with diabetes seen at a Primary and a Tertiary care center of Karachi-Pakistan.

PubMed

Masood, Shabeen Naz; Alvi, Syed Faraz Danish; Ahmedani, Muhammad Yakoob; Kiran, Shazia; Zeeshan, Nimra Fatima; Basit, Abdul; Shera, A Samad

2014-01-01

To compare Ramadan-specific education level in fasting patients with diabetes at a Primary and a Tertiary care center. An observational study was conducted in the Outpatient departments of a Primary care center and a Tertiary care center in Karachi-Pakistan. Recruitment of patients started at the end of Ramadan 2011 and continued till three months after Ramadan 2011. All patients with diabetes who observed fast during the month of Ramadan 2011 were included in the study. In Primary care center, patients were attended by physicians only, while at Tertiary care center patients were seen by physicians, diabetes educator and dietician. For data collection, standardized questionnaire based interview was conducted on one to one basis by trained healthcare professionals. Same questionnaire was used at both the centers. A total of 392 and 199 patients with diabetes recruited at Primary and Tertiary care centers, respectively. Ramadan-specific diabetes education received by 213 (55%) and 123 (61.80%) patients with diabetes at Primary and Tertiary care centers, respectively. Compared to Primary care center, patients at Tertiary care centers were more aware about components of Ramadan-specific diabetes education such as signs and symptoms of hypoglycemia and hyperglycemia, dose of medicines/insulin during Ramadan fasting, dose of medicines/insulin when not fasting, self-monitoring of blood glucose, dietary modifications, physical activity, adequate nutrition and adequate hydration during Ramadan (p<0.05). It was observed that Ramadan-specific education level of patients at Tertiary care center was significantly better compared to patients at Primary care center. Copyright © 2014 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Untapped Potential of Observational Research to Inform Clinical Decision Making: American Society of Clinical Oncology Research Statement.

PubMed

Visvanathan, Kala; Levit, Laura A; Raghavan, Derek; Hudis, Clifford A; Wong, Sandra; Dueck, Amylou; Lyman, Gary H

2017-06-01

ASCO believes that high-quality observational studies can advance evidence-based practice for cancer care and are complementary to randomized controlled trials (RCTs). Observational studies can generate hypotheses by evaluating novel exposures or biomarkers and by revealing patterns of care and relationships that might not otherwise be discovered. Researchers can then test these hypotheses in RCTs. Observational studies can also answer or inform questions that either have not been or cannot be answered by RCTs. In addition, observational studies can be used for postmarketing surveillance of new cancer treatments, particularly in vulnerable populations. The incorporation of observational research as part of clinical decision making is consistent with the position of many leading institutions. ASCO identified five overarching recommendations to enhance the role of observational research in clinical decision making: (1) improve the quality of electronic health data available for research, (2) improve interoperability and the exchange of electronic health information, (3) ensure the use of rigorous observational research methodologies, (4) promote transparent reporting of observational research studies, and (5) protect patient privacy.

Area-level variations in cancer care and outcomes.

PubMed

Keating, Nancy L; Landrum, Mary Beth; Lamont, Elizabeth B; Bozeman, Samuel R; McNeil, Barbara J

2012-05-01

: Substantial regional variations in health-care spending exist across the United States; yet, care and outcomes are not better in higher-spending areas. Most studies have focused on care in fee-for-service Medicare; whether spillover effects exist in settings without financial incentives for more care is unknown. : We studied care for cancer patients in fee-for-service Medicare and the Veterans Health Administration (VA) to understand whether processes and outcomes of care vary with area-level Medicare spending. : An observational study using logistic regression to assess care by area-level measures of Medicare spending. : Patients with lung, colorectal, or prostate cancers diagnosed during 2001-2004 in Surveillance, Epidemiology, and End Results (SEER) areas or the VA. The SEER cohort included fee-for-service Medicare patients aged older than 65 years. : Recommended and preference-sensitive cancer care and mortality. : In fee-for-service Medicare, higher-spending areas had higher rates of recommended care (curative surgery and adjuvant chemotherapy for early-stage non-small-cell lung cancer and chemotherapy for stage III colon cancer) and preference-sensitive care (chemotherapy for stage IV lung and colon cancer and primary treatment of local/regional prostate cancer) and had lower lung cancer mortality. In the VA, we observed minimal variation in care by area-level Medicare spending. : Our findings suggest that intensity of care for Medicare beneficiaries is not driving variations in VA care, despite some overlap in physician networks. Although the Dartmouth Atlas work has been of unprecedented importance in demonstrating variations in Medicare spending, new measures may be needed to better understand variations in other populations.

Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

PubMed Central

Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

2015-01-01

Background Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Results Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an ‘enabling environment’ for SBA. We highlight the need to ensure quality obstetric care prior to increasing coverage of facility births if cash transfer programmes like the JSY are to improve health outcomes. PMID:26160769

From Policy to Practice: Implementation of Water Policies in Child Care Centers in Connecticut

ERIC Educational Resources Information Center

Middleton, Ann E.; Henderson, Kathryn E.; Schwartz, Marlene B.

2013-01-01

Objective: Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. Design: One-day observations were conducted in a random sample of 40 Child and Adult Care Food…

Observations of Health Care in China: Four Perspectives.

ERIC Educational Resources Information Center

Attwood, Madge, Ed.

This collection consists of four papers dealing with the delivery of health care in the People's Republic of China. The papers resulted from a study tour of the Chinese health care system in June 1980. Included in the volume are the following papers: "A Comparison of Selected Aspects of the Health Care Systems of the Socialist Federal…

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…

Nursing staff work patterns in a residential aged care home: a time-motion study.

PubMed

Qian, Siyu; Yu, Ping; Hailey, David

2016-11-01

Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses' work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses' work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.

Effect of a medical toxicology admitting service on length of stay, cost, and mortality among inpatients discharged with poisoning-related diagnoses.

PubMed

Curry, Steven C; Brooks, Daniel E; Skolnik, Aaron B; Gerkin, Richard D; Glenn, Stuart

2015-03-01

There are no published studies that have compared quality outcomes of hospitalized poisoned patients primarily under the care of physician medical toxicologists to patients treated by non-toxicologists. We hypothesized that inpatients primarily cared for by medical toxicologists would exhibit shorter lengths of stay (LOS), lower costs, and decreased mortality. Patients discharged in 2010 and 2011 from seven hospitals within the same health care system and greater metropolitan area with Medicare severity diagnosis-related groups for "poisoning and toxic effects of drugs" with and without major comorbidities or complications (917 & 918, respectively) were identified from a Premier® database. The database contained severity-weighted comparisons between expected and observed outcomes for each patient. Outcome parameters were differences between expected and observed LOS, cost, and percent mortality. These were then compared among groups of patients primarily admitted and cared for by (1) medical toxicologists at one hospital (Banner Good Samaritan Medical Center, BGS), (2) non-toxicologists at BGS, and (3) non-toxicologists at six other hospitals. Records of 3,581 patients contained complete data for assessment of at least one outcome measure. Patients cared for by medical toxicologists experienced favorable differences in LOS, costs, and mortality compared with other patient groups (p < 0.001). If patients cared for by non-toxicologists had experienced similar differences in observed over expected values for LOS, cost, and mortality as those cared for by medical toxicologists, there would have been a median savings of 1,483 hospital days, $4.269 million, and a significant decrease in mortality during the 2-year study period. Differences between observed and expected LOS, cost, and mortality in patients primarily cared for by medical toxicologists were significantly better than in patients cared for by non-toxicologists, regardless of facility. These data suggest that significant reductions in patient hospital days, costs, and mortality are possible when medical toxicologists directly care for hospitalized patients.

Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care.

PubMed

Gunn, Rose; Davis, Melinda M; Hall, Jennifer; Heintzman, John; Muench, John; Smeds, Brianna; Miller, Benjamin F; Miller, William L; Gilchrist, Emma; Brown Levey, Shandra; Brown, Jacqueline; Wise Romero, Pam; Cohen, Deborah J

2015-01-01

This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care. We conducted an observational study of 19 diverse practices located across the United States. Practice-level data included field notes from 2-4-day site visits, transcripts from semistructured interviews with clinicians and clinical staff, online implementation diary posts, and facility photographs. A multidisciplinary team used a 4-stage, systematic approach to analyze data and identify how physical layout enabled the work of integrated care teams. Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space. We describe these layouts and the influence they have on situational awareness, interprofessional "bumpability," and opportunities for on-the-fly communication. We observed BHCs and PCCs engaging in more face-to-face methods for coordinating integrated care for patients in type 2 layouts (41.5% of observed encounters vs 11.7%; P < .05). We show that practices needed to strike a balance between professional proximity and private work areas to accomplish job tasks. Private workspace was needed for focused work, to see patients, and for consults between clinicians and clinical staff. We describe the ways practices modified and built new space and provide 2 recommended layouts for practices integrating care based on study findings. Physical layout and positioning of professionals' workspace is an important consideration in practices implementing integrated care. Clinicians, researchers, and health-care administrators are encouraged to consider the role of professional proximity and private working space when creating new facilities or redesigning existing space to foster delivery of integrated behavioral health and primary care. © Copyright 2015 by the American Board of Family Medicine.

Evaluating a Dutch cardiology primary care plus intervention on the Triple Aim outcomes: study design of a practice-based quantitative and qualitative research.

PubMed

Quanjel, Tessa C C; Spreeuwenberg, Marieke D; Struijs, Jeroen N; Baan, Caroline A; Ruwaard, Dirk

2017-09-06

In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+. The study is a practice-based, quantitative study with a longitudinal observational design, and an additional qualitative study to supplement, interpret and improve the quantitative study. The study population of the quantitative part will consist of adult patients (≥18 years) with non-acute and low-complexity cardiology-related health complaints, who will be referred to the cardiology PC+ centre (intervention group) or hospital-based outpatient cardiology care (control group). All eligible patients will be asked to complete questionnaires at three different time points consisting of questions about their demographics, health status and experience of care. Additionally, quantitative data will be collected about health-care utilization and related health-care costs at the PC+ centre and the hospital. The qualitative part, consisting of semi-structured interviews, focus groups, and observations, is designed to evaluate the process as well as to amplify, clarify and explain quantitative results. This study will evaluate a cardiology PC+ centre using quantitative and supplementary qualitative methods. The findings of both sub-studies will fill a gap in knowledge about the effects of PC+ and in particular whether PC+ is able to pursue the Triple Aim outcomes. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

Quality of residential care for older people: does education for healthcare assistants make a difference?

PubMed

Smith, Barbara; Kerse, Ngaire; Parsons, Matthew

2005-05-06

To determine the impact of a healthcare assistant education programme on the quality of care for older people living in a residential home in Auckland, New Zealand. A pre- and post-intervention evaluation study was undertaken within a residential home for older people. Quality of care was established by two periods of non-participant time-sampling observation of residents, separated by a programme of 10 interactive teaching sessions for healthcare assistants. Informed consent was gained from all observed residents and staff. Using the Quality Assessment Project (QAP) quality measure, the non-participant time-sampling observation data identified a 12.5% increase in resident care that was considered appropriate and adequate (chi-squared=12.05) and an 11.53% decrease in resident care that was considered inappropriate and inadequate (chi-squared=11.43). The intermediate grades did not alter significantly. Residents with low functional activity scores (Barthel Index) received better care after the education intervention (chi-squared=32.99), as did residents with moderate cognitive impairment (Abbreviated Mental Test Score [AMTS]<8/10). Healthcare assistant education can positively impact on the quality of care given to older people in residential care.

Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

PubMed Central

2012-01-01

Background Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes. Methods We searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented. Results Ten RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above. Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes. PMID:23151143

Transition to Adult Care for Youth with Type 1 Diabetes

PubMed Central

Garvey, Katharine C.; Markowitz, Jessica T.

2014-01-01

Emerging adults with type 1 diabetes are at risk for poor glycemic control, gaps in medical care, and adverse health outcomes. With the increasing incidence in type 1 diabetes in the pediatric population, there will be an increase in the numbers of teens and young adults transferring their care from pediatric providers to adult diabetes services in the future. In recent years, the topic of transitioning pediatric patients with type 1 diabetes to adult diabetes care has been discussed at length in the literature and there have been many observational studies. However, there are few interventional studies and, to date, no randomized clinical trials. This paper discusses the rationale for studying this important area. We review both observational and interventional literature over the past several years, with a focus on new research. In addition, important areas for future research are outlined. PMID:22922877

Care during labor and birth for the prevention of intrapartum-related neonatal deaths: a systematic review and Delphi estimation of mortality effect

PubMed Central

2011-01-01

Background Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events (“birth asphyxia”) in term babies for use in the Lives Saved Tool (LiST). Methods We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert Delphi consensus process was conducted to estimate cause-specific mortality effects. Results We identified evidence for the effect on perinatal/neonatal mortality of emergency obstetric care packages: 9 studies (8 observational, 1 quasi-experimental), and for skilled childbirth care: 10 studies (8 observational, 2 quasi-experimental). Studies were of low quality, but the GRADE recommendation for implementation is strong. Our Delphi process included 21 experts representing all WHO regions and achieved consensus on the reduction of intrapartum-related neonatal deaths by comprehensive emergency obstetric care (85%), basic emergency obstetric care (40%), and skilled birth care (25%). For TBA training we identified 2 meta-analyses and 9 studies reporting mortality effects (3 cRCT, 1 quasi-experimental, 5 observational). There was substantial between-study heterogeneity and the overall quality of evidence was low. Because the GRADE recommendation for TBA training is conditional on the context and region, the effect was not estimated through a Delphi or included in the LiST tool. Conclusion Evidence quality is rated low, partly because of challenges in undertaking RCTs for obstetric interventions, which are considered standard of care. Additional challenges for evidence interpretation include varying definitions of obstetric packages and inconsistent measurement of mortality outcomes. Thus, the LiST effect estimates for skilled birth and emergency obstetric care were based on expert opinion. Using LiST modelling, universal coverage of comprehensive obstetric care could avert 591,000 intrapartum-related neonatal deaths each year. Investment in childbirth care packages should be a priority and accompanied by implementation research and further evaluation of intervention impact and cost. Funding This work was supported by the Bill and Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US. PMID:21501427

Scope of Nursing Care in Polish Intensive Care Units

PubMed Central

Wysokiński, Mariusz; Ksykiewicz-Dorota, Anna; Fidecki, Wiesław

2013-01-01

Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation) and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours), that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ 2 = 16945.8,P < 0.001 between the nurses' workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs. PMID:24490162

The Reality of Well-Being-Focused Design in Dementia Care: A Case Study of Acute Dementia Wards in the United Kingdom.

PubMed

Catt, Megan; Giridharan, Renganathan

2018-01-01

The study explored design for well-being within dementia care by investigating the adoption of well-being-focused design in real-world practice, through observing National Health Service (NHS) wards. Design for well-being is an approach that considers the psychological and physiological effects of architecture to improve health and well-being. The high psychological care requirement for dementia patients makes them a significant group to study in the evaluation of current hospital facilities. A literature review was conducted to frame the current theoretical perception of the key characteristics of a good environment for dementia care. A framework was generated to summarize and used as an assessment tool in a series of observational visits to NHS wards. Interviews with clinical staff focused on care outcomes and practicalities of implementing well-being-focused design, considering the historical and economical context. Key findings from the observations and interviews were analyzed for recurring themes. The ward observations and interviews provided insight into the current progression of well-being-led design in NHS hospitals in England. The research highlights key areas of success and factors that inhibit further progression. The case studies showed a good degree of ambition to utilize well-being-focused design, with belief among staff that the physical environment has a substantial role in the health and well-being of patients. Staff also felt that this approach is most effective for those in the less advanced stages of dementia. Despite the high level of support, the current degree of implementation appears to be varied.

Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument--an observational study.

PubMed

Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F

2016-03-08

In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0.11) or observed non-technical skills performance (r(s) = 0.4, p = 0.1). This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance. The AeroNOTS framework could be used to facilitate education and training in non-technical skills for air ambulance clinicians, and further evaluation of this rating system is merited.

Do Effects of Early Child Care Extend to Age 15 Years? Results from the NICHD Study of Early Child Care and Youth Development

ERIC Educational Resources Information Center

Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Steinberg, Laurence; Vandergrift, Nathan

2010-01-01

Relations between nonrelative child care (birth to 4 1/2 years) and functioning at age 15 were examined (N = 1,364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with…

The Rise in Cortisol in Family Day Care: Associations with Aspects of Care Quality, Child Behavior, and Child Sex

ERIC Educational Resources Information Center

Gunnar, Megan R.; Kryzer, Erin; Van Ryzin, Mark J.; Phillips, Deborah A.

2010-01-01

This study examined the increase in salivary cortisol from midmorning to midafternoon in 151 children (3.0-4.5 years) in full-time home-based day care. Compared to cortisol levels at home, increases were noted in the majority of children (63%) at day care, with 40% classified as a stress response. Observations at day care revealed that intrusive,…

ICU nurses and physicians dialogue regarding patients clinical status and care options—a focus group study

PubMed Central

Kvande, Monica; Lykkeslet, Else; Storli, Sissel Lisa

2017-01-01

ABSTRACT Nurses and physicians work side-by-side in the intensive care unit (ICU). Effective exchanges of patient information are essential to safe patient care in the ICU. Nurses often rate nurse-physician communication lower than physicians and report that it is difficult to speak up, that disagreements are not resolved and that their input is not well received. Therefore, this study explored nurses’ dialogue with physicians regarding patients’ clinical status and the prerequisites for effective and accurate exchanges of information. We adopted a qualitative approach, conducting three focus group discussions with five to six nurses and physicians each (14 total). Two themes emerged. The first theme highlighted nurses’ contributions to dialogues with physicians; nurses’ ongoing observations of patients were essential to patient care discussions. The second theme addressed the prerequisites of accurate and effective dialogue regarding care options, comprising three subthemes: nurses’ ability to speak up and present clinical changes, establishment of shared goal and clinical understanding, and open dialogue and willingness to listen to each other. Nurses should understand their essential role in conducting ongoing observations of patients and their right to be included in care-related decision-making processes. Physicians should be willing to listen to and include nurses’ clinical observations and concerns. PMID:28452605

ICU nurses and physicians dialogue regarding patients clinical status and care options-a focus group study.

PubMed

Kvande, Monica; Lykkeslet, Else; Storli, Sissel Lisa

2017-12-01

Nurses and physicians work side-by-side in the intensive care unit (ICU). Effective exchanges of patient information are essential to safe patient care in the ICU. Nurses often rate nurse-physician communication lower than physicians and report that it is difficult to speak up, that disagreements are not resolved and that their input is not well received. Therefore, this study explored nurses' dialogue with physicians regarding patients' clinical status and the prerequisites for effective and accurate exchanges of information. We adopted a qualitative approach, conducting three focus group discussions with five to six nurses and physicians each (14 total). Two themes emerged. The first theme highlighted nurses' contributions to dialogues with physicians; nurses' ongoing observations of patients were essential to patient care discussions. The second theme addressed the prerequisites of accurate and effective dialogue regarding care options, comprising three subthemes: nurses' ability to speak up and present clinical changes, establishment of shared goal and clinical understanding, and open dialogue and willingness to listen to each other. Nurses should understand their essential role in conducting ongoing observations of patients and their right to be included in care-related decision-making processes. Physicians should be willing to listen to and include nurses' clinical observations and concerns.

"Best practice" in inflammatory bowel disease: an international survey and audit.

PubMed

Van Der Eijk, Ingrid; Verheggen, Frank W.; Russel, Maurice G.; Buckley, Martin; Katsanos, Kostas; Munkholm, Pia; Engdahl, Ingemar; Politi, Patrizia; Odes, Selwyn; Fossen, Jan; Stockbrügger, Reinhold W.

2004-04-01

Background: An observational study was conducted at eight university and four district hospitals in eight countries collaborating in clinical and epidemiological research in inflammatory bowel disease (IBD) to compare European health care facilities and to define current "best practice" with regard to IBD. Methods: The approach used in this multi-national survey was unique. Existing quality norms, developed for total hospital care by a specialized organization, were restricted to IBD-specific care and adapted to the frame of reference of the study group. In each center, these norms were surveyed by means of questionnaires and professional audits in all participating centers. The collected data were reported to the center, compared to data from other hospitals, and used to benchmark. Group consensus was reached with regard to defining current "best practice". Results: The observations in each center involved patient-oriented processes, technical and patient safety, and quality of the medical standard. Several findings could be directly implemented to improve IBD care in another hospital (benchmarks). These included a confidential relationship between health care worker(s) and patients, and availability of patient data. Conclusions: The observed benchmarks, in combination with other subjectively chosen "positive" procedures, have been defined as current "best practice in IBD", representing practical guidelines towards better quality of care in IBD.

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.

PubMed

Stergiopoulos, Vicky; Schuler, Andrée; Nisenbaum, Rosane; deRuiter, Wayne; Guimond, Tim; Wasylenki, Donald; Hoch, Jeffrey S; Hwang, Stephen W; Rouleau, Katherine; Dewa, Carolyn

2015-08-28

Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

Accuracy of remote burn scar evaluation via live video-conferencing technology.

PubMed

Cai, Lawrence Z; Caceres, Maria; Dangol, Mohan Krishna; Nakarmi, Kiran; Rai, Shankar Man; Chang, James; Gibran, Nicole S; Pham, Tam N

2016-12-05

Telemedicine in outpatient burn care, particularly in burn scar management, may provide cost-effective care and comes highly rated by patients. However, an effective scar scale using both video and photographic elements has not been validated. The purpose of this study is to test the reliability of the Patient and Observer Scar Assessment Scale (POSAS) using live video-conferencing. A prospective study was conducted with individuals with healed burn scars in Kathmandu, Nepal. Three independent observers assessed 85 burn scars from 17 subjects, using the Observer portion to evaluate vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion. The on-site observer was physically present with the subjects and used a live videoconferencing application to show the scars to two remote observers in the United States. Subjects used the Patient portion to evaluate the scar that they believed appeared the worst appearance and had the greatest impact on function. The single-rater reliability of the Observer scale was acceptable (ICC>0.70) in overall opinion, thickness, pliability, and surface area. The average-rater reliability for three observers was acceptable (ICC>0.70) for all parameters except for vascularity. When comparing Patients' and Observers' overall opinion scores, patients consistently reported worse opinion. Evaluation of burn scars using the Patient and Observer Scar Assessment Scale can be accurately performed via live videoconferencing and presents an opportunity to expand access to burn care to rural communities, particularly in low- and middle-income countries, where patients face significant access barriers to appropriate follow-up care. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Neonatal Early Warning Tools for recognising and responding to clinical deterioration in neonates cared for in the maternity setting: A retrospective case-control study.

PubMed

Paliwoda, Michelle; New, Karen; Bogossian, Fiona

2016-09-01

All newborns are at risk of deterioration as a result of failing to make the transition to extra uterine life. Signs of deterioration can be subtle and easily missed. It has been postulated that the use of an Early Warning Tool may assist clinicians in recognising and responding to signs of deterioration earlier in neonates, thereby preventing a serious adverse event. To examine whether observations from a Standard Observation Tool, applied to three neonatal Early Warning Tools, would hypothetically trigger an escalation of care more frequently than actual escalation of care using the Standard Observation Tool. A retrospective case-control study. A maternity unit in a tertiary public hospital in Australia. Neonates born in 2013 of greater than or equal to 34(+0) weeks gestation, admitted directly to the maternity ward from their birthing location and whose subsequent deterioration required admission to the neonatal unit, were identified as cases from databases of the study hospital. Each case was matched with three controls, inborn during the same period and who did not experience deterioration and neonatal unit admission. Clinical and physiological data recorded on a Standard Observation Tool, from time of admission to the maternity ward, for cases and controls were charted onto each of three Early Warning Tools. The primary outcome was whether the tool 'triggered an escalation of care'. Descriptive statistics (n, %, Mean and SD) were employed. Cases (n=26) comprised late preterm, early term and post-term neonates and matched by gestational age group with 3 controls (n=78). Overall, the Standard Observation Tool triggered an escalation of care for 92.3% of cases compared to the Early Warning Tools; New South Wales Health 80.8%, United Kingdom Newborn Early Warning Chart 57.7% and The Australian Capital Territory Neonatal Early Warning Score 11.5%. Subgroup analysis by gestational age found differences between the tools in hypothetically triggering an escalation of care. The Standard Observation Tool triggered an escalation of care more frequently than the Early Warning Tools, which may be as a result of behavioural data captured on the Standard Observation Tool and escalated, which could not be on the Early Warning Tools. Findings demonstrate that a single tool applied to all gestational age ranges may not be effective in identifying early deterioration or may over trigger an escalation of care. Further research is required into the sensitivity and specificity of Early Warning Tools in neonatal sub-populations. Copyright © 2016 Elsevier Ltd. All rights reserved.

A scoping review of female disadvantage in health care use among very young children of immigrant families.

PubMed

Pulver, Ariel; Ramraj, Chantel; Ray, Joel G; O'Campo, Patricia; Urquia, Marcelo L

2016-03-01

Preference for sons culminates in higher mortality and inadequate immunizations and health care visits for girls compared to boys in several countries. It is unknown if the negative consequences of son-preference persist among those who immigrate to Western, high-income countries. To review the literature regarding gender inequities in health care use among children of parents who migrate to Western, high-income countries, we completed a scoping literature review using Medline, Embase, PsycINFO and Scopus databases. We identified studies reporting gender-specific health care use by children aged 5 years and younger whose parents had migrated to a Western country. Two independent reviewers conducted data extraction and a quality assessment tool was applied to each included study. We retrieved 1547 titles, of which 103 were reviewed in detail and 12 met our inclusion criteria. Studies originated from the United States and Europe, using cross-sectional or registry-based designs. Five studies examined gender differences in health care use within immigrant groups, and only one study explored the female health disadvantage hypothesis. No consistent gender differences were observed for routine primary care visits however immunizations and prescriptions were elevated for boys. Greater use of acute health services, namely emergency department visits and hospitalizations, was observed for boys over girls in several studies. Studies did not formally complete gender-based analyses or assess for acculturation factors. Health care use among children in immigrant families may differ between boys and girls, but the reasons for why this is so are largely unexplored. Further gender-based research with attention paid to the diversity of immigrant populations may help health care providers identify children with unmet health care needs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Integrated Primary Care Information Database (IPCI)

Cancer.gov

The Integrated Primary Care Information Database is a longitudinal observational database that was created specifically for pharmacoepidemiological and pharmacoeconomic studies, inlcuding data from computer-based patient records supplied voluntarily by general practitioners.

[Yin Care--a natural product for prophylactics and treatment of vaginal infections].

PubMed

Mikhova, M; Batashki, I; Ivanov, St

2007-01-01

A prospective study, including 60 patients with vaginal discharge has been made at Maternity hospital "Majchin dom"--Sofia for the period November 2006- February 2007. In 32 patients no causative agent has been revealed. They have been counseled to use Yin Care--vaginal lotion for 3 months in prophylactic concentration. 88.4% reported for diminished discharge. No adverse effects have been observed. In 11 patients suffering from bacterial vaginitis, caused by S. Epidermidis, S. Aureus, Enterococcus and E. Coli cure was achieved in 72.7% of cases. 17 women with Candida vaginitis have been included in the study. After standard antifungal treatment, 8 of them continued therapy with Yin Care. Recurrence of disease has been observed in only one case, while in the group treated with antifungal medication only recurrence has been observed in 2 cases.

Length of day-care attendance and attachment behavior in eighteen-month-old infants.

PubMed

Schwartz, P

1983-08-01

Differences in the attachment behavior of 18-month-old full-time, part-time, and non-day-care infants from intact middle-class homes were compared. Mothers of the day-care infants had made arrangements to return to work before their infants' birth, and all the infants had been placed in day-care homes before 9 months of age. The study involved 2 sessions: a home observation and the strange-situation procedure in a laboratory setting. The home-observation and rating scale scores of maternal behaviors directed at the child yielded few group differences. More full-time day-care children (but not part-time children) were found to display avoidance of the mother during the final reunion episode of the strange-situation procedure than did non-day-care children. The length of the daily separation appears to be an important determinant of day-care effects on infant-mother attachment.

The influence of program acceptability on the effectiveness of public health policy: a study of directly observed therapy for tuberculosis.

PubMed Central

Heymann, S J; Sell, R; Brewer, T F

1998-01-01

OBJECTIVES: This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. METHODS: Decision and sensitivity analyses were used in assessing influences. RESULTS: If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range: 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% (range: 27% to 38%) of patients avoid seeking care. CONCLUSIONS: Patient acceptability must be taken into consideration before selecting public health strategies. PMID:9518978

Living at the farm, innovative nursing home care for people with dementia - study protocol of an observational longitudinal study.

PubMed

de Boer, B; Hamers, J P H; Beerens, H C; Zwakhalen, S M G; Tan, F E S; Verbeek, H

2015-11-02

In nursing home care, new care environments directed towards small-scale and homelike environments are developing. The green care farm, which provides 24-h nursing home care for people with dementia, is one such new care environment. Knowledge is needed on the relation between environmental features of green care farms such as nature, domesticity and offering care in small groups and the influence on the daily lives of residents. The aim of this study is to explore (1) the daily lives of residents, (2) the quality of care and (3) the experiences of caregivers on green care farms compared with other nursing home care environments. An observational longitudinal study including a baseline and a six-month follow-up measurement is carried out. Four types of nursing home care environments are included: (1) large scale nursing home ward, (2) small scale living facility on the terrain of a larger nursing home (3) stand-alone small scale living facility and (4) green care farm. Quality of care is examined through structure, process and outcome indicators. The primary outcome measure is the daily life of residents, assessed by ecological momentary assessments. Aspects of daily life include (1) activity (activity performed by the resident, the engagement in this activity and the degree of physical effort); (2) physical environment (the location of the resident and the interaction with the physical environment); (3) social environment (the level and type of social interaction, and with whom this social interaction took place) and (4) psychological well-being (mood and agitation). In addition, social engagement, quality of life, behavioral symptoms and agitation are evaluated through questionnaires. Furthermore, demographics, cognitive impairment, functional dependence and the severity of dementia are assessed. Semi-structured interviews are performed with caregivers regarding their experiences with the different nursing home care environments. This is the first study investigating green care farms providing 24-h nursing home care for people with dementia. The study provides valuable insight into the daily lives of residents, the quality of care, and the experiences of caregivers at green care farms in comparison with other nursing home care environments including small-scale care environments and large scale nursing home wards.

Child Care Teachers' Response to Children's Emotional Expression

ERIC Educational Resources Information Center

Ahn, Hey Jun; Stifter, Cynthia

2006-01-01

This observational study examined practices through which child care teachers socialize children's emotion. A specific aim was to describe strategies of teacher intervention in response to emotion displayed by children in child care centers, and to answer the question of differential interactions based on children's age and gender. The results of…

Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

PubMed

Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

2015-06-01

To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: birth in Brazil study.

PubMed

Domingues, Rosa Maria Soares Madeira; Szwarcwald, Celia Landmann; Souza Junior, Paulo Roberto Borges; Leal, Maria do Carmo

2014-10-01

Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95% CI 0.84; 1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: Birth in Brazil study

PubMed Central

Domingues, Rosa Maria Soares Madeira; Szwarcwald, Celia Landmann; Souza, Paulo Roberto Borges; Leal, Maria do Carmo

2014-01-01

OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil. PMID:25372167

Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania.

PubMed

Makene, Christina Lulu; Plotkin, Marya; Currie, Sheena; Bishanga, Dunstan; Ugwi, Patience; Louis, Henry; Winani, Kiholeth; Nelson, Brett D

2014-11-19

Every year, more than a million of the world's newborns die on their first day of life; as many as two-thirds of these deaths could be saved with essential care at birth and the early newborn period. Simple interventions to improve the quality of essential newborn care in health facilities - for example, improving steps to help newborns breathe at birth - have demonstrated up to 47% reduction in newborn mortality in health facilities in Tanzania. We conducted an evaluation of the effects of a large-scale maternal-newborn quality improvement intervention in Tanzania that assessed the quality of provision of essential newborn care and newborn resuscitation. Cross-sectional health facility surveys were conducted pre-intervention (2010) and post intervention (2012) in 52 health facilities in the program implementation area. Essential newborn care provided by health care providers immediately following birth was observed for 489 newborns in 2010 and 560 in 2012; actual management of newborns with trouble breathing were observed in 2010 (n = 18) and 2012 (n = 40). Assessments of health worker knowledge were conducted with case studies (2010, n = 206; 2012, n = 217) and a simulated resuscitation using a newborn mannequin (2010, n = 299; 2012, n = 213). Facility audits assessed facility readiness for essential newborn care. Index scores for quality of observed essential newborn care showed significant overall improvement following the quality-of-care intervention, from 39% to 73% (p <0.0001). Health worker knowledge using a case study significantly improved as well, from 23% to 41% (p <0.0001) but skills in resuscitation using a newborn mannequin were persistently low. Availability of essential newborn care supplies, which was high at baseline in the regional hospitals, improved at the lower-level health facilities. Within two years, the quality improvement program was successful in raising the quality of essential newborn care services in the program facilities. Some gaps in newborn care were persistent, notably practical skills in newborn resuscitation. Continued investment in life-saving improvements to newborn care through the health services is a priority for reduction of newborn mortality in Tanzania.

Using a didactic model to improve patient observation skills in neonatal intensive care nurse trainees - a pilot study.

PubMed

Solberg, Marianne Trygg; Tandberg, Bente Silnes; Lerdal, Anners

2012-08-01

To implement a didactic model for students specialising in intensive care nursing (n=12) and nurses working in neonatal intensive care units (NICU) (n=17). To evaluate nurse self-assessments following observation of children with congenital heart disease (CHD), before and after participation in the programme, as well as the usefulness of the programme. A pilot study with a pre- and post-test design, using self-administered questionnaires. The didactic model increased the number of clinical observations and assessments of physiological factors made by both students and NICU nurses during evaluation of children with suspected CHD. The majority of nurses reported that both participation in the programme and the didactic model were useful and they demonstrated high-level knowledge, according to Bloom's taxonomy for cognitive learning. In particular, subjects found that the literature provided and structured bedside guidance in the clinical setting assisted learning. Intensive care students and NICU nurses performed clinical observations and physical factor assessments more frequently after completing the programme, compared with baseline. We speculate that this didactic model may also be useful in other clinical settings. Copyright © 2011 Elsevier Ltd. All rights reserved.

Challenges for Nurses Caring for Patients With Peripherally Inserted Central Catheters in Skilled Nursing Facilities

PubMed Central

Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet

2016-01-01

Objectives To understand frontline nurses’ (registered nurses and licensed practical nurses), unit nurse managers’ and skilled nursing facility (SNF) administrators’ perceived preparedness in providing care for patients with peripherally inserted central catheters (PICCs) in SNFs. Design An exploratory, qualitative pilot study. Setting Two community based SNFs. Participants Patients, frontline nurses (registered nurses and licensed practical nurses), unit nurse managers and SNF administrators. Methods Over 36-weeks, we observed and conducted informal interviews with 56 patients with PICCs and their nurses focusing on PICC care practices and documentation. In addition, we collected baseline PICC data including placement indication (e.g., antimicrobial administration), placement setting (hospital vs. SNF), and dwell time. We then conducted focus groups with frontline nurses and unit nurse managers and semi-structured interviews with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Results During weekly informal interviews and observations variations in documentation were observed. Differences between patient-reported PICC concerns (quality-of-life) and those described by frontline nurses were noted. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs and gaps in training and education were highlighted as barriers in improving practice and safety. Conclusion Our study suggests that practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions and increase resource availability in SNFs appear necessary to enhance PICC care and patient safety. PMID:27603747

Poststroke Rehabilitation and Restorative Care Utilization: A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes.

PubMed

Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Bates, Barbara E; Vogel, W Bruce; Bidelspach, Douglas E; Wang, Xinping; Hoffman, Nannette

2016-03-01

Effective poststroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. Veterans affairs (VA) community living centers (CLCs) and VA-contracted community nursing homes (CNHs) are the 2 major sources of institutional long-term care for Veterans with stroke receiving care under VA auspices. This study compares rehabilitation therapy and restorative nursing care among Veterans residing in VA CLCs versus those Veterans in VA-contracted CNHs. Retrospective observational. All Veterans diagnosed with stroke, newly admitted to the CLCs or CNHs during the study period who completed at least 2 Minimum Data Set assessments postadmission. The outcomes were numbers of days for rehabilitation therapy and restorative nursing care received by the Veterans during their stays in CLCs or CNHs as documented in the Minimum Data Set databases. For rehabilitation therapy, the CLC Veterans had lower user rates (75.2% vs. 76.4%, P=0.078) and fewer observed therapy days (4.9 vs. 6.4, P<0.001) than CNH Veterans. However, the CLC Veterans had higher adjusted odds for therapy (odds ratio=1.16, P=0.033), although they had fewer average therapy days (coefficient=-1.53±0.11, P<0.001). For restorative nursing care, CLC Veterans had higher user rates (33.5% vs. 30.6%, P<0.001), more observed average care days (9.4 vs. 5.9, P<0.001), higher adjusted odds (odds ratio=2.28, P<0.001), and more adjusted days for restorative nursing care (coefficient=5.48±0.37, P<0.001). Compared with their counterparts at VA-contracted CNHs, Veterans at VA CLCs had fewer average rehabilitation therapy days (both unadjusted and adjusted), but they were significantly more likely to receive restorative nursing care both before and after risk adjustment.

Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa

PubMed Central

Tripathi, Vandana; Stanton, Cynthia; Strobino, Donna; Bartlett, Linda

2015-01-01

Background High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions. Methods and Findings Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries. Conclusions As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement. PMID:26107655

Assessment of a Self-Reported Drinks Diary for the Estimation of Drinks Intake by Care Home Residents: Fluid Intake Study in the Elderly (FISE).

PubMed

Jimoh, F O; Bunn, D; Hooper, L

2015-05-01

We evaluated the accuracy of a newly developed self-completed Drinks Diary in care home residents and compared it with direct observation and fluid intake charts. Observational study. Residential care homes in Norfolk, UK. 22 elderly people (18 women, mean age 86.6 years SD 8.6, 12 with MMSE scores <27). Participants recorded their own drinks intake over 24 hours using the Drinks Diary while care staff used the homes' usual fluid intake chart to record drinks intake. These records were compared with drinks intake assessed by researcher direct observation (reference method), during waking hours (6am to 10pm), while drinks taken from 10pm to 6am were self-reported and checked with staff. Drinks intake assessed by the Drinks Diary was highly correlated with researcher direct observation (Pearson correlation coefficient r=0.93, p<0.001, mean difference -163ml/day) while few staff-completed fluid charts were returned and correlation was low (r=0.122, p=0.818, mean difference 702ml/day). The Drinks Diary classified 19 of 22 participants correctly as drinking enough or not using both the European Food Safety Authority and US recommendations. The Drinks Diary estimate of drinks intake was comparable with direct observation and more accurate (and reliably completed) than staff records. The Drinks Diary can provide a reliable estimate of drinks intake in elderly care home residents physically and cognitively able to complete it. It may be useful for researchers, care staff and practitioners needing to monitor drinks intake of elderly people, to help them avoid dehydration.

The "ARIANNA" Project: An Observational Study on a Model of Early Identification of Patients with Palliative Care Needs through the Integration between Primary Care and Italian Home Palliative Care Units.

PubMed

Scaccabarozzi, Gianlorenzo; Amodio, Emanuele; Pellegrini, Giacomo; Limonta, Fabrizio; Lora Aprile, Pierangelo; Lovaglio, Pietro Giorgio; Peruselli, Carlo; Crippa, Matteo

2018-05-01

The aim of this study was to illustrate the characteristics of patients with palliative care (PC) needs, early identified by general practitioners (GPs), and to analyze their care process in home PC services. Early identification and service integration are key components to providing quality palliative care (PC) services ensuring the best possible service for patients and their families. However, in Italy, PC is often provided only in the last phase of life and for oncological patients, with a fragmented service. Multicenter prospective observational study, lasting in total 18 months, implemented in a sample of Italian Home Palliative Care Units (HPCUs), enrolling and monitoring patients with limited life expectancy, early identified by 94 GPs. The study began on March 1, 2014 and ended on August 31, 2015. Nine hundred thirty-seven patients, out of a total pool of 139,071, were identified by GPs as having a low life expectancy and PC needs. Of these, 556 (59.3%) were nononcological patients. The GPs sent 433 patients to the HPCUs for multidimensional assessment, and 328 (75.8%) were placed in the care of both settings (basic or specialist). For all patients included in the study, both oncological and nononcological patients, there was a high rate of death at home, around 70%. This study highlights how a model based on early identification, multidimensional evaluation, and integration of services can promote adequate PC, also for noncancer patients, with a population-based approach.

Examining Time Use of Dutch Nursing Staff in Long-Term Institutional Care: A Time-Motion Study.

PubMed

Tuinman, Astrid; de Greef, Mathieu H G; Krijnen, Wim P; Nieweg, Roos M B; Roodbol, Petrie F

2016-02-01

Increasing residents' acuity levels and available resources in long-term institutional care requires insight into the care provided by nursing staff so as to guide task allocation and optimal use of resources, and enhance quality of care. The purpose of this study was to examine the relationship between time use and type of nursing staff, residents' acuity levels, and unit type by using a standardized nursing intervention classification. A multicenter cross-sectional observational study was performed using time-motion technique. Five Dutch long-term institutional care facilities participated. In total, 4 residential care units, 3 somatic units, and 6 psycho-geriatric units were included. Data were collected from 136 nursing staff members: 19 registered nurses, 89 nursing assistants, 9 primary caregivers, and 19 health care assistants. A structured observation list was used based on the Nursing Interventions Classification (NIC). Residents' acuity levels, representing residents' needs, were based on the Dutch Care Severity Index. Medians and interquartile ranges were calculated for time spent on interventions per type of nursing staff and units. Linear mixed models were used to examine the relationship between time spent on nursing interventions and the type of nursing staff, residents' acuity levels, and unit type. Observations resulted in 52,628 registered minutes for 102 nursing interventions categorized into 6 NIC domains for 335 residents. Nursing staff spent the most time on direct care interventions, particularly in the domain of basic physiological care. Variances in time spent on interventions between types of nursing staff were minimal. Unit type was more significantly (P < .05) associated with time spent on interventions in domains than the type of nursing staff. Residents' acuity levels did not affect time spent by nursing staff (P > .05). The current study found limited evidence for task allocation between the types of nursing staff, which may suggest a blurring of role differentiation. Also, findings suggest that residents received similar care regardless of their needs, implying that care is predominantly task-oriented instead of person-centered. Managers may reconsider whether the needs of residents are adequately met by qualified nursing staff, considering the differences in education and taking into account increasing acuity levels of residents and available resources. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

The tradeoff between centralized and decentralized health services: evidence from rural areas in Mexico.

PubMed

Vargas Bustamante, Arturo

2010-09-01

This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Active methodology and blended learning: An experience in pharmaceutical care.

PubMed

Czepula, Alexandra Ingrid Dos Santos; Bottacin, Wallace Entringer; Júnior, Edson Hipólito; Pontarolo, Roberto; Correr, Cassyano Januário

The aim of this study was to analyze the implementation of an active methodology in a blended model of education in the teaching-learning processes of students enrolled in two disciplines: Pharmaceutical Care I and Pharmaceutical Care II, both part of the undergraduate Bachelor of Pharmacy program at the Federal University of Paraná. The study design was quasi-experimental, prospective, comparative, following a pre/posttest format, where Pharmaceutical Care classes were the intervention. Identical pre- and post-intervention tests were designed based on Anderson and Krathwohl's (2001) revision of Bloom's taxonomy, and according to the three levels of the cognitive domain: remember and understand; apply and analyze; evaluate and create. Participants were 133 students enrolled in the two Pharmaceutical Care classes. A significant difference between pre- and posttest results was observed, showing an increase in students' performance in the applied tests at all cognitive levels. This is the first study of its kind involving Pharmaceutical Care and Blended Learning. By comparing the results of the diagnostic and summative assessments based on Bloom's taxonomy at all levels of the cognitive domain, positive results were observed regarding the students' performance in the two disciplines (Pharmaceutical Care I and II). Copyright © 2017 Elsevier Inc. All rights reserved.

Understanding observed and unobserved health care access and utilization disparities among US Latino adults.

PubMed

Vargas Bustamante, Arturo; Fang, Hai; Rizzo, John A; Ortega, Alexander N

2009-10-01

This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder-Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were the most important factors that explained observable differences. In contrast, language and citizenship status were relatively unimportant. Although a significant share of these disparities may be explained by observed characteristics, disparities because of unobserved heterogeneity among the different Latino cohorts are also considerable.

Challenges for IT-supported shared care: a qualitative analyses of two shared care initiatives for diabetes treatment in Denmark “I'll never use it” (GP5).

PubMed Central

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

Purpose To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion The two cases faced the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general practitioners which hinder bridging the primary sector (general practitioners) and the secondary sector (hospitals and outpatient clinics). Especially the needs associated with the primary sector were not being satisfied. We discovered three main challenges related to bridging the gap between the two sectors: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must recognise the underlying and significant differences between the primary and secondary care sectors: If IT-supported shared care does not meet the needs of the general practitioners as well as the needs of the secondary care sector the initiative will fail. PMID:17627300

Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: a cross-sectional observational study of educational needs.

PubMed

Deodhar, Jayita Kedar; Muckaden, Mary Ann

2015-01-01

Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience) felt the need for self-care as a topic in the program than those with less (<5-years experience) (P < 0.05). Understanding palliative care volunteers' educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.

Health care aides use of time in a residential long-term care unit: a time and motion study.

PubMed

Mallidou, Anastasia A; Cummings, Greta G; Schalm, Corinne; Estabrooks, Carole A

2013-09-01

Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers' sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides' use of time with residents, and to describe working environment and unit culture. An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in "personal care" (52%) and in "other" activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers' time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. Re-organizing healthcare aides' routine practices may minimize the short one-to-three minute intervals spent on direct care activities, which can be interpreted as interruptions to continuity of care or waste of time. Fewer interruptions may allow healthcare aides to use their time with residents more effectively. Copyright © 2012 Elsevier Ltd. All rights reserved.

How nursing staff spend their time on activities in a nursing home: an observational study.

PubMed

Munyisia, Esther Naliaka; Yu, Ping; Hailey, David

2011-09-01

This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home. © 2011 Blackwell Publishing Ltd.

Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

PubMed

Jangland, Eva; Teodorsson, Therese; Molander, Karin; Muntlin Athlin, Åsa

2018-06-01

To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. A focused ethnographic approach. A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery. © 2017 John Wiley & Sons Ltd.

The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study.

PubMed

Taylor, Janice; Sims, Jane; Haines, Terry P

2014-12-01

To explore mobility care as provided by care staff in nursing homes. Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. A focused ethnography. The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of 'situation awareness' assisted data interpretation. Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care. © 2014 John Wiley & Sons Ltd.

Revitalization of Indigenous Culture in Child Care Centre

ERIC Educational Resources Information Center

Kulhankova, Jana

2011-01-01

In this study, I address contemporary ways of looking after children and care giving roles women play in today's Aboriginal community in Brisbane, Australia. Data were collected through participant observation and interviews during field work in a family care centre managed by Indigenous women with the staff and their clients. My main contribution…

Children's Physical Activity in Day Care and Preschool

ERIC Educational Resources Information Center

Reunamo, Jyrki; Hakala, Liisa; Saros, Leila; Lehto, Satu; Kyhälä, Anna-Liisa; Valtonen, Juha

2014-01-01

The purpose of the study was to investigate the dynamics of physical activity (PA) in day care and preschool. The participants were 823 Finnish 1-7-year-old children from 50 day care centres and preschools. The research methods were systematic observation, evaluation of children's skills and interviews with children. Altogether 18,366 observations…

Boys, Girls, and "Two Cultures" of Child Care

ERIC Educational Resources Information Center

Winer, Abby C.; Phillips, Deborah A.

2012-01-01

This study examined differences in the quality of child care experienced by toddler boys and girls. Boys were more likely to be in lower-quality child care than girls, assessed with both setting-level measures and observations of caregiver-child interaction. A possible explanatory mechanism for the gender differences is suggested by evidence that…

Infant and Toddler Child Care Quality Measures: Bibliography

ERIC Educational Resources Information Center

Ferguson, Daniel

2016-01-01

The Research Connections collection contains records for more than 1,300 instruments that have been used to conduct studies in the child care and early education field. This bibliography provides records for instruments in the collection that can be used to observe child care quality in center-based settings serving infants and toddlers. In…

Enacting Caring Pedagogy in the Infant Classroom

ERIC Educational Resources Information Center

Shin, Minsun

2015-01-01

This single case study was undertaken to explore how an infant head teacher meets the needs of the infants, who express their desire to be cared for, in their caring encounters. Natural daily interactions between infants and the teacher were observed for approximately 10 weeks. Through the qualitative data analysis, the results of this study…

Family caregivers in public tertiary care hospitals in Bangladesh: Risks and opportunities for infection control

PubMed Central

Islam, M. Saiful; Luby, Stephen P.; Sultana, Rebeca; Rimi, Nadia Ali; Zaman, Rashid Uz; Uddin, Main; Nahar, Nazmun; Rahman, Mahmudur; Hossain, M. Jahangir; Gurley, Emily S.

2015-01-01

Background Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers’ activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Methods Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Results Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Conclusion Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers’ knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers. PMID:24406254

Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control.

PubMed

Islam, M Saiful; Luby, Stephen P; Sultana, Rebeca; Rimi, Nadia Ali; Zaman, Rashid Uz; Uddin, Main; Nahar, Nazmun; Rahman, Mahmudur; Hossain, M Jahangir; Gurley, Emily S

2014-03-01

Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers' activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers' knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Mobile prehospital emergency care: an analysis of implementation in the State of Rio de Janeiro, Brazil.

PubMed

O'Dwyer, Gisele; Machado, Cristiani Vieira; Alves, Renan Paes; Salvador, Fernanda Gonçalves

2016-06-01

Mobile prehospital care is a key component of emergency care. The aim of this study was to analyze the implementation of the State of Rio de Janeiro's Mobile Emergency Medical Service (SAMU, acronym in Portuguese). The methodology employed included document analysis, visits to six SAMU emergency call centers, and semistructured interviews conducted with 12 local and state emergency care coordinators. The study's conceptual framework was based on Giddens' theory of structuration. Intergovernmental conflicts were observed between the state and municipal governments, and between municipal governments. Despite the shortage of hospital beds, the SAMUs in periphery regions were better integrated with the emergency care network than the metropolitan SAMUs. The steering committees were not very active and weaknesses were observed relating to the limited role played by the state government in funding, management, and monitoring. It was concluded that the SAMU implementation process in the state was marked by political tensions and management and coordination weaknesses. As a result, serious drawbacks remain in the coordination of the SAMU with the other health services and the regionalization of emergency care in the state.

[Street Outreach Offices: visibility, invisibility, and enhanced visibility].

PubMed

Hallais, Janaína Alves da Silveira; Barros, Nelson Filice de

2015-07-01

This article discusses care for street people from a socio-anthropological perspective, using participant observation conducted with a team from a street outreach project. Based on observations, street people are historically viewed as marginal and rarely obtain access to health services, thus making them invisible to the Brazilian Unified National Health System. Brazil's National Policy for the Homeless provides for their access to health care, but such care is not always guaranteed in practice, because health services and professionals have little experience in dealing with homeless persons. The study concludes that enhanced visibility is needed to ensure care for people living on the street, establishing a therapeutic bond that deconstructs stigmatizing practice.

Allonursing in captive belugas (Delphinapterus leucas).

PubMed

Leung, Elaine S; Vergara, Valeria; Barrett-Lennard, Lance G

2010-01-01

This study describes allonursing (females nursing offspring that are not their own) in captive belugas (Delphinapterus leucas). In addition to the calf's mother, two females that were not pregnant or nursing at the time of the calf's birth spontaneously lactated and nursed the male calf intermittently throughout 34 months of his life at the Vancouver Aquarium Marine Science Center. These observations suggest that allonursing may also take place in their wild counterparts and add to existing evidence of alloparental care in this species. Alloparental care, the care of nonoffspring, has been observed in every major mammalian taxon; the protection of calves through alloparental care may be a strong evolutionary benefit. © 2009 Wiley-Liss, Inc.

Finding a place to connect: A qualitative study exploring the influences of the physical and social environments on spouses' opportunities to maintain relationships when visiting a partner with dementia living in long-term care.

PubMed

Førsund, Linn Hege; Ytrehus, Siri

2016-06-17

The purpose of this qualitative study was to explore how physical and social environments influence spouses' opportunities to maintain relationships when visiting a partner with dementia living in long-term care. Interviews with 15 spouses whose partners lived in long-term care facilities for persons with dementia, observations of physical environments and participant observations were conducted. The results showed how finding a place for spouses to connect in the long-term care facility was important in maintaining relationships. Access to individual rooms was an important feature that enabled connections throughout the phases of dementia, whereas common areas appeared more difficult to use because small spaces limited private interactions. Health personnel were important in sustaining spouses' abilities to maintain their relationships in long-term care facilities for persons with dementia. © The Author(s) 2016.

Health and Safety Checklist for Early Care and Education Programs to Assess Key National Health and Safety Standards.

PubMed

Alkon, Abbey; Rose, Roberta; Wolff, Mimi; Kotch, Jonathan B; Aronson, Susan S

2016-01-01

The project aims were to (1) develop an observational Health and Safety Checklist to assess health and safety practices and conditions in early care and education (ECE) programs using Stepping Stones To Caring For Our Children, 3rd Edition national standards, (2) pilot test the Checklist, completed by nurse child care health consultants, to assess feasibility, ease of completion, objectivity, validity, and reliability, and (3) revise the Checklist based on the qualitative and quantitative results of the pilot study. The observable national health and safety standards were identified and then rated by health, safety, and child care experts using a Delphi technique to validate the standards as essential to prevent harm and promote health. Then, child care health consultants recruited ECE centers and pilot tested the 124-item Checklist. The pilot study was conducted in Arizona, California and North Carolina. The psychometric properties of the Checklist were assessed. The 37 participating ECE centers had 2627 children from ethnically-diverse backgrounds and primarily low-income families. The child care health consultants found the Checklist easy to complete, objective, and useful for planning health and safety interventions. The Checklist had content and face validity, inter-rater reliability, internal consistency, and concurrent validity. Based on the child care health consultant feedback and psychometric properties of the Checklist, the Checklist was revised and re-written at an 8th grade literacy level. The Health and Safety Checklist provides a standardized instrument of observable, selected national standards to assess the quality of health and safety in ECE centers.

Utilization of Observation Units for the Care of Poisoned Patients: Trends from the Toxicology Investigators Consortium Case Registry.

PubMed

Judge, Bryan S; Ouellette, Lindsey M; VandenBerg, Melissa; Riley, Brad D; Wax, Paul M

2016-03-01

Many poisoned patients may only require a period of observation after their exposure. There are limited data describing the use of observation units for managing poisoned adult and pediatric patients. We performed a retrospective review of all patients reported to the ToxIC Case Registry between January 1, 2012 and December 31, 2013. Eligible patients included those who received a bedside consultation by a medical toxicologist and whose care was provided in an observation unit, or those who were admitted under the care of a medical toxicologist in an observation unit. A total of 15,562 poisonings were reported to the registry during the study period, of which 340 (2.2 %) involved patients who were cared for in an observation unit. Of these patients, 22.1 % were 18 years of age or younger, and the remaining 77.9 % were greater than 18 years of age. The most common reason for exposure was the intentional ingestion of a pharmaceutical agent in both adult (30.2 %) and pediatric patients (36.0 %). Alcohols (ethanol) (24.9 %), opioids (20.0 %), and sedative-hypnotics (17.7 %) were the most common agent classes involved in adult patient exposures. The most common agent classes involved in pediatric exposures were antidepressants (12.0 %), anticonvulsants (10.7 %), and envenomations (10.7 %). In adult patients, the most common signs and symptoms involved the nervous system (52.0 %), a toxidrome (17.0 %), or a major vital sign abnormality (14.7 %). In pediatric patients, the most common signs and symptoms involved the nervous system (53.3 %), a toxidrome (21.3 %), or a major vital sign abnormality (17.3 %). The results of this study demonstrate that a wide variety of poisoned patients have been cared for in an observation unit in consultation with a board-certified medical toxicologist. Patterns for the reasons for exposure, agents responsible for the exposure, and toxicological treatments will continue to evolve. Further study is needed to identify better those poisoned patients who can be appropriately managed in an observation unit.

Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients.

PubMed

Oh, Hyunsung; Ell, Kathleen

2016-01-01

This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses. We analyzed data from a randomized clinical trial (N=387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N=281), 18-month (N=249), and 24-month (N=235) follow-up surveys. Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors. Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Designing a mixed methods study in primary care.

PubMed

Creswell, John W; Fetters, Michael D; Ivankova, Nataliya V

2004-01-01

Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research.

An ethnographic exploration of the delivery of psychosocial care to children with cancer in Argentina.

PubMed

Brage, Eugenia; Vindrola-Padros, Cecilia

2017-08-01

The integration of psychosocial care in the routine care of cancer patients has been set as an international standard, but there are healthcare contexts where these services are lacking as psychosocial care providers are not incorporated in multidisciplinary teams and screening for psychological distress is not carried out routinely or systematically. In this article, we discuss the findings from an ethnographic study that focused on exploring the working experiences of psychosocial care providers from one children's hospital in Buenos Aires, Argentina. The study is based on 10 in-depth interviews with hospital staff members and participant observation in selected hospital areas. The transcripts from the interviews and fieldnotes from the observations were analyzed using thematic analysis. We found that psychosocial care providers encounter difficulties while attempting to deliver services to children and their families, produced mainly by their lack of collaboration with other professional groups, insufficient human resources, and a growing patient population. As a result of this situation, psychosocial care providers often prioritize some patients over others, leaving a considerable number of patients and family members without psychosocial support. The study highlighted the barriers psychosocial care providers encounter while attempting to deliver services to children and their families. Further work needs to be carried out to fully integrate psychosocial care in national health policies and ensure this type of support is available for all patients and their families. Copyright © 2017 Elsevier Ltd. All rights reserved.

Handover of patient information from the crisis assessment and treatment team to the inpatient psychiatric unit.

PubMed

Waters, Amanda; Sands, Natisha; Keppich-Arnold, Sandra; Henderson, Kathryn

2015-06-01

Handover, or the communication of patient information between clinicians, is a fundamental component of health care. Psychiatric settings are dynamic environments relying on timely and accurate communication to plan care and manage risk. Crisis assessment and treatment teams are the primary interface between community and mental health services in many Australian and international health services, facilitating access to assessment, treatment, and admission to hospital. No previous research has investigated the handover between crisis assessment and treatment teams and inpatient psychiatric units, despite the importance of handover to care planning. The aim of the present study was to identify the nature and types of information transferred during these handovers, and to explore how these guides initial care planning. An observational, exploratory study design was used. A 20-item handover observation tool was used to observe 19 occasions of handover. A prospective audit was undertaken on clinical documentation arising from the admission. Clinical information, including psychiatric history and mental state, were handed over consistently; however, information about consumer preferences was reported less consistently. The present study identified a lack of attention to consumer preferences at handover, despite the current focus on recovery-oriented models for mental health care, and the centrality of respecting consumer preferences within the recovery paradigm. © 2014 Australian College of Mental Health Nurses Inc.

Observational studies in systematic [corrected] reviews of comparative effectiveness: AHRQ and the Effective Health Care Program.

PubMed

Norris, Susan L; Atkins, David; Bruening, Wendy; Fox, Steven; Johnson, Eric; Kane, Robert; Morton, Sally C; Oremus, Mark; Ospina, Maria; Randhawa, Gurvaneet; Schoelles, Karen; Shekelle, Paul; Viswanathan, Meera

2011-11-01

Systematic reviewers disagree about the ability of observational studies to answer questions about the benefits or intended effects of pharmacotherapeutic, device, or procedural interventions. This study provides a framework for decision making on the inclusion of observational studies to assess benefits and intended effects in comparative effectiveness reviews (CERs). The conceptual model and recommendations were developed using a consensus process by members of the methods workgroup of the Effective Health Care Program of the Agency for Healthcare Research and Quality. In considering whether to use observational studies in CERs for addressing beneficial effects, reviewers should answer two questions: (1) Are there gaps in the evidence from randomized controlled trials (RCTs)? (2) Will observational studies provide valid and useful information? The latter question involves the following: (a) refocusing the study questions on gaps in the evidence from RCTs, (b) assessing the risk of bias of the body of evidence of observational studies, and (c) assessing whether available observational studies address the gap review questions. Because it is unusual to find sufficient evidence from RCTs to answer all key questions concerning benefit or the balance of benefits and harms, comparative effectiveness reviewers should routinely assess the appropriateness of inclusion of observational studies for questions of benefit. Furthermore, reviewers should explicitly state the rationale for inclusion or exclusion of observational studies when conducting CERs. Copyright © 2011 Elsevier Inc. All rights reserved.

What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol.

PubMed

Loignon, Christine; Haggerty, Jeannie L; Fortin, Martin; Bedos, Christophe P; Barbeau, David; Allen, Dawn

2010-11-30

The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and "socially responsive" care for people living in poverty. Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada), using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis. This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals' experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty.

What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol

PubMed Central

2010-01-01

Background The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and "socially responsive" care for people living in poverty. Methods/Design Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada), using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis. Discussion This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals' experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty. PMID:21118560

Principle of Care and Giving to Help People in Need.

PubMed

Bekkers, René; Ottoni-Wilhelm, Mark

2016-01-01

Theories of moral development posit that an internalized moral value that one should help those in need-the principle of care-evokes helping behaviour in situations where empathic concern does not. Examples of such situations are helping behaviours that involve cognitive deliberation and planning, that benefit others who are known only in the abstract, and who are out-group members. Charitable giving to help people in need is an important helping behaviour that has these characteristics. Therefore we hypothesized that the principle of care would be positively associated with charitable giving to help people in need, and that the principle of care would mediate the empathic concern-giving relationship. The two hypotheses were tested across four studies. The studies used four different samples, including three nationally representative samples from the American and Dutch populations, and included both self-reports of giving (Studies 1-3), giving observed in a survey experiment (Study 3), and giving observed in a laboratory experiment (Study 4). The evidence from these studies indicated that a moral principle to care for others was associated with charitable giving to help people in need and mediated the empathic concern-giving relationship. © 2016 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology.

Physician-patient communication in the primary care office: a systematic review.

PubMed

Beck, Rainer S; Daughtridge, Rebecca; Sloane, Philip D

2002-01-01

The physician-patient interview is the key component of all health care, particularly of primary medical care. This review sought to evaluate existing primary-care-based research studies to determine which verbal and nonverbal behaviors on the part of the physician during the medical encounter have been linked in empirical studies with favorable patient outcomes. We reviewed the literature from 1975 to 2000 for studies of office interactions between primary care physicians and patients that evaluated these interactions empirically using neutral observers who coded observed encounters, videotapes, or audiotapes. Each study was reviewed for the quality of the methods and to find statistically significant relations between specific physician behaviors and patient outcomes. In examining nonverbal behaviors, because of a paucity of clinical outcome studies, outcomes were expanded to include associations with patient characteristics or subjective ratings of the interaction by observers. We found 14 studies of verbal communication and 8 studies of nonverbal communication that met inclusion criteria. Verbal behaviors positively associated with health outcomes included empathy, reassurance and support, various patient-centered questioning techniques, encounter length, history taking, explanations, both dominant and passive physician styles, positive reinforcement, humor, psychosocial talk, time in health education and information sharing, friendliness, courtesy, orienting the patient during examination, and summarization and clarification. Nonverbal behaviors positively associated with outcomes included head nodding, forward lean, direct body orientation, uncrossed legs and arms, arm symmetry, and less mutual gaze. Existing research is limited because of lack of consensus of what to measure, conflicting findings, and relative lack of empirical studies (especially of nonverbal behavior). Nonetheless, medical educators should focus on teaching and reinforcing behaviors known to be facilitative, and to continue to understand further how physician behavior can enhance favorable patient outcomes, such as understanding and adherence to medical regimens and overall satisfaction.

Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals.

PubMed

Cohen, Deborah J; Davis, Melinda; Balasubramanian, Bijal A; Gunn, Rose; Hall, Jennifer; deGruy, Frank V; Peek, C J; Green, Larry A; Stange, Kurt C; Pallares, Carla; Levy, Sheldon; Pollack, David; Miller, Benjamin F

2015-01-01

This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States. Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior. Primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice. © Copyright 2015 by the American Board of Family Medicine.

Implementation of behavioral health interventions in real world scenarios: Managing complex change.

PubMed

Clark, Khaya D; Miller, Benjamin F; Green, Larry A; de Gruy, Frank V; Davis, Melinda; Cohen, Deborah J

2017-03-01

A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Medical Waste Management in Community Health Centers.

PubMed

Tabrizi, Jafar Sadegh; Rezapour, Ramin; Saadati, Mohammad; Seifi, Samira; Amini, Behnam; Varmazyar, Farahnaz

2018-02-01

Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center's staff. The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

Does postacute care site matter? A longitudinal study assessing functional recovery after a stroke.

PubMed

Deutsch, Anne

2013-04-01

Patients with stroke may receive postacute rehabilitation services from one or more types of postacute care providers. An article in this issue of Archives of Physical Medicine and Rehabilitation compares the outcomes of patients who received rehabilitation care from an inpatient rehabilitation facility, a skilled nursing facility, a home health agency, or did not receive any postacute care. This commentary discusses challenges in conducting this type of observation study. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Achieving excellence in community health centers: implications for health reform.

PubMed

Gurewich, Deborah; Capitman, John; Sirkin, Jenna; Traje, Diana

2012-02-01

Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

Relating Child Care during Infancy to Externalizing and Internalizing Behaviors in Toddlerhood: How Specific Features of Child Care Quality Matter Depending on a Child's Gender and Temperament

ERIC Educational Resources Information Center

Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

2014-01-01

This study explored whether the relationships between specific features of child care quality and externalizing and internalizing behaviors in 24-month-old children are moderated by gender and temperament. Questionnaires were used to record children's gender and measure their temperament. Child care quality was observed with the "Échelles…

Transformational leadership in primary care: Clinicians' patterned approaches to care predict patient satisfaction and health expectations.

PubMed

Huynh, Ho Phi; Sweeny, Kate; Miller, Tricia

2018-04-01

Clinicians face the complex challenge of motivating their patients to achieve optimal health while also ensuring their satisfaction. Inspired by transformational leadership theory, we proposed that clinicians' motivational behaviors can be organized into three patient care styles (transformational, transactional, and passive-avoidant) and that these styles differentially predict patient health outcomes. In two studies using patient-reported data and observer ratings, we found that transformational patient care style positively predicted patients' satisfaction and health expectations above and beyond transactional and passive-avoidant patient care style. These findings provide initial support for the patient care style approach and suggest novel directions for the study of clinicians' motivational behaviors.

Nutrition and physical activity in child care centers: the impact of a wellness policy initiative on environment and policy assessment and observation outcomes, 2011.

PubMed

Lyn, Rodney; Maalouf, Joyce; Evers, Sarah; Davis, Justin; Griffin, Monica

2013-05-23

The child care environment has emerged as an ideal setting in which to implement policies that promote healthy body weight of children. The purpose of this study was to assess the effect of a wellness policy and training program on the physical activity and nutrition environment in 24 child care centers in Georgia. We used the Environment and Policy Assessment and Observation instrument to identify changes to foods served, staff behaviors, and physical activity opportunities. Observations were performed over 1 day, beginning with breakfast and concluding when the program ended for the day. Observations were conducted from February 2010 through April 2011 for a total of 2 observations in each center. Changes to nutrition and physical activity in centers were assessed on the basis of changes in scores related to the physical activity and nutrition environment documented in the observations. Paired t test analyses were performed to determine significance of changes. Significant improvements to total nutrition (P < .001) and physical activity scores (P < .001) were observed. Results indicate that centers significantly improved the physical activity environments of centers by enhancing active play (P = .02), the sedentary environment (P = .005), the portable environment (P = .002), staff behavior (P = .004), and physical activity training and education (P < .001). Significant improvements were found for the nutrition environment (P < .001), and nutrition training and education (P < .001). Findings from this study suggest that implementing wellness policies and training caregivers in best practices for physical activity and nutrition can promote healthy weight for young children in child care settings.

Watching Transitions Unfold: A Mixed-Method Study of Transitions within Early Childhood Care and Education Settings

ERIC Educational Resources Information Center

O'Farrelly, Christine; Hennessy, Eilis

2014-01-01

Unlike the transitions children make between settings, those they undertake between age groups within early childhood care and education (ECCE) settings are seldom studied. Accordingly, this exploratory study followed seven preschool children (three boys and four girls) as they moved to new rooms in five ECCE settings. Structured observations of…

Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study.

PubMed

Duysburgh, Els; Temmerman, Marleen; Yé, Maurice; Williams, Afua; Massawe, Siriel; Williams, John; Mpembeni, Rose; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

2016-01-01

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care. © 2015 John Wiley & Sons Ltd.

Hypertension risk and clinical care in patients with bipolar disorder or schizophrenia; a systematic review and meta-analysis.

PubMed

Ayerbe, Luis; Forgnone, Ivo; Addo, Juliet; Siguero, Ana; Gelati, Stefano; Ayis, Salma

2018-01-01

A higher cardiovascular morbidity and mortality has been observed in patients with bipolar disorder (BPD) or schizophrenia, partly due to an increased risk of hypertension (HTN), or a less effective care of it. This systematic review and meta-analysis, presents a critical appraisal and summary of the studies addressing the risk of HTN, or the differences in its care, for those with schizophrenia or BPD. Prospective studies were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2017. A meta-analysis was undertaken to obtain pooled estimates of the risk of HTN. Five studies reporting the risk of HTN, and five studies presenting differences in its clinical care, were identified. An increased risk of HTN was observed for BPD patients, with an overall Incidence Rate Ratio 1.27(1.15-1.40). The pooled Incidence Rate Ratio of HTN for those with schizophrenia was 0.94 (0.75 - 1.14). A poorer care of HTN (lower rates of screening, prescription, and adherence) was reported in four studies of schizophrenia, and two of BPD patients, compared to people without these conditions. reduced number of studies on risk and care of HTN on patients with BPD or schizophrenia. Limited evidence suggests that patients with BPD have a higher risk of HTN. Patients with schizophrenia and BPD receive poor care of HTN. Understanding the risk of HTN, and the differences in its care, is essential for clinicians to reduce the cardiovascular morbidity and overall mortality of these patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Who needs collaborative care treatment? A qualitative study exploring attitudes towards and experiences with mental healthcare among general practitioners and care managers.

PubMed

Møller, Marlene Christina Rosengaard; Mygind, Anna; Bro, Flemming

2018-05-30

Collaborative care treatment is widely recognized as an effective approach to improve the quality of mental healthcare through enhanced and structured collaboration between general practice and specialized psychiatry. However, studies indicate that the complexity of collaborative care treatment interventions challenge the implementation in real-life general practice settings. Four Danish Collaborative Care Models were launched in 2014 for patients with mild/moderate anxiety and depression. These involved collaboration between general practitioners, care managers and consultant psychiatrists. Taking a multi-practice bottom-up approach, this paper aims to explore the perceived barriers and enablers related to collaborative care for patients with mental health problems and to investigate the actual experiences with a Danish collaborative care model in a single-case study in order to identify enablers and barriers for successful implementation. Combining interviews and observations of usual treatment practices, we conducted a multi-practice study among general practitioners who were not involved in the Danish collaborative care models to explore their perspectives on existing mental health treatment and to investigate (from a bottom-up approach) their perceptions of and need for collaborative care in mental health treatment. Additionally, by combining observations and qualitative interviews, we followed the implementation of a Danish collaborative care model in a single-case study to convey identified barriers and enablers of the collaborative care model. Experienced and perceived enablers of the Danish collaborative care model mainly consisted of a need for new treatment options to deal with mild/moderate anxiety and depression. The model was considered to meet the need for a free fast track to high-quality treatment. Experienced barriers included: poor adaptation of the model to the working conditions and needs in daily general practice, time consumption, unsustainable logistical set-up and unclear care manager role. General practitioners in the multi-practice study considered access to treatment and not collaboration with specialised psychiatry to be essential for this group of patients. The study calls for increased attention to implementation processes and better adaptation of collaborative care models to the clinical reality of general practice. Future interventions should address the treatment needs of specific patient populations and should involve relevant stakeholders in the design and implementation processes.

Detection of medication-related problems in hospital practice: a review

PubMed Central

Manias, Elizabeth

2013-01-01

This review examines the effectiveness of detection methods in terms of their ability to identify and accurately determine medication-related problems in hospitals. A search was conducted of databases from inception to June 2012. The following keywords were used in combination: medication error or adverse drug event or adverse drug reaction, comparison, detection, hospital and method. Seven detection methods were considered: chart review, claims data review, computer monitoring, direct care observation, interviews, prospective data collection and incident reporting. Forty relevant studies were located. Detection methods that were better able to identify medication-related problems compared with other methods tested in the same study included chart review, computer monitoring, direct care observation and prospective data collection. However, only small numbers of studies were involved in comparisons with direct care observation (n = 5) and prospective data collection (n = 6). There was little focus on detecting medication-related problems during various stages of the medication process, and comparisons associated with the seriousness of medication-related problems were examined in 19 studies. Only 17 studies involved appropriate comparisons with a gold standard, which provided details about sensitivities and specificities. In view of the relatively low identification of medication-related problems with incident reporting, use of this method in tracking trends over time should be met with some scepticism. Greater attention should be placed on combining methods, such as chart review and computer monitoring in examining trends. More research is needed on the use of claims data, direct care observation, interviews and prospective data collection as detection methods. PMID:23194349

Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training.

PubMed

Kamath-Rayne, B D; Josyula, S; Rule, A R L; Vasquez, J C

2017-10-01

To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions. Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed. Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation. In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.

The role and potential contribution of clinical research nurses to clinical trials.

PubMed

Spilsbury, Karen; Petherick, Emily; Cullum, Nicky; Nelson, Andrea; Nixon, Jane; Mason, Su

2008-02-01

This study explores the scope and potential contribution of the Clinical Research Nurse (CRN) role to clinical trials of a nursing-specific topic. Over the past two decades, there have been increases in the numbers of nurses working as CRNs because of the increasing global demand for clinical trials. CRNs can influence the quality of clinical trials but the scope and contribution of the role to clinical trials is not known. Qualitative focus group study. A focus group interview was carried out with CRNs (n = 9) employed on a large, multi-centre (six NHS Trusts) randomized controlled trial of pressure area care. The focus group interview was recorded, alongside field notes of participant interactions and behaviours, and transcribed verbatim. Data were analysed for thematic content and process. CRNs described their transition to a clinical research role. They reported a lack of confidence, role conflict as researcher and nurse, the challenges of gaining cooperation of clinical nursing staff to comply with trial protocols and difficulties maintaining their own motivation. CRNs provided their perceptions and observations of pressure area care and prevention. They identified areas of inadequate treatment, management and care, influenced by organizational and clinical aspects of care delivery. The study reveals challenges associated with training and management of CRNs. CRNs are usually associated with trial recruitment and data collection. This study highlights the additional contributions of CRNs for the study of topics specific to nursing as the result of their unique placement in the research centres as informal 'participant observers.' Such observations enhance understanding of the contexts being studied. These findings are relevant to the design and conduct of research studies of nursing care and practice and present ways for investigators to optimize the skills and knowledge of nurses working as CRNs.

Informed Strangers: Witnessing and Responding to Unethical Care as Student Nurses.

PubMed

Engel, Joyce; Salfi, Jenn; Micsinszki, Samantha; Bodnar, Andrea

2017-01-01

Nursing students occupy a unique perspective in clinical settings because they are informed, through education, about how patient care ought to happen. Given the brevity of placements and their "visiting status" in clinical sites, students are less invested in the ethos of specific sites. Subsequently, their perspectives of quality care are informed by what should happen, which might differ from that of nurses and patients. The purpose of this study was to identify predominant themes in patient care, as experienced by students, and the influence that these observations have on the development of their ethical reasoning. Using a qualitative descriptive approach in which 27 nursing student papers and three follow-up in-depth interviews were analyzed, three main themes emerged: Good employee, poor nurse; damaged care; and negotiating the gap. The analysis of the ethical situations in these papers suggests that students sometimes observe care that lacks concern for the dignity, autonomy, and safety of patients. For these student nurses, this tension led to uncertainty about patient care and their eventual profession.

[Use of medicinal plants as home remedies in Primary Health Care in Blumenau - State of Santa Catarina, Brazil].

PubMed

Zeni, Ana Lúcia Bertarello; Parisotto, Amanda Varnier; Mattos, Gerson; Helena, Ernani Tiaraju de Santa

2017-08-01

An increase in the use of alternative therapeutic practices has been observed in the past decade, especially in medicinal plants, herbal and home remedies, which has been supported by policies within the scope of the Unified Health System (SUS). This study investigated the use of home remedies by users of Primary Health Care in Blumenau, State of Santa Catarina. It is a cross-sectional, observational and epidemiological study, the data for which were obtained via a questionnaire applied to 701 individuals. An unconditional logistic regression model was used to estimate the association between the use of home remedies and socio-demographic and medical care variables. It was observed that 21.9% of the sample use home remedies and medicinal plants grown in the back yard are the remedies of choice. Lemon balm, chamomile, peppermint and lime were the remedies most frequently mentioned. The use of home remedies was associated with the female gender, older age and the Family Health Strategy care model. The results supported that medicinal plants are used by the population as a therapeutic alternative option. However, it is necessary that primary care services ensure both access to natural products and supply qualified professionals to give instructions regarding the correct usage of home remedies.

Health and safety needs in early care and education programs: what do directors, child health records, and national standards tell us?

PubMed

Alkon, Abbey; To, Kim; Mackie, Joanna F; Wolff, Mimi; Bernzweig, Jane

2010-01-01

To identify the overlapping and unique health and safety needs and concerns identified by early care and education (ECE) directors, health records, and observed compliance with national health and safety (NHS) standards. Cross-sectional study. 127 ECE programs from 5 California counties participated in the study, including 118 directors and 2,498 children's health records. Qualitative data were collected using standardized ECE directors' interviews to identify their health and safety concerns; and objective, quantitative data were collected using child health record reviews to assess regular health care, immunizations, health insurance, special health care needs, and screening tests and an observation Checklist of 66 key NHS standards collected by research assistants. The overlapping health and safety needs and concerns identified by the directors and through observations were hygiene and handwashing, sanitation and disinfection, supervision, and the safety of indoor and outdoor equipment. Some of the health and safety needs identified by only one assessment method were health and safety staff training, medical plans for children with special health care needs and follow-up on positive screening tests. Comprehensive, multimethod assessments are useful to identify health and safety needs and develop public health nursing interventions for ECE programs.

Studies of Day Care Center Climate and Its Effect on Children's Social and Emotional Behavior.

ERIC Educational Resources Information Center

Ekholm, Bodil; Hedin, Anna

School climates at 12 day care centers in Sweden were compared to investigate effects of center climates on children's social and emotional behavior. Observations and interviews conducted at the day care centers revealed differences in center climates related to child-rearing patterns, patterns of interaction, the distribution of power, and in…

Transporting children with special health care needs: comparing recommendations and practice.

PubMed

O'Neil, Joseph; Yonkman, Janell; Talty, Judith; Bull, Marilyn J

2009-08-01

We compare the use of the American Academy of Pediatrics (AAP) guidelines for the safe transportation of children with special health care needs (CSHCN) with reported and observed practices. This observational study was based on a convenience sample of vehicles exiting the garage of a tertiary children's hospital. Certified child passenger safety technicians with a health care background and specialized training in the transportation of CSHCN gathered the driver's demographic information and the child's reported medical condition, weight, age, clinic visited, and relation to the driver. The safety technicians observed the car safety seat (CSS) type, vehicle seating position, and if the child required postural support. During the study, 275 drivers transporting 294 CSHCN were observed. Overall, most drivers complied with AAP recommendations by using a standard CSS seat (75.4%). Among the seats evaluated, 241 (82.0%) were the appropriate choice, but only 75 (26.8%) of 280 assessed had no misuses. Approximately 24% of the drivers modified the CSS, and 19.4% of the children would have benefited from additional body-positioning support. Only 8% of medical equipment was properly secured. Although most drivers seemed to choose the appropriate seat, many had at least 1 misuse. Drivers complied with most AAP recommendations; however, some deviated to facilitate care of the child during transport. Discussions with parents or caregivers about the proper transportation of CSHCN and referrals to child passenger safety technicians with special training may improve safety, care, and comfort in the vehicle.

How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study.

PubMed

McCloskey, Rose; Donovan, Cindy; Stewart, Connie; Donovan, Alicia

2015-09-01

Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

Observation Status, Poverty, and High Financial Liability Among Medicare Beneficiaries.

PubMed

Goldstein, Jennifer N; Zhang, Zugui; Schwartz, J Sanford; Hicks, LeRoi S

2018-01-01

Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries. We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated. After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24). Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability. Copyright © 2018 Elsevier Inc. All rights reserved.

What critical care nurses need to know about health care access when caring for elders in acute care settings.

PubMed

Jennings, Bonnie Mowinski; Lamb, Gerri

2007-09-01

Health care system issues, in general, and access to care, in particular, are not problems typically studied by critical care nurses. Rather, initial and continuing education focuses on clinical aspects of care. This focus is necessary to assure that critical care nurses have the expertise to care for patients who need astute surveillance for complicated physical problems and their emotional sequelae, as well as in-depth knowledge and skills related to care coordination for patient stabilization and transfer. However, evidence is growing that patients benefit when critical care nurses expand their knowledge about access to care. This article provides insights regarding access to health care and how it relates to many of the admission and readmission patterns that critical care nurses observe.

Patient handover in the emergency department: 'How' is as important as 'what'.

PubMed

de Lange, Santel; van Eeden, Ilze; Heyns, Tanya

2018-01-01

We explored the existing patient handover practices between emergency care practitioners and healthcare professionals in the emergency department. In the emergency department, patient handover between emergency care practitioner's and healthcare professionals is a complex process involving multiple functions, such as the transfer of information, responsibility and accountability from one person to another. We used a qualitative study design. Emergency care practitioners and healthcare professionals were identified using purposive and convenience sampling data. Data were collected through unstructured participant observation. We conducted 20 observation sessions, varying between 15 and 20min. The data were analysed using a creative hermeneutic approach. The 'how' or manner of patient handover observed between emergency care practitioners and health professionals was perceived as important. A diagnosis of disrespectful behaviour was made which could negatively influence patient handover and ultimately patient outcome. Disrespectful behaviour stemmed from the two signs that supported the diagnosis: task-orientated behaviour and the use of indigenous language. Involving the emergency care practitioners and healthcare professionals in observing and analysing the existing patient handover practices in the ED raised their awareness of the current workplace culture. Transforming behaviour from disrespectful to respectful should include greeting one another, listening attentively to the patient handover and include emergency care practitioners, patients and their significant other in the handover process that should be conducted in a commonly understood language. Emergency care practitioners and healthcare professionals should recognise that during patient handover 'how' is as important as 'what'. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

PubMed Central

Vinluan, Jessele; Retegan, Claudia; Chen, Andrew; Beiles, Charles Barry

2014-01-01

Objective Clinical management issues are contributory factors to mortality. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM), an educational peer-review process for surgeons, to discover differences in the incidence of these issues between surgical specialties in order to focus attention to areas of care that might be improved. Design This study used retrospectively analysed observational data from VASM. Clinical management issues between eight specialties were assessed using χ2 analysis. Data sources VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Results A total of 2946 specific clinical issues as deficiencies of care were reported. 15% of cases had significant issues of care. The most common clinical management issue was the delay in delivery of treatment. Other clinical issues included the quality of communication and documentation, preoperative and postoperative care, adverse events and protocol issues. There were significant differences in issues between specialties. Conclusions The clinical management issues presented across surgical specialties were similar; however, five issues of clinical care differed significantly in frequency across surgical specialties. The three main issues varying among specialties were complications after operation, communication and postoperative care. Addressing these clinical management issues via the peer-review process may impact positively on patient care. PMID:24980043

Year in review 2005: Critical Care – nephrology

PubMed Central

Ricci, Zaccaria; Ronco, Claudio

2006-01-01

We summarize original research in the field of critical care nephrology accepted or published in 2005 in Critical Care and, when considered relevant or directly linked to this research, in other journals. The articles have been grouped into four categories to facilitate a rapid overview. First, physiopathology, epidemiology and prognosis of acute renal failure (ARF): an extensive review and some observational studies have been performed with the aim of describing aspects of ARF physiopathology, precise epidemiology and long-term outcomes. Second, several authors have performed clinical trials utilizing a potential nephro-protective drug, fenoldopam, with different results. Third, the issue of continuous renal replacement therapies dose has been addressed in a small prospective study and a large observational trial. And fourth, alternative indications to extracorporeal treatment of ARF and systemic inflammatory response syndrome have been explored by three original clinical studies. PMID:16919174

Impact of the ‘Artful Moments’ Intervention on Persons with Dementia and Their Care Partners: a Pilot Study

PubMed Central

Hazzan, Afeez Abiola; Humphrey, Janis; Kilgour-Walsh, Laurie; Moros, Katherine L.; Murray, Carmen; Stanners, Shannon; Montemuro, Maureen; Giangregorio, Aidan; Papaioannou, Alexandra

2016-01-01

Background Engaging with art can be valuable for persons living with dementia. ‘Artful Moments’ was a collaborative project undertaken by the Art Gallery of Hamilton and the Behavioural Health Program at Hamilton Health Sciences that sought to develop and implement a program of arts-based activities for persons in the middle-to-late stages of dementia who exhibit behavioural symptoms and for their accompanying care partners. Methods This pilot study employed a qualitative descriptive design. Eight participants were observed during multiple art sessions to evaluate their level of engagement in the program. Care partners also completed a questionnaire describing their experience. Qualitative content analysis was used to identify themes. Results For program participants, factors that promoted continued interest and engagement in art included: care partner involvement, group activities, opportunities to share opinions, validation of their personhood, and increased engagement over time. Care partners observed improvements in participants’ creativity, communication, relationship forming, and task accomplishment, and some reported reduced stress. Conclusions ‘Artful Moments’ promoted engagement and expression in persons in the middle-to-late stages of dementia, as well as having benefits for their care partners. Limitations of the study included a small convenience sample drawn from one hospital setting. PMID:27403209

Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes.

PubMed

Chaudhury, Habib; Hung, Lillian; Rust, Tiana; Wu, Sarah

2017-10-01

Purpose Drawing on therapeutic physical environmental design principles and Kitwood's theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents' mealtime experience and staff practice in two care units. Method The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.

Multidimensional Treatment Foster Care for Adolescents in English care: randomised trial and observational cohort evaluation.

PubMed

Green, J M; Biehal, N; Roberts, C; Dixon, J; Kay, C; Parry, E; Rothwell, J; Roby, A; Kapadia, D; Scott, S; Sinclair, I

2014-03-01

Children in care often have poor outcomes. There is a lack of evaluative research into intervention options. To examine the efficacy of Multidimensional Treatment Foster Care for Adolescents (MTFC-A) compared with usual care for young people at risk in foster care in England. A two-arm single (assessor) blinded randomised controlled trial (RCT) embedded within an observational quasi-experimental case-control study involving 219 young people aged 11-16 years (trial registration: ISRCTN 68038570). The primary outcome was the Child Global Assessment Scale (CGAS). Secondary outcomes were ratings of educational attendance, achievement and rate of offending. The MTFC-A group showed a non-significant improvement in CGAS outcome in both the randomised cohort (n = 34, adjusted mean difference 1.3, 95% CI -7.1 to 9.7, P = 0.75) and in the trimmed observational cohort (n = 185, adjusted mean difference 0.95, 95% CI -2.38 to 4.29, P = 0.57). No significant effects were seen in secondary outcomes. There was a possible differential effect of the intervention according to antisocial behaviour. There was no evidence that the use of MTFC-A resulted in better outcomes than usual care. The intervention may be more beneficial for young people with antisocial behaviour but less beneficial than usual treatment for those without.

Incidence of venous thromboembolism in care homes: a prospective cohort study.

PubMed

Apenteng, Patricia N; Hobbs, Fd Richard; Roalfe, Andrea; Muhammad, Usman; Heneghan, Carl; Fitzmaurice, David

2017-02-01

Care home residents have venous thromboembolism (VTE) risk profiles similar to medical inpatients; however, the epidemiology of VTE in care homes is unclear. To determine the incidence of VTE in care homes. Observational cohort study of 45 care homes in Birmingham and Oxford, UK. A consecutive sample of care home residents was enrolled and followed up for 12 months. Data were collected via case note reviews of care home and GP records; mortality information was supplemented with Health and Social Care Information Centre (now called NHS Digital) cause of death data. All potential VTE events were adjudicated by an independent committee according to three measures of diagnostic certainty: definite VTE (radiological evidence), probable VTE (high clinical indication but no radiological evidence), or possible VTE (VTE cannot be ruled out). (Study registration number: ISTCTN80889792.) RESULTS: There were 1011 participants enrolled, and the mean follow-up period was 312 days (standard deviation 98 days). The incidence rate was 0.71 per 100 person years of observation (95% confidence interval [CI] = 0.26 to 1.54) for definite VTE, 0.83 per 100 person years (95% CI = 0.33 to 1.70) for definite and probable VTE, and 2.48 per 100 person years (95% CI = 1.53 to 3.79) for definite, probable, and possible VTE. The incidence of VTE in care homes in this study (0.71-2.48 per 100 person years) is substantial compared with that in the community (0.117 per 100 person years) and in people aged ≥70 years (0.44 per 100 person years). Further research regarding risk stratification and VTE prophylaxis in this population is needed. © British Journal of General Practice 2017.

Nurse students learning acute care by simulation - Focus on observation and debriefing.

PubMed

Abelsson, Anna; Bisholt, Birgitta

2017-05-01

Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. The study was designed as an observational study inspired by an ethnographic approach. Data was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis. Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity. High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety. Copyright © 2017 Elsevier Ltd. All rights reserved.

A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night.

PubMed

Hope, Joanna; Recio-Saucedo, Alejandra; Fogg, Carole; Griffiths, Peter; Smith, Gary B; Westwood, Greta; Schmidt, Paul E

2017-12-21

To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. A qualitative interpretative design informed this study. Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored. In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Computer screening for palliative care needs in primary care: a mixed-methods study.

PubMed

Mason, Bruce; Boyd, Kirsty; Steyn, John; Kendall, Marilyn; Macpherson, Stella; Murray, Scott A

2018-05-01

Though the majority of people could benefit from palliative care before they die, most do not receive this approach, especially those with multimorbidity and frailty. GPs find it difficult to identify such patients. To refine and evaluate the utility of a computer application (AnticiPal) to help primary care teams screen their registered patients for people who could benefit from palliative care. A mixed-methods study of eight GP practices in Scotland, conducted in 2016-2017. After a search development cycle the authors adopted a mixed-methods approach, combining analysis of the number of people identified by the search with qualitative observations of the computer search as used by primary care teams, and interviews with professionals and patients. The search identified 0.8% of 62 708 registered patients. A total of 27 multidisciplinary meetings were observed, and eight GPs and 10 patients were interviewed. GPs thought the search identified many unrecognised patients with advanced multimorbidity and frailty, but were concerned about workload implications of assessment and care planning. Patients and carers endorsed the value of proactive identification of people with advanced illness. GP practices can use computer searching to generate lists of patients for review and care planning. The challenges of starting a conversation about the future remain. However, most patients regard key components of palliative care (proactive planning, including sharing information with urgent care services) as important. Screening for people with deteriorating health at risk from unplanned care is a current focus for quality improvement and should not be limited by labelling it solely as 'palliative care'. © British Journal of General Practice 2018.

Associations between job demands, work-related strain and perceived quality of care: a longitudinal study among hospital physicians.

PubMed

Krämer, Tanya; Schneider, Anna; Spieß, Erika; Angerer, Peter; Weigl, Matthias

2016-12-01

Drawing on a sample of hospital physicians, we attempted to determine prospective associations between three job demands, work-related strain and perceived quality of care. Longitudinal follow-up study with with a 1-year time lag. Physicians of two acute-care hospitals in Germany (one general urban and one children's hospital). Ninety-five physicians filled out a standardized questionnaire. Physicians' evaluations of quality of care at both waves. Our results support the hypothesis that job demands directly influence quality of care irrespective of strain. Specifically, high social stressors (β = -0.15, P = 0.036) and time pressure (β = -0.19, P = 0.031) were associated with decreased quality of care over time. We additionally observed reversed effects from quality of care at baseline to time pressure at follow-up (β = -0.35, P = 0.006). Contrary to expectations, physicians' work-related strain did not mediate the job demands-quality of care-relationship, nor were strain-to-stressor effects observed. Our results corroborate that hospital work environments with high demands have a direct impact on physician-perceived quality of care. In turn, poor care practices contribute to increased job demands. Our findings also emphasize that further understanding is required of how physicians' workplace conditions affect job demands, well-being, and quality of care, respectively. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Improving the appropriateness of antimicrobial use in primary care after implementation of a local antimicrobial guide in both levels of care.

PubMed

Fernández Urrusuno, Rocío; Flores Dorado, Macarena; Vilches Arenas, Angel; Serrano Martino, Carmen; Corral Baena, Susana; Montero Balosa, Ma Carmen

2014-08-01

This study aims to assess the effectiveness of multiple interventions carried out during the implementation of a guide, on the improvement of the appropriateness of antimicrobial prescribing in primary care. This is a cross-sectional before/after study carried out in Aljarafe Health Care Area (Andalusia, Spain), with a population of 368,728 inhabitants assisted in 37 health centers. Subjects include patients with antibiotic prescriptions during 2009 (pre-intervention phase) or 2012 (postintervention phase) selected by simple random sampling (confidence level, 95%; accuracy, 5%), with infections registered in the electronic clinical history. This study involve training sessions in primary care centers and hospital services, incorporation of the electronic guide to the Health Care Service Websites, and incorporation of the guide to the Digital Health History as a tool to support decision making. Difference on appropriate antibiotic prescribing before and after interventions resulted from the study. Other variables also include age, gender, type of pharmacy, antibiotic prescribed, number of treatments per year, infection site, and main comorbidities In addition, this study uses computerized pharmacy records of reimbursed and dispensed drugs and electronic medical histories. The percentage of appropriate antibiotic prescribing increased from 36% in 2009 to 57% in 2012 (p < 0.001) is shown. The improvement was observed in all age patients of any sex and was higher among working-age patients and patients with comorbidities. The best results were observed in the group of beta-lactams and in the treatment of respiratory and skin infections. The realization of multifactorial interventions involving professionals from both levels of care could be an effective strategy to improve the use of antimicrobials in primary care.

Ethical Decisions in Palliative Care: Interprofessional Relations as a Burnout Protective Factor? Results From a Mixed-Methods Multicenter Study in Portugal.

PubMed

Hernández-Marrero, Pablo; Pereira, Sandra Martins; Carvalho, Ana Sofia

2016-09-01

Ethical decisions are part of contemporary practices in palliative care. The need of making such decisions is associated to higher burnout levels and other work related problems among healthcare professionals. As part of the project entitled "Decisions in End-of-Life Care in Spain and Portugal" (DELiCaSP), this study aims to (i) identify the most common ethical decisions made by Portuguese palliative care teams and (ii) understand how the making of such decisions relates to burnout. A mixed methods study was conducted with 9 palliative care teams, using (i) questionnaires of socio-demographic and professional variables, work-related experiences, (ii) the Maslach Burnout Inventory, (iii) interviews and (iv) observations. These teams were geographically dispersed across the country, covering the North, Centrum and South regions, and heterogeneous: Five palliative care units for inpatients; three home care teams; and one hospital support team. A total of 20 interviews and 240 hours of observations were completed until reaching saturation. The most common ethical decisions were related to communication issues (information disclosure of the diagnosis and prognosis), forgoing treatment and sedation. Although perceived as stressful, emotionally demanding and challenging, ethical decisions were not significantly associated with burnout. Making ethical decisions is not associated with higher burnout levels among professionals working in Portuguese palliative care teams. This can be explained by the interprofessional decision-making process followed by these teams, which promotes a sense of shared-decision and team-based empowerment; and by the advanced level of interdisciplinary education in palliative care that these professionals have. © The Author(s) 2015.

Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.

PubMed

Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro

2017-06-07

The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.

Directly observed treatment short course (DOTS) appears to have reduced the self-care role of the-pulmonary tuberculosis patient: evidence from a correlational study between personal health beliefs (PHB) and self-care practices (SCP).

PubMed

Gundani, Hv; Watyoka, H; Nyathi, C; Charumbira, A P

2010-01-01

To examine the relationship between personal health beliefs and self-care practices among 69 PTB patients aged 25 to 65 years at a tuberculosis clinic in Zimbabwe, in order to determine the role patients can play in self-care. Analysis of collected demographic data, personal health beliefs (PH B) and self-care practices (SCP) of PTB patients. Gwanda Provincial Hospital (GPH) Tuberculosis Clinic. PTB patients in the (GPH) register who were taking treatment. Key components of the study included administration of an interview schedule to 69 PTB patients on treatment, and the analysis and comparison of personal health beliefs and self-care practices. Scores of personal health beliefs, self-care practices, perceived self-efficacy, perceived threats, and cost-benefit analysis. Sixty- nine PTB patients with a median age of 38, screened during the month of March, 2009, showed a weak positive Pearson's correlational coefficient of (R2=0.177), indicating that personal health beliefs may have some influence on self-care practices. The regression analysis showed an association of 3.1%, thus health beliefs are responsible for self-care undertaken by 3.1 in a 100 PTB patients. Directly Observed Treatment Short Course (DOTS) seems to have reduced the self-care practice of PTS patients. It seems the PTB patient has a potential role to play in the management of his own treatment.

Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: a qualitative study.

PubMed

Caswell, Glenys; Pollock, Kristian; Harwood, Rowan; Porock, Davina

2015-08-01

This paper focuses on communication between hospital staff and family carers of patients dying on acute hospital wards, with an emphasis on the family carers' perspective. The age at which people in the UK die is increasing and many continue to die in the acute hospital setting. Concerns have been expressed about poor quality end of life care in hospitals, in particular regarding communication between staff and relatives. This research aimed to understand the factors and processes which affect the quality of care provided to frail older people who are dying in hospital and their family carers. The study used mixed qualitative methods, involving non-participant observation, semi-structured interviews and a review of case notes. Four acute wards in an English University teaching hospital formed the setting: an admissions unit, two health care of older people wards and a specialist medical and mental health unit for older people. Thirty-two members of staff took part in interviews, five members of the palliative care team participated in a focus group and 13 bereaved family carers were interviewed. In all, 245 hours of observation were carried out including all days of the week and all hours of the day. Forty-two individual patient cases were constructed where the patient had died on the wards during the course of the study. Thirty three cases included direct observations of patient care. Interviews were completed with 12 bereaved family carers of ten patient cases. Carers' experience of the end of life care of their relative was enhanced when mutual understanding was achieved with healthcare professionals. However, some carers reported communication to be ineffective. They felt unsure about what was happening with their relative and were distressed by the experience of their relative's end of life care. Establishing a concordant relationship, based on negotiated understanding of shared perspectives, can help to improve communication between healthcare professionals and family carers of their patients.

Designing A Mixed Methods Study In Primary Care

PubMed Central

Creswell, John W.; Fetters, Michael D.; Ivankova, Nataliya V.

2004-01-01

BACKGROUND Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. METHODS We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. RESULTS Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. DISCUSSION We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research. PMID:15053277

Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting.

PubMed

Juvé-Udina, Maria-Eulàlia; Pérez, Esperanza Zuriguel; Padrés, Núria Fabrellas; Samartino, Maribel Gonzalez; García, Marta Romero; Creus, Mònica Castellà; Batllori, Núria Vila; Calvo, Cristina Matud

2014-01-01

This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology. An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review. Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans. The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care. The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care. © 2013 Sigma Theta Tau International.

Prevalence and predictors of difficulty accessing the mouths of intubated critically ill adults to deliver oral care: An observational study.

PubMed

Dale, Craig M; Smith, Orla; Burry, Lisa; Rose, Louise

2018-04-01

Oral care of intubated patients is essential to the prevention of infection and patient discomfort. However, barriers to oral access and delivery of oral care have received little attention. To determine prevalence and predictors of oral access difficulty. A prospective, observational, multi-center study. Four intensive care units in Toronto, Canada. Adult patients orally intubated for ≥48 h. We screened consecutive admissions once a week to identify eligible participants. We observed each patient and asked the patient's nurse about presence or absence of difficulty accessing the mouth to deliver oral care across three categories: (1) visualizing inside the mouth; (2) obtaining patient cooperation, or (3) inserting instruments for delivery of oral care. We asked nurses to identify presence of patient behaviors contributing to oral access difficulty and perceived level of difficulty on a Likert response scale. We examined patient and treatment characteristics associated with extreme difficulty (i.e., difficulty in all 3 categories) using a generalized estimating equation regression model. A total of 428 patients were observed, 58% admitted with a medical diagnosis. More than half (57%) had ≥2 oral devices up to maximum of 4. Oral care difficulty was identified in 83% of patients and rated as moderate to high for 217 (51%). Difficulty concerned visibility (74%), patient cooperation (55%), and space to insert instruments (53%). Patient behaviors contributing difficulty included coughing/gagging (60%), mouth closing (49%), biting (45%) and localizing (27%) during care. Variables associated with extreme difficulty included neurological (OR 1.92, 95% CI 1.42-2.60) or trauma admission (OR 1.83, 95% CI 1.16-2.89), lack of pain assessment or treatment in the 4 h prior to oral care (OR 1.43, 95% CI 1.14-1.80), more oral devices (OR 1.40, 95% CI 1.05-1.87), and duration of intubation (OR 1.05, 95% CI 1.01-1.10). Absence of documented agitation in the 4 h prior to oral care was associated with less difficulty (OR 0.68, 95% CI 0.54-0.86). Oral care is complex and difficulties are experienced in a vast majority of intubated patients. Some difficulties are amenable to correction such as pain management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Multicultural health care in practice. An empirical exploration of multicultural care in The Netherlands.

PubMed

Olthuis, Gert; van Heteren, Godelieve

2003-09-01

This study presents a first assessment of the challenges faced by Dutch health care providers dealing with the increasing cultural diversity in Dutch society. Qualitative interviews with 24 Dutch caregivers and policy-makers point to a number of important difficulties encountered when confronted with the growing diversity of patient populations. The study focuses explicitly on the challenges health care providers perceive in their direct interactions with patients. On the basis of the observations of the 24 respondents five strategies were formulated to improve the delivery of care in a multicultural environment. Their findings were further evaluated by confronting the empirical data with care-ethical notions (attentiveness, responsibility, competence, and responsiveness) and intercultural communication-theory.

Improving Older Adults' Functional Ability through Service Use in a Home Care Program in Hong Kong

ERIC Educational Resources Information Center

Cheung, Chau-kiu; Ngan, Raymond Man-hung

2005-01-01

Objective: Despite past findings about the contribution of home care services to older users' functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care program. Method: The study gathered 116 observations during 2 years…

Observational studies using propensity score analysis underestimated the effect sizes in critical care medicine.

PubMed

Zhang, Zhongheng; Ni, Hongying; Xu, Xiao

2014-08-01

Propensity score (PS) analysis has been increasingly used in critical care medicine; however, its validation has not been systematically investigated. The present study aimed to compare effect sizes in PS-based observational studies vs. randomized controlled trials (RCTs) (or meta-analysis of RCTs). Critical care observational studies using PS were systematically searched in PubMed from inception to April 2013. Identified PS-based studies were matched to one or more RCTs in terms of population, intervention, comparison, and outcome. The effect sizes of experimental treatments were compared for PS-based studies vs. RCTs (or meta-analysis of RCTs) with sign test. Furthermore, ratio of odds ratio (ROR) was calculated from the interaction term of treatment × study type in a logistic regression model. A ROR < 1 indicates greater benefit for experimental treatment in RCTs compared with PS-based studies. RORs of each comparison were pooled by using meta-analytic approach with random-effects model. A total of 20 PS-based studies were identified and matched to RCTs. Twelve of the 20 comparisons showed greater beneficial effect for experimental treatment in RCTs than that in PS-based studies (sign test P = 0.503). The difference was statistically significant in four comparisons. ROR can be calculated from 13 comparisons, of which four showed significantly greater beneficial effect for experimental treatment in RCTs. The pooled ROR was 0.71 (95% CI: 0.63, 0.79; P = 0.002), suggesting that RCTs (or meta-analysis of RCTs) were more likely to report beneficial effect for the experimental treatment than PS-based studies. The result remained unchanged in sensitivity analysis and meta-regression. In critical care literature, PS-based observational study is likely to report less beneficial effect of experimental treatment compared with RCTs (or meta-analysis of RCTs). Copyright © 2014 Elsevier Inc. All rights reserved.

Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres.

PubMed

Nikolopoulos, Hara; Farmer, Anna; Berry, Tanya R; McCargar, Linda J; Mager, Diana R

2015-04-01

In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination. © 2012 Blackwell Publishing Ltd.

Considerations for Observational Research Using Large Data Sets in Radiation Oncology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jagsi, Reshma, E-mail: rjagsi@med.umich.edu; Bekelman, Justin E.; Chen, Aileen

The radiation oncology community has witnessed growing interest in observational research conducted using large-scale data sources such as registries and claims-based data sets. With the growing emphasis on observational analyses in health care, the radiation oncology community must possess a sophisticated understanding of the methodological considerations of such studies in order to evaluate evidence appropriately to guide practice and policy. Because observational research has unique features that distinguish it from clinical trials and other forms of traditional radiation oncology research, the International Journal of Radiation Oncology, Biology, Physics assembled a panel of experts in health services research to provide a concisemore » and well-referenced review, intended to be informative for the lay reader, as well as for scholars who wish to embark on such research without prior experience. This review begins by discussing the types of research questions relevant to radiation oncology that large-scale databases may help illuminate. It then describes major potential data sources for such endeavors, including information regarding access and insights regarding the strengths and limitations of each. Finally, it provides guidance regarding the analytical challenges that observational studies must confront, along with discussion of the techniques that have been developed to help minimize the impact of certain common analytical issues in observational analysis. Features characterizing a well-designed observational study include clearly defined research questions, careful selection of an appropriate data source, consultation with investigators with relevant methodological expertise, inclusion of sensitivity analyses, caution not to overinterpret small but significant differences, and recognition of limitations when trying to evaluate causality. This review concludes that carefully designed and executed studies using observational data that possess these qualities hold substantial promise for advancing our understanding of many unanswered questions of importance to the field of radiation oncology.« less

Considerations for observational research using large data sets in radiation oncology.

PubMed

Jagsi, Reshma; Bekelman, Justin E; Chen, Aileen; Chen, Ronald C; Hoffman, Karen; Shih, Ya-Chen Tina; Smith, Benjamin D; Yu, James B

2014-09-01

The radiation oncology community has witnessed growing interest in observational research conducted using large-scale data sources such as registries and claims-based data sets. With the growing emphasis on observational analyses in health care, the radiation oncology community must possess a sophisticated understanding of the methodological considerations of such studies in order to evaluate evidence appropriately to guide practice and policy. Because observational research has unique features that distinguish it from clinical trials and other forms of traditional radiation oncology research, the International Journal of Radiation Oncology, Biology, Physics assembled a panel of experts in health services research to provide a concise and well-referenced review, intended to be informative for the lay reader, as well as for scholars who wish to embark on such research without prior experience. This review begins by discussing the types of research questions relevant to radiation oncology that large-scale databases may help illuminate. It then describes major potential data sources for such endeavors, including information regarding access and insights regarding the strengths and limitations of each. Finally, it provides guidance regarding the analytical challenges that observational studies must confront, along with discussion of the techniques that have been developed to help minimize the impact of certain common analytical issues in observational analysis. Features characterizing a well-designed observational study include clearly defined research questions, careful selection of an appropriate data source, consultation with investigators with relevant methodological expertise, inclusion of sensitivity analyses, caution not to overinterpret small but significant differences, and recognition of limitations when trying to evaluate causality. This review concludes that carefully designed and executed studies using observational data that possess these qualities hold substantial promise for advancing our understanding of many unanswered questions of importance to the field of radiation oncology. Copyright © 2014 Elsevier Inc. All rights reserved.

Considerations for Observational Research using Large Datasets in Radiation Oncology

PubMed Central

Jagsi, Reshma; Bekelman, Justin E.; Chen, Aileen; Chen, Ronald C.; Hoffman, Karen; Shih, Ya-Chen Tina; Smith, Benjamin D.; Yu, James B.

2014-01-01

The radiation oncology community has witnessed growing interest in observational research conducted using large-scale data sources such as registries and claims-based datasets. With the growing emphasis on observational analyses in health care, the radiation oncology community must possess a sophisticated understanding of the methodological considerations of such studies in order to evaluate evidence appropriately to guide practice and policy. Because observational research has unique features that distinguish it from clinical trials and other forms of traditional radiation oncology research, the Red Journal assembled a panel of experts in health services research to provide a concise and well-referenced review, intended to be informative for the lay reader, as well as for scholars who wish to embark on such research without prior experience. This review begins by discussing the types of research questions relevant to radiation oncology that large-scale databases may help illuminate. It then describes major potential data sources for such endeavors, including information regarding access and insights regarding the strengths and limitations of each. Finally, it provides guidance regarding the analytic challenges that observational studies must confront, along with discussion of the techniques that have been developed to help minimize the impact of certain common analytical issues in observational analysis. Features characterizing a well-designed observational study include clearly defined research questions, careful selection of an appropriate data source, consultation with investigators with relevant methodological expertise, inclusion of sensitivity analyses, caution not to overinterpret small but significant differences, and recognition of limitations when trying to evaluate causality. This review concludes that carefully designed and executed studies using observational data that possess these qualities hold substantial promise for advancing our understanding of many unanswered questions of importance to the field of radiation oncology. PMID:25195986

The impact of individualized interaction on the quality of life of elderly dependent on care as a result of dementia: a study with a pre-post design.

PubMed

de Vocht, Hilde M; Hoogeboom, A M G Marcella; van Niekerk, Bob; den Ouden, Marjolein E M

2015-01-01

The aim was to assess the impact of a one-to-one 30-min individualized interaction per day on the behavior and quality of life of care-dependent residents with dementia. In a pre-/post-test study, 15 care-dependent residents with dementia (mean age 88.8 years, 86.7% women) were included. Resident behavior was measured using video observation and quality of life using Qualidem. Health care professionals (n = 13) and direct relatives (n = 4) were interviewed about the effect of the intervention. The effect of the intervention was analyzed using the Friedman analysis of variance. The video observation showed that maintaining eye contact, touching, responding to speaking, tracking observable stimuli and asking questions about the activity significantly increased during the intervention. These findings were supported by interviews with nurses who described experiences of making human-to-human contact with the residents. No significant overall changes were found in quality of life. These findings were partially supported by interviews with health care professionals and relatives as some perceived effects beyond the 30-min intervention. Interaction offered on a one-to-one basis tailored to individual preferences significantly improved positive interactive behavior of care-dependent residents with dementia during the intervention. Surveys revealed no significant overall effect of the intervention. The interviews indicated there might be effects beyond the intervention for some residents.

The correlation between mothers' participation in infant care in the NICU and their anxiety and problem-solving skill levels in caregiving.

PubMed

Çakmak, Emine; Karaçam, Zekiye

2018-01-01

To examine the correlation between mothers' participation in infant care in the Neonatal Intensive Care Unit (NICU) and their anxiety and problem-solving skill levels in caregiving. The cross-sectional study was conducted with 340 mothers whose babies were in the NICU. Data were collected with a questionnaire, a Participation in Caregiving Observation Form, the State and Trait Anxiety Inventory and the Problem-solving Skills Evaluation Form. Descriptive statistics and correlation analysis were used in the evaluation of the data. The mothers were with their babies an average of 6.28 ± 2.43 (range: 1-20) times a day, participating in many basic procedures of care. A negative correlation was found between the mothers' scores on the Participation in Caregiving Observation Form and their State and Trait Anxiety Inventory scores (respectively, r = -0.48, p < 0.001 and r = -0.12, p < 0.05), but a positive correlation was observed between the Problem-solving Process (r = 0.41, p < 0.001) and the Baby Care Skills (r = 0.24, p < 0.001) Subscale scores. The study revealed that mothers participated in many basic caregiving procedures in the NICU and this participation resulted in reduced state and trait anxiety levels and an improvement in the mothers' problem-solving skills with respect to baby care and related problems.

Entrepreneurs ' perspective on public-private partnership in health care and social services.

PubMed

Sinisammal, Janne; Leviäkangas, Pekka; Autio, Tommi; Hyrkäs, Elina

2016-01-01

The purpose of this paper is to probe experiences of entrepreneurs in the social and health care service provision. Information was collected regarding entrepreneurs' views on the factors affecting the collaboration between public and private sectors. A sample of social and health care entrepreneurs was interviewed using open-ended questions. The interviews were transcribed and analysed using inductive content analysis. Three main categories of factors affecting the success of partnership were identified: the nature of partnership, business aspects and tension builders. Research LIMITATIONS/IMPLICATIONS: The research was undertaken in rural Finland and the sample consisted 13 entrepreneurs. The results must be considered as observations with more generalised conclusions. PRACTICAL implications - The results of this study support municipalities in their social and health care service strategy work and especially in consideration of how to also facilitate a fruitful public-private partnership (PPP)-framework, which will largely depend on mutual understanding and consensus. The reform of the social and health care system has raised intensive public debate throughout Europe. Key issues include the reorganising of social and health care processes as well as PPPs in provision of services. This study observes the views and experiences of private entrepreneurs and points out where some potential problems and solutions of social and health care PPPs are.

Linkage to HIV care, postpartum depression, and HIV-related stigma in newly diagnosed pregnant women living with HIV in Kenya: a longitudinal observational study.

PubMed

Turan, Bulent; Stringer, Kristi L; Onono, Maricianah; Bukusi, Elizabeth A; Weiser, Sheri D; Cohen, Craig R; Turan, Janet M

2014-12-03

While studies have suggested that depression and HIV-related stigma may impede access to care, a growing body of literature also suggests that access to HIV care itself may help to decrease internalized HIV-related stigma and symptoms of depression in the general population of persons living with HIV. However, this has not been investigated in postpartum women living with HIV. Furthermore, linkage to care itself may have additional impacts on postpartum depression beyond the effects of antiretroviral therapy. We examined associations between linkage to HIV care, postpartum depression, and internalized stigma in a population with a high risk of depression: newly diagnosed HIV-positive pregnant women. In this prospective observational study, data were obtained from 135 HIV-positive women from eight antenatal clinics in the rural Nyanza Province of Kenya at their first antenatal visit (prior to testing HIV-positive for the first time) and subsequently at 6 weeks after giving birth. At 6 weeks postpartum, women who had not linked to HIV care after testing positive at their first antenatal visit had higher levels of depression and internalized stigma, compared to women who had linked to care. Internalized stigma mediated the effect of linkage to care on depression. Furthermore, participants who had both linked to HIV care and initiated antiretroviral therapy reported the lowest levels of depressive symptoms. These results provide further support for current efforts to ensure that women who are newly diagnosed with HIV during pregnancy become linked to HIV care as early as possible, with important benefits for both physical and mental health.

A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study.

PubMed

Gilmartin-Thomas, Julia Fiona-Maree; Smith, Felicity; Wolfe, Rory; Jani, Yogini

2017-07-01

No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. Prospective observational. Ten Greater London care homes. Nurses and carers administering medications. Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). Over 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, p<0.001). Similar differences existed when comparing medication administration error rates between original medication packaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration systems (RR=4.3, 95%CI 2.7 to 6.8, p<0.001). A significant difference in error rate was not observed between use of a single or combination medication administration system (p=0.44). The significant difference in, and high overall, medication administration error rate between original medication packaging and multi-compartment compliance aids supports the use of the latter in care homes, as well as local investigation of tablet and capsule impact on medication administration errors and staff training to prevent errors occurring. As a significant difference in error rate was not observed between use of a single or combination medication administration system, common practice of using both multi-compartment compliance aids (for most medications) and original packaging (for medications with stability issues) is supported. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City.

PubMed

Maheshwari, Veena; Kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-08-01

Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. A cross-sectional study. A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections.

Cardiovascular emergencies in primary care: an observational retrospective study of a large-scale telecardiology service.

PubMed

Marcolino, Milena Soriano; Santos, Thales Matheus Mendonça; Stefanelli, Fernanda Cotrim; Oliveira, João Antonio de Queiroz; E Silva, Maíra Viana Rego Souza; Andrade, Diomildo Ferreira; Silva, Grace Kelly Matos E; Ribeiro, Antonio Luiz

2017-01-01

Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies.The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG. After collection, the data were subjected to statistical analysis. Over the study period, 304 patients with cardiovascular emergencies were diagnosed within primary care. Only 73.4% of these were recognized by the local physicians. Overall, the most frequent ECG abnormalities were acute ischemic patterns (44.7%) and the frequency of such patterns was higher among the ECGs assigned as emergency priority (P = 0.03). It was possible to obtain complete information on 231 patients (75.9%). Among these, the mean age was 65 ± 14.4 years, 57.1% were men and the most prevalent comorbidity was hypertension (68.4%). In total, 77.9% were referred to a unit caring for cases of higher complexity and 11.7% of the patients died. In this study, cardiovascular emergencies were misdiagnosed in primary care settings, acute myocardial ischemia was the most frequent emergency and the mortality rate was high.

Is directly observed tuberculosis treatment strategy patient-centered? A mixed method study in Addis Ababa, Ethiopia.

PubMed

Getahun, Belete; Nkosi, Zethu Zerish

2017-01-01

The directly observed treatment, short course (DOTS) strategy has been considered as an efficacious approach for better tuberculosis (TB) treatment adherence and outcome. However, its level of patient centerdness has not been studied and documented well. Hence, the study aimed to determine the level of patient centeredness' of the DOTS. The study used explanatory sequential mixed method design in Addis Ababa, Ethiopia. The study employed an interviewer-administered questionnaire with 601 patients with TB, focus group discussions with 23 TB experts, and telephonic-interview with 25 persons lost to follow-up from TB treatment. Descriptive and multivariable analyses carried out for the quantitative data while thematic analysis was used for the qualitative data. Forty percent of patients with TB had not received patient-centered TB care (PC-TB care) with DOTS. Male gender (AOR = 0.45, 95% CI 0.3, 0.7), good communication (AOR = 3.2, 95%CI 1.6, 6.1), and health care providers as a treatment supporter (AOR = 3.4, 95% CI 2.1, 5.48) had significant associations with PC-TB care. All persons lost to follow-up and TB experts perceived that DOTS is merely patient-centered. The identified categories were patient preferences, treatment supporter choice, integration of DOTS with nutritional support, mental health, and transport services, provider's commitment and communication skills. DOTS is limited to provide patient-centered TB care. Hence, DOTS needs a model that enhances effectiveness towards patient centeredness of TB care.

Study on workloads of human care worker with the introduction of IT system - the characteristics of work loads by observational research and the suggestions for KAIZEN.

PubMed

Mizuno, Yuki; Yoshikawa, Toru; Matsuda, Fumiko; Takeuchi, Yuriko; Motegi, Nobuyuki; Ikegami, Thor; Sakai, Kazuhiro

2012-01-01

The purpose of this study was to clarify the characteristic of workloads on human care worker with the introduction of IT system, and suggested the support measures for KAIZEN in Japan. The investigation method is workflow line and hearing with a focus on work observation. The objects were 8 human care workers of the acute hospital that introduced an electronic system. By the introduction of the electronic chart, the nurse station sojourn time decreased, sickroom sojourn time increased, and time about direct nursing care to a patient increased. In addition, access to patient information became easy, and the offer of the health care service based on correct information came to be possible in real time. By The point of workflow line, it was effect that moving lengths decreased in order to install the electronic chart in patients' rooms. Though, it was a problem that it hasn't formed where to place the instruments such as sphygmomanometer, clinical thermometer and others.

Improving access to emergent spinal care through knowledge translation: an ethnographic study.

PubMed

Webster, Fiona; Fehlings, Michael G; Rice, Kathleen; Malempati, Harsha; Fawaz, Khaled; Nicholls, Fred; Baldeo, Navindra; Reeves, Scott; Singh, Anoushka; Ahn, Henry; Ginsberg, Howard; Yee, Albert J

2014-04-14

For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery. An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario's call centre. Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation. Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts.

Physical Activity Opportunities Within the Schedule of Early Care and Education Centers.

PubMed

Mazzucca, Stephanie; Hales, Derek; Evenson, Kelly R; Ammerman, Alice; Tate, Deborah F; Berry, Diane C; Ward, Dianne S

2018-02-01

Physical activity has many benefits for young children's health and overall development, but few studies have investigated how early care and education centers allot time for physical activity, along with measured individual physical activity levels for indoor/outdoor activities during a typical day. Fifty early care and education centers in central North Carolina participated in 4 full-day observations, and 559 children aged 3-5 years within centers wore accelerometers assessing physical activity during observation days. Observation and physical activity data were linked and analyzed for associations between child activity and type of classroom activity. Children averaged 51 (13) minutes per day of moderate to vigorous physical activity and 99 (18) minutes per day of light physical activity while in child care. Children averaged 6 (10) and 10 (13) minutes per day of observed outdoor and indoor daily teacher-led physical activity, respectively. Outdoor time averaged 67 (49) minutes per day, and physical activity levels were higher during outdoor time than during common indoor activities (center time, circle time, and TV time). Physical activity levels varied between indoor and outdoor class activities. Policy and program-related efforts to increase physical activity in preschoolers should consider these patterns to leverage opportunities to optimize physical activity within early care and education centers.

Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study.

PubMed

Mattsson, Janet Yvonne; Arman, Maria; Castren, Maaret; Forsner, Maria

2014-12-01

When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment. © The Author(s) 2013.

Measuring nursing support during childbirth.

PubMed

Gale, J; Fothergill-Bourbonnais, F; Chamberlain, M

2001-01-01

To examine the amount of support being provided by nurses to women during childbirth and factors that influence the provision of support. Exploratory, descriptive. Work sampling method was used to determine the percentage of time nurses spend in supportive care activities. Twelve nurses were observed over six nonconsecutive day shifts on a birthing unit of a Canadian teaching hospital in Quebec. A total of 404 observations were made. Nurses were also interviewed to determine their perceptions of what constitutes supportive nursing care and the factors that facilitate or inhibit the provision of this care. Nurses spent only 12.4% of their total time providing supportive care to laboring women. Interviews with nurses suggested that perceptions of the components of supportive care were comparable to this study's operational definition of support, namely: physical, emotional, and instructional/informational support and advocacy. Barriers to providing support identified by nurses included lack of time and insufficient staff. However, further content analysis of the interview data revealed that healthcare providers had a pervasive sense of control over laboring women and their partners. Although nursing support has been identified as an important aspect of nursing care in childbirth, this study demonstrated an incongruity between what nurses perceived as being supportive care and the amount of support that was actually provided. Barriers to the provision of supportive care in the practice setting as well as suggestions for its enhancement are discussed.

Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review.

PubMed

Gibson, Odette R; Segal, Leonie

2015-04-11

To describe reported studies of the impact on HbA1C levels, diabetes-related hospitalisations, and other primary care health endpoints of initiatives aimed at improving the management of diabetes in Indigenous adult populations of Australia, Canada, New Zealand and the United States. Systematic literature review using data sources of MEDLINE, Embase, the Cochrane Library, CINHAL and PsycInfo from January 1985 to March 2012. Inclusion criteria were a clearly described primary care intervention, model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on at least one quantitative diabetes-related health outcome, and where results were reported separately for Indigenous persons. Joanna Briggs Institute critical appraisal tools were used to assess the study quality. PRISMA guidelines were used for reporting. The search strategy retrieved 2714 articles. Of these, 13 studies met the review inclusion criteria. Three levels of primary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-level improvement processes to enhance the quality of diabetes care, 3) change in primary health funding to support better access to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care, specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studies reported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation. The methodological quality of the four comparable cohort and seven observational studies was good, and moderate for the two randomised control trials. The current literature provides an inadequate evidence base for making important policy and practice decisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very small number of published studies, the general reliance on intermediate health outcomes and the predominance of observational studies. Additional studies of the impacts of primary care need to consider carefully research design and the reporting of hospital outcomes or other primary end points. This is an important question for policy makers and further high quality research is needed to contribute to an evidence-base to inform decision making.

Effect of lens care system on silicone hydrogel contact lens wettability.

PubMed

Guillon, Michel; Maissa, Cécile; Wong, Stéphanie; Patel, Trisha; Garofalo, Renée

2015-12-01

The purpose was to compare the effect of the repeated usage of two care systems (one hydrogen peroxide cleaning and disinfecting system and one polyaminopropyl biguanide (PHMB) containing multi-purpose system) with silicone hydrogel contact lenses worn for three months on a daily wear modality. A specific aspect of interest was of the effect of the care systems on contact lens wettability. Seventy-four symptomatic contact lens wearers, habitually wearing either ACUVUE(®) OASYS(®) (n=37) or PureVision™ (n=37), constituted the study population. The study was a two-arm prospective, investigator-masked, bilateral study of three-month duration to evaluate the effects of CLEAR CARE(®) compared with renu(®) fresh™. The subjects were randomized to one of the two lens care systems. Contact lens wettability and surface cleanliness were assessed with the Tearscope and reported in terms of pre-lens non-invasive break-up time (PL-NIBUT) and visible deposits. Baseline assessments at enrollment were with the subjects' own contact lenses worn for at least 6h when using their habitual PHMB-preserved care system and at the dispensing visit with new contact lenses. At the follow-up visits, the contact lenses were worn for at least 6h, and were at least 11 days old for ACUVUE(®) OASYS(®) and 25 days old for PureVision™. The results obtained showed that: (i) with CLEAR CARE(®), a significant improvement in contact lens wettability was recorded compared with the habitual care system at the three-month follow-up visit (mean median PL-NIBUT 5.8 vs. 4.0 s, p<0.001). Further, with this same lens care system a significant increase in wettability was observed at the three-month follow-up visit compared with dispensing (mean median PL-NIBUT 5.8 vs. 4.5s, p=0.022). (ii) Whereas no difference in contact lens wettability was observed at dispensing between the two lens care groups (mean PL-NIBUT: 4.5 vs. 4.2s, p=0.518), a significantly more stable pre-lens tear film was observed with CLEAR CARE(®) than with renu(®) fresh™ at both the two-month (mean PL-NIBUT: 4.6 vs. 3.7s, p=0.005) and three-month (mean PL-NIBUT: 5.8 vs. 4.2 s, p=0.028) visits. iii. With renu(®) fresh™, no significant differences were observed at the end of three months of use compared with either the habitual care system or the new contact lens solution (mean PL-NIBUT: 3M 4.2 vs. Disp 4.2 s (p=0.420) vs. enrolment habitual care solution 5.1s (p=0.734)). iv. With CLEAR CARE(®) significant increases in the incidence of surfaces free of both mucus (3 month 95%. vs. habitual solution 82% enrolment; p=0.005) and lipid (3 month 87% vs. habitual solution 72% enrolment; p=0.009) were observed. Significantly better contact lens wettability and surface cleanliness were achieved for ACUVUE(®) OASYS(®) and PureVision™ with CLEAR CARE(®) than with renu(®) fresh™ at the end of three months of use. Copyright © 2015. Published by Elsevier Ltd.

[Nursing care time in a teaching hospital].

PubMed

Rogenski, Karin Emília; Fugulin, Fernanda Maria Togeiro; Gaidzinski, Raquel Rapone; Rogenski, Noemi Marisa Brunet

2011-03-01

This is a quantitative exploratory, descriptive study performed with the objective to identify and analyze the performance of the average time of nursing care delivered to patients of the Inpatient Units of the University Hospital at University of São Paulo (UH-USP), from 2001 to 2005. The average nursing care time delivered to patients of the referred units was identified by applying of a mathematical equation proposed in the literature, after surveying data from the Medical and Statistical Service and based on the monthly working shifts of the nursing professionals. Data analysis was performed using descriptive statistics. The average nursing care time observed in most units, despite some variations, remained stable during the analyzed period. Based on this observed stability, it is concluded that the nursing staff in the referred HU-USP units has been continuously evaluated with the purposes of maintaining the average time of assistance and, thus, the quality of the care being delivered.

Severity of illness and ambulatory care-sensitive conditions.

PubMed

Yuen, Elaine J

2004-09-01

This study describes how severity of illness may refine the definition of ambulatory care-sensitive conditions, or ACSCs. Hospital discharge abstract data from Philadelphia were combined with census data to develop population-based adjusted rates of hospitalization for diabetes and asthma, two ACSCs. By stratifying ACSC hospitalization by severity of illness, variations were observed by age, race, and gender. Minority groups may be at higher risk for less access to outpatient primary care and were observed to have higher rates of more severely ill, Stage 3 hospitalization. Geographic map displays indicated wide ranges of age-sex-adjusted rates for high-severity hospitalization in the five-county Philadelphia region. This refined ACSC measure may help to identify specific groups and clinical conditions within a population to assist health care planners estimate health care resources such as facilities, manpower, and programs, as well as to evaluate their outcomes.

The effect of simulation-based crew resource management training on measurable teamwork and communication among interprofessional teams caring for postoperative patients.

PubMed

Paull, Douglas E; Deleeuw, Lori D; Wolk, Seth; Paige, John T; Neily, Julia; Mills, Peter D

2013-11-01

Many adverse events in health care are caused by teamwork and communication breakdown. This study was conducted to investigate the effect of a point-of-care simulation-based team training curriculum on measurable teamwork and communication skills in staff caring for postoperative patients. Twelve facilities involving 334 perioperative surgical staff underwent simulation-based training. Pretest and posttest self-report data included the Self-Efficacy of Teamwork Competencies Scale. Observational data were captured with the Clinical Teamwork Scale. Teamwork scores (measured on a five-point Likert scale) improved for all eight survey questions by an average of 18% (3.7 to 4.4, p < .05). The observed communication rating (scale of 1 to 10) increased by 16% (5.6 to 6.4, p < .05). Simulation-based team training for staff caring for perioperative patients is associated with measurable improvements in teamwork and communication. Copyright 2013, SLACK Incorporated.

Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

PubMed

Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

2011-01-01

Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

Follicular Lymphoma in the United States: First Report of the National LymphoCare Study

PubMed Central

Friedberg, Jonathan W.; Taylor, Michael D.; Cerhan, James R.; Flowers, Christopher R.; Dillon, Hildy; Farber, Charles M.; Rogers, Eric S.; Hainsworth, John D.; Wong, Elaine K.; Vose, Julie M.; Zelenetz, Andrew D.; Link, Brian K.

2009-01-01

Purpose Optimal therapy of follicular lymphoma (FL) is not defined. We analyzed a large prospective cohort study to identify current demographics and patterns of care of FL in the United States. Patients and Methods The National LymphoCare Study is a multicenter, longitudinal, observational study designed to collect information on treatment regimens and outcomes for patients with newly diagnosed FL in the United States. Patients were enrolled between 2004 and 2007. There is no study-specific prescribed treatment regimen or intervention. Results Two thousand seven hundred twenty-eight subjects were enrolled at 265 sites, including the 80% of patients enrolled from nonacademic sites. Using the Follicular Lymphoma International Prognostic Index (FLIPI), three distinct groups independent of histologic grade could be defined. Initial therapeutic strategy was: observation, 17.7%; rituximab monotherapy, 13.9%; clinical trial 6.1%; radiation therapy, 5.6%; chemotherapy only, 3.2%; chemotherapy plus rituximab, 51.9%. Chemotherapy plus rituximab regimens were: rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone, 55.0%; rituximab plus cyclophosphamide, vincristine, and prednisone, 23.1%; rituximab plus fludarabine based, 15.5%; other, 6.4%. The choice to initiate therapy rather than observe was associated with age, FLIPI, stage, and grade (P < .01). Significant differences in treatment (P < .01) across regions of the United States were noted. Contrary to practice guidelines, treatment of stage I FL frequently omits radiation therapy. Conclusion Widely disparate therapeutic approaches are utilized for FL. Initial therapy is deferred in a small subset of patients. There is no single standard of care for the treatment of de novo FL, although antibody use is ubiquitous when therapy is initiated. These disparate approaches to the initial care of patients with FL render a heterogeneous group of patients at relapse. PMID:19204203

Commodification of care and its effects on maternal health in the Noun division (West Region - Cameroon).

PubMed

Moungbakou, Ibrahim Bienvenu Mouliom

2018-06-15

Since the mid-1980s, there has been a gradual ethical drift in the provision of maternal care in African health facilities in general, and in Cameroon in particular, despite government efforts. In fact, in Cameroon, an increasing number of caregivers are reportedly not providing compassionate care in maternity services. Consequently, many women, particularly the financially vulnerable, experience numerous difficulties in accessing these health services. In this article, we highlight the unequal access to care in public maternity services in Cameroon in general and the Noun Division in particular. For this study, in addition to documentary review, two qualitative data collection techniques were used: direct observation and individual interviews. Following the field work, the observation data were categorized and analyzed to assess their relevance and significance in relation to the topics listed in the observation checklist. Interviews were recorded using a dictaphone; they were subsequently transcribed and the data categorized and coded. After this stage, an analysis grid was constructed for content analysis of the transcripts, to study the frequency of topics addressed during the interviews, as well as divergences and convergences among the respondents. The results of this data analysis showed that money has become the driving force in service provision. As such, it is the patient's economic capital that counts. Considered "clients", pregnant women without sufficient financial resources wait long hours in corridors; some die in pain under the indifferent gaze of the professionals who are supposed to take care of them. In sharp contrast, the findings revealed that financially privileged patients are able to bribe caregivers to attract their favour and obtain prompt, careful, and effective care. These ethical abuses observed in the Noun public health facilities drive women to use, from the beginning of their pregnancies to the delivery, only healthcare delivered by traditional health attendants.

Initiating decision-making conversations in palliative care: an ethnographic discourse analysis.

PubMed

Bélanger, Emmanuelle; Rodríguez, Charo; Groleau, Danielle; Légaré, France; Macdonald, Mary Ellen; Marchand, Robert

2014-01-01

Conversations about end-of-life care remain challenging for health care providers. The tendency to delay conversations about care options represents a barrier that impedes the ability of terminally-ill patients to participate in decision-making. Family physicians with a palliative care practice are often responsible for discussing end-of-life care preferences with patients, yet there is a paucity of research directly observing these interactions. In this study, we sought to explore how patients and family physicians initiated decision-making conversations in the context of a community hospital-based palliative care service. This qualitative study combined discourse analysis with ethnographic methods. The field research lasted one year, and data were generated through participant observation and audio-recordings of consultations. A total of 101 consultations were observed longitudinally between 18 patients, 6 family physicians and 2 pivot nurses. Data analysis consisted in exploring the different types of discourses initiating decision-making conversations and how these discourses were affected by the organizational context in which they took place. The organization of care had an impact on decision-making conversations. The timing and origin of referrals to palliative care shaped whether patients were still able to participate in decision-making, and the decisions that remained to be made. The type of decisions to be made also shaped how conversations were initiated. Family physicians introduced decision-making conversations about issues needing immediate attention, such as symptom management, by directly addressing or eliciting patients' complaints. When decisions involved discussing impending death, decision-making conversations were initiated either indirectly, by prompting the patients to express their understanding of the disease and its progression, or directly, by providing a justification for broaching a difficult topic. Decision-making conversations and the initiation thereof were framed by the organization of care and the referral process prior to initial encounters. While symptom management was taken for granted as part of health care professionals' expected role, engaging in decisions regarding preparation for death implicitly remained under patients' control. This work makes important clinical contributions by exposing the rhetorical function of family physicians' discourse when introducing palliative care decisions.

Effectiveness of an Internet-based learning program on venous leg ulcer nursing care in home health care--study protocol.

PubMed

Ylönen, Minna; Viljamaa, Jaakko; Isoaho, Hannu; Junttila, Kristiina; Leino-Kilpi, Helena; Suhonen, Riitta

2015-10-01

To describe the study protocol for a study of the effectiveness of an internet-based learning program on venous leg ulcer nursing care (eVLU) in home health care. The prevalence of venous leg ulcers is increasing as population age. The majority of these patients are treated in a municipal home healthcare setting. However, studies show nurses' lack of knowledge of ulcer nursing care. Quasi-experimental study with pre- and postmeasurements and non-equivalent intervention and comparison groups. During the study, nurses taking care of patients with a chronic leg ulcer in home health care in one Finnish municipality will use the eVLU. Nurses working in home health care in another Finnish municipality will not use it providing standard care. Nurses will complete three questionnaires during the study and they will also be observed three times at patients' homes. Nurses' perceived and theoretical knowledge is the primary outcome of the study. Funding for this study was received from the Finnish Foundation for Nursing Education in 2014. Data from this study will provide information about the effectiveness of an internet-based educational program. After completing the program nurses will be accustomed to using internet-based resources that can aid them in the nursing care of patients with a VLU. Nurses will also have better knowledge of VLU nursing care. This study is registered with the International Clinical Trials Registry, identifier NCT02224300. © 2015 John Wiley & Sons Ltd.

The quality of hospital-based antenatal care in Istanbul.

PubMed

Turan, Janet Molzan; Bulut, Ayşpen; Nalbant, Hacer; Ortayli, Nuriye; Akalin, A Arzu Koloğlu

2006-03-01

The aim of this study was to gather comprehensive data from three hospitals in Istanbul, Turkey, in order to gain in-depth understanding of the quality of antenatal care in this setting. The Bruce-Jain framework for quality of care was adapted for use in evaluating antenatal care. Methods included examination of hospital records, in-depth interviews, exit questionnaires, and structured observations. The study revealed deficiencies in the quality of antenatal care being delivered at the study hospitals in all six elements of the quality-of-care framework. The technical content of visits varied greatly among the hospitals, and an overuse of technology was accompanied by neglect of some essential components of antenatal care. Although at the private hospital some problems with the technical content of care were identified, client satisfaction was higher there, where the care included good interpersonal relations, information provision, and continuity. Providers at all three hospitals felt constrained by heavy patient loads and a lack of resources. Multifaceted approaches are needed to improve the quality of antenatal care in this setting.

Patients' experiences of cold exposure during ambulance care.

PubMed

Aléx, Jonas; Karlsson, Stig; Saveman, Britt-Inger

2013-06-06

Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors. During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C. Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

An assessment of rural health care delivery system in some areas of West Bengal-an overview.

PubMed

Ray, Sandip Kumar; Basu, Subhra S; Basu, Amal Kumar

2011-01-01

A cross sectional observational study was carried out in three districts of West Bengal by following observational, quantitative and qualitative methods during July to December 2006 to find out the extent of utilization, strengths, weaknesses and gap as well as suggest recommendations in connection with health care delivery system for the state of West Bengal, India. A total of 672 episodes of illnesses were reported (2 weeks recall) by the study population of the three selected districts in three geographically separated divisions of West Bengal. None did seek care from any health facilities for treatment in case of 221 (32.89%) episodes; especially from tribal areas where in case of 76.19% none sought any health care from any facilities depended on their home remedies. In rest of episodes the (451), majority preferred government health facilities (38.58%), followed by Unqualified quacks (29.27%) due to low cost as well as living in close proximity, 27.27% preferred qualified Private practitioners and only 4.88% preferred AYUSH, as a first choice. Referral was mostly by self or by close relatives/families (61%) and not by a doctor. Awareness is required to avoid unnecessary referral. Cleanliness of the premises, face-lift, and clean toilet with privacy and availability of safe drinking water facilities could have an improved client satisfaction in rural health care delivery systems. This could be achieved through community participation with the involvement of PRI. However, as observed in the study RCH services including Family Planning as well as immunization services (preventive services) were utilized much better while there was a strong need of improvement of Post Natal Care, otherwise, Neonatal and Maternal mortality and morbidity will continue to be high.

MAXimising Involvement in MUltiMorbidity (MAXIMUM) in primary care: protocol for an observation and interview study of patients, GPs and other care providers to identify ways of reducing patient safety failures

PubMed Central

Daker-White, Gavin; Hays, Rebecca; Esmail, Aneez; Minor, Brian; Barlow, Wendy; Brown, Benjamin; Blakeman, Thomas; Bower, Peter

2014-01-01

Introduction Increasing numbers of older people are living with multiple long-term health conditions but global healthcare systems and clinical guidelines have traditionally focused on the management of single conditions. Having two or more long-term conditions, or ‘multimorbidity’, is associated with a range of adverse consequences and poor outcomes and could put patients at increased risk of safety failures. Traditionally, most research into patient safety failures has explored hospital or inpatient settings. Much less is known about patient safety failures in primary care. Our core aims are to understand the mechanisms by which multimorbidity leads to safety failures, to explore the different ways in which patients and services respond (or fail to respond), and to identify opportunities for intervention. Methods and analysis We plan to undertake an applied ethnographic study of patients with multimorbidity. Patients’ interactions and environments, relevant to their healthcare, will be studied through observations, diary methods and semistructured interviews. A framework, based on previous studies, will be used to organise the collection and analysis of field notes, observations and other qualitative data. This framework includes the domains: access breakdowns, communication breakdowns, continuity of care errors, relationship breakdowns and technical errors. Ethics and dissemination Ethical approval was received from the National Health Service Research Ethics Committee for Wales. An individual case study approach is likely to be most fruitful for exploring the mechanisms by which multimorbidity leads to safety failures. A longitudinal and multiperspective approach will allow for the constant comparison of patient, carer and healthcare worker expectations and experiences related to the provision, integration and management of complex care. This data will be used to explore ways of engaging patients and carers more in their own care using shared decision-making, patient empowerment or other relevant models. PMID:25138807

Resuscitative Hyperkalemia in Noncrush Trauma: A Prospective, Observational Study

DTIC Science & Technology

2006-12-01

Resuscitative Hyperkalemia in Noncrush Trauma: A Prospective, Observational Study Robert M. Perkins,*† Matthew C. Aboudara,* Kevin C. Abbott,*† and...Surgical Research, San Antonio, Texas The trauma patient is exposed to physiologic processes and life-saving interventions that predispose to hyperkalemia ...in the care of the massively traumatized patient may or may not increase the risk for hyperkalemia . This prospective, observational study was

Interventions to improve outpatient referrals from primary care to secondary care.

PubMed

Akbari, Ayub; Mayhew, Alain; Al-Alawi, Manal Alawi; Grimshaw, Jeremy; Winkens, Ron; Glidewell, Elizabeth; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia

2008-10-08

The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.

Access, quality, and costs of care at physician owned hospitals in the United States: observational study.

PubMed

Blumenthal, Daniel M; Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K

2015-09-02

To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Observational study. Acute care hospitals in 95 hospital referral regions in the United States, 2010. 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. © Blumenthal et al 2015.

Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score.

PubMed

Coyte, P C; Young, W; Croxford, R

2000-11-01

We estimated the impact of alternative discharge strategies, following joint replacement (JR) surgery, on acute care readmission rates and the total cost of a continuum of care. Following surgery, patients were discharged to one of four destinations. Propensity scores were used to adjust costs and outcomes for potential bias in the assignment of discharge destinations. We demonstrated that the use of rehabilitation hospitals may lower readmission rates, but at a prohibitive incremental cost of each saved readmission, that patients discharged with home care had longer acute care stays than other patients, that the provision of home care services increased health system costs, and that acute care readmission rates were greatest among patients discharged with home care. Our study should be seen as one important stepping stone towards a full economic evaluation of the continuum of care for patients.

[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.

Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India.

PubMed

Parmar, Veena Rani; Kumar, Ajay; Kaur, Rupinder; Parmar, Siddharth; Kaur, D; Basu, Srikant; Jain, Suksham; Narula, Sunny

2009-01-01

To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birth weight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, family members and health care workers (HCW) and to observe its effect on the vital parameters of the babies. A observation in the NICU. A total of 135 babies (74 boys and 61 girls) who completed minimum of 4 hrs of KMC/day, were included. The mean birth weight and gestation were 1460 gm and 30 week respectively. 47% babies started KMC within first week of age. Mean duration of KMC was 7 days (3-48) days. The O(2) saturation improved by 2-3%, temperature ( degrees C) rose from 36.75 +/- 0.19 to 37.23 +/- 0.25, respiration stabilized (p<0.05 for all) and heart rate dropped by 3-5 beats. No episodes of hypothermia or apnea were observed during KMC. KMC was accepted by 96 % mothers, 82% fathers and 84% other family members. 94% HCW considered it to be safe and conservative method of care of LBWI. Benefits of KMC on the babies' behavior and on maternal confidence and lactation were reported by 57%, 94% and 80% respectively. A decline in use of heating devices in the NICU was reported by 85% and 79% said it did not increase their work load. KMC was found to be safe, effective and feasible method of care of LBWI even in the NICU settings. Positive attitudes were observed in mothers, families and HCW.

National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015

PubMed Central

Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

2017-01-01

Objectives To evaluate national trends and geographic variation in the availability of home health care from 2002–2015 and identify county-specific characteristics associated with home health care. Design Observational study Setting All counties in the United States Participants All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. Measurements County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. Results The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002–2003 and 2014–2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North-East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. Conclusion The availability of home health care increased nationwide during the study period, but there was much geographic variation. PMID:28322441

Lived Experience of Caregivers of Family-Centered Care in the Neonatal Intensive Care Unit: “Evocation of Being at Home”

PubMed Central

Hadian Shirazi, Zahra; Sharif, Farkhondeh; Rakhshan, Mahnaz; Pishva, Narjes; Jahanpour, Faezeh

2016-01-01

Background In recent decades, family-centered care (FCC) has come to be known, accepted, and reported as the best care strategy for admitted children and their families. However, in spite of the increasing application of this approach, the experiences of the caregivers have not yet been studied. Objectives The present study aimed at the description and interpretation of the FCC experience in two neonatal intensive care units (NICU) at Shiraz University of Medical Sciences. Methods This study was conducted through the hermeneutic phenomenological approach. Semi-structured interviews were conducted with 17 professional and familial caregivers, and their interactions were observed in three work shifts. The interviews were audiotaped and transcribed verbatim. After observations, field notes were also written. Finally, the data were analyzed through van Manen’s methodology. Results One of the essential themes that emerged in this study was the “evocation of being at home” among familial and even professional caregivers. This theme had three subthemes: i.e., “meta-family interaction,” “comprehensive support,” and “reconstruction of a normal family.” Accordingly, FCC eliminated borders between professional and non-professional caregivers and built close relationships among them in the NICU. It also provided for the needs of neonates, their families, and even professional caregivers through perceived and received support. Conclusions Parents of the neonates admitted to the NICU experience hard moments. They not only play the role of primary caregivers, but they also receive the care. Focusing on the different meanings of this care from the caregivers’ points of view and having managers provide certain requirements can guarantee the establishment of comprehensive care for clients and proper support for the staff in this unit. PMID:28203324

Lived Experience of Caregivers of Family-Centered Care in the Neonatal Intensive Care Unit: "Evocation of Being at Home".

PubMed

Hadian Shirazi, Zahra; Sharif, Farkhondeh; Rakhshan, Mahnaz; Pishva, Narjes; Jahanpour, Faezeh

2016-10-01

In recent decades, family-centered care (FCC) has come to be known, accepted, and reported as the best care strategy for admitted children and their families. However, in spite of the increasing application of this approach, the experiences of the caregivers have not yet been studied. The present study aimed at the description and interpretation of the FCC experience in two neonatal intensive care units (NICU) at Shiraz University of Medical Sciences. This study was conducted through the hermeneutic phenomenological approach. Semi-structured interviews were conducted with 17 professional and familial caregivers, and their interactions were observed in three work shifts. The interviews were audiotaped and transcribed verbatim. After observations, field notes were also written. Finally, the data were analyzed through van Manen's methodology. One of the essential themes that emerged in this study was the "evocation of being at home" among familial and even professional caregivers. This theme had three subthemes: i.e., "meta-family interaction," "comprehensive support," and "reconstruction of a normal family." Accordingly, FCC eliminated borders between professional and non-professional caregivers and built close relationships among them in the NICU. It also provided for the needs of neonates, their families, and even professional caregivers through perceived and received support. Parents of the neonates admitted to the NICU experience hard moments. They not only play the role of primary caregivers, but they also receive the care. Focusing on the different meanings of this care from the caregivers' points of view and having managers provide certain requirements can guarantee the establishment of comprehensive care for clients and proper support for the staff in this unit.

Decreasing handoff-related care failures in children's hospitals.

PubMed

Bigham, Michael T; Logsdon, Tina R; Manicone, Paul E; Landrigan, Christopher P; Hayes, Leslie W; Randall, Kelly H; Grover, Purva; Collins, Susan B; Ramirez, Dana E; O'Guin, Crystal D; Williams, Catherine I; Warnick, Robin J; Sharek, Paul J

2014-08-01

Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures. Twenty-three children's hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. Twenty-three children's hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P < .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P < .05]; clear transition of responsibility from 92% to 96% [P < .05]; and minimized interruptions and distractions from 84% to 90% [P < .05]) as did overall satisfaction with the handoff (from 55% to 70% [P < .05]). Implementation of a standardized evidence-based handoff process across 23 children's hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction. Copyright © 2014 by the American Academy of Pediatrics.

National Trends and Geographic Variation in Availability of Home Health Care: 2002-2015.

PubMed

Wang, Yun; Leifheit-Limson, Erica C; Fine, Jonathan; Pandolfi, Michelle M; Gao, Yan; Liu, Fanglin; Eckenrode, Sheila; Lichtman, Judith H

2017-07-01

To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care. Observational study. All counties in the United States. All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system. County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years. The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care. The availability of home health care increased nationwide during the study period, but there was much geographic variation. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study

PubMed Central

Netscher, George; Agrawal, Pulkit; Tabb Noyce, Lynn; Bayen, Alexandre

2017-01-01

Background Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. Objective The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. Methods A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents’ falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. Results Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. Conclusions Video monitoring offers high potential to support conventional care in memory care facilities. PMID:29042342

Examining the accuracy of visual diagnosis of tinea pedis and tinea unguium in aged care facilities.

PubMed

Goto, T; Nakagami, G; Takehara, K; Nakamura, T; Kawashima, M; Tsunemi, Y; Sanada, H

2017-04-02

The aim of this study was to examine the accuracy of visual diagnosis of tinea pedis (Athlete's foot) and tinea unguium (fungal nail infection), as well as to provide information on skin abnormalities that could help identify these diseases in aged care facilities (long-term care facilities (LTCFs) and nursing homes). A multicentre, cross-sectional observational study was conducted in a LTCF and two nursing homes. A dermatologist observed the skin abnormalities in the participants' interdigital and plantar areas, to screen for tinea pedis, and in the participants' toenails, to screen for tinea unguium. If abnormalities were noted, samples such as scales or toenails were collected and examined using direct microscopy. The accuracy of the macroscopic observation for each skin abnormality was examined. A total of 173 residents were recruited. The accuracy of clinical diagnosis using macroscopic observation was relatively low. The sensitivities and specificities for clinical diagnosis were 0.37 and 0.95 for tinea pedis in the interdigital areas, 0.47 and 0.94 for tinea pedis in the plantar areas, and 0.80 and 0.61 for tinea unguium in toenails, respectively. Scales in the plantar areas and discoloration of the toenails were more frequently observed in residents with tinea pedis and tinea unguium than in those without them. Several skin abnormalities were observed in the residents recruited in this study, but there was insufficient correlation with tinea pedis and tinea unguium to be used for screening.

Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument.

PubMed

Couët, Nicolas; Desroches, Sophie; Robitaille, Hubert; Vaillancourt, Hugues; Leblanc, Annie; Turcotte, Stéphane; Elwyn, Glyn; Légaré, France

2015-08-01

We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking. (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0-100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15). Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this. © 2013 John Wiley & Sons Ltd.

Automated drug dispensing system reduces medication errors in an intensive care setting.

PubMed

Chapuis, Claire; Roustit, Matthieu; Bal, Gaëlle; Schwebel, Carole; Pansu, Pascal; David-Tchouda, Sandra; Foroni, Luc; Calop, Jean; Timsit, Jean-François; Allenet, Benoît; Bosson, Jean-Luc; Bedouch, Pierrick

2010-12-01

We aimed to assess the impact of an automated dispensing system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. We also evaluated the clinical significance of such errors and user satisfaction. Preintervention and postintervention study involving a control and an intervention medical intensive care unit. Two medical intensive care units in the same department of a 2,000-bed university hospital. Adult medical intensive care patients. After a 2-month observation period, we implemented an automated dispensing system in one of the units (study unit) chosen randomly, with the other unit being the control. The overall error rate was expressed as a percentage of total opportunities for error. The severity of errors was classified according to National Coordinating Council for Medication Error Reporting and Prevention categories by an expert committee. User satisfaction was assessed through self-administered questionnaires completed by nurses. A total of 1,476 medications for 115 patients were observed. After automated dispensing system implementation, we observed a reduced percentage of total opportunities for error in the study compared to the control unit (13.5% and 18.6%, respectively; p<.05); however, no significant difference was observed before automated dispensing system implementation (20.4% and 19.3%, respectively; not significant). Before-and-after comparisons in the study unit also showed a significantly reduced percentage of total opportunities for error (20.4% and 13.5%; p<.01). An analysis of detailed opportunities for error showed a significant impact of the automated dispensing system in reducing preparation errors (p<.05). Most errors caused no harm (National Coordinating Council for Medication Error Reporting and Prevention category C). The automated dispensing system did not reduce errors causing harm. Finally, the mean for working conditions improved from 1.0±0.8 to 2.5±0.8 on the four-point Likert scale. The implementation of an automated dispensing system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.

"Looking and Listening-In": A Methodological Approach to Generating Insights into Infants' Experiences of Early Childhood Education and Care Settings

ERIC Educational Resources Information Center

Sumsion, Jennifer; Goodfellow, Joy

2012-01-01

In this article, we describe an observational approach, "looking and listening-in," that we have used to try to understand the experience of an infant in an Australian family day-care home. The article is drawn from a larger study of infants' experiences of early childhood education and care settings. In keeping with the mosaic…

The impact of selection bias on vaccine effectiveness estimates from test-negative studies.

PubMed

Jackson, Michael L; Phillips, C Hallie; Benoit, Joyce; Kiniry, Erika; Madziwa, Lawrence; Nelson, Jennifer C; Jackson, Lisa A

2018-01-29

Estimates of vaccine effectiveness (VE) from test-negative studies may be subject to selection bias. In the context of influenza VE, we used simulations to identify situations in which meaningful selection bias can occur. We also analyzed observational study data for evidence of selection bias. For the simulation study, we defined a hypothetical population whose members are at risk for acute respiratory illness (ARI) due to influenza and other pathogens. An unmeasured "healthcare seeking proclivity" affects both probability of vaccination and probability of seeking care for an ARI. We varied the direction and magnitude of these effects and identified situations where meaningful bias occurred. For the observational study, we reanalyzed data from the United States Influenza VE Network, an ongoing test-negative study. We compared "bias-naïve" VE estimates to bias-adjusted estimates, which used data from the source populations to correct for sampling bias. In the simulation study, an unmeasured care-seeking proclivity could create selection bias if persons with influenza ARI were more (or less) likely to seek care than persons with non-influenza ARI. However, selection bias was only meaningful when rates of care seeking between influenza ARI and non-influenza ARI were very different. In the observational study, the bias-naïve VE estimate of 55% (95% CI, 47--62%) was trivially different from the bias-adjusted VE estimate of 57% (95% CI, 49--63%). In combination, these studies suggest that while selection bias is possible in test-negative VE studies, this bias in unlikely to be meaningful under conditions likely to be encountered in practice. Researchers and public health officials can continue to rely on VE estimates from test-negative studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Informed Strangers: Witnessing and Responding to Unethical Care as Student Nurses

PubMed Central

Engel, Joyce; Salfi, Jenn; Micsinszki, Samantha; Bodnar, Andrea

2017-01-01

Nursing students occupy a unique perspective in clinical settings because they are informed, through education, about how patient care ought to happen. Given the brevity of placements and their “visiting status” in clinical sites, students are less invested in the ethos of specific sites. Subsequently, their perspectives of quality care are informed by what should happen, which might differ from that of nurses and patients. The purpose of this study was to identify predominant themes in patient care, as experienced by students, and the influence that these observations have on the development of their ethical reasoning. Using a qualitative descriptive approach in which 27 nursing student papers and three follow-up in-depth interviews were analyzed, three main themes emerged: Good employee, poor nurse; damaged care; and negotiating the gap. The analysis of the ethical situations in these papers suggests that students sometimes observe care that lacks concern for the dignity, autonomy, and safety of patients. For these student nurses, this tension led to uncertainty about patient care and their eventual profession. PMID:28932765

Multidisciplinary acute care research organization (MACRO): if you build it, they will come.

PubMed

Early, Barbara J; Huang, David T; Callaway, Clifton W; Zenati, Mazen; Angus, Derek C; Gunn, Scott R; Yealy, Donald M; Unikel, Daniel; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2013-07-01

Clinical research will increasingly play a core role in the evolution and growth of acute care surgery program development across the country. What constitutes an efficient and effective clinical research infrastructure in the current fiscal and academic environment remains obscure. We sought to characterize the effects of implementation of a multidisciplinary acute care research organization (MACRO) at a busy tertiary referral university setting. In 2008, to minimize redundancy and cost as well as to maximize existing resources promoting acute care research, MACRO was created, unifying clinical research infrastructure among the Departments of Critical Care Medicine, Emergency Medicine, and Surgery. During the periods 2008 to 2012, we performed a retrospective analysis and determined volume of clinical studies, patient enrollment for both observational and interventional trials, and staff growth since MACRO's origination and characterized changes over time. From 2008 to 2011, the volume of patients enrolled in clinical studies, which MACRO facilitates has significantly increased more than 300%. The percentage of interventional/observational trials has remained stable during the same period (50-60%). Staff has increased from 6 coordinators to 10, with an additional 15 research associates allowing 24/7 service. With this significant growth, MACRO has become financially self-sufficient, and additional outside departments now seek MACRO's services. Appropriate organization of acute care clinical research infrastructure minimizes redundancy and can promote sustainable, efficient growth in the current academic environment. Further studies are required to determine if similar models can be successful at other acute care surgery programs.

Successes of a national study of the Chronic Disease Self-Management Program: meeting the triple aim of health care reform.

PubMed

Ory, Marcia G; Ahn, SangNam; Jiang, Luohua; Smith, Matthew Lee; Ritter, Philip L; Whitelaw, Nancy; Lorig, Kate

2013-11-01

Emerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions. Evidence-based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical, emotional, and social role management demands of chronic conditions. To examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among a national sample of participants organized around the Triple Aim goals of better health, better health care, and better value in terms of reduced health care utilization. Utilizing data collected from small-group CDSMP workshops, baseline, 6-month, and 12-month assessments were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects. Data were analyzed from 1170 community-dwelling CDSMP participants. Triple Aim-related outcome measures: better health (eg, self-reported health, pain, fatigue, depression), better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms), and better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo]. Significant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up. The odds of ER visits significantly reduced from baseline to 12-month follow-up, whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up. This National Study of CDSMP (National Study) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform.

Reports of unintended consequences of financial incentives to improve management of hypertension.

PubMed

Hysong, Sylvia J; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A

2017-01-01

Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Clinicaltrials.gov Identifier: NCT00302718.

Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU.

PubMed

Nilsen, Marci L; Sereika, Susan M; Hoffman, Leslie A; Barnato, Amber; Donovan, Heidi; Happ, Mary Beth

2014-01-01

The study purposes were to (a) describe interaction behaviors and factors that may effect communication and (b) explore associations between interaction behaviors and nursing care quality indicators among 38 mechanically ventilated patients (age ≥60 years) and their intensive care unit nurses (n = 24). Behaviors were measured by rating videorecorded observations from the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction. All positive behaviors occurred at least once. Significant (p < 0.05) associations were observed between (a) positive nurse and positive patient behaviors, (b) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, (c) individual patient unaided AAC strategies and individual nurse positive behaviors, (d) positive nurse behaviors and pain management, and (e) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors effect communication and may be associated with nursing care quality. Copyright 2014, SLACK Incorporated.

Experiences of Nursing Personnel Using PDAs in Home Health Care Services in Norwegian Municipalities

PubMed Central

Hansen, Linda M.; Fossum, Mariann; Söderhamn, Olle; Fruhling, Ann

2012-01-01

Although nursing personnel have used personal digital assistants (PDAs) to support home health care services for the past ten years, little is known about their experiences. This study was conducted to examine experiences of nursing personnel using a specialized home health care computer software application called Gerica. In addition, this research analyzed how well this application aligned with the workflow of the nursing personnel in their daily care of patients. The evaluation methods included user observations and learnability testing. Nursing personnel from two different municipalities were observed while performing real tasks in natural settings. This study shows that the nursing personnel were satisfied with the PDA user interface and the Gerica software; however, they identified areas for improvement. For example, the nursing personnel were concerned about trusting the reliability of the PDA in order to eliminate the need for handwritten documentation. Solutions to meet these shortcomings for nursing managers and vendors are discussed. PMID:24199073

Nurse and Patient Interaction Behaviors Effects on Nursing Care Quality for Mechanically Ventilated, Older Adults in the ICU

PubMed Central

Nilsen, Marci; Sereika, Susan M.; Hoffman, Leslie A.; Barnato, Amber; Donovan, Heidi; Happ, Mary Beth

2014-01-01

The study purposes were to 1) describe interaction behaviors and factors that may impact communication and 2) explore associations between interaction behaviors and nursing care quality indicators between 38 mechanically ventilated patients (≥60 years) and their intensive care unit nurses (n=24). Behaviors were measured by rating videotaped observations from the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction. All positive behaviors occurred at least once. Significant (p<.05) associations were observed between: 1) positive nurse and positive patient behaviors, 2) patient unaided augmentative and alternative communication (AAC) strategies and positive nurse behaviors, 3) individual patient unaided AAC strategies and individual nurse positive behaviors and 4) positive nurse behaviors and pain management, and 5) positive patient behaviors and sedation level. Findings provide evidence that nurse and patient behaviors impact communication and may be associated with nursing care quality. PMID:24496114

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 complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care. PMID:22123029

The association between nurse staffing and omissions in nursing care: A systematic review.

PubMed

Griffiths, Peter; Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Briggs, Jim; Maruotti, Antonello; Meredith, Paul; Smith, Gary B; Ball, Jane

2018-03-08

To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Systematic review. We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

A Retrospective Study of Non-Ventilator-Associated Hospital Acquired Pneumonia Incidence and Missed Opportunities for Nursing Care.

PubMed

Tesoro, Mary; Peyser, Diane J; Villarente, Farley

2018-05-01

To determine non-ventilator-associated hospital-acquired pneumonia (NV-HAP) incidence, assess negative impacts on patient outcomes and cost, and identify missed preventive nursing care opportunities. NV-HAP is inadequately studied and underreported. Missed nursing care opportunities, particularly oral care, may aid NV-HAP prevention. This descriptive, observational, retrospective chart review identified adult NV-HAP cases and associated demographic and hospital care data. Two hundred five NV-HAP cases occurred in 1 year at Montefiore Medical Center, equating to an incidence of 0.47 per 1000 patient-days and an estimated excess cost of $8.2 million. ICU transfer following pneumonia occurred in 15.6% of cases. Care requirements from specialist nursing facilities increased at discharge (26.8%), as compared with care requirements on admission (17.6%). Complete nursing care documentation was missing for most patients, with oral care undocumented 60.5% of the time. Preventable NV-HAP cases and their negative impact on cost and patient outcomes may decrease through improved basic nursing care.

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.

PubMed

Butler, Rachel; Monsalve, Mauricio; Thomas, Geb W; Herman, Ted; Segre, Alberto M; Polgreen, Philip M; Suneja, Manish

2018-04-09

Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers. We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers. For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists). Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined. Copyright © 2018 Elsevier Inc. All rights reserved.

Staff attitudes and job satisfaction in the care of demented elderly people: group living compared with long-term care institutions.

PubMed

Alfredson, B B; Annerstedt, L

1994-11-01

The present study is one part of a study evaluating group living (GL) care for demented elderly people in comparison with traditional institutional (TI) care. The present report concentrates on personal and work-related effects on staff. A staff training programme has been implemented, including relevant gerontological knowledge, principles of the new care concept, support and supervision. Effects are evaluated by staff interviews, observation and staff turnover rates. Results show increased knowledge and new emotional and social attitudes, resulting in higher competence and professional conduct towards patients as well as increased motivation, job satisfaction and quality of work for GL staff but not for TI staff. Group living is now a rapidly developing form of care in Sweden.

ESRD Databases, Public Policy, and Quality of Care: Translational Medicine and Nephrology.

PubMed

McClellan, William M; Plantinga, Laura C; Wilk, Adam S; Patzer, Rachel E

2017-01-06

Efforts to improve care of patients with ESRD and the policies that guide those activities depend on evidence-based best practices derived from clinical trials and carefully conducted observational studies. Our review describes this process in the context of the translational research model (bench to bedside to populations), with a particular emphasis on bedside care. We illustrate some of its accomplishments and describe the limitations of the data and evidence supporting policy and practice. Copyright © 2016 by the American Society of Nephrology.

Blood glucose control and quality of health care in non-insulin-treated patients with Type 2 diabetes in Spain: a retrospective and cross-sectional observational study

PubMed Central

Rodríguez, A; Calle, A; Vázquez, L; Chacón, F; Polavieja, P; Reviriego, J

2011-01-01

Aims To assess blood glucose control and quality of health care provided to non-insulin-treated patients with Type 2 diabetes mellitus in routine clinical practice in Spain. Methods In this observational, retrospective, cross-sectional study, patients were grouped as either having good or suboptimal blood glucose control according to International Diabetes Federation or American Diabetes Association HbA1c goals. Clinical and socio-demographic data and compliance with the main standard level of care recommendations of the International Diabetes Federation were recorded during a routine visit. Correlates of glucose control were analysed by logistic regression. Results Many patients were grouped as having suboptimal control under International Diabetes Federation (61.9%) or American Diabetes Association (45.0%) criteria. The mean number of accomplished International Diabetes Federation recommendations (7.3 out of 11) was higher for endocrinologists (than for internists or primary care physicians), and significantly more patients under their care were in the good glucose control group (than with primary care physicians). More recommendations were associated with blood glucose control using International Diabetes Federation than American Diabetes Association criteria, demanding higher quality of health care for achieving stricter goals. Some recommendations were poorly observed, particularly those concerning patients’ education on diabetes, the prompt prescription of effective treatments and monitoring of complications. Diabetes complications were associated with being in the suboptimal control group. Patients’ education on diabetes and HbA1c monitoring were associated with being in the good control group. Conclusions These results demonstrate the need for improvement in the management of patients with non-insulin-treated Type 2 diabetes in actual clinical practice in Spain. Such improvement would entail a stricter adherence to International Diabetes Federation recommendations. PMID:21294772

Caregiver-Child Verbal Interactions in Child Care: A Buffer against Poor Language Outcomes when Maternal Language Input is Less

PubMed Central

Vernon-Feagans, Lynne; Bratsch-Hines, Mary E.

2013-01-01

Recent research has suggested that high quality child care can buffer young children against poorer cognitive and language outcomes when they are at risk for poorer language and readiness skills. Most of this research measured the quality of parenting and the quality of the child care with global observational measures or rating scales that did not specify the exact maternal or caregiver behaviors that might be causally implicated in the buffering of these children from poor outcomes. The current study examined the actual language by the mother to her child in the home and the verbal interactions between the caregiver and child in the child care setting that might be implicated in the buffering effect of high quality childcare. The sample included 433 rural children from the Family Life Project who were in child care at 36 months of age. Even after controlling for a variety of covariates, including maternal education, income, race, child previous skill, child care type, the overall quality of the home and quality of the child care environment; observed positive caregiver-child verbal interactions in the child care setting interacted with the maternal language complexity and diversity in predicting children’s language development. Caregiver-child positive verbal interactions appeared to buffer children from poor language outcomes concurrently and two years later if children came from homes where observed maternal language complexity and diversity during a picture book task was less. PMID:24634566

The Development of an Instrument to Measure Global Dimensions of Maternal Care in Rhesus Macaques (Macaca mulatta)

PubMed Central

McCormack, K.; Howell, B. R.; Guzman, D.; Villongco, C.; Pears, K.; Kim, H.; Gunnar, M.R.; Sanchez, M.M.

2014-01-01

One of the strongest predictors of healthy child development is the quality of maternal care. Although many measures of observation and self-report exist in humans to assess global aspects of maternal care, such qualitative measures are lacking in nonhuman primates. In this study we developed an instrument to measure global aspects of maternal care in rhesus monkeys, with the goal of complementing the individual behavioral data collected using a well-established rhesus macaque ethogram during the first months postpartum. The 22 items of the instrument were adapted from human maternal sensitivity assessments and a maternal Q-sort instrument already published for macaques. The 22 items formed four dimensions with high levels of internal reliability that represented major constructs of maternal care: 1) Sensitivity/Responsivity, 2) Protectiveness, 3) Permissiveness, and 4) Irritability. These dimensions yielded high construct validity when correlated with mother-infant frequency and duration behavior that was collected from focal observations across the first three postnatal months. In addition, comparisons of two groups of mothers (Maltreating versus Competent mothers), showed significant differences across the dimensions suggesting that this instrument has strong concurrent validity, even after controlling for focal observation variables that have been previously shown to significantly differentiate these groups. Our findings suggest that this Instrument of Macaque Maternal Care (IMMC) has the potential to capture global aspects of the mother-infant relationship that complement individual behaviors collected through focal observations. PMID:25066041

The development of an instrument to measure global dimensions of maternal care in rhesus macaques (Macaca mulatta).

PubMed

McCormack, K; Howell, B R; Guzman, D; Villongco, C; Pears, K; Kim, H; Gunnar, M R; Sanchez, M M

2015-01-01

One of the strongest predictors of healthy child development is the quality of maternal care. Although many measures of observation and self-report exist in humans to assess global aspects of maternal care, such qualitative measures are lacking in nonhuman primates. In this study, we developed an instrument to measure global aspects of maternal care in rhesus monkeys, with the goal of complementing the individual behavioral data collected using a well-established rhesus macaque ethogram during the first months postpartum. The 22 items of the instrument were adapted from human maternal sensitivity assessments and a maternal Q-sort instrument already published for macaques. The 22 items formed four dimensions with high levels of internal reliability that represented major constructs of maternal care: (1) Sensitivity/Responsivity, (2) Protectiveness, (3) Permissiveness, and (4) Irritability. These dimensions yielded high construct validity when correlated with mother-infant frequency and duration behavior that was collected from focal observations across the first 3 postnatal months. In addition, comparisons of two groups of mothers (Maltreating vs. Competent mothers) showed significant differences across the dimensions suggesting that this instrument has strong concurrent validity, even after controlling for focal observation variables that have been previously shown to significantly differentiate these groups. Our findings suggest that this Instrument of Macaque Maternal Care has the potential to capture global aspects of the mother-infant relationship that complement individual behaviors collected through focal observations. © 2014 Wiley Periodicals, Inc.

[Environmental noise levels in 2 intensive care units in a tertiary care centre].

PubMed

Ornelas-Aguirre, José Manuel; Zárate-Coronado, Olivia; Gaxiola-González, Fabiola; Neyoy-Sombra, Venigna

2017-04-03

The World Health Organisation (WHO) has established a maximum noise level of 40 decibels (dB) for an intensive care unit. The aim of this study was to compare the noise levels in 2 different intensive care units at a tertiary care centre. Using a cross-sectional design study, an analysis was made of the maximum noise level was within the intensive coronary care unit and intensive care unit using a digital meter. A measurement was made in 4 different points of each room, with 5minute intervals, for a period of 60minutes 7:30, 14:30, and 20:30. The means of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to the mean noise level. The noise observed in the intensive care unit had a mean of 64.77±3.33dB (P=.08), which was similar to that in the intensive coronary care unit, with a mean of 60.20±1.58dB (P=.129). Around 25% or more of the measurements exceeded the level recommended by the WHO by up to 20 points. Noise levels measured in intensive care wards exceed the maximum recommended level for a hospital. It is necessary to design and implement actions for greater participation of health personnel in the reduction of environmental noise. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Patient's dignity in intensive care unit: A critical ethnography.

PubMed

Bidabadi, Farimah Shirani; Yazdannik, Ahmadreza; Zargham-Boroujeni, Ali

2017-01-01

Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

Which features of primary care affect unscheduled secondary care use? A systematic review

PubMed Central

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-01-01

Objectives To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Setting Observational studies at primary care practice level. Participants Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. Primary and secondary outcome measures The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. Results 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. Conclusions The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. PMID:24860000

Correlation between patients' reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC).

PubMed

Kaneko, Makoto; Ohta, Ryuichi; Nago, Naoki; Fukushi, Motoharu; Matsushima, Masato

2017-09-13

The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan need to be able to deal with "non-internal-medicine-related" RFEs and health problems, and that curriculum including practical non-internal medicine-related training is likely to be important.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study.

PubMed

Ausili, Davide; Rossi, Emanuela; Rebora, Paola; Luciani, Michela; Tonoli, Luca; Ballerini, Enrico; Androni, Silvia; Vellone, Ercole; Riegel, Barbara; Di Mauro, Stefania

2018-04-05

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population. A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006). Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

The Effects of Staff Training on the Types of Interactions Observed at Two Group Homes for Foster Care Children

ERIC Educational Resources Information Center

Crosland, Kimberly A.; Dunlap, Glen; Sager, Wayne; Neff, Bryon; Wilcox, Catherine; Blanco, Alfredo; Giddings, Tamela

2008-01-01

Objectives: An extensive literature base exists for behavioral parent training; however, few studies have focused on training direct care staff at group home and residential facilities for children. This study was conducted to determine whether a behavioral staff training program consisting of classroom training and in-home feedback would improve…

One- to Three-Year-Old Children's Experience of Subjective Wellbeing in Day Care

ERIC Educational Resources Information Center

Seland, Monica; Sandseter, Ellen Beate Hansen; Bratterud, Åse

2015-01-01

The aim of the study on which this paper is based was to explore in which situations and contexts Norwegian 1-3-year-olds experience subjective wellbeing in day care. The data in this study was collected through qualitative phenomenological observations of 18 children, and an inductive process of analysis was conducted. The results show that…

Blended e-learning and end of life care in nursing homes: a small-scale mixed-methods case study

PubMed Central

2014-01-01

Background A ‘blended’ (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. This paper evaluates the impact of the course on participants’ understandings of and confidence in delivering end of life care in one nursing home, while also considering barriers to change in practice. Methods A mixed-methods case study approach, incorporating pre- and post-course questionnaires (SHA East of England End of Life Care Education Programme ‘ABC’ Project Work Force C or Non Nurse Workforce B Pre and Post Course Questionnaire; E-Learning in End of Life Care Study Pre and Post Course Questionnaire), documentary analysis, semi-structured interviews, and observation of course workshops. Participants were 20 members of staff at a nursing home in a city in the East of England, including 14 Health Care Assistants (carers) and 6 others (administrative, activities, hosting, and catering staff). The questionnaires and interviews assessed understandings of and confidence towards end of life care delivery. Results Improvements in participants’ confidence in delivering end of life care were observed, particularly in the core competency areas of symptom management, communication, and advance care planning. A shift towards more detailed and more holistic understandings of end of life care was in evidence; some participants also championed end of life care in the home as a result of the course. Several barriers to changes in practice were encountered, including uneven participation, the absence of mechanisms for disseminating new insights and knowledge within the home, and a widespread perception that nurses’ professional dominance in the home made sustainable change difficult to enact. Conclusions While blended e-learning courses have the potential to generate positive change in participants’ understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes. PMID:24994948

Illness Beliefs in End Stage Renal Disease and Associations with Self-Care Modality Choice

PubMed Central

Jayanti, Anuradha; Foden, Philip; Wearden, Alison; Mitra, Sandip

2016-01-01

Background Interest in self-care haemodialysis (HD) has increased because it improves patients’clinical and quality-of-life outcomes. Patients who undertake self-management for haemodialysis may hold illness beliefs differently to those choosing institutional care at the time of making the modality choice or moulded by their illness and dialysis treatment experience. Illness perceptions amongst predialysis patients and in those undertaking fully-assisted and self-care haemodialysis are being investigated in a combined cross-sectional and longitudinal study. Study Design The study data are derived from the BASIC-HHD study, a multicentre observational study on factors influencing home haemodialysis uptake. 535 patients were enrolled into three groups: Predialysis CKD-5 group, prevalent ‘in-centre’ HD and self-care HD groups (93% at home). We explore illness perceptions in the cross-sectional analyses of the three study groups, using the revised Illness Perception Questionnaire (IPQ-R). Predialysis patients’ illness beliefs were reassessed prospectively, typically between 4 and 12 months after dialysis commencement. Results Illness belief subscales are significantly different between in-centre and self-care HD groups. In a step-wise hierarchical regression analysis, after adjustment for age, education, marital status, diabetes, dialysis vintage, depression, anxiety scores, and IPQ-R subscales, personal control (p = 0.01) and illness coherence (p = 0.04) are significantly higher in the self-care HD group. In the predialysis group, no significant associations were found between illness representations and modality choices. In prospectively observed predialysis group, scores for personal control, treatment control, timeline cyclical and emotional representations reduced significantly after commencing dialysis and increased significantly for illness coherence. Conclusions Illness beliefs differ between hospital and self-care haemodialysis patients. Patient’s affect and neurocognitive ability may have an important role in determining illness beliefs. The impact of modality upon illness representations may also be significant and remains to be explored. PMID:27368055

Review of information technology for surgical patient care.

PubMed

Robinson, Jamie R; Huth, Hannah; Jackson, Gretchen P

2016-06-01

Electronic health records (EHRs), computerized provider order entry (CPOE), and patient portals have experienced increased adoption by health care systems. The objective of this study was to review evidence regarding the impact of such health information technologies (HIT) on surgical practice. A search of Medline, EMBASE, CINAHL, and the Cochrane Library was performed to identify data-driven, nonsurvey studies about the effects of HIT on surgical care. Domain experts were queried for relevant articles. Two authors independently reviewed abstracts for inclusion criteria and analyzed full text of eligible articles. A total of 2890 citations were identified. Of them, 32 observational studies and two randomized controlled trials met eligibility criteria. EHR or CPOE improved appropriate antibiotic administration for surgical procedures in 13 comparative observational studies. Five comparative observational studies indicated that electronically generated operative notes had increased accuracy, completeness, and availability in the medical record. The Internet as an information resource about surgical procedures was generally inadequate. Surgical patients and providers demonstrated rapid adoption of patient portals, with increasing proportions of online versus inperson outpatient surgical encounters. The overall quality of evidence about the effects of HIT in surgical practice was low. Current data suggest an improvement in appropriate perioperative antibiotic administration and accuracy of operative reports from CPOE and EHR applications. Online consumer health educational resources and patient portals are popular among patients and families, but their impact has not been studied well in surgical populations. With increasing adoption of HIT, further research is needed to optimize the efficacy of such tools in surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.

Crowding measures associated with the quality of emergency department care: a systematic review.

PubMed

Stang, Antonia S; Crotts, Jennifer; Johnson, David W; Hartling, Lisa; Guttmann, Astrid

2015-06-01

Despite the substantial body of literature on emergency department (ED) crowding, to the best of our knowledge, there is no agreement on the measure or measures that should be used to quantify crowding. The objective of this systematic review was to identify existing measures of ED crowding that have been linked to quality of care as defined by the Institute of Medicine (IOM) quality domains (safe, effective, patient-centered, efficient, timely, and equitable). Six major bibliographic databases were searched from January 1980 to January 2012, and hand searches were conducted of relevant journals and conference proceedings. Observational studies (cross-sectional, cohort, and case-control), quality improvement studies, quasi-experimental (e.g., before/after) studies, and randomized controlled trials were considered for inclusion. Studies that did not provide measures of ED crowding were excluded. Studies that did not provide quantitative data on the link between crowding measures and quality of care were also excluded. Two independent reviewers assessed study eligibility, completed data extraction, and assessed study quality using the Newcastle-Ottawa Quality Assessment Scale (NOS) for observational studies and a modified version of the NOS for cross-sectional studies. The search identified 7,413 articles. Thirty-two articles were included in the review: six cross-sectional, one case-control, 23 cohort, and two retrospective reviews of performance improvement data. Methodologic quality was moderate, with weaknesses in the reporting of study design and methodology. Overall, 15 of the crowding measures studied had quantifiable links to quality of care. The three measures most frequently linked to quality of care were the number of patients in the waiting room, ED occupancy (percentage of overall ED beds filled), and the number of admitted patients in the ED awaiting inpatient beds. None of the articles provided data on the link between crowding measures and the IOM domains reflecting equitable and efficient care. The results of this review provide data on the association between ED crowding measures and quality of care. Three simple crowding measures have been linked to quality of care in multiple publications. © 2015 by the Society for Academic Emergency Medicine.

Initial antibiotic selection and patient outcomes: observations from the National Pneumonia Project.

PubMed

Bratzler, Dale W; Ma, Allen; Nsa, Wato

2008-12-01

Guidelines for empirical treatment of hospitalized patients with pneumonia provide specific recommendations for antibiotic selection that are primarily based on findings from observational studies. We conducted a retrospective study of 27,330 community-dwelling, immunocompetent Medicare patients (age, >65 years) with pneumonia who were hospitalized in 1998-1999 and 2000-2001. Associations between initial antimicrobial regimens and risk-adjusted mortality were assessed, accounting for differences in patient characteristics, comorbidities, illness severity, geographic location, and processes of care. Treatment with nonpseudomonal third-generation cephalosporin monotherapy constituted the reference group for comparisons. For patients not in the intensive care unit, initial treatment with fluoroquinolone monotherapy was associated with reduced in-hospital mortality, 14-day mortality, and 30-day mortality rates (adjusted odds ratio [AOR] for 30-day mortality, 0.7; 95% confidence interval [CI], 0.6-0.9; P = .001). The combination of a cephalosporin plus a macrolide was associated with reduced 14-day and 30-day mortality rates (AOR for 30-day mortality, 0.7; 95% CI, 0.6-0.9; P < .001). For intensive care unit patients, the combination of a cephalosporin and a macrolide was associated with reduced in-hospital mortality (AOR, 0.6; 95% CI, 0.3-0.9; P = .018). Initial antimicrobial treatment with the combination of a second- or third-generation cephalosporin and a macrolide or initial treatment with a fluoroquinolone was associated with a reduced 30-day mortality rate, compared with treatment with third-generation cephalosporin monotherapy, among non-intensive care unit patients. Although our results are consistent with other observational studies, controversy continues to exist about the use of nonexperimental cohort studies to demonstrate associations between processes of care, such as antibiotic selection, and patient outcomes.

[The elderly care practices of indigenous-performance of health].

PubMed

Rissardo, Leidyani Karina; Alvim, Neide Aparecida Titonelli; Marcon, Sonia Silva; Carreira, Lígia

2014-01-01

This research aims to understand the care practices of health professionals who assist the elderly Kaingang. It is a qualitative study, supported in ethnography, conducted by ten professionals working in primary health care in the indigenous land of Faxinal, Paraná, Brazil. The data was collected from November 2010 to February 2012 by participant observation and interviews, and analyzed based on the Transcultural Care Theory. Was identified the preoccupation of the carers practices with the medication and immunization, as well as traditional medical care. To achieve these, care professionals had strategies that implemented maintenance of older people in care. We conclude that cultural values and integrate scientific need assistance to improve the health of elderly indigenous.

Exploring Helpful Nursing Care in Pediatric Mental Health Settings: The Perceptions of Children with Suicide Risk Factors and Their Parents.

PubMed

Montreuil, Marjorie; Butler, Kat J D; Stachura, Michal; Pugnaire Gros, Catherine

2015-01-01

This qualitative descriptive study explored helpful nursing care from the perspective of children with suicide-associated risk factors, and their parents. Data were collected through participant observation followed by a debriefing session with children, and semi-structured interviews with parents. The inductive analysis revealed four themes of helpful interventions: (1) caring for the child as a special person; (2) caring for the parents; (3) managing the child's illness; and (4) creating a therapeutic environment. The study findings highlight the importance of the relational aspect of nursing care and provide important insights related to family-centered and strengths-based practice with children at increased risk for suicide later in life.

Provider and systems factors in diabetes quality of care.

PubMed

Ghaznavi, Kimia; Malik, Shaista

2012-02-01

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Nursing care complexity in a psychiatric setting: results of an observational study.

PubMed

Petrucci, C; Marcucci, G; Carpico, A; Lancia, L

2014-02-01

For nurses working in mental health service settings, it is a priority to perform patient assessments to identify patients' general and behavioural risks and nursing care complexity using objective criteria, to meet the demand for care and to improve the quality of service by reducing health threat conditions to the patients' selves or to others (adverse events). This study highlights that there is a relationship between the complexity of psychiatric patient care, which was assigned a numerical value after the nursing assessment, and the occurrence of psychiatric adverse events in the recent histories of the patients. The results suggest that nursing supervision should be enhanced for patients with high care complexity scores. © 2013 John Wiley & Sons Ltd.

Multiple determinants of the abortion care experience: from the patient's perspective.

PubMed

Taylor, Diana; Postlethwaite, Debbie; Desai, Sheila; James, E Angel; Calhoun, Amanda W; Sheehan, Katharine; Weitz, Tracy A

2013-01-01

Because of the highly stigmatized nature of abortion care delivery and the restriction of abortion provision in most states, little is known about abortion care quality beyond procedural safety. This study examined which aspects of abortion care contributed to patient experiences. Data from a prospective, observational study of 9087 women aged 16 to 44 years, from 22 clinics across California, who responded to a postprocedure survey, were analyzed using mixed-effects logistic regression. Patient experience scores were very high (mean overall satisfaction = 9.4 [0-10 scale]) for all clinicians trained in abortion provision (physicians, nurse practitioners, nurse-midwives, and physician assistants). Multiple patient factors (pain rating, expectations of care, sociodemographics) and clinic-level factors (timely care, treatment by clinicians and staff) were significantly associated with patient experience. Study findings demonstrated that clinic environment, treatment by clinical staff, and managed pain levels contributed to a patient's experience of abortion care, whereas clinician type was not significantly associated.

Development of a quality assessment tool for systematic reviews of observational studies (QATSO) of HIV prevalence in men having sex with men and associated risk behaviours

PubMed Central

Wong, William CW; Cheung, Catherine SK; Hart, Graham J

2008-01-01

Background Systematic reviews based on the critical appraisal of observational and analytic studies on HIV prevalence and risk factors for HIV transmission among men having sex with men are very useful for health care decisions and planning. Such appraisal is particularly difficult, however, as the quality assessment tools available for use with observational and analytic studies are poorly established. Methods We reviewed the existing quality assessment tools for systematic reviews of observational studies and developed a concise quality assessment checklist to help standardise decisions regarding the quality of studies, with careful consideration of issues such as external and internal validity. Results A pilot version of the checklist was developed based on epidemiological principles, reviews of study designs, and existing checklists for the assessment of observational studies. The Quality Assessment Tool for Systematic Reviews of Observational Studies (QATSO) Score consists of five items: External validity (1 item), reporting (2 items), bias (1 item) and confounding factors (1 item). Expert opinions were sought and it was tested on manuscripts that fulfil the inclusion criteria of a systematic review. Like all assessment scales, QATSO may oversimplify and generalise information yet it is inclusive, simple and practical to use, and allows comparability between papers. Conclusion A specific tool that allows researchers to appraise and guide study quality of observational studies is developed and can be modified for similar studies in the future. PMID:19014686

Intimate Partner Violence Screening and Response: Policies and Procedures Across Health Care Facilities.

PubMed

Williams, Jessica R; Halstead, Valerie; Salani, Deborah; Koermer, Natasha

2016-01-01

This study examines policies and procedures for identifying and responding to intimate partner violence (IPV) among different types of health care settings. This epidemiologic, cross-sectional, observational study design collected data from June 2014 to January 2015 through a telephone questionnaire from a stratified random sample of 288 health care facilities in Miami-Dade County, Florida. An overall response rate of 76.2% was achieved from 72 primary care clinics, 93 obstetrics/gynecology clinics, 106 pediatric clinics, and 17 emergency departments (EDs). There is a general awareness of the importance of IPV screening with 78.1% of facilities (95% CI, 73.9%-82.3%) reporting some type of IPV screening procedures. Wide variation exists, however, in how practices are implemented, with only 35.3% of facilities (95% CI, 29.5%-41.1%) implementing multicomponent, comprehensive IPV screening and response programs. Differences were also observed by setting with EDs reporting the most comprehensive programs. This study yields important empirical information regarding the extent to which IPV screening and response procedures are currently being implemented in both clinic and acute health care settings along with areas where improvements are needed. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Is directly observed tuberculosis treatment strategy patient-centered? A mixed method study in Addis Ababa, Ethiopia

PubMed Central

Getahun, Belete; Nkosi, Zethu Zerish

2017-01-01

Introduction The directly observed treatment, short course (DOTS) strategy has been considered as an efficacious approach for better tuberculosis (TB) treatment adherence and outcome. However, its level of patient centerdness has not been studied and documented well. Hence, the study aimed to determine the level of patient centeredness’ of the DOTS. Method The study used explanatory sequential mixed method design in Addis Ababa, Ethiopia. The study employed an interviewer-administered questionnaire with 601 patients with TB, focus group discussions with 23 TB experts, and telephonic-interview with 25 persons lost to follow-up from TB treatment. Descriptive and multivariable analyses carried out for the quantitative data while thematic analysis was used for the qualitative data. Result Forty percent of patients with TB had not received patient-centered TB care (PC-TB care) with DOTS. Male gender (AOR = 0.45, 95% CI 0.3, 0.7), good communication (AOR = 3.2, 95%CI 1.6, 6.1), and health care providers as a treatment supporter (AOR = 3.4, 95% CI 2.1, 5.48) had significant associations with PC-TB care. All persons lost to follow-up and TB experts perceived that DOTS is merely patient-centered. The identified categories were patient preferences, treatment supporter choice, integration of DOTS with nutritional support, mental health, and transport services, provider’s commitment and communication skills. Conclusion DOTS is limited to provide patient-centered TB care. Hence, DOTS needs a model that enhances effectiveness towards patient centeredness of TB care. PMID:28763456

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City

PubMed Central

kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-01-01

Background: Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. Objectives: To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. Materials and Methods: A cross-sectional study. Result: A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Conclusion: Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections. PMID:25302193

Differences in care burden of patients undergoing dialysis in different centres in the netherlands.

PubMed

de Kleijn, Ria; Uyl-de Groot, Carin; Hagen, Chris; Diepenbroek, Adry; Pasker-de Jong, Pieternel; Ter Wee, Piet

2017-06-01

A classification model was developed to simplify planning of personnel at dialysis centres. This model predicted the care burden based on dialysis characteristics. However, patient characteristics and different dialysis centre categories might also influence the amount of care time required. To determine if there is a difference in care burden between different categories of dialysis centres and if specific patient characteristics predict nursing time needed for patient treatment. An observational study. Two hundred and forty-two patients from 12 dialysis centres. In 12 dialysis centres, nurses filled out the classification list per patient and completed a form with patient characteristics. Nephrologists filled out the Charlson Comorbidity Index. Independent observers clocked the time nurses spent on separate steps of the dialysis for each patient. Dialysis centres were categorised into four types. Data were analysed using regression models. In contrast to other dialysis centres, academic centres needed 14 minutes more care time per patient per dialysis treatment than predicted in the classification model. No patient characteristics were found that influenced this difference. The only patient characteristic that predicted the time required was gender, with more time required to treat women. Gender did not affect the difference between measured and predicted care time. Differences in care burden were observed between academic and other centres, with more time required for treatment in academic centres. Contribution of patient characteristics to the time difference was minimal. The only patient characteristics that predicted care time were previous transplantation, which reduced the time required, and gender, with women requiring more care time. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Multi-disciplinary communication networks for skin risk assessment in nursing homes with high IT sophistication.

PubMed

Alexander, Gregory L; Pasupathy, Kalyan S; Steege, Linsey M; Strecker, E Bradley; Carley, Kathleen M

2014-08-01

The role of nursing home (NH) information technology (IT) in quality improvement has not been clearly established, and its impacts on communication between care givers and patient outcomes in these settings deserve further attention. In this research, we describe a mixed method approach to explore communication strategies used by healthcare providers for resident skin risk in NH with high IT sophistication (ITS). Sample included NH participating in the statewide survey of ITS. We incorporated rigorous observation of 8- and 12-h shifts, and focus groups to identify how NH IT and a range of synchronous and asynchronous tools are used. Social network analysis tools and qualitative analysis were used to analyze data and identify relationships between ITS dimensions and communication interactions between care providers. Two of the nine ITS dimensions (resident care-technological and administrative activities-technological) and total ITS were significantly negatively correlated with number of unique interactions. As more processes in resident care and administrative activities are supported by technology, the lower the number of observed unique interactions. Additionally, four thematic areas emerged from staff focus groups that demonstrate how important IT is to resident care in these facilities including providing resident-centered care, teamwork and collaboration, maintaining safety and quality, and using standardized information resources. Our findings in this study confirm prior research that as technology support (resident care and administrative activities) and overall ITS increases, observed interactions between staff members decrease. Conversations during staff interviews focused on how technology facilitated resident centered care through enhanced information sharing, greater virtual collaboration between team members, and improved care delivery. These results provide evidence for improving the design and implementation of IT in long term care systems to support communication and associated resident outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Challenges for Nurses Caring for Individuals with Peripherally Inserted Central Catheters in Skilled Nursing Facilities.

PubMed

Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet

2016-10-01

To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. Exploratory, qualitative pilot study. Two community based SNFs. Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Validation of the 'United Registries for Clinical Assessment and Research' [UR-CARE], a European Online Registry for Clinical Care and Research in Inflammatory Bowel Disease.

PubMed

Burisch, Johan; Gisbert, Javier P; Siegmund, Britta; Bettenworth, Dominik; Thomsen, Sandra Bohn; Cleynen, Isabelle; Cremer, Anneline; Ding, Nik John Sheng; Furfaro, Federica; Galanopoulos, Michail; Grunert, Philip Christian; Hanzel, Jurij; Ivanovski, Tamara Knezevic; Krustins, Eduards; Noor, Nurulamin; O'Morain, Neil; Rodríguez-Lago, Iago; Scharl, Michael; Tua, Julia; Uzzan, Mathieu; Ali Yassin, Nuha; Baert, Filip; Langholz, Ebbe

2018-04-27

The 'United Registries for Clinical Assessment and Research' [UR-CARE] database is an initiative of the European Crohn's and Colitis Organisation [ECCO] to facilitate daily patient care and research studies in inflammatory bowel disease [IBD]. Herein, we sought to validate the database by using fictional case histories of patients with IBD that were to be entered by observers of varying experience in IBD. Nineteen observers entered five patient case histories into the database. After 6 weeks, all observers entered the same case histories again. For each case history, 20 key variables were selected to calculate the accuracy for each observer. We assumed that the database was such that ≥ 90% of the entered data would be correct. The overall proportion of correctly entered data was calculated using a beta-binomial regression model to account for inter-observer variation and compared to the expected level of validity. Re-test reliability was assessed using McNemar's test. For all case histories, the overall proportion of correctly entered items and their confidence intervals included the target of 90% (Case 1: 92% [88-94%]; Case 2: 87% [83-91%]; Case 3: 93% [90-95%]; Case 4: 97% [94-99%]; Case 5: 91% [87-93%]). These numbers did not differ significantly from those found 6 weeks later [NcNemar's test p > 0.05]. The UR-CARE database appears to be feasible, valid and reliable as a tool and easy to use regardless of prior user experience and level of clinical IBD experience. UR-CARE has the potential to enhance future European collaborations regarding clinical research in IBD.

Work stress of primary care physicians in the US, UK and German health care systems.

PubMed

Siegrist, Johannes; Shackelton, Rebecca; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-07-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005 to 2007. Results demonstrate country-specific differences in work stress with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. Copyright 2010 Elsevier Ltd. All rights reserved.

Work stress of primary care physicians in the US, UK and German health care systems

PubMed Central

Siegrist, Johannes; Link, Carol; Marceau, Lisa; von dem Knesebeck, Olaf; McKinlay, John

2010-01-01

Work-related stress among physicians has been an issue of growing concern in recent years. How and why this may vary between different health care systems remains poorly understood. Using an established theoretical model (effort-reward imbalance), this study analyses levels of work stress among primary care physicians (PCPs) in three different health care systems, the United States, the United Kingdom and Germany. Whether professional autonomy and specific features of the work environment are associated with work stress and account for possible country differences are examined. Data are derived from self-administered questionnaires obtained from 640 randomly sampled physicians recruited for an international comparative study of medical decision making conducted from 2005–2007. Results demonstrate country-specific differences in work stress- with the highest level in Germany, intermediate level in the US and lowest level among UK physicians. A negative correlation between professional autonomy and work stress is observed in all three countries, but neither this association nor features of the work environment account for the observed country differences. Whether there will be adequate numbers of PCPs, or even a field of primary care in the future, is of increasing concern in several countries. To the extent that work-related stress contributes to this, identification of its organizational correlates in different health care systems may offer opportunities for remedial interventions. PMID:20494505

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland

PubMed Central

Busato, André; Künzi, Beat

2008-01-01

Background The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. Methods The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Results Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. Conclusion The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations. PMID:18190705

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland.

PubMed

Busato, André; Künzi, Beat

2008-01-11

The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations.

Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

PubMed

Chenault, Kristin; Moga, Michael-Alice; Shin, Minah; Petersen, Emily; Backer, Carl; De Oliveira, Gildasio S; Suresh, Santhanam

2016-05-01

Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit. This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase). A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively. We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery. © 2016 John Wiley & Sons Ltd.

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

PubMed Central

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-01-01

Objective To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Design Cross-sectional observational health facility assessment. Setting Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Participants Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Main outcome measures Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Results Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. Conclusions The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives. PMID:28348194

Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies.

PubMed

Norman, Gregory J; Orton, Kristann; Wade, Amy; Morris, Andrea M; Slaboda, Jill C

2018-01-27

Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. Six practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office. The aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology. Learnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.

Bridging Organizational Divides in Health Care: An Ecological View of Health Information Exchange

PubMed Central

Johnson, Kevin B; Gadd, Cynthia S; Lorenzi, Nancy M

2013-01-01

Background The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term successful implementation. Objective Our study investigated the impacts of HIE technology on organizations, health care providers, and patients through a new, context-aware perspective, the Regional Health Information Ecology. Methods We conducted more than 180 hours of direct observation, informal interviews during observation, and 9 formal semi-structured interviews. Data collection focused on workflow and information flow among health care team members and patients and on health care provider use of HIE technology. Results We structured the data analysis around five primary information ecology components: system, locality, diversity, keystone species, and coevolution. Our study identified three main roles, or keystone species, involved in HIE: information consumers, information exchange facilitators, and information repositories. The HIE technology impacted patient care by allowing providers direct access to health information, reducing time to obtain health information, and increasing provider awareness of patient interactions with the health care system. Developing the infrastructure needed to support HIE technology also improved connections among information technology support groups at different health care organizations. Despite the potential of this type of technology to improve continuity of patient care, HIE technology adoption by health care providers was limited. Conclusions To successfully build a HIE network, organizations had to shift perspectives from an ownership view of health data to a continuity of care perspective. To successfully integrate external health information into clinical work practices, health care providers had to move toward understanding potential contributions of external health information. Our study provides a foundation for future context-aware development and implementation of HIE technology. Integrating concepts from the Regional Health Information Ecology into design and implementation may lead to wider diffusion and adoption of HIE technology into clinical work. PMID:25600166

Friends in Passing: Social Interaction at an Adult Day Care Center.

ERIC Educational Resources Information Center

Williams, Barbara; Roberts, Pamela

1995-01-01

Participant observation study explored social interactions and friendships among cognitively impaired adult day-care participants. Found clients engage in a variety of social interactions and friendships, enabling them to maintain a sense of self and to adjust to group norms. Discussed general socializing, enduring friendships, helping…

CTEPP DATA COLLECTION FORM 03:HOUSE/BUILDING CHARACTERISTICS OBSERVATION SURVEY FOR THE DAY CARE CENTER

EPA Science Inventory

This data collection form is used to document the physical characteristics of the day care center and identify and inventory possible sources of pollutants.

The Children's Total Exposure to Persistent Pesticides and Other Persistent Pollutant (CTEPP) study was one of the large...

CTEPP NC DATA COLLECTED ON FORM 03:HOUSE/BUILDING CHARACTERISTICS OBSERVATION SURVEY FOR THE DAY CARE CENTER

EPA Science Inventory

This data set contains data concerning the physical characteristics of the day care center and identified possible sources of pollutants.

The Children’s Total Exposure to Persistent Pesticides and Other Persistent Pollutant (CTEPP) study was one of the largest aggregate exposu...

Social Support, a Mediator in Collaborative Depression Care for Cancer Patients

ERIC Educational Resources Information Center

Oh, Hyunsung; Ell, Kathleen

2015-01-01

Objective: This study assessed whether perceived social support (PSS) is a factor in improving physical and functional well-being observed among cancer patients receiving collaborative depression care. Methods: A secondary analysis was conducted of data collected in a randomized clinical trial testing the effectiveness of collaborative depression…

Comprehensive Health Assessments During De-Institutionalization: An Observational Study

ERIC Educational Resources Information Center

Lennox, N.; Rey-Conde, T.; Cooling, N.

2006-01-01

Background: People with intellectual disability (ID) leaving institutions pass through a transition stage that makes them vulnerable to inadequate health care. They enter into community care under general practitioners (GPs) who are often untrained and inexperienced in their needs. Specifically designed health reviews may be of assistance to both…

[Palliative care support teams and the commitment of primary care teams to terminally ill patients in their homes].

PubMed

Rocafort Gil, Javier; Herrera Molina, Emilio; Fernández Bermejo, Félix; Grajera Paredes María, María Eulalia; Redondo Moralo, María José; Díaz Díez, Fátima; Espinosa Rojas, José Armando

2006-10-15

To find out if the activity of palliative care support teams (PCST) does not negatively influences the performance of the primary care "care of terminally ill patients" service. Terminally ill patients cared for at home. Multicentre observational study. The observed variable is the increase in the number of registered patients in primary care, and the number of patients covered between the years 2002 and 2003 and the 4 intervention variables are: total visits, joint visits, assessments, and teaching sessions. The number of patients covered in 2002 was 41.19%, increasing to 45.44% in 2003. The activity rate of the PCST for each 100 000 inhabitants was 526 home visits in 2003, 86.15 joint visits, 313.68 professional assessments, and 23.14 teaching sessions. The joint visits and the teaching sessions were strongly associated with an improvement in the coverage of primary care (Pearson correlation of 0.784 and 0.759, respectively). The total visits were moderately associated (0.525) and the assessments were weakly associated (0.245). Joint visits and teaching sessions of a PCST are associated to an increase in the activity of primary care teams. Assessments and total visits did not have a negative influence.

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.

PubMed

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2016-05-01

While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. © The Author(s) 2015.

[Intuitive ability in nursing care].

PubMed

da Silva, Alcione Leite

2003-01-01

This study aimed to understand the intuitive ability of nursing professionals in caring. The study method was qualitative, adopting a descriptive exploratory approach. Sampling involved 87 female nursing professionals, being 31 nurses, 29 nursing technicians and 18 nursing auxiliaries. The result showed different levels of intuitive abilities, related to novice, standard, and veteran. The relation between the three levels of intuitive abilities and the corresponding figures in years, observed in a North American study, was not identified. The factors described as affecting the intuitive experience were both environmental and intra-interpersonal (personological). The experiences of the professionals portrayed the importance of intuition in nursing care, mainly in doubtful and conflicting situations and, in this sense, its vital function was decision-making towards better quality of nursing care.

The design and testing of a caring teaching model based on the theoretical framework of caring in the Chinese Context: a mixed-method study.

PubMed

Guo, Yujie; Shen, Jie; Ye, Xuchun; Chen, Huali; Jiang, Anli

2013-08-01

This paper aims to report the design and test the effectiveness of an innovative caring teaching model based on the theoretical framework of caring in the Chinese context. Since the 1970's, caring has been a core value in nursing education. In a previous study, a theoretical framework of caring in the Chinese context is explored employing a grounded theory study, considered beneficial for caring education. A caring teaching model was designed theoretically and a one group pre- and post-test quasi-experimental study was administered to test its effectiveness. From Oct, 2009 to Jul, 2010, a cohort of grade-2 undergraduate nursing students (n=64) in a Chinese medical school was recruited to participate in the study. Data were gathered through quantitative and qualitative methods to evaluate the effectiveness of the caring teaching model. The caring teaching model created an esthetic situation and experiential learning style for teaching caring that was integrated within the curricula. Quantitative data from the quasi-experimental study showed that the post-test scores of each item were higher than those on the pre-test (p<0.01). Thematic analysis of 1220 narratives from students' caring journals and reports of participant class observation revealed two main thematic categories, which reflected, from the students' points of view, the development of student caring character and the impact that the caring teaching model had on this regard. The model could be used as an integrated approach to teach caring in nursing curricula. It would also be beneficial for nursing administrators in cultivating caring nurse practitioners. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Therapy Process Observational Coding System for Child Psychotherapy Strategies Scale

ERIC Educational Resources Information Center

McLeod, Bryce D.; Weisz, John R.

2010-01-01

Most everyday child and adolescent psychotherapy does not follow manuals that document the procedures. Consequently, usual clinical care has remained poorly understood and rarely studied. The Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) is an observational measure of youth psychotherapy procedures…

Medication communication during handover interactions in specialty practice settings.

PubMed

Braaf, Sandra; Rixon, Sascha; Williams, Allison; Liew, Danny; Manias, Elizabeth

2015-10-01

To investigate what and how medication information is communicated during handover interactions in specialty hospital settings. Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care. An exploratory qualitative design and observational study. Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed. Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover. Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings. For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered. © 2015 John Wiley & Sons Ltd.

Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

PubMed

Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

2016-12-01

This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

Influence of the day care, home and neighbourhood environment on young children's physical activity and health: protocol for the PLAYCE observational study

PubMed Central

Christian, Hayley; Maitland, Clover; Enkel, Stephanie; Trapp, Georgina; Trost, Stewart G; Schipperijn, Jasper; Boruff, Bryan; Lester, Leanne; Rosenberg, Michael; Zubrick, Stephen R

2016-01-01

Introduction The early years are a critical period in a child's health and development, yet most preschool children fail to meet physical activity guidelines. Outside of the home and neighbourhood, children spend a large proportion of time within early childhood education and care (ECEC) services such as long day care. Research is required to determine how the design of day care outdoor (and indoor) spaces provides opportunities or constraints for physical activity. A significant evidence gap surrounds what objectively measured attributes of the home and neighbourhood environment influence preschoolers’ physical activity. The PLAY Spaces & Environments for Children's Physical Activity (PLAYCE) study will empirically investigate the relative and cumulative influence of the day care, home and neighbourhood environment on preschoolers’ physical activity. Methods and analysis The PLAYCE study is a cross-sectional observational study (April 2015 to April 2018) of 2400 children aged 2–5 years attending long day care in metropolitan Perth, Western Australia. Accelerometers will measure physical activity with indoor physical activity measured using radio frequency identification. Global positioning systems will be used to determine outdoor location of physical activity around the home and neighbourhood for a subsample (n=310). The day care environment will be objectively measured using a validated audit tool. Other potential individual, social and physical environmental influences on preschoolers’ physical activity will be collected by geographic information systems measures, parent and day care educator surveys. Ethics and dissemination Ethical approval has been granted by The University of Western Australia Human Ethics Research Committee, approval number RA/4/1/7417. Findings will be published in international peer-reviewed journals and presented at international conferences. Key findings will be disseminated to stakeholders, collaborators, policymakers and practitioners working in the ECEC sector. Day care centre directors and parents will be given a summary report of the key findings. PMID:27932343

Knowledge translation interventions for critically ill patients: a systematic review*.

PubMed

Sinuff, Tasnim; Muscedere, John; Adhikari, Neill K J; Stelfox, Henry T; Dodek, Peter; Heyland, Daren K; Rubenfeld, Gordon D; Cook, Deborah J; Pinto, Ruxandra; Manoharan, Venika; Currie, Jan; Cahill, Naomi; Friedrich, Jan O; Amaral, Andre; Piquette, Dominique; Scales, Damon C; Dhanani, Sonny; Garland, Allan

2013-11-01

We systematically reviewed ICU-based knowledge translation studies to assess the impact of knowledge translation interventions on processes and outcomes of care. We searched electronic databases (to July, 2010) without language restrictions and hand-searched reference lists of relevant studies and reviews. Two reviewers independently identified randomized controlled trials and observational studies comparing any ICU-based knowledge translation intervention (e.g., protocols, guidelines, and audit and feedback) to management without a knowledge translation intervention. We focused on clinical topics that were addressed in greater than or equal to five studies. Pairs of reviewers abstracted data on the clinical topic, knowledge translation intervention(s), process of care measures, and patient outcomes. For each individual or combination of knowledge translation intervention(s) addressed in greater than or equal to three studies, we summarized each study using median risk ratio for dichotomous and standardized mean difference for continuous process measures. We used random-effects models. Anticipating a small number of randomized controlled trials, our primary meta-analyses included randomized controlled trials and observational studies. In separate sensitivity analyses, we excluded randomized controlled trials and collapsed protocols, guidelines, and bundles into one category of intervention. We conducted meta-analyses for clinical outcomes (ICU and hospital mortality, ventilator-associated pneumonia, duration of mechanical ventilation, and ICU length of stay) related to interventions that were associated with improvements in processes of care. From 11,742 publications, we included 119 investigations (seven randomized controlled trials, 112 observational studies) on nine clinical topics. Interventions that included protocols with or without education improved continuous process measures (seven observational studies and one randomized controlled trial; standardized mean difference [95% CI]: 0.26 [0.1, 0.42]; p = 0.001 and four observational studies and one randomized controlled trial; 0.83 [0.37, 1.29]; p = 0.0004, respectively). Heterogeneity among studies within topics ranged from low to extreme. The exclusion of randomized controlled trials did not change our results. Single-intervention and lower-quality studies had higher standardized mean differences compared to multiple-intervention and higher-quality studies (p = 0.013 and 0.016, respectively). There were no associated improvements in clinical outcomes. Knowledge translation interventions in the ICU that include protocols with or without education are associated with the greatest improvements in processes of critical care.

Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making.

PubMed

Coombs, Maureen A; Parker, Roses; de Vries, Kay

2017-07-01

Increasing importance is being placed on the coordination of services at the end of life. To describe decision-making processes that influence transitions in care when approaching the end of life. Qualitative study using field observations and longitudinal semi-structured interviews. Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.

Dying with dementia: what we know after more than a decade of research.

PubMed

van der Steen, Jenny T

2010-01-01

Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

Is home health care a substitute for hospital care?

PubMed

Lichtenberg, Frank R

2012-01-01

A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care and concluded that "there is no evidence that services provided at home replace hospital services." However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data--observations on states in two time periods--which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998-2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days. The estimates are consistent with the hypothesis that this was entirely due to the increase in the fraction of hospital patients discharged to home health care, from 6.4% in 1998 to 9.9% in 2008. The estimated reduction in 2008 hospital costs resulting from the rise in the fraction of hospital patients discharged to home health care may have been 36% larger than the increase in the payroll of the home health care industry.

Clinical outcomes of HIV care delivery models in the US: a systematic review.

PubMed

Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H

2016-10-01

With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially across different staffing models and among different patient populations and geographic locations, is urgently needed to improve HIV disease management.

Multidisciplinary care planning in the primary care management of completed stroke: a systematic review

PubMed Central

Mitchell, Geoffrey K; Brown, Robyn M; Erikssen, Lars; Tieman, Jennifer J

2008-01-01

Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006), Cochrane Library (Issue 1 2006), and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1) a multi-disciplinary primary care team or 2) through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact of active GP involvement in multidisciplinary care planning is warranted. PMID:18681977

Study protocol: evaluation of specialized outpatient palliative care (SOPC) in the German state of Hesse (ELSAH study) - work package II: palliative care for pediatric patients.

PubMed

Ulrich, Lisa-R; Gruber, Dania; Hach, Michaela; Boesner, Stefan; Haasenritter, Joerg; Kuss, Katrin; Seipp, Hannah; Gerlach, Ferdinand M; Erler, Antje

2018-01-05

In 2007, the European Association of Palliative Care (EAPC) provided a comprehensive set of recommendations and standards for the provision of adequate pediatric palliative care. A number of studies have shown deficits in pediatric palliative care compared to EAPC standards. In Germany, pediatric palliative care patients can be referred to specialized outpatient palliative care (SOPC) services, which are known to enhance quality of life, e.g. by avoiding hospitalization. However, current regulations for the provision of SOPC in Germany do not account for the different circumstances and needs of children and their families compared to adult palliative care patients. The "Evaluation of specialized outpatient palliative care (SOPC) in the German state of Hesse (ELSAH)" study aims to perform a needs assessment for pediatric patients (children, adolescents and young adults) receiving SOPC. This paper presents the study protocol for this assessment (work package II). The study uses a sequential mixed-methods study design with a focus on qualitative research. Data collection from professional and family caregivers and, as far as possible, pediatric patients, will involve both a written questionnaire based on European recommendations for pediatric palliative care, and semi-structured interviews. Additionally, professional caregivers will take part in focus group discussions and participatory observations. Interviews and focus groups will be tape- or video-recorded, transcribed verbatim and analyzed in accordance with the principles of grounded theory (interviews) and content analysis (focus groups). A structured field note template will be used to record notes taken during the participatory observations. Statistical Package for Social Sciences (SPSS, version 22 or higher) will be used for descriptive statistical analyses. The qualitative data analyses will be software-assisted by MAXQDA (version 12 or higher). This study will provide important information on what matters most to family caregivers and pediatric patients receiving SOPC. The results will add valuable knowledge to the criteria that distinguish SOPC for pediatric from SOPC for adult patients, and will provide an indication of how the German SOPC rule of procedure can be optimized to satisfy the special needs of pediatric patients. Internet Portal of the German Clinical Trials Register ( www.germanctr.de , DRKS-ID: DRKS00012431).

Behavioral observation differentiates the effects of an intervention to promote sleep in premature infants: a pilot study.

PubMed

Lacina, Linda; Casper, Tammy; Dixon, Melodie; Harmeyer, Joann; Haberman, Beth; Alberts, Jeffrey R; Simakajornboon, Narong; Visscher, Marty O

2015-02-01

Sleep and ongoing cycling of sleep states are required for neurosensory processing, learning, and brain plasticity. Many aspects of neonatal intensive care environments such as handling for routine and invasive procedures, bright lighting, and noise can create stress, disrupt behavior, and interfere with sleep in prematurely born infants. The study empirically investigated whether a 30-minute observation of infant sleep states and behavior could differentiate an intervention to promote sleep in premature infants with feeding difficulties relative to conventional care (standard positioning, standard crib mattress [SP]). We included an intervention to determine the ability of the method to discriminate treatments and generate a benchmark for future improvements. The intervention, a conformational positioner (CP), is contoured around the infant to provide customized containment and boundaries. To more fully verify the 30-minute observational sleep results, standard polysomnography was conducted simultaneously and sleep outcomes for the 2 modalities were compared. In a randomized crossover clinical trial, 25 infants, 31.5 ± 0.6 weeks' gestational age and 38.4 ± 0.6 weeks at the study, with gastrointestinal conditions or general feeding difficulties used each intervention during an overnight neonatal intensive care unit sleep study. Infant sleep states and behaviors were observed during two 30-minute periods--that is, on the positioner and mattress--using the naturalistic observation of newborn behavior. Two certified developmental care nurses assessed sleep state, self-regulatory, and stress behaviors during 2-minute intervals and summed over 30 minutes. Sleep characteristics from standard polysomnography were measured at the time of behavior observations. Infants on CP spent significantly less time in alert, active awake, or crying states by observation compared with SP. Surgical subjects spent more time awake, active awake, or crying and displayed a higher number of behavior state changes than the nonsurgical infants. The percentage of time in observed deep sleep and quiet sleep was correlated with both percentage sleep efficiency (r = 0.78) and fewer state shifts per hour (r = -0.65) from electroencephalogram (EEG). Sleep efficiency by EEG was greater on CP versus SP. The CP enabled sleep compared with the standard mattress (SP) over 30-minute observation periods. Sleep status from behavioral observation was verified by standard EEG-based sleep techniques. Behavioral observation of sleep states may be a useful strategy for measuring the effectiveness of strategies to facilitate sleep in premature infants. Surgical subjects may benefit from additional interventions to promote sleep.

Clinical leadership: using observations of care to focus risk management and quality improvement activities in the clinical setting.

PubMed

Ferguson, Lorraine; Calvert, Judy; Davie, Marilyn; Fallon, Mark; Fred, Nada; Gersbach, Vicki; Sinclair, Lynn

2007-04-01

In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery. This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting. The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.

Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study.

PubMed

Miller, James S; English, Lacey; Matte, Michael; Mbusa, Rapheal; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Siedner, Mark J; Reyes, Raquel; Lee, Patrick T; Mulogo, Edgar; Stone, Geren S

2018-02-27

Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a "Sick Child Job Aid" that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period. Patient characteristics and clinical services were summarized using existing aggregate programme data. Lot quality assurance sampling of individual patient records was used to estimate adherence to the iCCM algorithm, VHW-level quality (based on adherence to the iCCM protocol), and change over time in quality of care (using generalized estimating equations regression modelling). For each of 23 VHWs, 25 patient visits were randomly selected from a 2-year period after iCCM care initiation. In these visits, 97% (150) of patients with diarrhoea were treated with oral rehydration and zinc, 95% (216) of patients with pneumonia were treated with amoxicillin, and 94% (240) of patients with malaria were treated with artemisinin-based combination therapy or rectal artesunate. However, only 44% (44) of patients with a negative rapid test for malaria were appropriately referred to a health facility. Overall, 75% (434) of patients received all the correct evaluation and management steps. Only 9 (39%) of the 23 VHWs met the pre-determined LQAS threshold for high-quality care over the 2-year observation period. Quality of care increased significantly in the first 6 months after initiation of iCCM services (p = 0.003), and then plateaued during months 7-24. Quality of care was high for uncomplicated malaria, pneumonia and diarrhoea. Overall quality of care was lower, in part because VHWs often did not follow the guidelines to refer patients with fever who tested negative for malaria. Quality of care appears to improve in the initial months after iCCM implementation, as VHWs gain initial experience in iCCM care.

An evaluation of gender equity in different models of primary care practices in Ontario

PubMed Central

2010-01-01

Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued. PMID:20331861

Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study.

PubMed

Lindberg, Maria; Lindberg, Magnus; Skytt, Bernice

2017-05-01

Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations. The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections. Unstructured nonparticipant observations were performed at three medical wards. Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities. The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was. The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparison of midwifery care to medical care in hospitals in the Quebec pilot projects study: clinical indicators. L'Equipe dEvaluation des Projets-Pilotes Sages-Femmes.

PubMed

Fraser, W; Hatem-Asmar, M; Krauss, I; Maillard, F; Bréart, G; Blais, R

2000-01-01

The purpose of this study was to compare indicators of process and outcome of midwifery services provided in the Quebec pilot projects to those associated with standard hospital-based medical services. Women receiving each type of care (961 per group) were matched on the basis of socio-demographic characteristics and level of obstetrical risk. We found midwifery care to be associated with less obstetrical intervention and a reduction in selected indicators of maternal morbidity (caesarean section and severe perineal injury). For neonatal outcome indicators, midwifery care was associated with a mixture of benefits and risks: fewer babies with preterm birth and low birthweight, but a trend toward a higher stillbirth ratio and more frequent requirement for neonatal resuscitation. The study design does not permit to conclude that the associations were causal in nature. However, the high stillbirth rate observed in the group of women who were selected for midwife care raises concerns both regarding the appropriateness of the screening procedures for admission to such care and regarding the quality of care itself.

Considering social ergonomics: the effects of HIT on interpersonal relationships between patients and clinicians.

PubMed

Montague, Enid; Asan, Onur

2012-01-01

This study explored physicians' interactions with EHRs to understand the qualities that contribute to patient satisfaction with their use of the technologies and patient satisfaction with physician. Video-taped observations of 100 medical consultations were used to distinguish interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Ten primary care physicians and 100 patients from five clinics participated in the study. Visits were videotaped and coded using an objective coding methodology to understand how physicians interacted with electronic health records. Results indicate, a variety of EHR interaction styles may be effective in providing patient-centered care.

Incidence and Outcomes of Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

PubMed Central

Berg, Robert A.; Nadkarni, Vinay M.; Clark, Amy E.; Moler, Frank; Meert, Kathleen; Harrison, Rick E.; Newth, Christopher J. L.; Sutton, Robert M.; Wessel, David L.; Berger, John T.; Carcillo, Joseph; Dalton, Heidi; Heidemann, Sabrina; Shanley, Thomas P.; Zuppa, Athena F.; Doctor, Allan; Tamburro, Robert F.; Jenkins, Tammara L.; Dean, J. Michael; Holubkov, Richard; Pollack, Murray M.

2015-01-01

Objective To determine the incidence of cardiopulmonary resuscitation (CPR) in pediatric intensive care units (PICU) and subsequent outcomes. Design, Setting, and Patients Multi-center prospective observational study of children 30 minutes, p30 minutes of CPR. Conclusions These data establish that contemporary PICU CPR, including long durations of CPR, results in high rates of survival to hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data. PMID:26646466

Systematic Review of Economic Evaluations of Units Dedicated to Acute Coronary Syndromes.

PubMed

Azeredo-Da-Silva, André Luis Ferreira; Perini, Silvana; Rigotti Soares, Pedro Henrique; Polaczyk, Carisi Anne

2016-01-01

Dedicated units for the care of acute coronary syndrome (ACS) have been submitted to economic evaluations; however, the results have not been systematically presented. To identify and summarize economic outcomes of studies on hospital units dedicated to the initial care of patients with suspected or confirmed ACS. A systematic review of literature to identify economic evaluations of chest pain unit (CPU), coronary care unit (CCU), or equivalent units was done. Two search strategies were used: the first one to identify economic evaluations irrespective of study design, and the second one to identify randomized clinical trials that reported economic outcomes. The following databases were searched: MEDLINE, EMBASE, CENTRAL, and National Health Service (NHS)Economic Evaluation Database. Data extraction was performed by two independent reviewers. Costs were inflated to 2012 values. Search strategies retrieved five partial economic evaluations based on observational studies, six randomized clinical trials that reported economic outcomes, and five model-based economic evaluations. Overall, cost estimates based on observational studies and randomized clinical trials reported statistically significant cost savings of more than 50% with the adoption of CPU care instead of routine hospitalization or CCU care for suspected low-to-intermediate risk patients with ACS (median per-patient cost US $1,969.89; range US $1,002.12-13,799.15). Model-based economic evaluations reported incremental cost-effectiveness ratios below US $ 50,000/quality-adjusted life-year for all comparisons between intermediate care unit, CPU, or CCU with routine hospital admissions. This finding was sensible to myocardial infarction probability. Published economic evaluations indicate that more intensive care is likely to be cost-effective in comparison to routine hospital admission for patients with suspected ACS. Copyright © 2016. Published by Elsevier Inc.

Effect of time and day of admission on hospital care quality for patients with chronic obstructive pulmonary disease exacerbation in England and Wales: single cohort study

PubMed Central

Roberts, Christopher Michael; Lowe, Derek; Skipper, Emma; Steiner, Michael C; Jones, Rupert; Gelder, Colin; Hurst, John R; Lowrey, Gillian E; Thompson, Catherine; Stone, Robert A

2017-01-01

Objective To evaluate if observed increased weekend mortality was associated with poorer quality of care for patients admitted to hospital with chronic obstructive pulmonary disease (COPD) exacerbation. Design Prospective case ascertainment cohort study. Setting 199 acute hospitals in England and Wales, UK. Participants Consecutive COPD admissions, excluding subsequent readmissions, from 1 February to 30 April 2014 of whom 13 414 cases were entered into the study. Main outcomes Process of care mapped to the National Institute for Health and Care Excellence clinical quality standards, access to specialist respiratory teams and facilities, mortality and length of stay, related to time and day of the week of admission. Results Mortality was higher for weekend admissions (unadjusted OR 1.20, 95% CI 1.00 to 1.43), and for case-mix adjusted weekend mortality when calculated for admissions Friday morning through to Monday night (adjusted OR 1.19, 95% CI 1.00 to 1.43). Median time to death was 6 days. Some clinical processes were poorer on Mondays and during normal working hours but not weekends or out of hours. Specialist respiratory care was less available and less prompt for Friday and Saturday admissions. Admission to a specialist ward or high dependency unit was less likely on a Saturday or Sunday. Conclusions Increased mortality observed in weekend admissions is not easily explained by deficiencies in early clinical guideline care. Further study of out-of-hospital factors, specialty care and deaths later in the admission are required if effective interventions are to be made to reduce variation by day of the week of admission. PMID:28882909

The Effects of Health Care and Father Support for Mother on the Children's Emotions

ERIC Educational Resources Information Center

Lestari, Tri Riana; Suwandi, Tjipto; Nursalam; Narendra, Moersintowarti B.

2015-01-01

Toddler stage is referred to as the golden era (golden age period), especially at the age of 0-2 years, the brain development reach 80%. This study examines the effects of health care support and father support for mother on the emotions of children aged less than 2 years. This study was observational, with cross-sectional design. The sampling…

Barriers and facilitators of surgical care in rural Uganda: a mixed methods study.

PubMed

Nwanna-Nzewunwa, Obieze C; Ajiko, Mary-Margaret; Kirya, Fred; Epodoi, Joseph; Kabagenyi, Fiona; Batibwe, Emmanuel; Feldhaus, Isabelle; Juillard, Catherine; Dicker, Rochelle

2016-07-01

Surgical care delivery is poorly understood in resource-limited settings. To effectively move toward universal health coverage, there is a critical need to understand surgical care delivery in developing countries. This study aims to identify the barriers and facilitators of surgical care delivery at Soroti Regional Referral Hospital in Uganda. In this mixed methods study, we (1) applied the Surgeons OverSeas' Personnel, Infrastructure, Procedures, Equipment, and Supplies tool to assess surgical capacity; (2) retrospectively reviewed inpatient records; (3) conducted four semistructured focus group discussions with 18 purposively sampled providers involved in perioperative care; and (4) observed the perioperative process of care using a time and motion approach. Descriptive statistics were generated from quantitative data. Qualitative data were thematically analyzed. The Personnel, Infrastructure, Procedures, Equipment, and Supplies survey revealed severe deficiencies in workforce (P-score = 14) and infrastructure (I-score = 5). Equipment, supplies, and procedures were generally available. Male and female wards were overbooked 83% and 60% of the time, respectively. Providers identified lack of space, patient overload, and superfluous patients' attendants as barriers to surgical care. Workforce challenges were tackled using teamwork and task sharing. Inadequate equipment and processes were addressed using improvisations. All observed subjects (n = 31) received interventions. The median decision-to-intervention time was 2.5 h (Interquartile Range [IQR], 0.4, 21.4). However, 48% of subjects experienced delays. Median decision-to-intervention delay was 14.8 h (IQR, 0.9, 26.6). Despite severe workforce and physical infrastructural deficiencies at Soroti Regional Referral Hospital, providers are adjusting and innovating to deliver surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.

When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

PubMed

Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

2013-01-01

Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

Methodological tools for the collection and analysis of participant observation data using grounded theory.

PubMed

Laitinen, Heleena; Kaunonen, Marja; Astedt-Kurki, Päivi

2014-11-01

To give clarity to the analysis of participant observation in nursing when implementing the grounded theory method. Participant observation (PO) is a method of collecting data that reveals the reality of daily life in a specific context. In grounded theory, interviews are the primary method of collecting data but PO gives a distinctive insight, revealing what people are really doing, instead of what they say they are doing. However, more focus is needed on the analysis of PO. An observational study carried out to gain awareness of nursing care and its electronic documentation in four acute care wards in hospitals in Finland. Discussion of using the grounded theory method and PO as a data collection tool. The following methodological tools are discussed: an observational protocol, jotting of notes, microanalysis, the use of questioning, constant comparison, and writing and illustrating. Each tool has specific significance in collecting and analysing data, working in constant interaction. Grounded theory and participant observation supplied rich data and revealed the complexity of the daily reality of acute care. In this study, the methodological tools provided a base for the study at the research sites and outside. The process as a whole was challenging. It was time-consuming and it required rigorous and simultaneous data collection and analysis, including reflective writing. Using these methodological tools helped the researcher stay focused from data collection and analysis to building theory. Using PO as a data collection method in qualitative nursing research provides insights. It is not commonly discussed in nursing research and therefore this study can provide insight, which cannot be seen or revealed by using other data collection methods. Therefore, this paper can produce a useful tool for those who intend to use PO and grounded theory in their nursing research.

The uses and implications of standards in general practice consultations.

PubMed

Lippert, Maria Laura; Reventlow, Susanne; Kousgaard, Marius Brostrøm

2017-01-01

Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While 'hard' biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include standards for the 'softer' aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development has been introduced. Data from semi-structured interviews and observations among 17 general practitioners were analysed using an iterative analytical approach, which served to identify important variations in the uses and impacts of the technology. The most pronounced impact of the technology was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor-patient dialogues and to divert general practitioners' attention from patients' personal concerns. Similar consequences of quality standards have previously been framed as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the 'softer' aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients.

Real-Time Observation of Apathy in Long-Term Care Residents With Dementia: Reliability of the Person-Environment Apathy Rating Scale.

PubMed

Jao, Ying-Ling; Mogle, Jacqueline; Williams, Kristine; McDermott, Caroline; Behrens, Liza

2018-04-01

Apathy is prevalent in individuals with dementia. Lack of responsiveness to environmental stimulation is a key characteristic of apathy. The Person-Environment Apathy Rating (PEAR) scale consists of environment and apathy subscales, which allow for examination of environmental impact on apathy. The interrater reliability of the PEAR scale was examined via real-time observation. The current study included 45 observations of 15 long-term care residents with dementia. Each participant was observed at three time points for 10 minutes each. Two raters observed the participant and surrounding environment and independently rated the participant's apathy and environmental stimulation using the PEAR scale. Weighted Kappa was 0.5 to 0.82 for the PEAR-Environment subscale and 0.5 to 0.8 for the PEAR-Apathy subscale. Overall, with the exception of three items with relatively weak reliability (0.50 to 0.56), the PEAR scale showed moderate to strong interrater reliability (0.63 to 0.82). The results support the use of the PEAR scale to measure environmental stimulation and apathy via real-time observation in long-term care residents with dementia. [Journal of Gerontological Nursing, 44(4), 23-28.]. Copyright 2018, SLACK Incorporated.

[Communication strategies of the nursing team in the aphasia after cerebrovascular accident].

PubMed

Souza, Regina Cláudia Silva; Arcuri, Edna Apparecida Moura

2014-04-01

This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.

Chronic care coordination by integrating care through a team-based, population-driven approach: a case study.

PubMed

van Eeghen, Constance O; Littenberg, Benjamin; Kessler, Rodger

2018-05-23

Patients with chronic conditions frequently experience behavioral comorbidities to which primary care cannot easily respond. This study observed a Vermont family medicine practice with integrated medical and behavioral health services that use a structured approach to implement a chronic care management system with Lean. The practice chose to pilot a population-based approach to improve outcomes for patients with poorly controlled Type 2 diabetes using a stepped-care model with an interprofessional team including a community health nurse. This case study observed the team's use of Lean, with which it designed and piloted a clinical algorithm composed of patient self-assessment, endorsement of behavioral goals, shared documentation of goals and plans, and follow-up. The team redesigned workflows and measured reach (patients who engaged to the end of the pilot), outcomes (HbA1c results), and process (days between HbA1c tests). The researchers evaluated practice member self-reports about the use of Lean and facilitators and barriers to move from pilot to larger scale applications. Of 20 eligible patients recruited over 3 months, 10 agreed to participate and 9 engaged fully (45%); 106 patients were controls. Relative to controls, outcomes and process measures improved but lacked significance. Practice members identified barriers that prevented implementation of all changes needed but were in agreement that the pilot produced useful outcomes. A systematized, population-based, chronic care management service is feasible in a busy primary care practice. To test at scale, practice leadership will need to allocate staffing, invest in shared documentation, and standardize workflows to streamline office practice responsibilities.

Patient-reported care coordination: associations with primary care continuity and specialty care use.

PubMed

Liss, David T; Chubak, Jessica; Anderson, Melissa L; Saunders, Kathleen W; Tuzzio, Leah; Reid, Robert J

2011-01-01

Care coordination is increasingly recognized as a necessary element of high-quality, patient-centered care. This study investigated (1) the association between care coordination and continuity of primary care, and (2) differences in this association by level of specialty care use. We conducted a cross-sectional study of Medicare enrollees with select chronic conditions in an integrated health care delivery system in Washington State. We collected survey information on patient experiences and automated health care utilization data for 1 year preceding survey completion. Coordination was defined by the coordination measure from the short form of the Ambulatory Care Experiences Survey (ACES). Continuity was measured by primary care visit concentration. Patients who had 10 or more specialty care visits were classified as high users. Linear regression was used to estimate the association between coordination and continuity, controlling for potential confounders and clustering within clinicians. We used a continuity-by-specialty interaction term to determine whether the continuity-coordination association was modified by high specialty care use. Among low specialty care users, an increase of 1 standard deviation (SD) in continuity was associated with an increase of 2.71 in the ACES coordination scale (P <.001). In high specialty care users, we observed no association between continuity and reported coordination (P= .77). High use of specialty care may strain the ability of primary care clinicians to coordinate care effectively. Future studies should investigate care coordination interventions that allow for appropriate specialty care referrals without diminishing the ability of primary care physicians to manage overall patient care.

Safer handling practice: influence of staff education on older people.

PubMed

Wilson, Christine Brown

The purpose of this small-scale survey was to explore the level of moving and handling training undertaken by nurses within private sector continuing care environments and the potential this training had to influence the care of older people. This study uses a definition of safer handling practice derived from existing literature to examine how nurses report the application of this training and whether they observe changes to the mobility of older people within their care. The limitations of this study indicate that generalizations must be made cautiously. However, this study tentatively suggests that potential exists to influence positively the use of safer handling practice as defined within this study. Recommendations for further study are made.

Patterns of task and network actions performed by navigators to facilitate cancer care.

PubMed

Clark, Jack A; Parker, Victoria A; Battaglia, Tracy A; Freund, Karen M

2014-01-01

Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized. The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care. We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes. Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly. Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.

Lounging with robots--social spaces of residents in care: A comparison trial.

PubMed

Peri, Kathryn; Kerse, Ngaire; Broadbent, Elizabeth; Jayawardena, Chandimal; Kuo, Tony; Datta, Chandan; Stafford, Rebecca; MacDonald, Bruce

2016-03-01

To investigate whether robots could reduce resident sleeping and stimulate activity in the lounges of an older persons' care facility. Non-randomised controlled trial over a 12-week period. The intervention involved situating robots in low-level and high-dependency ward lounges and a comparison with similar lounges without robots. A time sampling observation method was utilised to observe resident behaviour, including sleep and activities over periods of time, to compare interactions in robot and no robot lounges. The use of robots was modest; overall 13% of residents in robot lounges used the robot. Utilisation was higher in the low-level care lounges; on average, 23% used the robot, whereas in high-level care lounges, the television being on was the strongest predictor of sleep. This study found that having robots in lounges was mostly a positive experience. The amount of time residents slept during the day was significantly less in low-level care lounges that had a robot. © 2015 AJA Inc.

Characteristics of High-Cost Patients Diagnosed with Opioid Abuse.

PubMed

Shei, Amie; Rice, J Bradford; Kirson, Noam Y; Bodnar, Katharine; Enloe, Caroline J; Birnbaum, Howard G; Holly, Pamela; Ben-Joseph, Rami

2015-10-01

Prescription opioid abuse is associated with substantial economic burden, with estimates of incremental annual per-patient health care costs of diagnosed opioid abuse exceeding $10,000 in prior literature. A subset of patients diagnosed with opioid abuse has disproportionately high health care costs, but little is known about the characteristics of these patients.  To describe the characteristics of a subset of patients diagnosed with opioid abuse with disproportionately high health care costs to assist physicians and managed care organizations in targeting interventions at the costliest patients. This retrospective claims data analysis identified patients aged 12 to 64 years diagnosed with opioid abuse/dependence in the OptumHealth Reporting and Insights medical and pharmacy claims database, Quarter 1 (Q1) 1999-Q1 2012. Inclusion criteria required that patients had a diagnosis of opioid abuse during or after Q1 2006, no prior diagnoses of opioid abuse, and continuous non-HMO coverage over an 18-month study period. The study period comprised a 12-month observation period centered on the date of the first opioid abuse diagnosis (index date) and a 6-month baseline period immediately preceding the observation period. Patients in the top 20% of total health care costs in the observation period were classified as "high-cost patients," and the remaining patients were classified as "lower-cost patients." Patient characteristics, comorbidities, health care resource use, and health care costs were compared between high-cost patients and lower-cost patients using chi-square tests for dichotomous variables and Wilcoxon rank-sum tests for continuous variables. In addition, multivariate regression was used to assess the relationship between patient characteristics in the baseline period and total health care costs in the observation period among all patients diagnosed with opioid abuse.  9,291 patients diagnosed with opioid abuse met the inclusion criteria. The 20% of patients classified as high-cost patients accounted for approximately two thirds of the total health care costs of patients diagnosed with opioid abuse. Compared with lower-cost patients, high-cost patients were older (42.5 vs. 36.1; P  less than  0.001) and more likely to be female (55.9% vs. 42.9%; P  less than  0.001). They had a higher comorbidity burden at baseline, as reflected in the Charlson Comorbidity Index (0.8 vs. 0.2; P  less than  0.001), and rates of conditions such as chronic pulmonary disease (12.9% vs. 5.6%; P  less than  0.001) and mild/moderate diabetes (8.4% vs. 3.4%; P  less than  0.001). High-cost patients also had higher rates of nonopioid substance abuse diagnoses (12.4% vs. 8.9%; P  less than  0.001) and psychotic disorders (26.5% vs. 13.6%; P  less than  0.001). In the observation period, high-cost patients continued to have higher rates of nonopioid substance abuse diagnoses (53.0% vs. 47.2%; P  less than  0.001) and psychotic disorders (67.1% vs. 47.5%; P  less than  0.001). In addition, they had greater medical resource use across all places of service (i.e., inpatient, emergency department, outpatient, drug/alcohol rehabilitation facility, and other) compared with lower-cost patients. The mean observation period health care costs of high-cost patients was $89,177 compared with $11,653 for lower-cost patients (P  less than  0.001). High-cost patients had higher medical costs linked to claims with an opioid abuse diagnosis in absolute terms, but the share of total medical costs attributed to such claims was lower among high-cost patients than among lower-cost patients. While many baseline characteristics were found to have a statistically significant (P  less than  0.05) association with observation period health care costs, only 27.3% of the variation in observation period health care costs was explained by patient characteristics in the baseline period. This study found that the costliest patients diagnosed with opioid abuse had high rates of preexisting and concurrent chronic comorbidities and mental health conditions, suggesting potential indicators for targeted intervention and a need for greater awareness and screening of comorbid conditions. Opioid abuse may exacerbate existing conditions and make it difficult for patients to adhere to treatment plans for those underlying conditions. Baseline patient characteristics explained only a small share of the variation in observation period health care costs, however. Future research should explore the degree to which other factors not captured in administrative claims data (e.g., severity of abuse) can explain the wide variation in health care costs among opioid abusers.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts

PubMed Central

Gómez-García, Teresa; Ruzafa-Martínez, María; Fuentelsaz-Gallego, Carmen; Madrid, Juan Antonio; Rol, Maria Angeles; Martínez-Madrid, María José; Moreno-Casbas, Teresa

2016-01-01

Objective The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. Methods This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. Results 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). Conclusions Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers. PMID:27496241

A Comprehensive Observational Coding Scheme for Analyzing Instrumental, Affective, and Relational Communication in Health Care Contexts

PubMed Central

SIMINOFF, LAURA A.; STEP, MARY M.

2011-01-01

Many observational coding schemes have been offered to measure communication in health care settings. These schemes fall short of capturing multiple functions of communication among providers, patients, and other participants. After a brief review of observational communication coding, the authors present a comprehensive scheme for coding communication that is (a) grounded in communication theory, (b) accounts for instrumental and relational communication, and (c) captures important contextual features with tailored coding templates: the Siminoff Communication Content & Affect Program (SCCAP). To test SCCAP reliability and validity, the authors coded data from two communication studies. The SCCAP provided reliable measurement of communication variables including tailored content areas and observer ratings of speaker immediacy, affiliation, confirmation, and disconfirmation behaviors. PMID:21213170

The Impact of an eHealth Portal on Health Care Professionals' Interaction with Patients: Qualitative Study.

PubMed

Das, Anita; Faxvaag, Arild; Svanæs, Dag

2015-11-24

People who undergo weight loss surgery require a comprehensive treatment program to achieve successful outcomes. eHealth solutions, such as secure online portals, create new opportunities for improved health care delivery and care, but depend on the organizational delivery systems and on the health care professionals providing it. So far, these have received limited attention and the overall adoption of eHealth solutions remains low. In this study, a secure eHealth portal was implemented in a bariatric surgery clinic and offered to their patients. During the study period of 6 months, 60 patients and 5 health care professionals had access. The portal included patient information, self-management tools, and communication features for online dialog with peers and health care providers at the bariatric surgery clinic. The aim of this study was to characterize and assess the impact of an eHealth portal on health care professionals' interaction with patients in bariatric surgery. This qualitative case study involved a field study consisting of contextual interviews at the clinic involving observing and speaking with personnel in their actual work environment. Semi-structured in-depth interviews were conducted with health care professionals who interacted with patients through the portal. Analysis of the collected material was done inductively using thematic analysis. The analysis revealed two main dimensions of using an eHealth portal in bariatric surgery: the transparency it represents and the responsibility that follows by providing it. The professionals reported the eHealth portal as (1) a source of information, (2) a gateway to approach and facilitate the patients, (3) a medium for irrevocable postings, (4) a channel that exposes responsibility and competence, and (5) a tool in the clinic. By providing an eHealth portal to patients in a bariatric surgery program, health care professionals can observe patients' writings and revelations thereby capturing patient challenges and acting and implementing measures. Interacting with patients through the portal can prevent dropouts and deterioration of patients' health. However, professionals report on organizational challenges and personal constraints related to communicating with patients in writing online. Further development of guidelines and education of health care professionals about how to handle, prioritize, communicate, and facilitate patients online is required in addition to increased attention to the organizational infrastructures and incentives for enabling such solutions in health care.

The Impact of an eHealth Portal on Health Care Professionals’ Interaction with Patients: Qualitative Study

PubMed Central

Faxvaag, Arild; Svanæs, Dag

2015-01-01

Background People who undergo weight loss surgery require a comprehensive treatment program to achieve successful outcomes. eHealth solutions, such as secure online portals, create new opportunities for improved health care delivery and care, but depend on the organizational delivery systems and on the health care professionals providing it. So far, these have received limited attention and the overall adoption of eHealth solutions remains low. In this study, a secure eHealth portal was implemented in a bariatric surgery clinic and offered to their patients. During the study period of 6 months, 60 patients and 5 health care professionals had access. The portal included patient information, self-management tools, and communication features for online dialog with peers and health care providers at the bariatric surgery clinic. Objective The aim of this study was to characterize and assess the impact of an eHealth portal on health care professionals’ interaction with patients in bariatric surgery. Methods This qualitative case study involved a field study consisting of contextual interviews at the clinic involving observing and speaking with personnel in their actual work environment. Semi-structured in-depth interviews were conducted with health care professionals who interacted with patients through the portal. Analysis of the collected material was done inductively using thematic analysis. Results The analysis revealed two main dimensions of using an eHealth portal in bariatric surgery: the transparency it represents and the responsibility that follows by providing it. The professionals reported the eHealth portal as (1) a source of information, (2) a gateway to approach and facilitate the patients, (3) a medium for irrevocable postings, (4) a channel that exposes responsibility and competence, and (5) a tool in the clinic. Conclusions By providing an eHealth portal to patients in a bariatric surgery program, health care professionals can observe patients’ writings and revelations thereby capturing patient challenges and acting and implementing measures. Interacting with patients through the portal can prevent dropouts and deterioration of patients’ health. However, professionals report on organizational challenges and personal constraints related to communicating with patients in writing online. Further development of guidelines and education of health care professionals about how to handle, prioritize, communicate, and facilitate patients online is required in addition to increased attention to the organizational infrastructures and incentives for enabling such solutions in health care. PMID:26601678

Which features of primary care affect unscheduled secondary care use? A systematic review.

PubMed

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-05-23

To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Observational studies at primary care practice level. Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evaluation of a chronic disease management system for the treatment and management of diabetes in primary health care practices in Ontario: an observational study.

PubMed

O'Reilly, D J; Bowen, J M; Sebaldt, R J; Petrie, A; Hopkins, R B; Assasi, N; MacDougald, C; Nunes, E; Goeree, R

2014-01-01

Computerized chronic disease management systems (CDMSs), when aligned with clinical practice guidelines, have the potential to effectively impact diabetes care. The objective was to measure the difference between optimal diabetes care and actual diabetes care before and after the introduction of a computerized CDMS. This 1-year, prospective, observational, pre/post study evaluated the use of a CDMS with a diabetes patient registry and tracker in family practices using patient enrolment models. Aggregate practice-level data from all rostered diabetes patients were analyzed. The primary outcome measure was the change in proportion of patients with up-to-date "ABC" monitoring frequency (i.e., hemoglobin A1c, blood pressure, and cholesterol). Changes in the frequency of other practice care and treatment elements (e.g., retinopathy screening) were also determined. Usability and satisfaction with the CDMS were measured. Nine sites, 38 health care providers, and 2,320 diabetes patients were included. The proportion of patients with up-to-date ABC (12%), hemoglobin A1c (45%), and cholesterol (38%) monitoring did not change over the duration of the study. The proportion of patients with up-to-date blood pressure monitoring improved, from 16% to 20%. Data on foot examinations, retinopathy screening, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and documentation of self-management goals were not available or not up to date at baseline for 98% of patients. By the end of the study, attitudes of health care providers were more negative on the Training, Usefulness, Daily Practice, and Support from the Service Provider domains of the CDMS, but more positive on the Learning, Using, Practice Planning, CDMS, and Satisfaction domains. Few practitioners used the CDMS, so it was difficult to draw conclusions about its efficacy. Simply giving health care providers a potentially useful technology will not ensure its use. This real-world evaluation of a web-based CDMS for diabetes failed to impact physician practice due to limited use of the system. Patients and health care providers need timely access to information to ensure proper diabetes care. This study looked at whether a computer-based system at the doctor's office could improve diabetes management. However, few clinics and health care providers used the system, so no improvement in diabetes care was seen.

Critical care nurses' decision making: sedation assessment and management in intensive care.

PubMed

Aitken, Leanne M; Marshall, Andrea P; Elliott, Rosalind; McKinley, Sharon

2009-01-01

This study was designed to examine the decision making processes that nurses use when assessing and managing sedation for a critically ill patient, specifically the attributes and concepts used to determine sedation needs and the influence of a sedation guideline on the decision making processes. Sedation management forms an integral component of the care of critical care patients. Despite this, there is little understanding of how nurses make decisions regarding assessment and management of intensive care patients' sedation requirements. Appropriate nursing assessment and management of sedation therapy is essential to quality patient care. Observational study. Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during two separate occasions for two hours of care. Follow-up interviews were conducted to collect data from five expert critical care nurses pre- and postimplementation of a sedation guideline. Data from all sources were integrated, with data analysis identifying the type and number of attributes and concepts used to form decisions. Attributes and concepts most frequently used related to sedation and sedatives, anxiety and agitation, pain and comfort and neurological status. On average each participant raised 48 attributes related to sedation assessment and management in the preintervention phase and 57 attributes postintervention. These attributes related to assessment (pre, 58%; post, 65%), physiology (pre, 10%; post, 9%) and treatment (pre, 31%; post, 26%) aspects of care. Decision making in this setting is highly complex, incorporating a wide range of attributes that concentrate primarily on assessment aspects of care. Clinical guidelines should provide support for strategies known to positively influence practice. Further, the education of nurses to use such guidelines optimally must take into account the highly complex iterative process and wide range of data sources used to make decisions.

Health care use of patients with osteoarthritis of the hip or knee after implementation of a stepped-care strategy: an observational study.

PubMed

Smink, Agnes J; Dekker, Joost; Vliet Vlieland, Thea P M; Swierstra, Bart A; Kortland, Joke H; Bijlsma, Johannes W J; Teerenstra, Steven; Voorn, Theo B; Bierma-Zeinstra, Sita M A; Schers, Henk J; van den Ende, Cornelia H M

2014-06-01

To enhance guideline-based nonsurgical management of osteoarthritis (OA), a multidisciplinary stepped-care strategy has been implemented in clinical practice. This study aimed to describe health care use after implementation of this strategy and to identify factors related to such use at multiple levels. For this 2-year observational prospective cohort, patients with symptomatic hip or knee OA were included by their general practitioner. Activities aligned with patients and health care providers were executed to implement the strategy. Health care use was described as the cumulative percentage of "users" for each modality recommended in the strategy. Determinants were identified at the level of the patient, general practitioner, and practice using backward stepwise logistic multilevel regression models. Three hundred thirteen patients were included by 70 general practitioners of 38 practices. Their mean ± SD age was 64 ± 10 years and 120 (38%) were men. The most frequently used modalities were education, acetaminophen, lifestyle advice, and exercise therapy, which were used by 242 (82%), 250 (83%), 214 (73%), and 187 (63%) patients, respectively. Fourteen percent of the overweight patients reported being treated by a dietician. Being female, having an active coping style, using the booklet "Care for Osteoarthritis," and having limitations in functioning were recurrently identified as determinants of health care use. After implementation of the stepped-care strategy, most recommended nonsurgical modalities seem to be well used. Health care could be further improved by providing dietary therapy in overweight patients and making more efforts to encourage patients with a passive coping style to use nonsurgical modalities. Copyright © 2014 by the American College of Rheumatology.

Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases.

PubMed

Heins, Marianne J; Korevaar, Joke C; Hopman, Petra E P C; Donker, Gé A; Schellevis, François G; Rijken, Mieke P M

2016-03-15

The number of cancer survivors is steadily increasing and these patients often experience long-lasting health problems. To make care for cancer survivors sustainable for the future, it would be relevant to put the effects of cancer in this phase into perspective. Therefore, the authors compared health-related quality of life (HRQOL) and health care use among cancer survivors with that of patients with chronic diseases. Patients diagnosed at age >18 years with a cancer with a 5-year survival rate > 20% and no distant metastases at the time of diagnosis and patients aged >18 years with physician-diagnosed somatic chronic diseases without cancer were sent a questionnaire. HRQOL was measured with the RAND-36, a measure of HRQOL. Self-reported health care use was measured for general practitioner care, specialist care, rehabilitative care, physical therapy, ambulatory mental health care, and occupational health care. A total of 601 cancer survivors and 1052 patients with chronic diseases without cancer were included in the current study. Multimorbidity was observed in 63% of the cancer survivors and 61% of the patients with chronic diseases. The HRQOL of the cancer survivors was significantly better than that of patients with chronic diseases after adjustment for age and sex. For the mental functioning subscale, no significant differences were found between the 2 groups. Cancer survivors were found to be less likely to have visited a general practitioner or cardiologist compared with patients with chronic diseases. When considering physical HRQOL and health care use, cancer survivors appear to fare better than the average patient with chronic diseases. No difference in mental functioning was observed in the current study. © 2016 American Cancer Society.

Evaluating and improving a model of nursing care delivery: a process of partnership.

PubMed

Hall, Catherine; McCutcheon, Helen; Deuter, Kate; Matricciani, Lisa

2012-01-01

Evaluating and improving a model of nursing care is a fundamental part of clinical practice improvement. While Australian nurses are showing increasing interest in improving models of care delivery, more research is needed that addresses and articulates the processes attendant upon evaluating, re-designing and implementing improvements to the provision of nursing care. Providing nurses with an open opportunity to plan, act, observe and reflect on their practice promotes successful partnerships between academics and clinicians. The aim of this study was to evaluate and improve the model of nursing care delivery to patients in a general surgical ward using participatory action research. Researchers conducted non-participant observations (n = 9) of two hours duration across the 24 h period. Focus groups (n = 3) were used to share non-participant observation data with staff, providing them with an opportunity to reflect on their practice and explore possible solutions. Data was collected in 2008-2009. Two main problem areas were identified as impeding the nurses' ability to provide care to patients: (i) practices and behaviours of nurses and (ii) infrastructure and physical layout of the ward. An overview of issues within each problem area is presented. Shifting the focus of task-centred care towards a more patient-centred care approach, results directly in improvements in resource utilisation, improved cost-effectiveness and job satisfaction for nursing staff. New ways of thinking about nursing processes and systems, workflow design and skill allocation will guide hospital administrators and managers in the effective and efficient allocation of nursing work in similar settings.

Physician Activities During Time Out of the Examination Room

PubMed Central

Gilchrist, Valerie; McCord, Gary; Schrop, Susan Labuda; King, Bridget D.; McCormick, Kenelm F.; Oprandi, Allison M.; Selius, Brian A.; Cowher, Michael; Maheshwary, Rishi; Patel, Falguni; Shah, Ami; Tsai, Bonny; Zaharna, Mia

2005-01-01

PURPOSE Comprehensive medical care requires direct physician-patient contact, other office-based medical activities, and medical care outside of the office. This study was a systematic investigation of family physician office-based activities outside of the examination room. METHODS In the summer of 2000, 6 medical students directly observed and recorded the office-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day. RESULTS The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records. CONCLUSIONS If office-based, medically related activities were averaged over the number of patients seen in the office that day, the average office visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care. PMID:16338912

An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery.

PubMed

Symons, Nicholas R A; Almoudaris, Alex M; Nagpal, Kamal; Vincent, Charles A; Moorthy, Krishna

2013-01-01

To investigate the nature of process failures in postoperative care, to assess their frequency and preventability, and to explore their relationship to adverse events. Adverse events are common and are frequently caused by failures in the process of care. These processes are often evaluated independently using clinical audit. There is little understanding of process failures in terms of their overall frequency, relative risk, and cumulative effect on the surgical patient. Patients were observed daily from the first postoperative day until discharge by an independent surgeon. Field notes on the circumstances surrounding any nonroutine or atypical event were recorded. Field notes were assessed by 2 surgeons to identify failures in the process of care. Preventability, the degree of harm caused to the patient, and the underlying etiology of process failures were evaluated by 2 independent surgeons. Fifty patients undergoing major elective general surgery were observed for a total of 659 days of postoperative care. A total of 256 process failures were identified, of which 85% were preventable and 51% directly led to patient harm. Process failures occurred in all aspects of care, the most frequent being medication prescribing and administration, management of lines, tubes, and drains, and pain control interventions. Process failures accounted for 57% of all preventable adverse events. Communication failures and delays were the main etiologies, leading to 54% of process failures. Process failures are common in postoperative care, are highly preventable, and frequently cause harm to patients. Interventions to prevent process failures will improve the reliability of surgical postoperative care and have the potential to reduce hospital stay.

Transcultural nursing and a care management partnership project.

PubMed

Lazure, G; Vissandjée, B; Pepin, J; Kérouac, S

1997-09-01

This paper aims to illustrate how Leininger's Theory of Culture Care Diversity and Universality has influenced the research process of a study that emerged from a care management partnership between Canadian nursing teachers and Tunisian nurses. The purpose of the study was to investigate the meanings of care as viewed by university hospital-based Tunisian nurses. The qualitative analysis of data gathered through observation-participation and interviews highlights recurrent patterns and reveals three major professional care themes. For Tunisian nurses care means to secure the patient's cooperation towards the medical regimen within established rules in the hospital; to contribute to curing the patient by using current technology as well as by maintaining their technical skills and improving their medical knowledge; to take charge of the patient to assist the physician in treating disease. This study showed that Tunisian nurses emphasize curing rather than widely shared community values such as interdependence, intercommunication, understanding, presence and responsibility for others. Discussion of the study's findings draws upon the perspective provided by Freire's Oppressed Group Theory. In order to promote cultural congruence within the Care Management Partnership Project in Tunisia, the three predicted modes of care within Leininger's theory guide the decisions and actions for future nursing research and partnership activities.

A Time-Motion Study of ICU Workflow and the Impact of Strain.

PubMed

Hefter, Yosefa; Madahar, Purnema; Eisen, Lewis A; Gong, Michelle N

2016-08-01

Understanding ICU workflow and how it is impacted by ICU strain is necessary for implementing effective improvements. This study aimed to quantify how ICU physicians spend time and to examine the impact of ICU strain on workflow. Prospective, observational time-motion study. Five ICUs in two hospitals at an academic medical center. Thirty attending and resident physicians. None. In 137 hours of field observations, the most time-84 hours (62% of total observation time)-was spent on professional communication. Reviewing patient data and documentation occupied a combined 52 hours (38%), whereas direct patient care and education occupied 24 hours (17%) and 13 hours (9%), respectively. The most frequently used tool was the computer, used in tasks that occupied 51 hours (37%). Severity of illness of the ICU on day of observation was the only strain factor that significantly impacted work patterns. In a linear regression model, increase in average ICU Sequential Organ Failure Assessment was associated with more time spent on direct patient care (β = 4.3; 95% CI, 0.9-7.7) and education (β = 3.2; 95% CI, 0.7-5.8), and less time spent on documentation (β = -7.4; 95% CI, -11.6 to -3.2) and on tasks using the computer (β = -7.8; 95% CI, -14.1 to -1.6). These results were more pronounced with a combined strain score that took into account unit census and Sequential Organ Failure Assessment score. After accounting for ICU type (medical vs surgical) and staffing structure (resident staffed vs physician assistant staffed), results changed minimally. Clinicians spend the bulk of their time in the ICU on professional communication and tasks involving computers. With the strain of high severity of illness and a full unit, clinicians reallocate time from documentation to patient care and education. Further efforts are needed to examine system-related aspects of care to understand the impact of workflow and strain on patient care.

[Comparison of survival under domestic or institutional care: the Hannover morbidity and mortality long-term care study].

PubMed

Seger, W; Sittaro, N-A; Lohse, R; Rabba, J

2011-07-01

Empirical data, representative of the total population are necessary for medico-actuarial risk calculations. Our study compares mortalities of long-term care (LTC) patients with regard to age, gender and distribution of care levels when in home or institutional care. The data of 88.575 long-term care patients were analysed longitudinally for ten years, using routine data on the files of the German Federal Health Insurance fund (average observation period 2.5 years, a total of 221.625 observation years). The numbers of LTC patients and their care levels while remaining in home or institutional care were calculated, as were any changes to another care level or discontinuation of long-term care benefits (as a result of the need for care falling below the eligibility criteria for care level I or to death) during 1 - 10 years after the onset of long-term care. Total mortality was found to increase with age and care level in homecare as well as in institutional settings for both sexes. It is greatly influenced by the first year mortality, which for both genders was lower for care level 1 in home care settings but higher for care level 2 and much higher for care level 3 than in institutional care settings. Follow-up mortality (second to tenth year after the start of LTC) was lower for care level 1 and 2 in home care settings than for institutional care. But for care level 3 the follow-up mortality was conversely higher in home care settings than in institutional care (for both genders). The number of patients returning to an active life after rehabilitation is much higher for home care patients than those who had been in institutional care. The transfer rate from homecare to institutional care increased during the first three years after onset of care, descending thereafter, and was much higher than conversely. The slogan "outpatient care before inpatient care" must be differentiated and considered carefully with regard to the character and constellation of diseases, age attained, length of time after onset of care, care level, potential for resuming an active life, as well as level of compensation and number and nature of activities of daily life together with being given the necessary help when choosing between homecare or institutional care. Differentiation between first year and follow-up mortalities is recommended when undertaking medico-actuarial calculations. Georg Thieme Verlag KG Stuttgart · New York.

Identifying organisational principles and management practices important to the quality of health care services for chronic conditions.

PubMed

Frølich, Anne

2012-02-01

The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved. The aim of this dissertation is to describe the effect of determinants, such as organisational structures and management practices including two selected incentives, on the quality of care in chronic diseases. The dissertation is based on four studies with the following purposes: 1) macro- or healthcare system-level identification of organisational structures and principles that affect the quality of health care services, based on a comparison of KP and the Danish health care system; 2) meso- or organisation-level identification of management practices with positive effects on screening rates for hemoglobin A1c and lipid profile in diabetes; 3) evaluation of the effect of the CCM on quality of health care services and continuity of care in a Danish setting; 4) micro- or practice-level evaluation of the effect of financial incentives and public performance reporting on the behaviour of professionals and quality of care. Using secondary data, KP and the Danish health care system were compared in terms of six central dimensions: population, health care professionals, health care organisations, utilization patterns, quality measurements, and costs. Differences existed between the two systems on all dimensions, complicating the interpretation of findings. For instance, observed differences might be due to similar tendencies in the two health care systems that were observed at different times, rather than true structural differences. The expenses in the two health care systems were corrected for differences in the populations served and the purchasing power of currencies. However, no validated methods existed to correct for observed differences in case-mixes of chronic conditions. Data from a population of about half a million patients with diabetes in a large U.S. integrated health care delivery system affiliated with 41 medical centers employing 15 different CCM management practices was the basis for identifying effective management practices. Through the use of statistical modelling, the management practice of provider alerts was identified as most effective for promoting screening for hemoglobin A1c and lipid profile. The CCM was used as a framework for implementing four rehabilitation programs. The model promoted continuity of care and quality of health care services. New management practices were developed in the study, and known practices were further developed. However, the observational nature of the study limited the generalisability of the findings. In a structured literature survey focusing on the effect of financial incentives and public performance reporting on the quality of health care services, few studies documenting an effect were identified. The results varied, and important program aspects or contextual variables were often omitted. A model describing the effects of the two incentives on the conduct of health care professionals and their interaction with the organisations in which they serve was developed. On the macro-level, organisational differences between KP and the Danish health care system related to the primary care sectors, utilization patterns, and the quality of health care services, supporting a hypothesis that KP's focus on primary care is a beneficial form of organisation. On the meso-level, use of the CCM improved quality of health care services, but the effect is complicated and context dependent. The CCM was found to be useful in the Danish health care system, and the model was also further developed in a Danish setting. On the micro-level, quality was improved by financial incentives and disclosure in a complex interplay with other central factors in the work environment of health care professionals.

[The model of Human Caring: results of a pre- and post-intervention study with a control group].

PubMed

Brunetti, Piercarlo; Pellegrini, Walter; Masera, Giuliana; Berchialla, Paola; Dal Molin, Alberto

2015-01-01

The "Human Caring" model is a philosophy of care based on individual centrality and which, although developed within nursing discipline, could be used by all professionals who take care of individuals. Nurses who work within the field of Mental Health, is subjected to a considerable emotional burden and it is believed that the introduction of this model can have a positive impact. To evaluate the effects of the introduction of the model Human Caring in the Department of Mental Health Asl Cuneo 1, in order to improve health care professionals' well-being and patients' perception with respect to care and assistance. A pre and post intervention design approach with control group where variables were measured before (T0) and after (T1) the implementation of the model of care Human Caring. 80 health care professionals and 125 clients were observed. Results show a non statistically significant difference between the pre and post test both for health care professionals and clients. Human Caring model does not seem to have a positive impact in the short term. However, it is arguably a protective action for health care professionals that further studies should deeply explore with longer period of follow-up.

Moments of homecoming among people with advanced dementia disease in a residential care facility.

PubMed

Norberg, Astrid; Ternestedt, Britt-Marie; Lundman, Berit

2017-07-01

This study concerns moments of homecoming among people with advanced dementia disease living in a residential care facility. Our main finding from participant observations with nine residents was that the residents showed moments of homecoming, i.e. they alternated between verbal and/or nonverbal expressions of feeling at home and of not feeling at home. If care providers understand that they can help people with advanced dementia disease experience moments of homecoming, they can focus on aspects of care that can promote these experiences.

Creating learning momentum through overt teaching interactions during real acute care episodes.

PubMed

Piquette, Dominique; Moulton, Carol-Anne; LeBlanc, Vicki R

2015-10-01

Clinical supervisors fulfill a dual responsibility towards patient care and learning during clinical activities. Assuming such roles in today's clinical environments may be challenging. Acute care environments present unique learning opportunities for medical trainees, as well as specific challenges. The goal of this paper was to better understand the specific contexts in which overt teaching interactions occurred in acute care environments. We conducted a naturalistic observational study based on constructivist grounded theory methodology. Using participant observation, we collected data on the teaching interactions occurring between clinical supervisors and medical trainees during 74 acute care episodes in the critical care unit of two academic centers, in Toronto, Canada. Three themes contributed to a better understanding of the conditions in which overt teaching interactions among trainees and clinical supervisors occurred during acute care episodes: seizing emergent learning opportunities, coming up against challenging conditions, and creating learning momentum. Our findings illustrate how overt learning opportunities emerged from certain clinical situations and how clinical supervisors and trainees could purposefully modify unfavorable learning conditions. None of the acute care episodes encountered in the critical care environment represented ideal conditions for learning. Yet, clinical supervisors and trainees succeeded in engaging in overt teaching interactions during many episodes. The educational value of these overt teaching interactions should be further explored, as well as the impact of interventions aimed at increasing their use in acute care environments.

Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership.

PubMed

Kerr, Christopher W; Donohue, Kathleen A; Tangeman, John C; Serehali, Amin M; Knodel, Sarah M; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen; Marien, Melanie J

2014-12-01

In the United States, 5% of the population is responsible for nearly half of all health care expenditures, with a large concentration of spending driven by individuals with expensive chronic conditions in their last year of life. Outpatient palliative care under the Medicare Hospice Benefit excludes a large proportion of the chronically ill and there is widespread recognition that innovative strategies must be developed to meet the needs of the seriously ill while reducing costs. This study aimed to evaluate the impact of a home-based palliative care program, implemented through a hospice-private payer partnership, on health care costs and utilization. This was a prospective, observational database study where insurance enrollment and claims data were analyzed. The study population consisted of Home Connections (HC) program patients enrolled between January 1, 2010 and December 31, 2012 who subsequently expired (n=149) and who were also Independent Health members. A control group (n=537) was derived using propensity-score matching. The primary outcome variable was overall costs within the last year of life. Costs were also examined at six months, three months, one month, and two weeks. Inpatient, outpatient, ancillary, professional, and pharmacy costs were compared between the two groups. Medical service utilization and hospice enrollment and length of stay were also evaluated. Cost savings were apparent in the last three months of life—$6,804 per member per month (PMPM) cost for palliative care participants versus $10,712 for usual care. During the last two weeks of life, total allowed PMPM was $6,674 versus $13,846 for usual care. Enhanced hospice entry (70% versus 25%) and longer length of stay in hospice (median 34 versus 9 days) were observed. Palliative care programs partnered with community hospice providers may achieve cost savings while helping provide care across the continuum.

Experiences of adult patients using primary care services in Poland - a cross-sectional study in QUALICOPC study framework.

PubMed

Oleszczyk, Marek; Krztoń-Królewiecka, Anna; Schäfer, Willemijn L A; Boerma, Wienke G W; Windak, Adam

2017-11-22

Patients as real healthcare system users are important observers of primary care and are able to provide reliable information about the quality of care. The aim of this study was to explore the patients' experiences and their level of satisfaction with the process and outcomes of care provided by primary care physicians in Poland and to identify the characteristics of the patients, their physicians, and facilities associated with patient satisfaction. The study is based on data from the Polish part of the Quality and Costs of Primary Care in Europe (QUALICOPC) cross-sectional, questionnaire-based study. In Poland, a nationally representative sample of 220 PC physicians and 1980 of their patients were recruited to take part in the study. As a study tool we used 3 out of 4 QUALICOPC questionnaires: "Patient Experience", "PC Physician" and "Fieldworker" questionnaires. The areas of the best quality perceived by Polish PC patients are: equity, accessibility of care and quality of service. Coordination and comprehensiveness of care are evaluated relatively worse. The patients' and their physicians' characteristics have a limited influence on patient satisfaction and experiences with Polish primary care. Primary health care in Poland is of good overall quality as perceived by the patients. Study participants were at most satisfied with accessibility and equity of care and less satisfied with coordination and comprehensiveness of care. Longer patient-doctor relationship and older age of patients were found as the most influential determinants of higher satisfaction. However, variables used in this study poorly explain the overall level of satisfaction. Further research is needed to identify the other determinants of patient satisfaction in the Polish population. Rural practices deserve additional attention due to highest proportions of both extremely satisfied and dissatisfied patients.

Organization of care for persons with HIV-infection: a systematic review.

PubMed

Handford, Curtis D; Tynan, Anne-Marie; Agha, Ayda; Rzeznikiewiz, Damian; Glazier, Richard H

2017-07-01

The objective of this systematic review was to examine the effectiveness of the organization of care: case management, multidisciplinary care, multi-faceted treatment, hours of service, outreach programs and health information systems on medical, immunological, virological, psychosocial and economic outcomes for persons living with HIV/AIDS. We searched PubMed (MEDLINE) and 10 other electronic databases from 1 January 1980 to April, 2012 for both experimental and controlled observational studies. Thirty-three studies met the inclusion criteria. Eleven studies were randomized controlled trials (RCTs), three of which were conducted in low-middle income settings. Patient characteristics, study design, organization measures and outcomes data were abstracted independently by two reviewers from all studies. A risk of bias tool was applied to RCTs and a separate tool was used to assess the quality of observational studies. This review concludes that case management interventions were most consistently associated with improvements in immunological outcomes but case management demonstrates no clear association with other outcome measures. The same mixed results were also identified for multidisciplinary and multi-faceted care interventions. Eight studies with an outreach intervention were identified and demonstrated improvements or non-inferiority with respect to mortality, receipt of antiretroviral medications, immunological outcomes, improvements in healthcare utilization and lower reported healthcare costs when compared to usual care. Of the interventions examined in this review, sustained in-person case management and outreach interventions were most consistently associated with improved medical and economic outcomes, in particular antiretroviral prescribing, immunological outcomes and healthcare utilization. No firm conclusions can be reached about the impact of any one intervention on patient mortality.

Exploring interprofessional, interagency multimorbidity care: case study based observational research

PubMed Central

McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

2017-01-01

Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID:29090190

Body language in health care: a contribution to nursing communication.

PubMed

de Rezende, Rachel de Carvalho; de Oliveira, Rosane Mara Pontes; de Araújo, Sílvia Teresa Carvalho; Guimarães, Tereza Cristina Felippe; do Espírito Santo, Fátima Helena; Porto, Isaura Setenta

2015-01-01

to classify body language used in nursing care, and propose "Body language in nursing care" as an analytical category for nursing communication. quantitative research with the systematic observation of 21:43 care situations, with 21 members representing the nursing teams of two hospitals. Empirical categories: sound, facial, eye and body expressions. sound expressions emphasized laughter. Facial expressions communicated satisfaction and happiness. Eye contact with members stood out in visual expressions. The most frequent body expressions were head movements and indistinct touches. nursing care team members use body language to establish rapport with patients, clarify their needs and plan care. The study classified body language characteristics of humanized care, which involves, in addition to technical, non-technical issues arising from nursing communication.

Context of care for Jordanian women.

PubMed

Miller, June E; Petro-Nustas, Wasileh

2002-07-01

The purpose of this research study was to document, describe, and analyze diverse and universal care patterns for Jordanian women. The authors used a qualitative design of observation-participation and interview data collected from 15 women in two cities and three villages in Jordan over a 4-month period. Methods used incorporated Leininger's theory of culture care diversity and universality as well as the ethnonursing research method. Themes discovered from the data include (a) culture of caring connectedness, (b) caring for family honor: the agony and the ecstasy, (c) Islam as feminist thought, (d) political care as intertwined with tribal and religious influences, and (e) reviving Rufaida: return to community care. Findings are being used for collaborative curriculum design for new community health nursing roles focusing on women's health.

Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-06-01

Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

The Home Independence Program with non-health professionals as care managers: an evaluation.

PubMed

Lewin, Gill; Concanen, Karyn; Youens, David

2016-01-01

The Home Independence Program (HIP), an Australian restorative home care/reablement service for older adults, has been shown to be effective in reducing functional dependency and increasing functional mobility, confidence in everyday activities, and quality of life. These gains were found to translate into a reduced need for ongoing care services and reduced health and aged care costs over time. Despite these positive outcomes, few Australian home care agencies have adopted the service model - a key reason being that few Australian providers employ health professionals, who act as care managers under the HIP service model. A call for proposals from Health Workforce Australia for projects to expand the scope of practice of health/aged care staff then provided the opportunity to develop, implement, and evaluate a service delivery model, in which nonprofessionals replaced the health professionals as Care Managers in the HIP service. Seventy older people who received the HIP Coordinator (HIPC) service participated in the outcomes evaluation. On a range of personal outcome measures, the group showed statistically significant improvement at 3 and 12 months compared to baseline. On each outcome, the improvement observed was larger than that observed in a previous trial in which the service was delivered by health professionals. However, differences in the timing of data collection between the two studies mean that a direct comparison cannot be made. Clients in both studies showed a similarly reduced need for ongoing home care services at both follow-up points. The outcomes achieved by HIPC, with non-health professionals as Care Managers, were positive and can be considered to compare favorably with the outcomes achieved in HIP when health professionals take the Care Manager role. These findings will be of interest to managers of home care services and to policy makers interested in reducing the long-term care needs of older community dwelling individuals.

Effectiveness and Persistence of Liraglutide Treatment Among Patients with Type 2 Diabetes Treated in Primary Care and Specialist Settings: A Subgroup Analysis from the EVIDENCE Study, a Prospective, 2-Year Follow-up, Observational, Post-Marketing Study.

PubMed

Martinez, Luc; Penfornis, Alfred; Gautier, Jean-Francois; Eschwège, Eveline; Charpentier, Guillaume; Bouzidi, Amira; Gourdy, Pierre

2017-03-01

The objective of this subgroup analysis is to investigate the effectiveness of liraglutide in people with type 2 diabetes (T2D) treated within the primary care physician (PCP) and specialist care settings. EVIDENCE is a prospective, observational study of 3152 adults with T2D recently starting or about to start liraglutide treatment in France. We followed patients in the PCP and specialist settings for 2 years to evaluate the effectiveness of liraglutide in glycemic control and body weight reduction. Furthermore, we evaluated the changes in combined antihyperglycemic treatments, the reasons for prescribing liraglutide, patient satisfaction, and safety of liraglutide in these two treatment settings. After 2 years of follow-up, 477 out of 1209 (39.0%) of PCP and 297 out of 1398 (21.2%) of specialist-treated patients still used liraglutide and maintained the glycated hemoglobin (HbA 1c ) target of <7.0%. Significant reductions from baseline were observed in both PCP- and specialist-treated cohorts in mean HbA 1c (-1.22% and -0.8%, respectively), fasting plasma glucose (FPG) concentration (-39 and -23 mg/dL), body weight (-4.4 and -3.8 kg), and body mass index (BMI) (-1.5 and -1.4 kg/m 2 ), all p < 0.0001. Reductions in HbA 1c and FPG were significantly greater among PCP- compared with specialist-treated patients, p < 0.0001 for both. Patient treatment satisfaction was also significantly increased in both cohorts. Reported gastrointestinal adverse events were less frequent among PCP-treated patients compared with specialist-treated patients (4.5% vs. 16.1%). Despite differences in demography and clinical characteristics of patients treated for T2D in PCP and specialty care, greater reduction in HbA 1c and increased glycemic control durability were observed with liraglutide in primary care, compared with specialist care. These data suggest that liraglutide treatment could benefit patients in primary care by delaying the need for further treatment intensification. ClinicalTrials.gov identifier, NCT01226966. Novo Nordisk A/S.

The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.

PubMed

Wu, Robert C; Lo, Vivian; Morra, Dante; Wong, Brian M; Sargeant, Robert; Locke, Ken; Cavalcanti, Rodrigo; Quan, Sherman D; Rossos, Peter; Tran, Kim; Cheung, Mark

2013-01-01

Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. To describe the effects of different communication interventions and their problems. Prospective observational case study using a mixed methods approach of quantitative and qualitative methods. General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals. Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards. Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010. We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories. Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.

Paediatric nurses' perceptions and practices of family-centred care in Saudi hospitals: A mixed methods study.

PubMed

Alabdulaziz, Hawa; Moss, Cheryle; Copnell, Beverley

2017-04-01

Family-centred care is widely accepted as the underlying philosophy of paediatric nursing. Studies of family-centred care have mainly been conducted in western countries and little is known of its practice in other contexts. No studies have been undertaken in the Middle East. To explore family-centred care in the Saudi context from the perspectives of paediatric nurses. A mixed methodology was utilised with an explanatory sequential design. In the quantitative phase a convenience sample of 234 nurses from six hospitals in Jeddah, Saudi Arabia completed the Family Centred Care Questionnaire. The qualitative phase took place in one hospital and involved 140h of non-participant observation of paediatric nurses' practice. A convenience sample of 14 nurses was involved. Additionally, 10 face-to-face semi-structured interviews were conducted with key staff members. A purposeful sample of 10 nurses was involved. The findings from both phases were integrated in the final analysis. The survey results indicated that participants identified most elements of family-centred care as necessary for its practice. They were less likely to incorporate them into their practice (p<0.001, paired t-tests, all subscales). These findings were supported by the observation data, which revealed that, while several elements of family-centred care were frequently practised, others were implemented either inconsistently or not at all. Findings from the interview data indicated that participants had limited and superficial understanding of what family-centred care means as a model of care; rather, they worked with the elements as a set of core tasks. In the current study, there were similarities between what has been found in the Saudi context and findings from other studies using the same tool in western contexts. There is general agreement regarding the differences between theory and practice. Nurses do believe and acknowledge the importance of family-centred care; however, they struggle with practising this model in their everyday work. In the current study, many factors contributed to this issue, including language barriers, communication issues, cultural issues and hospital policies. Western concepts of family-centred care appear to be accepted by paediatric nurses in Saudi Arabia. However, full adoption of family-centred care in keeping with western values is likely not to be appropriate or successful in the Saudi context where both nurses and families have a non-western culture. The western model of family-centred care requires cultural modification and further development to fit Saudi and Middle Eastern cultures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Creation and use of a survey instrument for comparing mobile computing devices.

PubMed

Macri, Jennifer M; Lee, Paul P; Silvey, Garry M; Lobach, David F

2005-01-01

Both personal digital assistants (PDAs) and tablet computers have emerged to facilitate data collection at the point of care. However, little research has been reported comparing these mobile computing devices in specific care settings. In this study we present an approach for comparing functionally identical applications on a Palm operating system-based PDA and a Windows-based tablet computer for point-of-care documentation of clinical observations by eye care professionals when caring for patients with diabetes. Eye-care professionals compared the devices through focus group sessions and through validated usability surveys. This poster describes the development and use of the survey instrument used for comparing mobile computing devices.

Practices and challenges of infectious waste management: A qualitative descriptive study from tertiary care hospitals in Pakistan

PubMed Central

Kumar, Ramesh; Shaikh, Babar Tasneem; Somrongthong, Ratana; Chapman, Robert S

2015-01-01

Background and Objective: Infectious waste management practices among health care workers in the tertiary care hospitals have been questionable. The study intended to identify issues that impede a proper infectious waste management. Methods: Besides direct observation, in-depths interviews were conducted with the hospital administrators and senior management involved in healthcare waste management during March 2014. We looked at the processes related to segregation, collection, storage and disposal of hospital waste, and identified variety of issues in all the steps. Results: Serious gaps and deficiencies were observed related to segregation, collection, storage and disposal of the hospital wastes, hence proving to be hazardous to the patients as well as the visitors. Poor safety, insufficient budget, lack of trainings, weak monitoring and supervision, and poor coordination has eventually resulted in improper waste management in the tertiary hospitals of Rawalpindi. Conclusion: Study has concluded that the poor resources and lack of healthcare worker’s training in infectious waste results in poor waste management at hospitals. PMID:26430405

Palliative care is not yet a well-defined product within the Dutch healthcare insurance system.

PubMed

Jansen, Wim J J; Vissers, Kris C P; Zuurmond, Wouter W A; van Montfort, Guus P W P; Rhebergen, Andre; Loer, Stephan A

2009-07-01

In the Netherlands, the quality and availability of palliative care has improved markedly within the last decade. However, many open questions remain concerning the position of palliative care as an insurable product on the Dutch healthcare market. Therefore, we analysed the policies of all private Dutch healthcare insurance companies as well as the public insurance policy for extraordinary medical costs. We studied how and which parts of palliative care were reimbursed in 2007. We observed a huge variability in costs and reimbursement regulations reflecting a rapid turnover of products for palliative care due to various new developments on this specific field of medical care. We conclude that a better definition of the product 'palliative care' is necessary for patients, health care providers and insurance companies.

Assessing validity of observational intervention studies - the Benchmarking Controlled Trials.

PubMed

Malmivaara, Antti

2016-09-01

Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. To create and pilot test a checklist for appraising methodological validity of a BCT. The checklist was created by extracting the most essential elements from the comprehensive set of criteria in the previous paper on BCTs. Also checklists and scientific papers on observational studies and respective systematic reviews were utilized. Ten BCTs published in the Lancet and in the New England Journal of Medicine were used to assess feasibility of the created checklist. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. However, the piloted checklist should be validated in further studies. Key messages Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. This paper presents a checklist for appraising methodological validity of BCTs and pilot-tests the checklist with ten BCTs published in leading medical journals. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies.

[Intervention to reduce the impact of light and noise on sleep in an emergency department observation area].

PubMed

Villamor Ordozgoiti, Alberto; Priu Parra, Inmaculada; España Salvador, María Carmen; Torres Valdés, Constancia; Bas Ciutad, María Pilar; Ponce Quílez, María Rosa

2017-02-01

To study quality of patient rest before and after an intervention to reduce nighttime light and noise in the emergency department observation area of an urban hospital. Quasi-experimental study in 2 groups before and after the intervention in the observation area of the Hospital Clínic de Barcelona. We administered a questionnaire about the quality of nighttime rest to assess the effect of light and noise on sleep. Light and noise were reduced by means of structural changes to the environment and through the introduction of protocols to modify how care plans were carried out at night. Fifty nurses participated in the pre-intervention study and 371 in the post-intervention study. Seventy-two percent and 91.37% of the patients reported resting well before and after the intervention, respectively (P< .001). Factors like pain, nursing care, or daytime naps do not affect sleep quality. Nighttime rest in emergency department observation areas is affected by ambient light and noise more than by other variables. Reducing light and noise at night can measurably improve patients' rest.

Evaluation of the effects of implementing an electronic early warning score system: protocol for a stepped wedge study.

PubMed

Bonnici, Timothy; Gerry, Stephen; Wong, David; Knight, Julia; Watkinson, Peter

2016-02-09

An Early Warning Score is a clinical risk score based upon vital signs intended to aid recognition of patients in need of urgent medical attention. The use of an escalation of care policy based upon an Early Warning Score is mandated as the standard of practice in British hospitals. Electronic systems for recording vital sign observations and Early Warning Score calculation offer theoretical benefits over paper-based systems. However, the evidence for their clinical benefit is limited. Previous studies have shown inconsistent results. The majority have employed a "before and after" study design, which may be strongly confounded by simultaneously occurring events. This study aims to examine how the implementation of an electronic early warning score system, System for Notification and Documentation (SEND), affects the recognition of clinical deterioration occurring in hospitalised adult patients. This study is a non-randomised stepped wedge evaluation carried out across the four hospitals of the Oxford University Hospitals NHS Trust, comparing charting on paper and charting using SEND. We assume that more frequent monitoring of acutely ill patients is associated with better recognition of patient deterioration. The primary outcome measure is the time between a patient's first observations set with an Early Warning Score above the alerting threshold and their subsequent set of observations. Secondary outcome measures are in-hospital mortality, cardiac arrest and Intensive Care admission rates, hospital length of stay and system usability measured using the System Usability Scale. We will also measure Intensive Care length of stay, Intensive Care mortality, Acute Physiology and Chronic Health Evaluation (APACHE) II acute physiology score on admission, to examine whether the introduction of SEND has any effect on Intensive Care-related outcomes. The development of this protocol has been informed by guidance from the Agency for Healthcare Research and Quality (AHRQ) Health Information Technology Evaluation Toolkit and Delone and McLeans's Model of Information System Success. Our chosen trial design, a stepped wedge study, is well suited to the study of a phased roll out. The choice of primary endpoint is challenging. We have selected the time from the first triggering observation set to the subsequent observation set. This has the benefit of being easy to measure on both paper and electronic charting and having a straightforward interpretation. We have collected qualitative measures of system quality via a user questionnaire and organisational descriptors to help readers understand the context in which SEND has been implemented.

[Family odysseys: the search for infant mental health care].

PubMed

Delfini, Patricia Santos de Souza; Bastos, Isabella Teixeira; Reis, Alberto Olavo Advincula

2017-12-18

The aim was to analyze the peregrination of families of children treated in a Center for Psychosocial Care for Children and Adolescents in their search for mental health care. The study included participant observations at the clinic and focus groups with the children's families. The qualitative study used institutional analysis as the theoretical and methodological reference, and the material was discussed in light of the approach to psychosocial care. The families' search in the face of the child's psychological distress is a prime indicator for assessing strengths and weaknesses in building the network of care, and for revealing the families' understanding of their children's mental health problems and treatments. The study found contradictory forces at play in daily care, demonstrating both the provider's transformative force and occasionally the user's crystallization and maintenance. In this sense, the hegemonic model - disease-centered, fragmenting patients and their care - has been challenged by the instituting force that proposes to reposition the patient and incorporate psychological distress as part of overall health, linking services and actions in a model of care. Despite the tangled maze that families face in their peregrination for care, strides have been made in psychosocial care, while highlighting challenges. Such progress has been anchored in relational technologies (shelter, bonding, trust, and accountability) with the various actors involved in the care.

Course and predictors of supportive care needs among Mexican breast cancer patients: A longitudinal study.

PubMed

Pérez-Fortis, Adriana; Fleer, Joke; Schroevers, Maya J; López, Patricia Alanís; Sosa, Juan José Sánchez; Eulenburg, Christine; Ranchor, Adelita V

2018-05-26

This study examined the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories. Data from 172 (66.4% response rate) patients were considered in this observational longitudinal study. Participants were measured after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment and the first post-treatment follow-up visit. Psychological, Health System and Information, Physical and Daily Living, Patient Care and Support, Sexual, and Additional care needs were measured with the Supportive Care Needs Survey (SCNS-SF34). Linear mixed models with maximum-likelihood estimation were computed. The course of supportive care needs was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first post-treatment follow-up visit. Health System and Information care needs were the highest needs over time. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in course of supportive care needs of these patients. Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory. This article is protected by copyright. All rights reserved.

Health-Promoting Lifestyles Among Health Care Workers in a Postdisaster Area: A Cross-sectional Study.

PubMed

Yang, Wanqiu; Sim, Timothy; Cui, Ke; Zhang, Jun; Yang, Yanchun; Ma, Xiaohong

2018-06-18

Health care workers performing rescue tasks in large-scale disaster areas are usually challenged in terms of physical and mental endurance, which can affect their lifestyles. Nevertheless, data on whether health care workers tend to adopt healthy lifestyles after disasters are limited. This paper compares the adoption of healthy lifestyle behaviors among health care workers with that among non-health care workers in a postdisaster area. This cross-sectional observational study was conducted in August 2016. The Health-Promoting Lifestyle Profile II questionnaire was used to interview 261 health care workers and 848 non-health care workers. Results of the multivariable linear models showed that health care workers had lower physical activity levels (ß=-1.363, P<.0001), worse stress management (ß=-1.282, P<.0001), slower spiritual growth (ß=-1.228, P=.002), and poorer interpersonal relationships (ß=-0.814, P=.019) than non-health care workers. However, no significant differences were found in either nutrition (ß=-0.362, P=.319) or health responsibility (ß=-0.421, P=.283). Health care workers had less healthy lifestyle behaviors, including physical activity, stress management, spiritual growth, and interpersonal relationships. Further studies are needed to develop health-improving interventions for health care workers in postdisaster areas. (Disaster Med Public Health Preparedness. 2018;page 1 of 6).

Needs of family caregivers in home care for older adults 1

PubMed Central

Bierhals, Carla Cristiane Becker Kottwitz; dos Santos, Naiana Oliveira; Fengler, Fernanda Laís; Raubustt, Kamila Dellamora; Forbes, Dorothy Anne; Paskulin, Lisiane Manganelli Girardi

2017-01-01

ABSTRACT Objective: to reveal the felt and normative needs of primary family caregivers when providing instrumental support to older adults enrolled in a Home Care Program in a Primary Health Service in the South of Brazil. Methods: using Bradshaw's taxonomy of needs to explore the caregiver's felt needs (stated needs) and normative needs (defined by professionals), a mixed exploratory study was conducted in three steps: Descriptive quantitative phase with 39 older adults and their caregiver, using a data sheet based on patient records; Qualitative exploratory phase that included 21 caregiver interviews, analyzed by content analysis; Systematic observation, using an observation guide with 16 caregivers, analyzed by descriptive statistics. Results: the felt needs were related to information about instrumental support activities and subjective aspects of care. Caregivers presented more normative needs related to medications care. Conclusion: understanding caregivers' needs allows nurses to plan interventions based on their particularities. PMID:28403338

Actively caring to prevent bullying in an elementary school: Prompting and rewarding prosocial behavior.

PubMed

McCarty, Shane; Teie, Sophia; McCutchen, Jenna; Geller, E Scott

2016-01-01

This field study evaluated the impact of an intervention designed to prevent bullying among elementary-school students by prompting and rewarding prosocial behavior. More specifically, teachers of 404 second-, third-, fourth-, fifth-, and sixth-grade students from an elementary school in northeast Virginia asked their students to look out for other students' prosocial behaviors (termed "actively caring") and to submit their stories about actively caring. At the start of every class day, the teachers read three of these stories and recognized one story and the two associated students (i.e., the observer and the performer) by providing each with a wristband engraved with "Actively Caring for People." For six consecutive Fridays, students reported their observations of bullying and completed a single item estimate of self-esteem. Weekly surveys revealed reductions in "being bullied" and "bullying others," as well as an increase in self-esteem.

To belong or not to belong: nursing students' interactions with clinical learning environments - an observational study.

PubMed

Liljedahl, Matilda; Björck, Erik; Kalén, Susanne; Ponzer, Sari; Bolander Laksov, Klara

2016-08-05

Belongingness has been argued to be a prerequisite for students' learning in the clinical setting but making students feel like they belong to the workplace is a challenge. From a sociocultural perspective, workplace participatory practices is a framework that views clinical learning environments to be created in interaction between students and the workplace and hence, are dependent on them both. The aim of this study was to explore the interdependence between affordances and engagement in clinical learning environments. The research question was: How are nursing students influenced in their interactions with clinical learning environments? An observational study with field observations and follow-up interviews was performed. The study setting comprised three academic teaching hospitals. Field observations included shadowing undergraduate nursing students during entire shifts. Fifty-five hours of field observations and ten follow-up interviews with students, supervisors and clinical managers formed the study data. A thematic approach to the analysis was taken and performed iteratively with the data collection. The results revealed that students strived to fill out the role they were offered in an aspirational way but that they became overwhelmed when given the responsibility of care. When students' basic values did not align with those enacted by the workplace, they were not willing to compromise their own values. Workplaces succeeded in inviting students into the community of nurses and the practice of care. Students demonstrated hesitance regarding their desire to belong to the workplace community. The results imply that the challenge for clinical education is not to increase the experience of belongingness but to maintain students' critical and reflective approach to health care practice. Additionally, results suggest students to be included as an important stakeholder in creating clinical learning environments rather than being viewed as consumer of clinical education.

Unique challenges of hospice for patients with heart failure: A qualitative study of hospice clinicians.

PubMed

Lum, Hillary D; Jones, Jacqueline; Lahoff, Dana; Allen, Larry A; Bekelman, David B; Kutner, Jean S; Matlock, Daniel D

2015-09-01

Patients with heart failure have end-of-life care needs that may benefit from hospice care. The goal of this descriptive study was to understand hospice clinicians' perspectives on the unique aspects of caring for patients with heart failure to inform approaches to improving end-of-life care. This qualitative study explored experiences, observations, and perspectives of hospice clinicians regarding hospice care for patients with heart failure. Thirteen hospice clinicians from a variety of professional disciplines and clinical roles, diverse geographic regions, and varying lengths of time working in hospice participated in semistructured interviews. Through team-based, iterative qualitative analysis, we identified 3 major themes. Hospice clinicians identified 3 themes regarding care for patients with heart failure. First, care for patients with heart failure involves clinical complexity and a tailored approach to cardiac medications and advanced cardiac technologies. Second, hospice clinicians describe the difficulty patients with heart failure have in trusting hospice care due to patient optimism, prognostic uncertainty, and reliance on prehospice health care providers. Third, hospice clinicians described opportunities to improve heart failure-specific hospice care, highlighting the desire for collaboration with referring cardiologists. From a hospice clinician perspective, caring for patients with heart failure is unique compared with other hospice populations. This study suggests potential opportunities for hospice clinicians and referring providers who seek to collaborate to improve care for patients with heart failure during the transition to hospice care. Published by Elsevier Inc.

Togetherness--A Manifestation of Day Care Life.

ERIC Educational Resources Information Center

Hannikainen, Maritta

1999-01-01

This study used observations of quality of 5-year olds' lives in Danish, Finnish, and Swedish day-care centers to examine impact of adults on development of togetherness. Findings suggest that togetherness has to do with positive emotional relations. Article hypothesizes that togetherness may contribute to building of a real community of learners…

An Investigation of Nurses' Interaction Styles with Physicians and Suggested Patient Care Interventions.

ERIC Educational Resources Information Center

Redland, Alice R.

The purpose of this study was to identify relations between nurses' interaction styles and patient care interventions (PCI) that occurred after nurse-doctor interactions. A nonparticipant observer recorded interactions of 48 female registered nurses with physicians. Transcripts were coded and assigned to one of five theoretical nurse interaction…

CTEPP-OH DATA COLLECTED ON FORM 03:HOUSE/BUILDING CHARACTERISTICS OBSERVATION SURVEY FOR THE DAY CARE CENTER

EPA Science Inventory

This data set contains data concerning the physical characteristics of the day care center and identified possible sources of pollutants for CTEPP-OH.

The Children’s Total Exposure to Persistent Pesticides and Other Persistent Pollutant (CTEPP) study was one of the largest agg...

Creating a Ninth-Grade Community of Care

ERIC Educational Resources Information Center

Ellerbrock, Cheryl R.; Kiefer, Sarah M.

2010-01-01

This qualitative case study analyzed how one large high school created a community of care for ninth-grade students. Data were collected during the 2006-2007 school year, including observations, individual interviews, and focus group interviews of 1 female teacher and 9 of her students. Findings suggest the Freshman Focus teachers and program…

Social Support Is Associated with Blood Pressure Responses in Parents Caring for Children with Developmental Disabilities

ERIC Educational Resources Information Center

Gallagher, Stephen; Whiteley, Jenny

2012-01-01

The present study tested whether parents caring for children with developmental disabilities would have higher blood pressure compared to parents of typically developing children (controls). It also examined the psychosocial factors underlying this observation. Thirty-five parents of children with developmental disability and thirty controls…

Development and validation of an observation tool for the assessment of nursing pain management practices in intensive care unit in a standardized clinical simulation setting.

PubMed

Gosselin, Emilie; Bourgault, Patricia; Lavoie, Stephan; Coleman, Robin-Marie; Méziat-Burdin, Anne

2014-12-01

Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p < .001) for the whole tool, with variations from 0.619 to 0.920 (p < .01) between dimensions. The expert panel was satisfied with the content and face validity of the tool. The psychometric qualities of the NOTPaM developed in this study are satisfactory. However, the tool could be improved with slight modifications. Nevertheless, it was useful in assessing intensive care nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time.

PubMed

Westbrook, Johanna I; Ampt, Amanda; Kearney, Leanne; Rob, Marilyn I

2008-05-05

To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. Observational time and motion study. 400-bed teaching hospital in Sydney. 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.

Parental involvement in neonatal comfort care.

PubMed

Skene, Caryl; Franck, Linda; Curtis, Penny; Gerrish, Kate

2012-01-01

To explore how parents interact with their infants and with nurses regarding the provision of comfort care in a Neonatal Intensive Care Unit (NICU). Focused ethnography. A regional NICU in the United Kingdom. Eleven families (10 mothers, 8 fathers) with infants residing in the NICU participated in the study. Parents were observed during a caregiving interaction with their infants and then interviewed on up to four occasions. Twenty-five periods of observation and 24 semistructured interviews were conducted between January and November 2008. Five stages of learning to parent in the NICU were identified. Although the length and duration of each stage differed for individual parents, movement along the learning trajectory was facilitated when parents were involved in comforting their infants. Transfer of responsibility from nurse to parents for specific aspects of care was also aided by parental involvement in pain care. Nurses' encouragement of parental involvement in comfort care facilitated parental proximity, parent/infant reciprocity, and parental sense of responsibility. Findings suggest that parental involvement in comfort care can aid the process of learning to parent, which is difficult in the NICU. Parental involvement in infant comfort care may also facilitate the transfer of responsibility from nurse to parent and may facilitate antecedents to parent/infant attachment. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Knowledge and Practice on Injection Safety among Primary Health Care Workers in Kaski District, Western Nepal

PubMed Central

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kc, Vikash Kumar; Jha, Nisha; Sharma, Damodar

2016-01-01

Background Unsafe injection practice can transmit various blood borne infections. The aim of this study was to assess the knowledge and practice of injection safety among injection providers, to obtain information about disposal of injectable devices, and to compare the knowledge and practices of urban and rural injection providers. Methods The study was conducted with injection providers working at primary health care facilities within Kaski district, Nepal. Ninety-six health care workers from 69 primary health care facilities were studied and 132 injection events observed. A semi-structured checklist was used for observing injection practice and a questionnaire for the survey. Respondents were interviewed to complete the questionnaire and obtain possible explanations for certain observed behaviors. Results All injection providers knew of at least one pathogen transmitted through use/re-use of unsterile syringes. Proportion of injection providers naming hepatitis/jaundice as one of the diseases transmitted by unsafe injection practice was significantly higher in urban (75.6%) than in rural (39.2%) area. However, compared to urban respondents (13.3%), a significantly higher proportion of rural respondents (37.3%) named Hepatitis B specifically as one of the diseases transmitted. Median (inter-quartile range) number of therapeutic injection and injectable vaccine administered per day by the injection providers were 2 (1) and 1 (1), respectively. Two handed recapping by injection providers was significantly higher in urban area (33.3%) than in rural areas (21.6%). Most providers were not aware of the post exposure prophylaxis guideline. Conclusion The knowledge of the injection providers about safe injection practice was acceptable. The use of safe injection practice by providers in urban and rural health care facilities was almost similar. The deficiencies noted in the practice must be addressed. PMID:27540325

[Primary care follow-up of newborns with sickle cell disease detected in neonatal screening in the Community of Madrid].

PubMed

Rodríguez-Moldes, B; Carbajo, A J; Sánchez, B; Fernández, M; Garí, M; Fernández, M C; Álvarez, J; García, A; Cela, E

2015-04-01

The main aim of the study was to assess the effects of the recommended preventive program in the population affected with Sickle Cell Disease in Primary Care. The program included, antibiotic prophylaxis, immunizations and health education, following the introduction of universal neonatal screening program for Sickle Cell Disease in the Community of Madrid. A cross-sectional observational study was performed with retrospective data collected from a cohort of newborns with Sickle Cell Disease diagnosed by neonatal screening test in the Community of Madrid. From the data obtained from a sample of 20 patients, it was found that 95% had been diagnosed by the newborn screening test performed between 5 and 13 days of life. The mean age was 39 months when the study was conducted. During follow-up, from Primary Care Paediatric clinic, it was observed that the compliance for antibiotic prophylaxis was 90%, and the coverage for the official vaccination schedule was 85%. Specific vaccine coverage as a risk population was highly variable (85% for pneumococcal 23V, 50% for influenza, and 15% for hepatitis A). Health education only reached one in every four families. Acceptable compliance with antibiotic prophylaxis was observed during the follow-up of patients with sickle cell disease in Primary Care, but a low coverage of routine immunization, as well as specific immunizations. Coverage of health education was very low. Improving these parameters would require greater coordination and involvement of Primary Care Professionals so that these patients were followed up appropriately, and could be translated into a reduction of disease complications and an improvement in the quality of life of these patients. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain.

PubMed

Mata-Cases, M; Roura-Olmeda, P; Berengué-Iglesias, M; Birulés-Pons, M; Mundet-Tuduri, X; Franch-Nadal, J; Benito-Badorrey, B; Cano-Pérez, J F

2012-03-01

To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia. Sequential cross-sectional studies were performed during 1993-2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals. Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA(1c) (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA(1c) ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed. Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia. © 2012 Blackwell Publishing Ltd.

Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain

PubMed Central

Mata-Cases, M; Roura-Olmeda, P; Berengué-Iglesias, M; Birulés-Pons, M; Mundet-Tuduri, X; Franch-Nadal, J; Benito-Badorrey, B; Cano-Pérez, J F

2012-01-01

Aims To assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia. Methods Sequential cross-sectional studies were performed during 1993–2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals. Results Clinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA1c (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA1c ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed. Conclusions Although those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia. PMID:22340449

[Detection of palliative care needs in an acute care hospital unit. Pilot study].

PubMed

Rodríguez-Calero, Miguel Ángel; Julià-Mora, Joana María; Prieto-Alomar, Araceli

2016-01-01

Previous to wider prevalence studies, we designed the present pilot study to assess concordance and time invested in patient evaluations using a palliative care needs assessment tool. We also sought to estimate the prevalence of palliative care needs in an acute care hospital unit. A cross-sectional study was carried out, 4 researchers (2 doctors and 2 nurses) independently assessed all inpatients in an acute care hospital unit in Manacor Hospital, Mallorca (Spain), using the validated tool NECPAL CCOMS-ICO©, measuring time invested in every case. Another researcher revised clinical recordings to analise the sample profile. Every researcher assessed 29 patients, 15 men and 14 women, mean age 74,03 ± 10.25 years. 4-observer concordance was moderate (Kappa 0,5043), tuning out to be higher between nurses. Mean time per patient evaluation was 1.9 to 7.72 minutes, depending on researcher. Prevalence of palliative care needs was 23,28%. Moderate concordance lean us towards multidisciplinary shared assessments as a method for future research. Avarage of time invested in evaluations was less than 8 minutes, no previous publications were identified regarding this variable. More than 20% of inpatients of the acute care unit were in need of palliative care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

An Instrument to Assess the Obesogenic Environment of Child Care Centers

ERIC Educational Resources Information Center

Ward, Dianne; Hales, Derek; Haverly, Katie; Marks, Julie; Benjamin, Sara; Ball, Sarah; Trost, Stewart

2008-01-01

Objectives: To describe protocol and interobserver agreements of an instrument to evaluate nutrition and physical activity environments at child care. Methods: Interobserver data were collected from 9 child care centers, through direct observation and document review (17 observer pairs). Results: Mean agreement between observer pairs was 87.26%…

Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): study protocol.

PubMed

Puschner, Bernd; Steffen, Sabine; Slade, Mike; Kaliniecka, Helena; Maj, Mario; Fiorillo, Andrea; Munk-Jørgensen, Povl; Larsen, Jens Ivar; Egerházi, Anikó; Nemes, Zoltan; Rössler, Wulf; Kawohl, Wolfram; Becker, Thomas

2010-11-10

A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome. The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. ISRCTN75841675.

Working under pressure: a pilot study of nurse work in a postoperative setting.

PubMed

Willis, Karen; Brown, Claire R; Sahlin, Ingrid; Svensson, Björn; Arnetz, Bengt B; Arnetz, Judith E

2005-01-01

Postoperative services provide an excellent setting to study nursing work due to the patients' needing highly technical, yet highly comforting, care. The current study examined nursing work in postoperative services in an attempt to discern how nursing work is structured. Observations of nursing interactions in a 14-bed postoperative unit of a large Swedish university hospital found that nursing work in this setting is highly intensive and multidimensional. The need to provide nursing interactions that are caring and respectful of patients, while at the same time ensuring a high level of technical capacity, was obvious throughout all stages of patient stays in this unit. Furthermore, although each interaction is necessarily time-limited there is a caring relationship sustained with each patient. There is a pattern of caring that emerges that can be encapsulated as a "contingent routine." Nursing work cannot be broken down into "dimensions of caring." The work is high-pressure and involves, by necessity, multitasking. There are many dimensions of nursing care, but, usually, these are supplied simultaneously.

Chronic heart failure management in Australia -- time for general practice centred models of care?

PubMed

Scott, Ian; Jackson, Claire

2013-05-01

Chronic heart failure (CHF) is an increasingly prevalent problem within ageing populations and accounts for thousands of hospitalisations and deaths annually in Australia. Disease management programs for CHF (CHF-DMPs) aim to optimise care, with the predominant model being cardiologist led, hospital based multidisciplinary clinics with cardiac nurse outreach. However, findings from contemporary observational studies and clinical trials raise uncertainty around the effectiveness and sustainability of traditional CHF-DMPs in real-world clinical practice. To suggest an alternative model of care that involves general practitioners with a special interest in CHF liaising with, and being up-skilled by, specialists within community based, multidisciplinary general practice settings. Preliminary data from trials evaluating primary care based CHF-DMPs are encouraging, and further studies are underway comparing this model of care with traditional hospital based, specialist led CHF-DMPs. Results of studies of similar primary care models targeting diabetes and other chronic diseases suggest potential for its application to CHF.

Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study.

PubMed

Kawaguchi, S; Mirza, R; Nissim, R; Ridley, J

2017-05-01

Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.

Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

PubMed

Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk

2018-05-09

In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

PubMed Central

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

PubMed

Leslie, Hannah H; Sun, Zeye; Kruk, Margaret E

2017-12-01

It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.

“Just another fish in the pond”: the transitional care experience of a hip fracture patient

PubMed Central

Toscan, Justine; Manderson, Brooke; Santi, Selena M; Stolee, Paul

2013-01-01

Introduction Miscommunication and lack of coordination can compromise care quality and patient safety during transitions in care, especially for medically complex older adults. Little research has been done to investigate care transitions from the perspective of those receiving and providing care. Methods This study explored multiple care transitions for an elderly hip fracture patient, post-surgery. Interviews and observations were conducted with the patient, their family caregivers, and health care providers, at each point of transition between four different care settings. Results Four key themes were identified over the patients care trajectory: ‘Missing Crucial Coversations’—Patient and family caregivers did not feel involved or informed about decisions in care; ‘Who’s Who’—Confusion about the role of health care providers; ‘Ready or Not’—Not knowing what to expect or what is expected; and, ‘Playing by the Rules’—Health system policies and procedures hinder individualized care. Conclusion Study findings point to the need for the health care system to engage patients and family caregivers more fully and consistently in the process of care transitions as well as the importance of understanding these processes from multiple perspectives. Recommendations for system integration are proposed with a focus on transitional care. PMID:23882170

Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians.

PubMed

Weigl, Matthias; Müller, Andreas; Zupanc, Andrea; Angerer, Peter

2009-06-29

Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact - a key principle of effective medical care. Second, simultaneous task performance ('multitasking') which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested. 35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument. Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17-20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities. Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.

Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

PubMed

Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

2016-03-01

Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The conceptions of care among family caregivers of persons living with HIV/AIDS in Addis Ababa, Ethiopia.

PubMed

Aga, Fekadu; Kylmä, Jari; Nikkonen, Merja

2009-01-01

This focused ethnographic study explores and describes the conceptions of care among family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Leininger's theory of culture care diversity and universality is the conceptual anchor of this ethnographic study. Using semistructured interviews and participant observation, 6 key informants and 12 general informants were interviewed in their home in Amharic language. Data were analyzed in Amharic using Leininger's phases of ethnonursing analysis for qualitative data and then translated to English. Four major themes representing family caregivers' conceptions of care were identified: nourishing the PLWA while struggling with poverty, maintenance of cleanliness and hygiene of the person and surroundings, comforting the PLWA, and sacrificing self to sustain the PLWA. Valuable data were gathered about the family caregivers' conceptions of care. Nurses can use this knowledge to design and provide culturally congruent care to family caregivers and PLWAs in the community.

Building a Common Pediatric Research Terminology for Accelerating Child Health Research

PubMed Central

Bailey, L. Charles; Forrest, Christopher B.; Padula, Michael A.; Hirschfeld, Steven

2014-01-01

Longitudinal observational clinical data on pediatric patients in electronic format is becoming widely available. A new era of multi-institutional data networks that study pediatric diseases and outcomes across disparate health delivery models and care settings are also enabling an innovative collaborative rapid improvement paradigm called the Learning Health System. However, the potential alignment of routine clinical care, observational clinical research, pragmatic clinical trials, and health systems improvement requires a data infrastructure capable of combining information from systems and workflows that historically have been isolated from each other. Removing barriers to integrating and reusing data collected in different settings will permit new opportunities to develop a more complete picture of a patient’s care and to leverage data from related research studies. One key barrier is the lack of a common terminology that provides uniform definitions and descriptions of clinical observations and data. A well-characterized terminology ensures a common meaning and supports data reuse and integration. A common terminology allows studies to build upon previous findings and to reuse data collection tools and data management processes. We present the current state of terminology harmonization and describe a governance structure and mechanism for coordinating the development of a common pediatric research terminology that links to clinical terminologies and can be used to align existing terminologies. By reducing the barriers between clinical care and clinical research, a Learning Health System can leverage and reuse not only its own data resources but also broader extant data resources. PMID:24534404

Business process re-engineering a cardiology department.

PubMed

Bakshi, Syed Murtuza Hussain

2014-01-01

The health care sector is the world's third largest industry and is facing several problems such as excessive waiting times for patients, lack of access to information, high costs of delivery and medical errors. Health care managers seek the help of process re-engineering methods to discover the best processes and to re-engineer existing processes to optimize productivity without compromising on quality. Business process re-engineering refers to the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality and speed. The present study is carried out at a tertiary care corporate hospital with 1000-plus-bed facility. A descriptive study and case study method is used with intensive, careful and complete observation of patient flow, delays, short comings in patient movement and workflow. Data is collected through observations, informal interviews and analyzed by matrix analysis. Flowcharts were drawn for the various work activities of the cardiology department including workflow of the admission process, workflow in the ward and ICCU, workflow of the patient for catheterization laboratory procedure, and in the billing and discharge process. The problems of the existing system were studied and necessary suggestions were recommended to cardiology department module with an illustrated flowchart.

An observational study of socioeconomic and clinical gradients among diabetes patients hospitalized for avoidable causes: evidence of underlying health disparities in China?

PubMed

Chen, Brian; Eggleston, Karen; Li, Hong; Shah, Nilay; Wang, Jian

2014-01-30

Diabetes is an ambulatory care sensitive condition that can generally be managed in outpatient settings with little or no need for inpatient care. As a preliminary step to investigate whether health disparities can be detected in the inpatient setting in China, we study how diabetic patients hospitalized without prior primary care contact or with greater severity of illness differ from other diabetic inpatients along socioeconomic and clinical dimensions. We conduct an observational study using three years of clinical data for more than 1,800 adult patients with diabetes at two tertiary hospitals in East China. Univariate analysis and probit regression are used to characterize the differences in socioeconomic and clinical factors between patients hospitalized for diabetes with no prior primary care contact and those hospitalized with previous treatment experience. Secondarily, we use ordinary least squares regression to estimate the socioeconomic and clinical differences associated with poor serum glucose control at admission. We find that compared with patients hospitalized after prior treatment experience, inpatients with no previous primary care contact for diabetes have worse clinical laboratory values, are more likely to be young and male, to have lower education attainment, and to have poorer blood sugar control. Insurance, urban residence, and previous use of diabetic medication are in turn negatively correlated with HbA1c levels upon admission. Among hospitalized diabetic patients, socioeconomic factors such as lower education attainment, rural residence and lack of full insurance are associated with avoidable hospitalizations or worse indicators of health. Although we cannot definitively rule out selection bias, these findings are consistent with health disparities observable even at the inpatient level. Future studies should study the underlying mechanism by which traditionally vulnerable groups are more likely to be hospitalized for avoidable causes and with greater severity of illness.

Deviation from a preoperative surgical and anaesthetic care plan is associated with increased risk of adverse intraoperative events in major abdominal surgery.

PubMed

Gauss, T; Merckx, P; Brasher, C; Kavafyan, J; Le Bihan, E; Aussilhou, B; Belghiti, J; Mantz, J

2013-02-01

Perioperative coordination facilitates team communication and planning. The aim of this study was to determine how often deviation from predicted surgical conditions and a pre-established anaesthetic care plan in major abdominal surgery occurred, and whether this was associated with an increase in adverse clinical events. In this prospective observational study, weekly preoperative interdisciplinary team meetings were conducted according to a joint care plan checklist in a tertiary care centre in France. Any discordance with preoperative predictions and deviation from the care plan were noted. A link to the incidence of predetermined adverse intraoperative events was investigated. Intraoperative adverse clinical events (ACEs) occurred in 15 % of all cases and were associated with postoperative complications [relative risk (RR) = 1.5; 95 % confidence interval (1.1; 2.2)]. Quality of prediction of surgical procedural items was modest, with one in five to six items not correctly predicted. Discordant surgical prediction was associated with an increased incidence of ACE. Deviation from the anaesthetic care plan occurred in around 13 %, which was more frequent when surgical prediction was inaccurate (RR > 3) and independently associated with ACE (odds ratio 6). Surgery was more difficult than expected in up to one out of five cases. In a similar proportion, disagreement between preoperative care plans and observed clinical management was independently associated with an increased risk of adverse clinical events.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.

PubMed

Wilberforce, Mark; Tucker, Sue; Brand, Christian; Abendstern, Michele; Jasper, Rowan; Challis, David

2016-11-01

To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission. An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission. Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types. Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

The knowledge of intensive care professionals about diarrhea

PubMed Central

Lordani, Cláudia Regina Felicetti; Eckert, Raquel Goreti; Tozetto, Altevir Garcia; Lordani, Tarcísio Vitor Augusto; Duarte, Péricles Almeida Delfino

2014-01-01

Objective To assess the opinions and practices of intensive care professionals with regard to diarrhea in critically ill patients. Methods A multicenter cross-sectional study was conducted among health care professionals working at three adult intensive care units. Participants responded individually to a self-administered questionnaire about their length of work experience in intensive care; the definition, characterization, and causes of diarrhea; types of records in the patient's medical record; and training received. Results A total of 78 professionals participated in this study, of whom 59.0% were nurse technicians, 25.7% were nurses, and 15.3% were physicians; 77.0% of them had worked in intensive care for over 1 year. Only 37.2% had received training on this topic. Half of the interviewees defined diarrhea as "liquid and/or pasty stools" regardless of frequency, while the other 50.0% defined diarrhea based on the increased number of daily bowel movements. The majority of them mentioned diet as the main cause of diarrhea, followed by "use of medications" (p<0.001). Distinct nutritional practices were observed among the analyzed professionals regarding episodes of diarrhea, such as discontinuing, maintaining, or reducing the volume of enteral nutrition; physicians reported that they do not routinely communicate the problem to other professionals (for example, to a nutritionist) and do not routinely record and quantify diarrhea events in patients' medical records. Conclusion Different opinions and practices were observed in intensive care professionals with regard to diarrhea. PMID:25295825

How does age affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund.

PubMed

Schnitzer, Susanne; von dem Knesebeck, Olaf; Kohler, Martin; Peschke, Dirk; Kuhlmey, Adelheid; Schenk, Liane

2015-10-23

The objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease? The study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis. 21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0-65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82-16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88-6.71) in patients aged 76-85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %). Our results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.

From policy to practice: implementation of water policies in child care centers in Connecticut.

PubMed

Middleton, Ann E; Henderson, Kathryn E; Schwartz, Marlene B

2013-03-01

Child care policies may contribute to healthy beverage consumption patterns. This study documented availability and accessibility of water and correspondence with state and federal policy and accreditation standards in child care centers. One-day observations were conducted in a random sample of 40 Child and Adult Care Food Program-participating preschool classrooms in Connecticut. Child care centers, center directors, and preschool teachers. Raters observed water availability and teacher behaviors during lunch, physical activity, and in the classroom. National, state, and childcare center water regulations and policies were reviewed. Descriptive statistics present data on water availability, promotion, and modeling. Bivariate relationships between water availability and accreditation status, center water policy, location of physical activity, and verbal promotion were assessed using the Fisher exact test (P < .05). Many centers were in violation of water-promoting policies. Water was available in most classrooms (84%) but was only adult accessible in over half of those classrooms. Water was available during one third of physical activity periods observed. Verbal prompts for children to drink water were few. Support is needed to help centers meet existing water policies and new water requirements included in the 2010 Child Nutrition Reauthorization Act. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Regional variation in health care utilization in Sweden - the importance of demand-side factors.

PubMed

Johansson, Naimi; Jakobsson, Niklas; Svensson, Mikael

2018-06-04

Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.

Implementation research to improve quality of maternal and newborn health care, Malawi.

PubMed

Brenner, Stephan; Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-07-01

To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities' essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants' adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care.

Evaluation of the effect of Spiritual care on patients with generalized anxiety and depression: a randomized controlled study.

PubMed

Sankhe, A; Dalal, K; Save, D; Sarve, P

2017-12-01

The present study was conducted to assess the effect of spiritual care in patients with depression, anxiety or both in a randomized controlled design. The participants were randomized either to receive spiritual care or not and Hamilton anxiety rating scale-A (HAM-A), Hamilton depression rating scale-D (HAM-D), WHO-quality of life-Brief (WHOQOL-BREF) and Functional assessment of chronic illness therapy - Spiritual well-being (FACIT-Sp) were assessed before therapy and two follow-ups at 3 and 6 week. However, with regard to the spiritual care therapy group, statistically significant differences were observed in both HAM-A and HAM-D scales between the baseline and visit 2 (p < 0.001), thus significantly reducing symptoms of anxiety and depression, respectively. No statistically significant differences were observed for any of the scales during the follow-up periods for the control group of participants. When the scores were compared between the study groups, HAM-A, HAM-D and FACIT-Sp 12 scores were significantly lower in the interventional group as compared to the control group at both third and sixth weeks. This suggests a significant improvement in symptoms of anxiety and depression in the spiritual care therapy group than the control group; however, large randomized controlled trials with robust design are needed to confirm the same.

Advancing the Big Five of user-oriented care and accounting for its variations.

PubMed

Kajonius, Petri; Kazemi, Ali

2016-01-01

Care process quality (i.e. how care is enacted by a care worker toward a client at the interpersonal level) is a strong predictor of satisfaction in a wide range of health care services. The purpose of this paper is to describe the basic elements of care process quality as user-oriented care. Specifically, the questions of how and why quality in user-oriented care varies were investigated in the context of elderly care. Two municipalities were selected for in-depth field studies. First, in each municipality, the authors interviewed and observed care workers' interactions with the older persons in both home care and nursing homes during two weeks (Study 1). Second, in an attempt to gain a deeper understanding of why process quality in terms of user-oriented care varies, the authors conducted interviews with care workers and care unit managers (Study 2). A new taxonomy for categorizing process quality variation, the Big Five of user-oriented care (task-focus, person-focus, affect, cooperation, and time-use), is proposed. In addition, the perceived reasons for process quality variation are reported in our own developed Quality Agents Model, suggesting that variations in care process evaluations may be explained from different perspectives at multiple levels (i.e., older person, care worker-, unit-, department-, and municipality level). The proposed taxonomy and model are useful for describing user-oriented care quality and the reasons for its variations. These findings are of relevance for future quality developments of elderly care services, but also may be adapted to applications in any other enterprise employing a user-oriented approach.

Patients’ experiences of cold exposure during ambulance care

PubMed Central

2013-01-01

Background Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients’ experiences of cold exposure and to identify related factors. Method During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients’ finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. Results In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from −22.3°C to 8.4°C. Conclusion Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons. PMID:23742143

The Determinants of Place of Death: An Evidence-Based Analysis

PubMed Central

Costa, V

2014-01-01

Background According to a conceptual model described in this analysis, place of death is determined by an interplay of factors associated with the illness, the individual, and the environment. Objectives Our objective was to evaluate the determinants of place of death for adult patients who have been diagnosed with an advanced, life-limiting condition and are not expected to stabilize or improve. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2004, to September 24, 2013. Review Methods Different places of death are considered in this analysis—home, nursing home, inpatient hospice, and inpatient palliative care unit, compared with hospital. We selected factors to evaluate from a list of possible predictors—i.e., determinants—of death. We extracted the adjusted odds ratios and 95% confidence intervals of each determinant, performed a meta-analysis if appropriate, and conducted a stratified analysis if substantial heterogeneity was observed. Results From a literature search yielding 5,899 citations, we included 2 systematic reviews and 29 observational studies. Factors that increased the likelihood of home death included multidisciplinary home palliative care, patient preference, having an informal caregiver, and the caregiver's ability to cope. Factors increasing the likelihood of a nursing home death included the availability of palliative care in the nursing home and the existence of advance directives. A cancer diagnosis and the involvement of home care services increased the likelihood of dying in an inpatient palliative care unit. A cancer diagnosis and a longer time between referral to palliative care and death increased the likelihood of inpatient hospice death. The quality of the evidence was considered low. Limitations Our results are based on those of retrospective observational studies. Conclusions The results obtained were consistent with previously published systematic reviews. The analysis identified several factors that are associated with place of death. PMID:26351550

The effects of asking a fertility intention question in primary care settings: a systematic review protocol.

PubMed

Henning, Paul A; Burgess, Carolyne K; Jones, Heidi E; Norman, Wendy V

2017-01-19

Planning for pregnancy has been associated with reduced unwanted pregnancies and improved pregnancy outcomes. Despite the benefits of planned pregnancy, there are no guideline recommendations on routine counseling regarding pregnancy intention in primary care settings. The objective of the systematic review is to determine the effectiveness of incorporating questions of pregnancy intention into primary care. A systematic search of the literature will be conducted for any studies comparing questions of pregnancy intention in primary care settings with no intervention or a control intervention. Types of studies will include randomized controlled trials, non-randomized trials, and observation studies. Participants will include patients of reproductive age presenting to primary health care settings. Interventions will include any assessment of fertility intention and follow-up care compared with a control group or no intervention. Outcomes will include quantitative data with rates for contraceptive uptake, and any pregnancy related outcome. Databases (Ovid MEDLINE; Pubmed; CINAHL; EMBASE; CDR/DARE databases; Web of Science; ISRCTN registry; Clinicaltrials.gov; Cochrane Library) will be searched from the year 2000 to current. Screening of identified articles and data extraction will be conducted in duplicate by two independent reviewers. Methodological quality will be assessed using the Jadad scale. Methodological quality of observational and non-randomized trials will be assessed using the Newcastle-Ottawa scale. Discrepancies will be resolved by consensus or by consulting a third author. Meta-analyses will be performed if appropriate. Determining the effect of including questions of pregnancy intention into primary care can provide evidence for the development of clinical practice guidelines and inform primary care providers if this simple and low-cost intervention should be routinely employed. This review will also identify any gaps in the current literature on this topic and provide direction for future research in this area of study. Systematic Review Registration: PROSPERO CRD42015019726.

Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study.

PubMed

Bayen, Eleonore; Jacquemot, Julien; Netscher, George; Agrawal, Pulkit; Tabb Noyce, Lynn; Bayen, Alexandre

2017-10-17

Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents' falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. Video monitoring offers high potential to support conventional care in memory care facilities. ©Eleonore Bayen, Julien Jacquemot, George Netscher, Pulkit Agrawal, Lynn Tabb Noyce, Alexandre Bayen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.10.2017.

How architectural design affords experiences of freedom in residential care for older people.

PubMed

Van Steenwinkel, Iris; Dierckx de Casterlé, Bernadette; Heylighen, Ann

2017-04-01

Human values and social issues shape visions on dwelling and care for older people, a growing number of whom live in residential care facilities. These facilities' architectural design is considered to play an important role in realizing care visions. This role, however, has received little attention in research. This article presents a case study of a residential care facility for which the architects made considerable effort to match the design with the care vision. The study offers insights into residents' and caregivers' experiences of, respectively, living and working in this facility, and the role of architectural features therein. A single qualitative case study design was used to provide in-depth, contextual insights. The methods include semi-structured interviews with residents and caregivers, and participant observation. Data concerning design intentions, assumptions and strategies were obtained from design documents, through a semi-structured interview with the architects, and observations on site. Our analysis underlines the importance of freedom (and especially freedom of movement), and the balance between experiencing freedom and being bound to a social and physical framework. It shows the architecture features that can have a role therein: small-scaleness in terms of number of residents per dwelling unit, size and compactness; spatial generosity in terms of surface area, room to maneuver and variety of places; and physical accessibility. Our study challenges the idea of family-like group living. Since we found limited sense of group belonging amongst residents, our findings suggest to rethink residential care facilities in terms of private or collective living in order to address residents' social freedom of movement. Caregivers associated 'hominess' with freedom of movement, action and choice, with favorable social dynamics and with the building's residential character. Being perceived as homey, the facility's architectural design matches caregivers' care vision and, thus, helped them realizing this vision. Copyright © 2017 Elsevier Inc. All rights reserved.

The association between home care visits and same-day emergency department use: a case-crossover study.

PubMed

Jones, Aaron; Schumacher, Connie; Bronskill, Susan E; Campitelli, Michael A; Poss, Jeffrey W; Seow, Hsien; Costa, Andrew P

2018-04-30

The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs ("long stay") or short-term home care needs ("short stay"). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. © 2018 Joule Inc. or its licensors.

The association between home care visits and same-day emergency department use: a case–crossover study

PubMed Central

Jones, Aaron; Schumacher, Connie; Bronskill, Susan E.; Campitelli, Michael A.; Poss, Jeffrey W.; Seow, Hsien

2018-01-01

BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. METHODS: We conducted a population-based case–crossover study among patients receiving publicly funded home care in the Hamilton–Niagara–Haldimand–Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the previous week. The cohort was stratified according to whether patients had ongoing home care needs (“long stay”) or short-term home care needs (“short stay”). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. RESULTS: A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17–1.48) and short-stay patients (OR 1.22, 95% CI 1.07–1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. INTERPRETATION: Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation. PMID:29712671

What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

PubMed

Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

2016-02-01

U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician-administered pharmaceuticals was slightly higher in HRP, their use did not alter this spending pattern. Overall, expenditures in the HRP population are more than 10-fold higher compared with the full population. Managed care pharmacy can benefit from understanding what contributes to these higher costs, and managed care directors should consider an appropriately balanced assessment of the share of total spend by service and therapeutic category in HRP when devising drug usage and related cost-management strategies.

[Temporal and structural differences in the care of obese and non-obese people in nursing homes].

PubMed

Apelt, G; Ellert, S; Kuhlmey, A; Garms-Homolová, V

2012-08-01

Obesity is a common disease in Germany. Although care facilities are confronted with an increasing number of obese people, the care of them in nursing homes is barely investigated. The present study examines the amount of work using the example of the activity of dressing obese and non-obese nursing home residents and discloses with its temporal and structural differences. In five nursing homes in Berlin a fully structured observational study based on a convenience sample was conducted. 48 nurses were observed while performing the activity of dressing 70 residents aged 65 years and older. The residents' demographic data and medical diagnoses were taken from the nursing records. Information about the functional/cognitive status and pain events were collected by using the interRAI Contact Assessment. Further data regarding the nurses were obtained through face-to-face interviews. The results show a significant correlation between Body Mass Index and the required time of dressing. No correlations exist between age, qualifications and nurses' level of education and the time of dressing. Structural differences in the care of obese and non-obese residents appear by changes of, single activity sequences. The care of the obese residents is associated with increased time requirements and structurally differs from the care of the non-obese residents. This should lead to further research because it has implications for staffing in nursing homes.

Case studies in medical futility.

PubMed

Mains, Douglas A; Coustasse, Alberto; Lurie, Sue G

2007-01-01

Technology has provided means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient. This study presents two case histories, compiled from historical patient charts, staff notes and observations, that illustrate the variety of ethical issues involved and the role culture plays in the decision making process related to possible futile medical treatment. Ethical and cultural issues related to the cases are discussed and processes are presented that can help hospitals to avoid, or decrease the level of, medically futile care, and improve the cultural appropriateness of medical care and relationships with patients.

Is older adult care mediated by caregivers' cultural stereotypes? The role of competence and warmth attribution.

PubMed

Fernández-Ballesteros, Rocío; Bustillos, Antonio; Santacreu, Marta; Schettini, Rocio; Díaz-Veiga, Pura; Huici, Carmen

2016-01-01

The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers. A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers' cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers' cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents' functioning) were applied. Caregivers' cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research. Our results underline the influence of caregivers' cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers' cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component.

Is older adult care mediated by caregivers’ cultural stereotypes? The role of competence and warmth attribution

PubMed Central

Fernández-Ballesteros, Rocío; Bustillos, Antonio; Santacreu, Marta; Schettini, Rocio; Díaz-Veiga, Pura; Huici, Carmen

2016-01-01

Purpose The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers. Methods A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers’ cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers’ cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents’ functioning) were applied. Results Caregivers’ cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research. Conclusion Our results underline the influence of caregivers’ cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers’ cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component. PMID:27217736

Effect of stepped care on health outcomes in patients with osteoarthritis: an observational study in Dutch general practice.

PubMed

Smink, Agnes J; van den Ende, Cornelia H M; Vliet Vlieland, Thea P M; Bijlsma, Johannes W J; Swierstra, Bart A; Kortland, Joke H; Voorn, Theo B; Teerenstra, Steven; Schers, Henk J; Dekker, Joost; Bierma-Zeinstra, Sita M A

2014-09-01

A stepped care strategy (SCS) to improve adequate healthcare use in patients with osteoarthritis was developed and implemented in a primary care region in the Netherlands. To assess the association between care that is in line with the SCS recommendations and health outcomes. Data were used from a 2-year observational study of 313 patients who had consulted their GP because of osteoarthritis. Care was considered 'SCS-consistent' if all advised modalities of the previous steps of the SCS were offered before more advanced modalities of subsequent steps. Pain and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (range 0-100); active pain coping with the Pain Coping Inventory (range 10-40); and self-efficacy with the Dutch General Self-Efficacy Scale (range 12-48). Crude and adjusted associations between SCS-consistent care and outcomes were estimated with generalised estimating equations. No statistically significant differences were found in changes over a 2-year period in pain and physical function between patients who received SCS-inconsistent care (n = 163) and patients who received SCS-consistent care (n = 117). This was also the case after adjusting for possible confounders, that is, -4.3 (95% confidence interval [CI] = -10.3 to 1.7) and -1.9 (95% CI = -7.0 to 3.1), respectively. Furthermore, no differences were found in changes over time between groups in self-efficacy and pain coping. The results raised several important issues that need to be considered regarding the value of the SCS, such as the reasons that GPs provide SCS-inconsistent care, the long-term effects of the SCS, and the effects on costs and side effects. © British Journal of General Practice 2014.

[Results of conservative treatment in patients with occult pneumothorax].

PubMed

Llaquet Bayo, Heura; Montmany Vioque, Sandra; Rebasa, Pere; Navarro Soto, Salvador

2016-04-01

An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included. In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Observing outer planet satellites (except Titan) with JWST: Science justification and observational requirements

USGS Publications Warehouse

Kestay, Laszlo P.; Grundy, Will; Stansberry, John; Sivaramakrishnan, Anand; Thatte, Deepashri; Gudipati, Murthy; Tsang, Constantine; Greenbaum, Alexandra; McGruder, Chima

2016-01-01

The James Webb Space Telescope (JWST) will allow observations with a unique combination of spectral, spatial, and temporal resolution for the study of outer planet satellites within our Solar System. We highlight the infrared spectroscopy of icy moons and temporal changes on geologically active satellites as two particularly valuable avenues of scientific inquiry. While some care must be taken to avoid saturation issues, JWST has observation modes that should provide excellent infrared data for such studies.

Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature.

PubMed

Watterson, Jessica L; Walsh, Julia; Madeka, Isheeta

2015-01-01

Mobile health (mHealth) technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients', caretakers', or health workers' behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%, n = 8) and most were conducted in African countries (80%, n = 8). All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings.

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries

PubMed Central

Sun, Zeye

2017-01-01

Background It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)—the structural inputs to care—predicts the clinical quality of care provided to patients. Methods and findings Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers’ adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from −0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Conclusion Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care. PMID:29232377

Identified Palliative Care Approach Needs with SPICT in Family Practice: A Preliminary Observational Study.

PubMed

Hamano, Jun; Oishi, Ai; Kizawa, Yoshiyuki

2018-02-09

Identifying patients who require palliative care approach is challenging for family physicians, even though several identification tools have been developed for this purpose. To explore the prevalence and characteristics of family practice patients who need palliative care approach as determined using Supportive and Palliative Care Indicators Tool (SPICT™, April 2015) in Japan. Single-center cross-sectional study. We enrolled all patients ≥65 years of age who visited the chief researcher's outpatient clinic in October 2016. We used Japanese version of SPICT (SPICT-J) to identify patients who need palliative care approach. We assessed patients' backgrounds and whether they had undergone advance care planning with their family physicians. This study included 87 patients (61 females) with a mean age of 79.0 ± 7.4 years. Eight patients (9.2%) were identified as needing palliative care approach. The mean age of patients who needed this approach was 82.3 ± 8.3 years and main underlying conditions were heart/vascular disease (37.5%), dementia/frailty (25.0%), and respiratory disease (12.5%). Only two of eight patients identified as needing palliative care approach had discussed advance care planning with their family physicians. In family practice, 9.2% of outpatients ≥65 years of age were identified as needing palliative care approach. Family physicians should carefully evaluate whether outpatients need palliative care approach.

A Survey of Nurses' Compliance with Hand Hygiene Guidelines in Caring for Patients with Cancer in a Selected Center of Isfahan, Iran, in 2016

PubMed Central

Mostafazadeh-Bora, Mostafa; Bahrami, Masoud; Hosseini, Abbas

2018-01-01

Background: Hand hygiene is one of the key ways of preventing healthcare-associated infections (HCAI), especially in patients with cancer. The aim of this study was to determine nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center in Isfahan, Iran, in 2016. Materials and Methods: The present observational study was conducted on nurses in a cancer center in Isfahan in 2016. The participants were selected via convenience sampling method. Nurses serving at bedsides and willing to participate were entered into the study. Data were collected through the direct observation of nurses during delivering routine care, using the standard checklist for direct observation of the “five moments for hand hygiene” approach. Results: In the present study, 94 nurses were studied at 500 clinical moments. The overall hand hygiene compliance rate was 12.80%. The highest hand hygiene compliance rate was observed in the after body fluid exposure moment (72.70%). In addition, hand hygiene compliance rate in preprocedure indications (before patient contact and before aseptic procedure) and postprocedure indications (after patient contact, after body fluid exposure, and after patient surrounding contact) were 3.40 and 21%, respectively, which had a significant correlation (p = 0.001). Conclusions: The findings indicate that the hand hygiene compliance rate among nurses was low. Further research in this regard is recommended in order to find the causes of low compliance with hand hygiene and design interventions for improvement in hand hygiene compliance rate among nurses. PMID:29628959

Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.

PubMed

Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

2016-08-02

The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries. The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users' satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users. These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.

Delirium in adult patients receiving palliative care: a systematic review of the literature.

PubMed

Sánchez-Román, Sofía; Beltrán Zavala, Cristina; Lara Solares, Argelia; Chiquete, Erwin

2014-01-01

Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

[The meanings constructed in the attention to a crisis in the territory: the psychosocial care center as a protagonist].

PubMed

Willrich, Janaína Quinzen; Kantorski, Luciane Prado; Chiavagatti, Fabieli Gopinger; Cortes, Jandro Moraes; Antonacci, Milena Hohmann

2013-06-01

The attention to a crisis is a strategic point in the process of paradigm changes proposed by the Brazilian psychiatric reform, requiring changes in alternative services and in the professionals that must use new technologies of care. This study aimed to identify the actions of attention to a crisis in the territory and the meanings as they evolved, beginning from the discursive practices of the professionals. It was a qualitative study that used the theoretical perspective of social constructionism. From the database of the research, Evaluation of the Psychosocial Care Centers in Southern Brazil (CAPSUL), 27 interviews were analyzed from the professionals of Psychosocial Care Center for Alegrete, along with field diaries with 390 hours of observation. Results showed patient engagement/welcoming and accountability for care. We concluded that freedom, reciprocity, contractuality and responsibility for care were the new meanings needed for the alternative care services to overcome the asylum and sense of exclusion and dangerousness.

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

PubMed Central

Arndt, Brian G.; Beasley, John W.; Watkinson, Michelle D.; Temte, Jonathan L.; Tuan, Wen-Jan; Sinsky, Christine A.; Gilchrist, Valerie J.

2017-01-01

PURPOSE Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. METHODS We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from “event logging” records over a 3-year period for both direct patient care and non–face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. RESULTS Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). CONCLUSIONS Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. PMID:28893811

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.

PubMed

Arndt, Brian G; Beasley, John W; Watkinson, Michelle D; Temte, Jonathan L; Tuan, Wen-Jan; Sinsky, Christine A; Gilchrist, Valerie J

2017-09-01

Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non-face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. © 2017 Annals of Family Medicine, Inc.

Patient factors associated with increased acute care costs of hip fractures: a detailed analysis of 402 patients.

PubMed

Aigner, R; Meier Fedeler, T; Eschbach, D; Hack, J; Bliemel, C; Ruchholtz, S; Bücking, B

2016-12-01

The aim of the present study was to identify patient factors associated with higher costs in hip fracture patients. The mean costs of a prospectively observed sample of 402 patients were 8853 €. The ASA score, Charlson comorbidity index, and fracture location were associated with increased costs. Fractures of the proximal end of the femur (hip fractures) are of increasing incidence due to demographic changes. Relevant co-morbidities often present in these patients cause high complication rates and prolonged hospital stays, thus leading to high costs of acute care. The aim of this study was to perform a precise cost analysis of the actual hospital costs of hip fractures and to identify patient factors associated with increased costs. The basis of this analysis was a prospectively observed single-center trial, which included 402 patients with fractures of the proximal end of the femur. All potential cost factors were recorded as accurately as possible for each of the 402 patients individually, and statistical analysis was performed to identify associations between pre-existing patient factors and acute care costs. The mean total acute care costs per patient were 8853 ± 5676 € with ward costs (5828 ± 4294 €) and costs for surgical treatment (1972 ± 956 €) representing the major cost factors. The ASA score, Charlson comorbidity index, and fracture location were identified as influencing the costs of acute care for hip fracture treatment. Hip fractures are associated with high acute care costs. This study underlines the necessity of sophisticated risk-adjusted payment models based on specific patient factors. Economic aspects should be an integral part of future hip fracture research due to limited health care resources.

The effects of health promotion model-based educational program on self-care behaviors in patients undergoing coronary artery bypass grafting in Iran

PubMed Central

Mohsenipouya, Hossein; Majlessi, Fereshteh; Ghafari, Rahman

2018-01-01

Background and aim Post-operative self-care behaviors, have positive effects on increase in adaptability, and reduce cardiac surgery patients’ disability. The present study is carried out aimed at determining the effect of education based on a health promotion model on the patients’ self-care behaviors after coronary artery bypass surgery. Methods This is a semi-experimental study carried out in Mazandaran (Iran) in 2016. Two hundred and twenty patients who participated in the study were selected using a simple random sampling method from a population of postoperative patients, and divided into control and experimental groups (110 patients in each) using block (AABB) randomization. Self-designed self-care questionnaires based on a health promotion model were distributed among the patients once before and three months after intervention. The data were analyzed by SPSS-22, Chi-Square tests, Mann-Whitney and ANCOVA at the significance level of p<0.05. Results The average score of total self-care behaviors in cardiac surgery patients was not significant between the two groups before education (p=0.065), but after training, a significant difference was observed between the two groups (p<0.001). The analysis of ANOVA with repeated measure indicated that following the intervention, significant difference was observed between the two groups in terms of improvement of self-care behaviors after excluding the effect of pre-test and controlling demographic and health-related characteristics. Conclusions Developing and implementing a training program based on the health promotion model can enhance self-care behaviors and reduce the number of admissions in patients after cardiac surgery. PMID:29588828

Palmar skin conductance variability and the relation to stimulation, pain and the motor activity assessment scale in intensive care unit patients.

PubMed

Günther, Anders C; Bottai, Matteo; Schandl, Anna R; Storm, Hanne; Rossi, Patrik; Sackey, Peter V

2013-03-19

Many intensive care unit (ICU) patients describe pain and other adverse feelings that may impact long-term psychological morbidity. Sympathetically mediated palmar skin conductance variability is related to emotionally induced perspiration and correlates with pain levels in the perioperative setting but has not been studied in ICU patients. Twenty non-intubated and 20 intubated general ICU patients were included in this observational study. Patients were monitored with the MED-STORM Pain Monitoring System®. The number of skin conductance fluctuations per second (NSCF) was measured in parallel with bedside observation during one hour of intensive care, including rest, procedures and patient-staff interactions. Arousal-agitation level was monitored with the motor activity assessment scale (MAAS). Pain was monitored with the numeric rating scale (0 to 10) in patients able to communicate or by observation in patients unable to communicate. In non-intubated patients, NSCF increased with increasing stimulation/pain but also with higher MAAS (P=0.002). An interaction effect was found, with increased NSCF response to stimulation/pain with increasing MAAS (P<0.001). In critically ill patients, NSCF may be more useful evaluating emotional distress rather than pain alone. It needs to be assessed whether NSCF monitoring is clinically useful and whether controlling emotional distress with the aid of such monitoring may impact on patient care and outcomes.

The effect of contact precautions on healthcare worker activity in acute care hospitals.

PubMed

Morgan, Daniel J; Pineles, Lisa; Shardell, Michelle; Graham, Margaret M; Mohammadi, Shahrzad; Forrest, Graeme N; Reisinger, Heather S; Schweizer, Marin L; Perencevich, Eli N

2013-01-01

Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities. Prospective cohort study. Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus. Trained observers performed "secret shopper" monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods. A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; [Formula: see text]) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; [Formula: see text]). Patients on contact precautions tended to have fewer visitors (23.6% fewer; [Formula: see text]). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; [Formula: see text]). Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

PubMed Central

Jakobsen, Louise M; Jorgensen, Anette F B; Thomsen, Birthe L; Greiner, Birgit A; Rugulies, Reiner

2015-01-01

Objectives Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers. Methods Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. Results Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. Conclusions Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions. PMID:26560058

Mandatory Nap Times and Group Napping Patterns in Child Care: An Observational Study.

PubMed

Staton, Sally L; Smith, Simon S; Hurst, Cameron; Pattinson, Cassandra L; Thorpe, Karen J

2017-01-01

Policy provision for naps is typical in child care settings, but there is variability in the practices employed. One practice that might modify children's early sleep patterns is the allocation of a mandatory nap time in which all children are required to lie on their beds without alternate activity permitted. There is currently limited evidence of the effects of such practices on children's napping patterns. This study examined the association between duration of mandatory nap times and group-level napping patterns in child care settings. Observations were undertaken in a community sample of 113 preschool rooms with a scheduled nap time (N = 2,114 children). Results showed that 83.5% of child care settings implemented a mandatory nap time (range = 15-145 min) while 14.2% provided alternate activities for children throughout the nap time period. Overall, 31% of children napped during nap times. Compared to rooms with ≤ 30 min of mandatory nap time, rooms with 31-60 min and > 60 min of mandatory nap time had a two-and-a-half and fourfold increase, respectively, in the proportion of children napping. Nap onset latency did not significantly differ across groups. Among preschool children, exposure to longer mandatory nap times in child care may increase incidence of napping.

Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands.

PubMed

Wind, Jentina; van Mook, Walther N K A; Dhanani, Sonny; van Heurn, Ernest W L

2016-02-01

Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation. The Determination of Cardiac Death Practices in Intensive Care Survey was sent to all intensive care physicians. Fifty-five percent of 568 Dutch intensive care physicians responded. Most respondents learned death determination from clinical practice. The most commonly used tests for death determination were flat arterial line tracing, flat electrocardiogram (standard 3-lead electrocardiogram), and fixed and dilated pupils. Rarely used tests were absence pulse by echo Doppler, absent blood pressure by noninvasive monitoring, and unresponsiveness to painful stimulus. No diagnostic test or procedure was uniformly performed, but 80% of respondents perceived a need for standardization of death determination. Autoresuscitation was witnessed by 37%, after withdrawal of treatment or after unsuccessful resuscitation. Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies. Copyright © 2015 Elsevier Inc. All rights reserved.

The first year of behavioral development and maternal care of beluga (Delphinapterus leucas) calves in human care.

PubMed

Hill, Heather M; Campbell, Carolyn; Dalton, Les; Osborn, Steven

2013-01-01

The current study provides additional information for the behavioral development and maternal care of belugas or white whales (Delphinapterus leucas) in the care of humans. The behaviors and mother-calf interactions of two female beluga calves were recorded from birth to 12 months as part of a longitudinal study of beluga behavioral development. As expected, the primary calf activity for both calves involved swimming with their mothers. The calves initiated the majority of the separations from and reunions with their mothers and exhibited early bouts of independence. Both mothers bonded with their calves and displayed similar maternal care behaviors but exhibited different behavioral patterns. Despite differences in social groupings, housing, and physical health, the two female belugas followed the behavioral development of beluga calves observed previously. © 2013 Wiley Periodicals, Inc.

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries.

PubMed

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-03-27

To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Cross-sectional observational health facility assessment. Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to save newborn lives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Patterns of Colorectal Cancer Care in Europe, Australia, and New Zealand

PubMed Central

2013-01-01

Colorectal cancer is the second most common cancer in women and the third most common in men worldwide. In this study, we used MEDLINE to conduct a systematic review of existing literature published in English between 2000 and 2010 on patterns of colorectal cancer care. Specifically, this review examined 66 studies conducted in Europe, Australia, and New Zealand to assess patterns of initial care, post-diagnostic surveillance, and end-of-life care for colorectal cancer. The majority of studies in this review reported rates of initial care, and limited research examined either post-diagnostic surveillance or end-of-life care for colorectal cancer. Older colorectal cancer patients and individuals with comorbidities generally received less surgery, chemotherapy, or radiotherapy. Patients with lower socioeconomic status were less likely to receive treatment, and variations in patterns of care were observed by patient demographic and clinical characteristics, geographical location, and hospital setting. However, there was wide variability in data collection and measures, health-care systems, patient populations, and population representativeness, making direct comparisons challenging. Future research and policy efforts should emphasize increased comparability of data systems, promote data standardization, and encourage collaboration between and within European cancer registries and administrative databases. PMID:23962509

Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse-Family Interactions in the Neuro ICU.

PubMed

Rippin, Allyn S; Zimring, Craig; Samuels, Owen; Denham, Megan E

2015-01-01

This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement. A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse. Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families. Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control. Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support. © The Author(s) 2015.

The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review.

PubMed

de Almeida, Cesar Cimonari; Boone, M Dustin; Laviv, Yosef; Kasper, Burkhard S; Chen, Clark C; Kasper, Ekkehard M

2018-02-01

Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission. A systematic review was performed in July 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist of the Medline database. The search strategy was created based on the following key words: "craniotomy," "neurosurgical procedure," and "intensive care unit." The nine articles that satisfied the inclusion criteria yielded a total of 2227 patients. Of these patients, 879 were observed in a non-ICU setting. The most frequent diagnoses were supratentorial brain tumors, followed by patients with cerebrovascular diseases and infratentorial brain tumors. Three percent (30/879) of the patients originally assigned to floor or intermediate care status were transferred to the ICU. The most frequently observed neurological complications leading to ICU transfer were delayed postoperative neurological recovery, seizures, worsening of neurological deficits, hemiparesis, and cranial nerves deficits. Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.

Ibrutinib versus previous standard of care: an adjusted comparison in patients with relapsed/refractory chronic lymphocytic leukaemia.

PubMed

Hansson, Lotta; Asklid, Anna; Diels, Joris; Eketorp-Sylvan, Sandra; Repits, Johanna; Søltoft, Frans; Jäger, Ulrich; Österborg, Anders

2017-10-01

This study explored the relative efficacy of ibrutinib versus previous standard-of-care treatments in relapsed/refractory patients with chronic lymphocytic leukaemia (CLL), using multivariate regression modelling to adjust for baseline prognostic factors. Individual patient data were collected from an observational Stockholm cohort of consecutive patients (n = 144) diagnosed with CLL between 2002 and 2013 who had received at least second-line treatment. Data were compared with results of the RESONATE clinical trial. A multivariate Cox proportional hazards regression model was used which estimated the hazard ratio (HR) of ibrutinib versus previous standard of care. The adjusted HR of ibrutinib versus the previous standard-of-care cohort was 0.15 (p < 0.0001) for progression-free survival (PFS) and 0.36 (p < 0.0001) for overall survival (OS). A similar difference was observed also when patients treated late in the period (2012-) were compared separately. Multivariate analysis showed that later line of therapy, male gender, older age and poor performance status were significant independent risk factors for worse PFS and OS. Our results suggest that PFS and OS with ibrutinib in the RESONATE study were significantly longer than with previous standard-of-care regimens used in second or later lines in routine healthcare. The approach used, which must be interpreted with caution, compares patient-level data from a clinical trial with outcomes observed in a daily clinical practice and may complement results from randomised trials or provide preliminary wider comparative information until phase 3 data exist.

Findings from non-participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses.

PubMed

Casey, Dympna

2007-03-01

This paper reports on the non-participant observational findings from a study, which examined hospital-based nurses' health promoting nursing practice in an acute setting. Nurses are considered to have a key role in health promotion. However, the development of the role of the generalist hospital-based nurse in health promotion has been slow and is not well-understood. The conceptual framework used was based on the Ottawa Charter (WHO 1986). A single qualitative embedded case study, employing data source and methodological triangulation was used. A framework for identifying nurse's use of health promotion methods was developed and used to collect non-participant observations on a purposive sample of eight nurses working on an acute hospital ward. Following the observations a semi structured one-to-one interview was conducted with each observed nurse. One randomly selected patient that the observed nurse had cared for during the observations was also interviewed. Qualitative data analysis based on the work of Miles and Huberman was employed. Two categories were identified 'health promotion strategies and content' and 'patient participation'. The findings indicated that, overall, the strategies used by nurses to promote health were prescriptive and individualistic. The main strategy observed was information giving and the content was 'preparatory information'. Predominantly, nurses practised traditional health education. Overall, patient participation was limited to minor personal aspects of care as nurses focused on the routine and getting the tasks completed. There was no evidence of a ward culture which valued health promotion. Ward managers are key in creating a culture for health promotion. A review of the methods of organizing nursing care is warranted. Nursing programmes must highlight health promotion as integral to practice and emphasis the socio-political dimensions of health promotion.

Ethnic minority, young onset, rare dementia type, depression: A case study of a Muslim male accessing UK dementia health and social care services.

PubMed

Regan, Jemma L

2016-07-01

A case study comprised of formal interviews, formal observations and informal discussions investigated the motivations and experiences accessing dementia care health and social care services for a Muslim, Pakistani male with dementia. Motivations derived from 'desperation' and an inability to access support from family or religious community. Experiences of accessing services were mostly negative. Dementia services were ill-informed about how to support persons with young onset dementia, with pre-existing mental health conditions, from an ethnic minority. Education and training to remove barriers to all dementia care services is required for persons with dementia, their families and within dementia services and religious communities. © The Author(s) 2014.

[Standardisation of nursing care amongst patients in prison].

PubMed

Martínez-Delgado, M M

2014-01-01

To develop the Standardized Nursing Care Process format amongst patients in a prison. Observational, descriptive study, conducted on a sample of thirty patients in Soria Prison between March and June 2011. We collected information via a review of medical records and conducted an interview of nursing assessments using functional patterns. Subsequent nursing diagnoses and interrelated problems were obtained using NANDA taxonomy. The subsequent use of NIC and NOC taxonomy marked the activities and performance criteria for each diagnosis, in the same way as for interrelated problems. The nursing diagnoses found in the patient sample analyzed, and the frequency thereof, reveal peculiarities in terms of the health care needs of the prison population, which makes it possible to standardize nursing care plans for the population under study.

Measuring Child-Staff Ratios in Child Care Centers: Balancing Effort and Representativeness

ERIC Educational Resources Information Center

Le, Vi-Nhuan; Perlman, Michal; Zellman, Gail L.; Hamilton, Laura S.

2006-01-01

Child-staff ratios are an important quality indicator. They are often collected by observing one randomly selected classroom several times during a 2-h period on a single day. However, it is unclear whether these measures represent the ratios that children actually experience during most of their time in care. This study compared ratio data…

Alternative Health Care Practitioners in a Chinese American Community: A Preliminary Report of Findings.

ERIC Educational Resources Information Center

Kao, Jessica Ching-Yi

This paper provides a brief review of the literature on traditional Chinese medicine in both China and the United States and presents observations from a preliminary study of Chinese practitioners in the Chinatown section of Los Angeles, California. The dualistic health care system in Chinese culture is described as comprising both scholarly and…

Day Care in Alberta, Canada: Overcoming the Barriers for Children with Disabilities. Working Paper Series, No. 231.

ERIC Educational Resources Information Center

Fink, Dale Borman

This study of integrated day care in the province of Alberta, Canada, involved observations and interviews at preschool sites in Calgary and Edmonton. The discussion resulting from the Calgary visits considers: combining funding from a provincial agency with the availability of hospital-sponsored mobile clinical services to support integration in…

Children's Individual Experiences in Early Care and Education: Relations with Overall Classroom Quality and Children's School Readiness

ERIC Educational Resources Information Center

Jeon, Hyun-Joo; Langill, Carolyn C.; Peterson, Carla A.; Luze, Gayle J.; Carta, Judith J.; Atwater, Jane B.

2010-01-01

This study examined relations among children's individual experiences, global classroom quality, and school readiness. Preschool children from low-income backgrounds (N = 138; M = 62.16 months; SD = 3.93; range = 55-70) were observed in their early care and education settings, and their language and cognitive skills were assessed. Research…

The Impact of Personal Loss on the Experience of Health Professions: Graduate Students in End-of-Life and Bereavement Care

ERIC Educational Resources Information Center

Supiano, Katherine P.; Vaughn-Cole, Beth

2011-01-01

This study explored the impact of prior personal experience with grief on self-reported personal and professional development of graduate students in nursing, social work, counseling, pastoral care, and genetic counseling involved as cofacilitators in bereavement support groups, and of medical students observing interdisciplinary inpatient…

The effect of horticultural therapy on the quality of life of palliative care patients.

PubMed

Lai, Claudia Kam-Yuk; Lau, Carmen Ka-Yan; Kan, Wai Yin; Lam, Wai Man; Fung, Connie Yuen Yee

2017-01-01

Palliative care patients experience a variety of needs and perceive their quality of life as being only fair. This study adopted a single-group repeated-measure design to investigate the effect of horticultural therapy on the quality of life of palliative care patients using the Quality of Life Concern in End of Life Questionnaire. Significant differences in the domains of "existential distress" and "health care concern" were observed immediately postintervention and at 4 weeks postintervention, respectively. No other significant differences were seen in the other domains or in the total mean score of the outcome measure.

[Achievement and Future Direction of the PEACE Project - A National Education Project for Palliative Care Education].

PubMed

Kizawa, Yoshiyuki; Yamamoto, Ryo

2017-07-01

Although palliative care is assuming an increasingly important role in patient care, most physicians did not learn to provide palliative care during their medical training. To address these serious deficiencies in physician training in palliative care, government decided to provide basic palliative education program for all practicing cancer doctors as a national policy namely Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education(PEACE). The program was 2-days workshop based on adult learning theory and focusing on symptom management and communication. In this 9 years, 4,888 educational workshop has been held, and 93,250 physicians were trained. In prospective observational study, both knowledges and difficulties practicing palliative care were significantly improved. In 2017, the new palliative care education program will be launched including combined program of e-learning and workshop to provide tailor made education based on learner's readiness and educational needs in palliative care.

Resilience and unmet supportive care needs in patients with cancer during early treatment: A descriptive study.

PubMed

Dubey, C; De Maria, J; Hoeppli, C; Betticher, D C; Eicher, M

2015-10-01

The concept of resilience is gaining increasing importance as a key component of supportive care but to date has rarely been addressed in studies with adult cancer patients. The purpose of our study was to describe resilience and its potential predictors and supportive care needs in cancer patients during early treatment and to explore associations between both concepts. This descriptive study included adult cancer patients under treatment in ambulatory cancer services of a Swiss hospital. Subjects completed the 25-item Connor-Davidson-Resilience Scale and the 34-item Supportive Care Needs Survey. Descriptive, correlational and regression analysis were performed. 68 patients with cancer were included in the study. Compared to general population, resilience scores were significantly lower (74.4 ± 12.6 vs. 80.4 ± 12.8, p = .0002). Multiple regression analysis showed predictors ("age", "metastasis", "recurrence" and "living alone") of resilience (adjusted R2 = .19, p < .001). Highest unmet needs were observed in the domain of psychological needs. Lower resilience scores were significantly and strongly associated with higher levels of unmet psychological needs (Rho = -.68, p < .001), supportive care needs (Rho = -.49, p < .001) and information needs (Rho = -.42, p = .001). Ambulatory patients with higher levels of resilience express fewer unmet needs. Further work is needed to elucidate the mechanism of the observed relationships and if interventions facilitating resilience have a positive effect on unmet needs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Information exchange networks for chronic illness care in primary care practices: an observational study

PubMed Central

2010-01-01

Background Information exchange networks for chronic illness care may influence the uptake of innovations in patient care. Valid and feasible methods are needed to document and analyse information exchange networks in healthcare settings. This observational study aimed to examine the usefulness of methods to study information exchange networks in primary care practices, related to chronic heart failure, diabetes and chronic obstructive pulmonary disease. Methods The study was linked to a quality improvement project in the Netherlands. All health professionals in the practices were asked to complete a short questionnaire that documented their information exchange relations. Feasibility was determined in terms of response rates and reliability in terms of reciprocity of reports of receiving and providing information. For each practice, a number of network characteristics were derived for each of the chronic conditions. Results Ten of the 21 practices in the quality improvement project agreed to participate in this network study. The response rates were high in all but one of the participating practices. For the analysis, we used data from 67 health professionals from eight practices. The agreement between receiving and providing information was, on average, 65.6%. The values for density, centralization, hierarchy, and overlap of the information exchange networks showed substantial variation between the practices as well as between the chronic conditions. The most central individual in the information exchange network could be a nurse or a physician. Conclusions Further research is needed to refine the measure of information networks and to test the impact of network characteristics on the uptake of innovations. PMID:20205758

Improved Virologic Suppression With HIV Subspecialty Care in a Large Prison System Using Telemedicine: An Observational Study With Historical Controls

PubMed Central

Young, Jeremy D.; Patel, Mahesh; Badowski, Melissa; Mackesy-Amiti, Mary Ellen; Vaughn, Pyrai; Shicker, Louis; Puisis, Michael; Ouellet, Lawrence J.

2014-01-01

Correctional populations have an elevated human immunodeficiency virus (HIV) prevalence, yet many individuals lack access to subspecialty care. Our study showed that HIV-infected inmates had significantly greater virologic suppression and higher CD4 T-lymphocyte counts when managed by a multidisciplinary team of subspecialists conducting clinics via telemedicine. In other studies, these outcomes have been associated with reductions on HIV-related morbidity and mortality, as well as HIV transmission. PMID:24723283

Do men perform better than women in trauma?

PubMed

Hernández-Tejedor, Alberto; García-Fuentes, Carlos; Alted-López, Emilio

2014-02-27

In recent decades, numerous studies have compared survival according to gender of patients admitted to general hospitals and particularly to intensive care units. In a previous issue of Critical Care, Schoeneberg and colleagues presented the results of a German observational study on a sample from a 10 year registry in a Level 1 trauma center. The conclusion is that there is a trend towards a higher mortality in women than in men.

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

PubMed Central

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2015-01-01

Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID:26294218

Impact of an educational program on nursing students' caring and self-perception in intensive clinical training in Jordan.

PubMed

Khouri, Rawda

2011-01-01

Framing and development of clinical skills in nursing students during their clinical practice is critical because this can shape their future caring skills. Professional caring empowers patients and contributes to their well-being and health. Education may enhance the capacity of nurses to be effective caring practitioners. Their study program encourages caring behavior in nursing students, consequently affecting their professional self-perception. The present study investigated the effect of an educational program on caring behavior and professional self-perception in nursing students using a controlled pre/post test study design. The study sample consisted of 50 nursing students undertaking their final year in 2010-2011. Subjects were randomly assigned to either an experimental or a control group. The study was conducted in two critical care units affiliated to the Ma'an and Queen Rania hospitals in the south of Jordan. The instruments utilized were the Caring Dimensions Inventory, Nursing Students Attitude Observational Checklist, and Professional Self-Concept of Nurses Instrument. The study findings favor the effect of the educational program because there was increased knowledge and understanding of caring theory and related concepts, a more holistic approach to care, enhanced caring practices, and improved self-perception in the study group compared with the control group during different periods of assessment. The study group showed significantly better caring perception in psychological, technical, and professional terms than the control group during different periods of assessment. There was a significant positive trend of overall professional self-perception for the study group compared with the control group. Nursing curricula should incorporate concepts and principles that guide students in developing caring, safe, competent, and professional behavior. Nursing students must seek educational opportunities to acquire knowledge for role preparation, to participate in knowledge generation, and for personal and professional development.

Impact of an educational program on nursing students’ caring and self-perception in intensive clinical training in Jordan

PubMed Central

Khouri, Rawda

2011-01-01

Background Framing and development of clinical skills in nursing students during their clinical practice is critical because this can shape their future caring skills. Professional caring empowers patients and contributes to their well-being and health. Education may enhance the capacity of nurses to be effective caring practitioners. Their study program encourages caring behavior in nursing students, consequently affecting their professional self-perception. Methods The present study investigated the effect of an educational program on caring behavior and professional self-perception in nursing students using a controlled pre/post test study design. The study sample consisted of 50 nursing students undertaking their final year in 2010–2011. Subjects were randomly assigned to either an experimental or a control group. The study was conducted in two critical care units affiliated to the Ma’an and Queen Rania hospitals in the south of Jordan. The instruments utilized were the Caring Dimensions Inventory, Nursing Students Attitude Observational Checklist, and Professional Self-Concept of Nurses Instrument. Results The study findings favor the effect of the educational program because there was increased knowledge and understanding of caring theory and related concepts, a more holistic approach to care, enhanced caring practices, and improved self-perception in the study group compared with the control group during different periods of assessment. The study group showed significantly better caring perception in psychological, technical, and professional terms than the control group during different periods of assessment. There was a significant positive trend of overall professional self-perception for the study group compared with the control group. Conclusion Nursing curricula should incorporate concepts and principles that guide students in developing caring, safe, competent, and professional behavior. Nursing students must seek educational opportunities to acquire knowledge for role preparation, to participate in knowledge generation, and for personal and professional development. PMID:23745088

A comparison of observers' and self-report pain ratings for children with cerebral palsy.

PubMed

Hadden, Kellie L; LeFort, Sandra; OʼBrien, Michelle; Coyte, Peter C; Guerriere, Denise N

2015-01-01

This study aimed to examine (1) the relationship between children's self-reports of pain and their different care providers' pain ratings, (2) the relationship between different care providers' ratings of pain in children with cerebral palsy (CP), and (3) whether the child's level of disability influences care providers' pain ratings. Sixty-three children with CP were separated into 2 groups according to whether they were able to pass a self-report training task. Pain was rated using a Numerical Rating Scale and the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV). Children were observed during their regular physiotherapy sessions at 3 separate time segments (Baseline, Stretch Procedure, and Recovery). As anticipated, results showed that all observers reported significantly higher pain scores during a physiotherapy stretching procedure than the baseline and recovery segments. Observers' NCCPC-PV scores were significantly higher during the stretch procedure for the children who did not pass the self-report training task. Findings also indicated that parents tended to report significantly lower pain scores compared with both their children and other observers. The findings bring into question the accuracy of single-observer pain ratings for children with CP and possess implications for the management of pain in children with CP.

As CMS makes another policy change, policy makers distinguish between different forms of care.

PubMed

2013-10-01

As observation care continues to draw fire from critics who charge that the designation ends up costing hospitals money while also sticking patients with exorbitant fees, the medical directors of dedicated observation units counter that the kind of care delivered by their specialized units actually saves money and gets patients out of the hospital sooner. They note that the problem is that only about one-third of hospitals actually have dedicated observation units, so patients placed on observation typically wind up in inpatient beds, where they may only be evaluated once a day. CMS has just released a new policy rule on observation that should help patients avoid excessive charges, but many experts would like to see the agency take steps to incentivize the kind of quality care that is delivered in dedicated units. The new CMS rule for 2014 caps observation stays at 48 hours. Patients who remain in the hospital beyond this point become inpatients, as long as they meet inpatient criteria. Proponents of observation care contend that the average length-of-stay in a dedicated observation unit is just 15 hours--typically much shorter than the LOS of patients who are placed on observation in inpatient beds. Care in a dedicated observation unit is generally driven by protocol in an emergency medicine environment where there is continuous rounding. Discharges can occur at any time of the day or night. Experts note that observation patients account for the largest portion of both misdiagnoses and malpractice lawsuits stemming from emergency settings.

A questionnaire to assess the relevance and credibility of observational studies to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report.

PubMed

Berger, Marc L; Martin, Bradley C; Husereau, Don; Worley, Karen; Allen, J Daniel; Yang, Winnie; Quon, Nicole C; Mullins, C Daniel; Kahler, Kristijan H; Crown, William

2014-03-01

Evidence-based health care decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. Widespread adoption of evidence from observational studies, however, has been limited because of various factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two task forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other Task Force addressing prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Bias reduction in repeated-measures observational studies by the use of propensity score: the case of enteral sedation for critically ill patients.

PubMed

Umbrello, Michele; Mistraletti, Giovanni; Corbella, Davide; Cigada, Marco; Salini, Silvia; Morabito, Alberto; Iapichino, Gaetano

2012-12-01

Within the evidence-based medicine paradigm, randomized controlled trials represent the "gold standard" to produce reliable evidence. Indeed, planning and implementing randomized controlled trials in critical care medicine presents limitations because of intrinsic and structural problems. As a consequence, observational studies still occur frequently. In these cases, propensity score (PS) (probability of receiving a treatment conditional on observed covariates) is an increasingly used technique to adjust the results. Few studies addressed the specific issue of a PS correction of repeated-measures designs. Three techniques for correcting the analysis of nonrandomized designs (matching, stratification, regression adjustment) are presented in a tutorial form and applied to a real case study: the comparison between intravenous and enteral sedative therapy in the intensive care unit setting. After showing the results before and after the use of PS, we suggest that such a tool allows to partially overcoming the bias associated with the observational nature of the study. It permits to correct the estimates for any observed covariate, while unobserved confounders cannot be controlled for. Propensity score represents a useful additional tool to estimate the effects of treatments in nonrandomized studies. In the case study, an enteral sedation approach was equally effective to an intravenous regime, allowing for a lower level of sedation and spare of resources. Copyright © 2012 Elsevier Inc. All rights reserved.

From spouse to caregiver and back: a grounded theory study of post-intensive care unit spousal caregiving.

PubMed

Ågård, Anne Sophie; Egerod, Ingrid; Tønnesen, Else; Lomborg, Kirsten

2015-08-01

To explore the challenges and caring activities of spouses of intensive care unit survivors during the first year of patient recovery. Every year, millions of people globally are discharged from an intensive care unit after critical illness to continue treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. Consequently, millions of spouses become informal caregivers. Little is known, however, about the concrete challenges spouses face in post-intensive care unit everyday life. Explorative, qualitative grounded theory study. Participants were spouses of intensive care unit survivors. The study was undertaken in Denmark in 2009-2010. Data consisted of 35 semi-structured dyad interviews at 3 and 12 months post-intensive care unit discharge, two group interviews with patients and two with spouses. 'Shifting their role from spouse to caregiver and back' was identified as the core category of the study. The role shifts progressed in a dynamic process involving four elements: (1) committing to caregiving; (2) acquiring caregiving skills; (3) negotiating level of caregiving and (4) gradually leaving the caregiver role. Post-ICU caregiving comprised five patient dimensions: observing, assisting, coaching, advocating and managing activities. Spouses play a vital and multifaceted role in post-intensive care unit recovery. The findings can inform healthcare professionals in their efforts to prepare intensive care unit patients' families for the time following intensive care unit and hospital discharge. Hospital staff, rehabilitation experts and primary care professionals must acknowledge spouses' important contribution from intensive care unit admission throughout recovery. © 2015 John Wiley & Sons Ltd.

Empowerment, environment and person-centred care: A qualitative study exploring the hospital experience for adults with cognitive impairment.

PubMed

Prato, Laura; Lindley, Lyndsay; Boyles, Miriam; Robinson, Louise; Abley, Clare

2018-01-01

It is acknowledged that there are many challenges to ensuring a positive hospital experience for patients with cognitive impairment. The study ('Improving hospital care for adults with cognitive impairment') aimed to explore the positive and negative experiences of older adults with cognitive impairment (dementia and delirium) and their relatives and/or carers, during an acute hospital stay, from admission to discharge, using a qualitative, case study methodology. Six participants with cognitive impairment, eight relatives and 59 members of the health care team were recruited. Data was collected via ethnographic, observational periods at each stage of the hospital journey and through the use of semi-structured interviews with relatives, carers and health care staff including: medical staff; nursing staff; physiotherapists and ward managers. Interpretive phenomenological analysis was used to facilitate data analysis. 52 hours 55 minutes of ethnographic observations and 18 interviews with ward staff and relatives were undertaken. Three superordinate themes emerged from the data as crucial in determining the quality of the hospital experience: valuing the person; activities of empowerment and disempowerment and the interaction of environment with patient well-being. Whether the patient's hospital experience was positive or negative was powerfully influenced by family involvement and ward staff actions and communication. Participants identified a requirement for a ward based activity service for patients with cognitive impairment. Further research must be undertaken focusing on the development of ward based activities for patients with cognitive impairment, alongside a move towards care which explores measures to improve and expand relative involvement in hospital care.

Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data

PubMed Central

Avaldi, Vera Maria; Urbinati, Stefano; Molinazzi, Dario; Descovich, Carlo; Campagna, Anselmo; Taglioni, Martina; Fioritti, Angelo

2017-01-01

Objectives To evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF). Design Retrospective observational study based on administrative data. Setting Local Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants. Participants All patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015. Primary and secondary outcome measures Multivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge. Results The study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (–53% and –28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (–28%). Conclusions Compared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF. PMID:29101146