Effects of government policies on the work of home care personnel and their occupational health and safety.

PubMed

Cloutier, Esther; David, Hélène; Ledoux, Elise; Bourdouxhe, Madeleine; Gagnon, Isabelle; Ouellet, François

2008-01-01

The health sector in Québec (Canada) is dealing with profound macro-economic and macro-organizational changes. This article is interested in the impact of these changes on the work of home health aides (HHAs) and home care nurses and their occupational health and safety (OHS). The study was carried out in the home care services (HCS) of four local community service centres (CLSC) with different organizational characteristics. It is based on an analysis by triangulation of 66 individual and group interviews, 22 observed workdays and 35 observed multidisciplinary or professional meetings, as well as on administrative documents. HHAs are experiencing an erosion of their job because the relational and affective aspects of their work are disappearing. This may be due to an increase in their physical workload, leading to an increase in musculoskeletal problems and, to a lesser extent, in psychological health problems. Nurses are seeing an increase in the volume of invisible work that they have to do, which also has the effect of decreasing the relational aspects of their activity. The increasingly numerous psychological health problems are the consequence of this change in their profession. This study also shows that managers' decisions at the local level can reduce or increase the work constraints of HHAs and nurses. Examples of good practices for HHAs are the stabilization of clienteles and the possibility of organizing their itinerary, while for nurses, it is in how clientele follow-up tools are implemented. This article discusses the effects of government policies and decisions on the work and OHS of home care personnel. To address this subject, we use a specific analysis of the workload of home health aides (HHAs) and nurses. We will show the relationships between managers' organizational choices to respond to governmental constraints and the resulting work changes. We will also look at their consequences on occupational health and safety (OHS) and on the work of different personnel.

Development of a Curriculum for Long-Term Care Nurses to Improve Recognition of Depression in Dementia

ERIC Educational Resources Information Center

Williams, Christine L.; Molinari, Victor; Bond, Jennifer; Smith, Michael; Hyer, Kathryn; Malphurs, Julie

2006-01-01

There is increasing recognition of the severe consequences of depression in long-term care residents with dementia. Most health care providers are unprepared to recognize and to manage the complexity of depression in dementia. Targeted educational initiatives in nursing homes are needed to address this growing problem. This paper describes the…

Establishment and Maintenance of Positive Behavior Change Under Alternate Procedures for Microeconomy Initiation and Termination.

ERIC Educational Resources Information Center

Byrd, Gary R.; Locke, Bill J.

Token management procedures, initiated in a community residential home for six reatarded subjects, were designed to affect social behaviors and personal care habits. Two delivery formats were used, one in which prior announcement of reinforcement contingencies was explained, a second in which target behaviors were consequated as they occurred. The…

Organization aesthetics in nursing homes.

PubMed

Hujala, Anneli; Rissanen, Sari

2011-05-01

The aim of this study was to make visible the material dimensions of nursing management.   Management theories have mainly ignored the material dimensions, namely the physical spaces in which management actually takes place as well as the physical bodies of organization members. The perspective of organization aesthetics enhances our understanding of the role of materiality in nursing management. The data were collected in 2009 using observation and interviews in eight nursing homes. Qualitative content analysis with critical interpretations was used. Three main issues of organizational aesthetics related to nursing management were identified: (1) the functionality of working spaces and equipment; (2) the relevance of 'organizational' space; and (3) the emotional-aesthetic dimension of daily work. Materiality is closely related to management topics, such as decision-making, values and identity formation of organizational members. Aesthetic dimensions of care are constructed by management practices which, in their turn, influence the nature of management. Implications for nursing management  Nurse managers need to be aware of the unintended and unnoticed consequences of materiality and aesthetics. Space and body issues may have considerable effects, for example, on the identity of care workers and on the attractiveness of the care branch. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

Diagnostic accuracy of Parkinson's disease and atypical parkinsonism in nursing homes.

PubMed

Weerkamp, N J; Tissingh, G; Poels, P J E; Zuidema, S U; Munneke, M; Koopmans, R T C M; Bloem, B R

2014-11-01

Management of Parkinson's disease (PD) and atypical parkinsonism in nursing homes depends on a timely and accurate diagnosis. However, little is known about the diagnostic accuracy of these parkinsonian syndromes in nursing homes. We examined this issue in a large group of Dutch nursing home residents. Twelve large nursing home organizations in the Netherlands accounting for 100 nursing homes with a total population of 5480 residents participated. Residents with PD or atypical parkinsonism were identified according to their nursing home medical chart diagnosis. Additionally, local pharmacists provided a list of all residents using antiparkinson medication. We compared the admission diagnosis to a clinical diagnosis made in the study, based upon interview and detailed neurological examination by movement disorders experts. Diagnoses were based on accepted clinical criteria for PD and atypical parkinsonism. In the total population of 5480 residents, 258 had previously been diagnosed with a form of parkinsonism according to their medical record. In 53 of these residents (20.5%) we changed or rejected the diagnosis. Specifically, we found no parkinsonism in 22 of these 53 residents (8.5% of all patients with suspected parkinsonism). In the remaining 31 residents (12%), we established a new diagnosis within the parkinsonian spectrum. In a large population of Dutch nursing home residents, 20% of diagnoses within the parkinsonian spectrum were inaccurate. Almost 9% of residents had inadvertently received a diagnosis of parkinsonism. Better recognition of parkinsonism in nursing homes is important, because of the consequences for management and prognosis. Copyright © 2014. Published by Elsevier Ltd.

Unintended adverse consequences of introducing electronic health records in residential aged care homes.

PubMed

Yu, Ping; Zhang, Yiting; Gong, Yang; Zhang, Jiajie

2013-09-01

The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

ROSA: Resource-Oriented Service Management Schemes for Web of Things in a Smart Home

PubMed Central

Chen, Peng-Yu

2017-01-01

A Pervasive-computing-enriched smart home environment, which contains many embedded and tiny intelligent devices and sensors coordinated by service management mechanisms, is capable of anticipating intentions of occupants and providing appropriate services accordingly. Although there are a wealth of research achievements in recent years, the degree of market acceptance is still low. The main reason is that most of the devices and services in such environments depend on particular platform or technology, making it hard to develop an application by composing the devices or services. Meanwhile, the concept of Web of Things (WoT) is becoming popular recently. Based on WoT, the developers can build applications based on popular web tools or technologies. Consequently, the objective of this paper is to propose a set of novel WoT-driven plug-and-play service management schemes for a smart home called Resource-Oriented Service Administration (ROSA). We have implemented an application prototype, and experiments are performed to show the effectiveness of the proposed approach. The results of this research can be a foundation for realizing the vision of “end user programmable smart environments”. PMID:28934159

Fire and chaparral management at the chaparral/urban interface

Treesearch

Philip J. Riggan; Scott Franklin; James A. Brass

1986-01-01

The historic Bel Air fire of 1961 was not unusually large or fast-moving, nor was it a disaster for the native chaparral ecosystem. Yet it was disastrous for residents of the area, a consequence of unrestricted urban development in the chaparral of Southern California. Its costs included human suffering and financial loss from the destruction of 484 of 2,300 homes....

Does Home Internet Use Influence the Academic Performance of Low-Income Children?

ERIC Educational Resources Information Center

Jackson, Linda A.; von Eye, Alexander; Biocca, Frank A.; Barbatsis, Gretchen; Zhao, Yong; Fitzgerald, Hiram E.

2006-01-01

HomeNetToo is a longitudinal field study designed to examine the antecedents and consequences of home Internet use in low-income families http://www.HomeNetToo.org). The study was done between December 2000 and June 2002. Among the consequences considered was children's academic performance. Participants were 140 children, mostly African…

Automatic for the Borrower: How Repayment Based on Income Can Reduce Loan Defaults and Manage Risk

ERIC Educational Resources Information Center

Baum, Sandy; Carew, Diana; Fraire, Jacob; Jacks, Kay; James, Kevin; Madzelan, Daniel; Miller, Scott E.; Simmons, Barry; Thompson, Jessica

2014-01-01

When borrowers default on a federal student loan, it can have catastrophic consequences. Their credit scores drop dramatically, severely curtailing their ability to afford a home or a car, and even limiting their ability to sign up for utilities. The cost of their loan rises as late fees pile up. Moreover, the federal government can garnish…

Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework.

PubMed

Lavallée, Jacqueline F; Gray, Trish A; Dumville, Jo; Cullum, Nicky

2018-06-01

Pressure ulcers are areas of localised damage to the skin and underlying tissue; and can cause pain, immobility, and delay recovery, impacting on health-related quality of life. The individuals who are most at risk of developing a pressure ulcer are those who are seriously ill, elderly, have impaired mobility and/or poor nutrition; thus, many nursing home residents are at risk. To understand the context of pressure ulcer prevention in nursing homes and to explore the potential barriers and facilitators to evidence-informed practices. Semi-structured interviews were conducted with nursing home nurses, healthcare assistants and managers, National Health Service community-based wound specialist nurses (known in the UK as tissue viability nurses) and a nurse manager in the North West of England. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to pressure ulcer prevention in nursing home residents. Data were analysed using a framework analysis and domains were identified as salient based on their frequency and the potential strength of their impact. 25 participants (nursing home: 2 managers, 7 healthcare assistants, 11 qualified nurses; National Health Service community services: 4 tissue viability nurses, 1 manager) were interviewed. Depending upon the behaviours reported and the context, the same domain could be classified as both a barrier and a facilitator. We identified seven domains as relevant in the prevention of pressure ulcers in nursing home residents mapping to four "barrier" domains and six "facilitator" domains. The four "barrier" domains were knowledge, physical skills, social influences and environmental context and resources and the six "facilitator" domains were interpersonal skills, environmental context and resources, social influences, beliefs about capabilities, beliefs about consequences and social/professional role and identity). Knowledge and insight into these barriers and facilitators provide a theoretical understanding of the complexities in preventing pressure ulcers with reference to the staff capabilities, opportunities and motivation related to pressure ulcer prevention. Pressure ulcer prevention in nursing home residents is complex and is influenced by several factors. The findings will inform a theory and evidence-based intervention to aid the prevention of pressure ulcers in nursing home settings. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

People with learning disabilities in 'out-of-area' residential placements: 2. Reasons for and effects of placement.

PubMed

Beadle-Brown, J; Mansell, J L; Whelton, B; Hutchinson, A; Skidmore, C

2006-11-01

Official guidance on out-of-area placements creates incentives that could lead to people being placed against their own best interests, with negative consequences for them and for the 'receiving' authorities. Information was collected for 30 people through interviews with them, their families, home managers and care managers. Interviews concerned resident needs, reasons for placement, the homes, care management arrangements, resident quality of life and social inclusion. Information on care standards was abstracted from official records. The main reasons for out-of-area placement were insufficient local services of acceptable quality, financial incentives and loss of family contact through prior institutionalization. The effects varied, with the most disabled people experiencing worst outcomes. Some aspects were worse than comparison studies (choice, community involvement, number of homes meeting all the national minimum standards), some were the same (participation, family visiting and other contact), and one was better (visits to families). Variation was also evident in the involvement of social services staff from the placing authority and in ease of access to local healthcare resources. Social services and health authorities should develop services locally that can support people with the full range of individual needs. Perverse incentives should be removed, perhaps by increasing the application of direct payments and personalized budgets.

Absent husbands, single wives: success, domesticity, and seminuclear families in the nineteenth-century Great Lakes world.

PubMed

Nutting, P Bradley

2010-01-01

The industrial and transportation revolutions of nineteenth-century America separated work from home (at least for the growing middle class) and intensified the development of masculine and feminine spheres devoted to success and domesticity, respectively. This development tended to reduce the husband's traditional patriarchal roles to that of provider only, while leaving the wife and mother with enhanced authority over household management and child rearing, a development with consequences for feminism. This article examines two extreme cases of separation of work from home: absent husbands, respected professional men, who left their wives alone for months or years and, while they provided financial support, surrendered all household authority to "single" wives.

Work schedules of home care workers for the elderly in France: fragmented work, deteriorating quality of care, detrimental health impact.

PubMed

Doniol-Shaw, Ghislaine; Lada, Emmanuelle

2011-01-01

Like most Western countries, France is faced with rapid changes in how social welfare and care regimes are being organized. Home care for the elderly has been closely affected by such trends. This study will analyse the consequences of such developments on work schedules and working conditions of female home care workers. We carried out 55 biographical interviews with experienced female home care workers employed by six associations as well as 13 interviews with representatives of those associations. The findings reveal an increase in time pressure linked to a reduction in care time per care recipient as well as the fragmentation of care work. These conditions negatively affect the provision of quality care as well as care workers' physical and mental well-being and blur the distinction between workers' professional and home lives. The negative impacts observed call for a change in perspective in relation to how home care work for fragile, elderly people is organized. Our research bears out the necessity of drawing on the experience of the most highly-qualified care workers and entrusting them with the autonomy needed to manage the care time allotted to each care recipient.

Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.

PubMed

Dingley, Catherine E; Clayton, Margaret; Lai, Djin; Doyon, Katherine; Reblin, Maija; Ellington, Lee

Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.

The political economy of a public health case management program's transition into medical homes.

PubMed

Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele

2015-11-01

Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. Published by Elsevier Ltd.

"And mostly they have a need for sleeping pills": physicians' views on treatment of sleep disorders with drugs in nursing homes.

PubMed

Flick, Uwe; Garms-Homolová, Vjenka; Röhnsch, Gundula

2012-12-01

The percentage of nursing home residents treated with hypnotic medications is high, as many authors report, despite the fact that such medications are almost always associated with undesirable effects for old people. This article takes a closer look at nursing home physicians' views of prescriptions when treating sleep disorders of nursing home residents. How do physicians characterize the treatment strategy for residents suffering from sleep disorders? How do they balance the benefits and risks of the hypnotic medication? Under what circumstances do they accept negative consequences? To answer these questions, N=20 physicians (aged 36 to 68 years) in 16 nursing homes in a German city were interviewed. The physicians were either employed by nursing homes or worked on a contract basis. Comparative categorization of the data produced a typology across cases. Three interpretative patterns concerning the use of drugs for treating sleep disorders were identified--"by request," "ambivalence," and "reflected prescription." Differences between them were determined by the significance of residents' wishes, neglect of risks, particularly that of addiction, and the attempt to balance benefits and disadvantages. The study showed deficits in professional management of sleep disorders in nursing homes. Copyright © 2012 Elsevier Inc. All rights reserved.

'Doing with …' rather than 'doing for …' older adults: rationale and content of the 'Stay Active at Home' programme.

PubMed

Metzelthin, Silke F; Zijlstra, Gertrud Ar; van Rossum, Erik; de Man-van Ginkel, Janneke M; Resnick, Barbara; Lewin, Gill; Parsons, Matthew; Kempen, Gertrudis Ijm

2017-11-01

Owing to increasing age, accidents or periods of illness, home care services are provided to community-dwelling older adults. Traditionally, these services focus on doing things for older adults rather than with them; though from a rehabilitative perspective, it is important to assist older adults to attain and maintain their highest level of functioning. Consequently, a re-orientation of home care services is required away from treating disease and creating dependency towards focusing on capabilities and opportunities and maximising independence. To achieve this behavioural change in home care professionals, the 'Stay Active at Home' programme was developed. The aim of this article is to give a detailed description of the rationale and content of the 'Stay Active at Home' programme by making use of the TIDieR (Template for Intervention Description and Replication) Checklist. 'Stay Active at Home' is a comprehensive training programme that aims to equip home care professionals (i.e. community nurses and domestic support workers) with the necessary knowledge, attitude, skills and social and organisational support to deliver day-to-day services at home from a more rehabilitative perspective. More specifically, home care professionals are expected to deliver goal-oriented, holistic and person-centred services focusing on supporting older adults to maintain, gain or restore their competences to engage in physical and daily activities so that they can manage their everyday life as independently as possible.

District nurses' perceptions of osteoporosis management: a qualitative study.

PubMed

Claesson, A; Toth-Pal, E; Piispanen, P; Salminen, H

2015-07-01

Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention. Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system. Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis. The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture. Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.

Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents.

PubMed

Dräger, Dagmar; Budnick, Andrea; Kuhnert, Ronny; Kalinowski, Sonja; Könner, Franziska; Kreutz, Reinhold

2017-10-01

Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary. Geriatr Gerontol Int 2017; 17: 1534-1543. © 2016 Japan Geriatrics Society.

Home and Building Energy Management Systems | Grid Modernization | NREL

Science.gov Websites

Home and Building Energy Management Systems Home and Building Energy Management Systems NREL building assets and energy management systems can provide value to the grid. Photo of a pair of NREL researchers who received a record of invention for a home energy management system in a smart home laboratory

Home and leisure injuries among the French electricity and gas company active employees: circumstances and short-term consequences.

PubMed

Verrier, Agnès; Chevalier, A

2007-11-01

To characterize home and leisure injuries and their immediate consequences among adults aged 20-60 years and to look for homogeneous profiles of injury circumstances to assess the possibility of setting up prevention programs. Cross-sectional survey by questionnaire completed on the occasion of a medical visit after a first episode of absence for home or leisure injury between 1 January and 31 December 1997 among Electricité de France Gaz de France (EDF GDF) workforce of three geographical areas (47,681 employees). Incidence and relative risks according to sex, age and work grade and a multidimensional classification of injury circumstances. Eight hundred and fifty four injuries were studied. Risk was estimated at 18.4 injury victims per 1000 employees, of which 13.4 per 1000 employees were home injury victims and 3.7 leisure injury victims. The risk of all injuries was higher among men than women (RR=1.3) and decreased as work grade rose: for men, it was five times higher among operating employees than managers. Multidimensional analysis of injury circumstances ended by distributing into four main classes which may be useful for prevention: gardening and do-it-yourself injuries outdoors (19.9%), coming and going on the streets (6.9%), falling while coming and going in the home on the stairs (13.4%), and do-it-yourself inside the home (13.0%). Injuries induced essentially four types of lesions: sprains (34%), fractures (31.8%), contusions (24.5%) and wounds. The mean sick-leave lasted 32.1 days but half the subjects returned to work in less than 17 days. Hospitalization was necessary in 19.2% of cases. This study completed by an analysis of the behavioural factors of injuries led us to propose programs aimed at changing the risk behaviours related to do-it-yourself, stairs falls and gardening.

An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial

PubMed Central

2011-01-01

Background Chronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF. Methods/Design A randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain). All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months. The primary outcome of the trial is the physical functioning domain of quality of life, measured by the physical functioning subscale of the Medical Outcome Study Short Form -36. Secondary outcomes include physical functional capacity measured by the standard six minute walk test, self-management capacity, health related quality of life measured by Medical Outcome Study Short Form -36 and Minnesota Living With Heart Failure Questionnaire, self-efficacy and self-care behaviour. Discussion A self-monitoring intervention that can improve individual's exercise self-efficacy, self-management capacity could have potential significance in improving the management of people with chronic heart failure in community settings. Trial Registration Australian New Zealand Clinical Trial Registry 12609000437268 PMID:21366927

An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial.

PubMed

Du, Hui Y; Newton, Phillip J; Zecchin, Robert; Denniss, Robert; Salamonson, Yenna; Everett, Bronwyn; Currow, David C; Macdonald, Peter S; Davidson, Patricia M

2011-03-02

Chronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF. A randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain).All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months. The primary outcome of the trial is the physical functioning domain of quality of life, measured by the physical functioning subscale of the Medical Outcome Study Short Form -36. Secondary outcomes include physical functional capacity measured by the standard six minute walk test, self-management capacity, health related quality of life measured by Medical Outcome Study Short Form -36 and Minnesota Living With Heart Failure Questionnaire, self-efficacy and self-care behaviour. A self-monitoring intervention that can improve individual's exercise self-efficacy, self-management capacity could have potential significance in improving the management of people with chronic heart failure in community settings. Australian New Zealand Clinical Trial Registry 12609000437268.

Danish Observational Study of Eldercare work and musculoskeletal disorderS (DOSES): a prospective study at 20 nursing homes in Denmark

PubMed Central

Karstad, Kristina; Jørgensen, Anette F B; Greiner, Birgit A; Burdorf, Alex; Søgaard, Karen; Rugulies, Reiner; Holtermann, Andreas

2018-01-01

Purpose Musculoskeletal disorders (MSDs), sickness absence and premature retirement are highly prevalent among eldercare workers. We conducted a prospective observational workplace study with the main purpose to investigate longitudinal associations between physical and psychosocial working conditions and occurrence of MSD and its consequences (pain-related interference with daily work activities and sickness absence) among Danish eldercare workers. Participants At 20 Danish nursing homes, a total of 941 eldercare workers employed in day and evening shifts were invited to the study. Of those, 553 participated in the baseline measurements, and 441 completed the total period of 12 months follow-up. Findings to date Data were collected from September 2013 to January 2016. Physical and psychosocial working conditions were assessed with multiple methods (observations, accelerometer measurements and work schedules), and multiple levels of information (nursing home, ward, resident and eldercare worker) were incorporated in the data collection. MSD and the consequences hereof were assessed monthly during a 1-year follow-up. Study participants and non-participants were comparable on most of the 27 sociodemographic, health and working condition characteristics at baseline. The exceptions were higher neck–shoulder pain intensity, less sickness absence, more exposure to negative behaviour from residents and a higher percentage of working day shifts and fewer evening shifts among participants compared with non-participants. Future plans The first publications will report on the associations of physical and psychosocial working conditions with occurrence of MSD and its consequences. In addition, the cohort gives the opportunity to investigate the importance of organisational, management and team factors for distribution of physical work demands and development of MSD among the workers. This will provide important knowledge for future workplace interventions to reduce MSD and sickness absence. PMID:29490965

Stress and workload of men and women in high-ranking positions.

PubMed

Lundberg, U; Frankenhaeuser, M

1999-04-01

Psychological and physiological stress responses related to work and family were investigated in 21 female and 21 male managers and professional specialists in high-ranking positions. The main result was that both women and men experienced their jobs as challenging and stimulating, although almost all data indicated a more favorable situation for men than for women. In addition, women were more stressed by their greater unpaid workload and by a greater responsibility for duties related to home and family. Women had higher norepinephrine levels than men did, both during and after work, which reflected their greater workload. Women with children at home had significantly higher norepinephrine levels after work than did the other participants. The possible long-term health consequences of women's higher stress levels are discussed.

Round and large: morphological and genetic consequences of artificial selection on the gourd tree Crescentia cujete by the Maya of the Yucatan Peninsula, Mexico

PubMed Central

Aguirre-Dugua, Xitlali; Eguiarte, Luis E.; González-Rodríguez, Antonio; Casas, Alejandro

2012-01-01

Background and Aims Artificial selection, the main driving force of domestication, depends on human perception of intraspecific variation and operates through management practices that drive morphological and genetic divergences with respect to wild populations. This study analysed the recognition of varieties of Crescentia cujete by Maya people in relation to preferred plant characters and documents ongoing processes of artificial selection influencing differential chloroplast DNA haplotype distribution in sympatric wild and home-garden populations. Methods Fifty-three home gardens in seven villages (93 trees) and two putative wild populations (43 trees) were sampled. Through semi-structured interviews we documented the nomenclature of varieties, their distinctive characters, provenance, frequency and management. Phenotypic divergence of fruits was assessed with morphometric analyses. Genetic analyses were performed through five cpDNA microsatellites. Key Results The Maya recognize two generic (wild/domesticated) and two specific domesticated (white/green) varieties of Crescentia cujete. In home gardens, most trees (68 %) were from domesticated varieties while some wild individuals (32 %) were tolerated. Cultivation involves mainly vegetative propagation (76 %). Domesticated fruits were significantly rounder, larger and with thicker pericarp than wild fruits. Haplotype A was dominant in home gardens (76 %) but absent in wild populations. Haplotypes B–F were found common in the wild but at low frequency (24 %) in home gardens. Conclusions The gourd tree is managed through clonal and sexual propagules, fruit form and size being the main targets of artificial selection. Domesticated varieties belong to a lineage preserved by vegetative propagation but propagation by seeds and tolerance of spontaneous trees favour gene flow from wild populations. Five mutational steps between haplotypes A and D suggest that domesticated germplasm has been introduced to the region. The close relationship between Maya nomenclature and artificial selection has maintained the morphological and haplotypic identity (probably for centuries) of domesticated Crescentia despite gene flow from wild populations. PMID:22499854

Round and large: morphological and genetic consequences of artificial selection on the gourd tree Crescentia cujete by the Maya of the Yucatan Peninsula, Mexico.

PubMed

Aguirre-Dugua, Xitlali; Eguiarte, Luis E; González-Rodríguez, Antonio; Casas, Alejandro

2012-06-01

Artificial selection, the main driving force of domestication, depends on human perception of intraspecific variation and operates through management practices that drive morphological and genetic divergences with respect to wild populations. This study analysed the recognition of varieties of Crescentia cujete by Maya people in relation to preferred plant characters and documents ongoing processes of artificial selection influencing differential chloroplast DNA haplotype distribution in sympatric wild and home-garden populations. Fifty-three home gardens in seven villages (93 trees) and two putative wild populations (43 trees) were sampled. Through semi-structured interviews we documented the nomenclature of varieties, their distinctive characters, provenance, frequency and management. Phenotypic divergence of fruits was assessed with morphometric analyses. Genetic analyses were performed through five cpDNA microsatellites. The Maya recognize two generic (wild/domesticated) and two specific domesticated (white/green) varieties of Crescentia cujete. In home gardens, most trees (68 %) were from domesticated varieties while some wild individuals (32 %) were tolerated. Cultivation involves mainly vegetative propagation (76 %). Domesticated fruits were significantly rounder, larger and with thicker pericarp than wild fruits. Haplotype A was dominant in home gardens (76 %) but absent in wild populations. Haplotypes B-F were found common in the wild but at low frequency (24 %) in home gardens. The gourd tree is managed through clonal and sexual propagules, fruit form and size being the main targets of artificial selection. Domesticated varieties belong to a lineage preserved by vegetative propagation but propagation by seeds and tolerance of spontaneous trees favour gene flow from wild populations. Five mutational steps between haplotypes A and D suggest that domesticated germplasm has been introduced to the region. The close relationship between Maya nomenclature and artificial selection has maintained the morphological and haplotypic identity (probably for centuries) of domesticated Crescentia despite gene flow from wild populations.

Epidemiological Criminology: Contextualization of HIV/AIDS Health Care for Female Inmates.

PubMed

Lanier, Mark M; Zaitzow, Barbara H; Farrell, C Thomas

2015-04-01

Worldwide, women are increasingly being incarcerated. One unintended consequence is the increase in unhealthy female offenders. Among the more serious health concerns are HIV and AIDS. Challenges associated with caring for women with HIV/AIDS impacts not only disease management and infection control within correctional facilities but also the prisoners' home communities where they will need health care, drug and alcohol rehabilitation, housing assistance, and employment opportunities. No bridging theory has been presented that links prison and community health concerns with criminal justice policy. This article not only presents recommendations for effective HIV/AIDS policy but also suggests epidemiological criminology as a means of explicit merging of health with justice issues and consequently provides a bridging framework. © The Author(s) 2015.

Optimizing the care model for an uncomplicated acute pain episode in sickle cell disease.

PubMed

Telfer, Paul; Kaya, Banu

2017-12-08

The pathophysiology, clinical presentation, and natural history of acute pain in sickle cell disease are unique and require a disease-centered approach that also applies general principles of acute and chronic pain management. The majority of acute pain episodes are managed at home without the need to access health care. The long-term consequences of poorly treated acute pain include chronic pain, adverse effects of chronic opioid usage, psychological maladjustment, poor quality of life, and excessive health care utilization. There is no standard protocol for management of an acute pain crisis in either the hospital or the community. The assumptions that severe acute pain must be managed in the hospital with parenteral opioids and that strong opioids are needed for home management of pain need to be questioned. Pain management in the emergency department often does not meet acceptable standards, while chronic use of strong opioids is likely to result in opioid-induced hyperalgesia, exacerbation of chronic pain symptoms, and opioid dependency. We suggest that an integrated approach is needed to control the underlying condition, modify psychological responses, optimize social support, and ensure that health care services provide safe, effective, and prompt treatment of acute pain and appropriate management of chronic pain. This integrated approach should begin at an early age and continue through the adolescent, transition, and adult phases of the care model. © 2016 by The American Society of Hematology. All rights reserved.

Novel pervasive scenarios for home management: the Butlers architecture.

PubMed

Denti, Enrico

2014-01-01

Many efforts today aim to energy saving, promoting the user's awareness and virtuous behavior in a sustainability perspective. Our houses, appliances, energy meters and devices are becoming smarter and connected, domotics is increasing possibilities in house automation and control, and ambient intelligence and assisted living are bringing attention onto people's needs from different viewpoints. Our assumption is that considering these aspects together allows for novel intriguing possibilities. To this end, in this paper we combine home energy management with domotics, coordination technologies, intelligent agents, ambient intelligence, ubiquitous technologies and gamification to devise novel scenarios, where energy monitoring and management is just the basic brick of a much wider and comprehensive home management system. The aim is to control home appliances well beyond energy consumption, combining home comfort, appliance scheduling, safety constraints, etc. with dynamically-changeable users' preferences, goals and priorities. At the same time, usability and attractiveness are seen as key success factors: so, the intriguing technologies available in most houses and smart devices are exploited to make the system configuration and use simpler, entertaining and attractive for users. These aspects are also integrated with ubiquitous and pervasive technologies, geo-localization, social networks and communities to provide enhanced functionalities and support smarter application scenarios, hereby further strengthening technology acceptation and diffusion. Accordingly, we first analyse the system requirements and define a reference multi-layer architectural model - the Butlers architecture - that specifies seven layers of functionalities, correlating the requirements, the corresponding technologies and the consequent value-added for users in each layer. Then, we outline a set of notable scenarios of increasing functionalities and complexity, discuss the structure of the corresponding system patterns in terms of the proposed architecture, and make this concrete by presenting some comprehensive interaction examples as comic strip stories. Next, we discuss the implementation requirements and how they can be met with the available technologies, discuss a possible architecture, refine it in the concrete case of the TuCSoN coordination technology, present a subsystem prototype and discuss its properties in the Butlers perspective.

Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes.

PubMed

Fromer, Len

2011-01-01

Current primary care patterns for chronic obstructive pulmonary disease (COPD) focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.

Potential unintended consequences of smoke-free policies in public places on pregnant women in China.

PubMed

Yao, Tingting; Lee, Anita H; Mao, Zhengzhong

2009-08-01

Smoke-free policies in public places have become more common in China. Little is known, however, about the potential unintended consequences of such policies on pregnant women. The study was conducted in 2006 in Chengdu, China. Nonsmoking pregnant women (N=55) whose husband were smokers participated in a study of their knowledge about secondhand smoke and smoke-free policies, their exposure to secondhand smoke, and their husbands' smoking status at home. This study presents descriptive statistics, analyses based on family income and pregnant women's education level, and the findings of focus group discussions that examined the potential unintended consequences of the smoke-free policies on pregnant women. Exposure to secondhand smoke at home was reported by 69.1% of the pregnant women. Both family income and the education level of the pregnant women had a significant (p<0.05) association with exposure to secondhand smoke. The four main potential unintended consequences of the smoke-free policies were: (1) increased exposure of pregnant women to secondhand smoke at home; (2) reduced work efficiency; (3) adverse effect on family harmony; and (4) poor air quality at home. Education is needed to increase knowledge of secondhand smoke among smokers and nonsmokers alike. When the smoking location is shifted from public places and workplaces to home, women, and in particular pregnant women, become the victims. Policymakers should recognize such potential unintended consequences and take necessary measures to increase awareness about the harms of secondhand smoke.

Care home manager attitudes to balancing risk and autonomy for residents with dementia.

PubMed

Evans, Elizabeth A; Perkins, Elizabeth; Clarke, Pam; Haines, Alina; Baldwin, Ashley; Whittington, Richard

2018-02-01

To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach. There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home. There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.

Genes and Hearing Loss

MedlinePlus

... Programs Professional Development Home AcademyU Home Study Course Maintenance of Certification Conferences & Events Practice Management Home Resources ... Programs Professional Development Home AcademyU Home Study Course Maintenance of Certification Conferences & Events Practice Management Home Resources ...

Initial development of the Systems Approach to Home Medication Management (SAHMM) model.

PubMed

Doucette, William R; Vinel, Shanrae'l; Pennathur, Priyadarshini

Adverse drug events and medication nonadherence are two problems associated with prescription medication use for chronic conditions. These issues often develop because patients have difficulty managing their medications at home. To guide patients and providers for achieving safe and effective medication use at home, the Systems Approach to Home Medication Management (SAHMM) model was derived from a systems engineering model for health care workplace safety. To explore how well concepts from the SAHMM model can represent home medication management by using patient descriptions of how they take prescription medications at home. Twelve patients were interviewed about home medication management using an interview guide based on the factors of the SAHMM model. Each interview was audio-taped and then transcribed verbatim. Interviews were coded to identify themes for home medication management using MAXQDA for Windows. SAHMM concepts extracted from the coded interview transcripts included work system components of person, tasks, tools & technology, internal environment, external environment, and household. Concepts also addressed work processes and work outcomes for home medication management. Using the SAHMM model for studying patients' home medication management is a promising approach to improving our understanding of the factors that influence patient adherence to medication and the development of adverse drug events. Copyright © 2016 Elsevier Inc. All rights reserved.

Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries

PubMed Central

Kaur, Rajanbir; Kaur, Kanwaljit

2018-01-01

Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on. PMID:29675047

Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries.

PubMed

Kaur, Rajanbir; Kaur, Kanwaljit; Kaur, Rajinder

2018-01-01

Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on.

41 CFR 102-5.35 - Who is authorized home-to-work transportation?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Who is authorized home... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK TRANSPORTATION Authorizing Home-to-Work Transportation § 102-5.35 Who is authorized home-to-work transportation...

41 CFR 102-5.35 - Who is authorized home-to-work transportation?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Who is authorized home... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK TRANSPORTATION Authorizing Home-to-Work Transportation § 102-5.35 Who is authorized home-to-work transportation...

Diagnostic and therapeutic yield of a patient-controlled portable EEG device with dry electrodes for home-monitoring neurological outpatients-rationale and protocol of the HOMEONE pilot study.

PubMed

Neumann, Thomas; Baum, Anne Katrin; Baum, Ulrike; Deike, Renate; Feistner, Helmut; Hinrichs, Hermann; Stokes, Joseph; Robra, Bernt-Peter

2018-01-01

The HOME ONE study is part of the larger HOME project, which aims to provide evidence of diagnostic and therapeutic yield ("change of management") of a patient-controlled portable EEG device with dry electrodes for the purposes of EEG home-monitoring neurological outpatients. The HOME ONE study is the first step in the process of investigating whether outpatient EEG home-monitoring changes the diagnosis and treatment of patients in comparison to conventional EEG ("change of management"). Both EEG devices (conventional and portable) will be systematically compared via a two-phase intra-individual assessment.In the first phase (pilot study phase), both EEG devices will be used within neurologist practices (all other things being equal). This pilot study (involving 130 patients) will evaluate the technical usability and efficacy of the new portable dry electrode EEG recorder in comparison to conventional EEG devices. Judgements will be based on technical assessments and EEG record examinations of private practitioners and two experienced neurologists (percent of concordant readings and kappa values).The second phase (feasibility study phase) aims to assess patients' acceptability and feasibility of the EEG home-monitoring and will provide insights into the extent diagnostic and therapeutic yields can be expected.For this purpose, a conventional EEG will be recorded in neurologist practices. Thereafter, the practice staff will instruct the patients on how the portable EEG device functions. The patients will subsequently use the devices in their home environment.The evaluation will compare the before and after documented diagnostic findings and the therapeutic consequences of the private practitioners with those of two experienced neurologists. To the best of our knowledge, this will be the first study of its kind to examine new approaches to diagnosing unclear consciousness disorders or other disorders of the CNS or the cardiovascular system through the use of a patient-controlled portable EEG device with dry electrodes for the purpose of home-monitoring neurological outpatients. If the two phases of the HOME ONE study provide sufficient evidence of diagnostic and therapeutic yields, this would justify (indication-specific) full-scale randomized controlled trials or observational studies. DRKS DRKS00012685. Registered 9 August 2017, retrospectively registered.

Factors associated with parents’ perceptions of parental smoking in the presence of children and its consequences on children.

PubMed

Chen, Yu-Ting; Hsiao, Fei-Hsiu; Miao, Nae-Fang; Chen, Ping-Ling

2013-01-07

Parental smoking is the major source of children's secondhand smoke exposure and is influenced by parents' perception of children's exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents' perceptions about parental smoking in the presence of children and its consequences. We conducted a cross-sectional study on parents' perceptions of parental smoking and measured their evaluations of its consequences using a self-report questionnaire. Other variables include socio-demographic characteristics and smoking-related experience. Results show that parents' gender, education level, occupational type, smoking status, and agreement on a home smoking ban independently predict parents' evaluation of the consequences of parental smoking in the presence of children. Parents' gender, education level, annual family income, smoking status, agreement on a home smoking ban, and evaluation of the consequences of parental smoking independently predicted parents' perceptions. Findings indicated that a specific group expressed greater acceptance of parental smoking and was less aware of its risks. Motivating parents to create a smoke-free home and increasing awareness of the adverse consequences of parental smoking is beneficial in reinforcing attitudes opposed to parental smoking.

Factors Associated with Parents’ Perceptions of Parental Smoking in the Presence of Children and Its Consequences on Children

PubMed Central

Chen, Yu-Ting; Hsiao, Fei-Hsiu; Miao, Nae-Fang; Chen, Ping-Ling

2013-01-01

Parental smoking is the major source of children’s secondhand smoke exposure and is influenced by parents’ perception of children’s exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents’ perceptions about parental smoking in the presence of children and its consequences. We conducted a cross-sectional study on parents’ perceptions of parental smoking and measured their evaluations of its consequences using a self-report questionnaire. Other variables include socio-demographic characteristics and smoking-related experience. Results show that parents’ gender, education level, occupational type, smoking status, and agreement on a home smoking ban independently predict parents’ evaluation of the consequences of parental smoking in the presence of children. Parents’ gender, education level, annual family income, smoking status, agreement on a home smoking ban, and evaluation of the consequences of parental smoking independently predicted parents’ perceptions. Findings indicated that a specific group expressed greater acceptance of parental smoking and was less aware of its risks. Motivating parents to create a smoke-free home and increasing awareness of the adverse consequences of parental smoking is beneficial in reinforcing attitudes opposed to parental smoking. PMID:23296207

Managing Home Health Care (For Parents)

MedlinePlus

... Videos for Educators Search English Español Managing Home Health Care KidsHealth / For Parents / Managing Home Health Care What's ... español La atención médica en el hogar Intensive Health Care at Home Kids can need intensive health care ...

[Analysis of end-of-life care for elderly with dementia in group homes managed by different corporations].

PubMed

Konagaya, Yoko

2010-01-01

The number of group homes for elderly people with dementia has been increasing since the introduction of public long-term care insurance in Japan. The aim of this report is to clarify the differences in the end-of-life policy and practices among group homes managed by medical corporations and those run by social welfare corporations. A questionnaire for end-of-life care policy and practices was mailed to 1,535 group homes managed by medical corporations and 2,022 group homes managed by social welfare corporations. The questions related to the general characteristics of group homes, availability of admission to hospital, whether a doctor visits regularly or not, involvement in end-of-life care, experiences of previous end-of-life care, and provisions for anticipated end-of life care. The response rates were 55.2% for medical corporations and 59.6% for public welfare corporations. Most group homes have one care unit. More than 50% of medical corporation-managed and more than 30% of social welfare corporation-managed group homes were involved with end-of-life care. Previous experiences with end-of-life care experienced in both types of group homes were reported to be 38.0% and 30.1%, respectively. The results of end-of-life care were evaluated positively in both types of group home. Group homes managed by medical corporations which also managed hospitals and group homes managed by social welfare corporations with regular visits of doctors showed a high percentage of cooperation with and previous experience of end-of-life care. Cooperation between medical and care staffs in end-of-life care of the elderly with dementia in group homes is important. This report demonstrated that education about end-of-life care to the staffs of group home is necessary.

Assessing the welfare of laboratory mice in their home environment using animal-based measures--a benchmarking tool.

PubMed

Spangenberg, Elin M F; Keeling, Linda J

2016-02-01

Welfare problems in laboratory mice can be a consequence of an ongoing experiment, or a characteristic of a particular genetic line, but in some cases, such as breeding animals, they are most likely to be a result of the design and management of the home cage. Assessment of the home cage environment is commonly performed using resource-based measures, like access to nesting material. However, animal-based measures (related to the health status and behaviour of the animals) can be used to assess the current welfare of animals regardless of the inputs applied (i.e. the resources or management). The aim of this study was to design a protocol for assessing the welfare of laboratory mice using only animal-based measures. The protocol, to be used as a benchmarking tool, assesses mouse welfare in the home cage and does not contain parameters related to experimental situations. It is based on parameters corresponding to the 12 welfare criteria established by the Welfare Quality® project. Selection of animal-based measures was performed by scanning existing published, web-based and informal protocols, and by choosing parameters that matched these criteria, were feasible in practice and, if possible, were already validated indicators of mouse welfare. The parameters should identify possible animal welfare problems and enable assessment directly in an animal room during cage cleaning procedures, without the need for extra equipment. Thermal comfort behaviours and positive emotional states are areas where more research is needed to find valid, reliable and feasible animal-based measures. © The Author(s) 2015.

Dyspnea Management in Palliative Home Care: A Case Series in Malaysia

PubMed Central

Thongkhamcharoen, Rojanasak; Breaden, Katrina; Agar, Meera; Hamzah, Ednin

2012-01-01

Managing dyspnea at home is a challenging task. Although a competent palliative home care team can assist a patient to live at home with better pain control, dyspnea is usually not as well managed. In the Asian context, there are few research studies in dyspnea management in palliative home care. This paper aims to illustrate the cultural context that has an impact on dyspnea management at home and the assessment and management of dyspnea in a community palliative care setting in Malaysia. This paper reports on a study of 5 dyspneic patients suffering from both cancer-related and non–cancer-related dyspnea. Its focus is on a unique Asian cultural belief system that affects communication about prognosis and the role of family in palliative home care. In addition, this paper also describes dyspnea assessment, the barriers to morphine use, benzodiazepine prescription, oxygen therapy, and nonpharmacologic intervention in this center. PMID:23093829

Identifying fallacious arguments in a qualitative study of antipsychotic prescribing in dementia.

PubMed

Donyai, Parastou

2017-10-01

Dementia can result in cognitive, noncognitive and behavioural symptoms which are difficult to manage. Formal guidelines for the care and management of dementia in the UK state that antipsychotics should only be prescribed where fully justified. This is because inappropriate use, particularly problematic in care-home settings, can produce severe side effects including death. The aim of this study was to explore the use of fallacious arguments in professionals' deliberations about antipsychotic prescribing in dementia in care-home settings. Fallacious arguments have the potential to become unremarkable discourses that construct and validate practices which are counter to guidelines. This qualitative study involved interviews with 28 care-home managers and health professionals involved in caring for patients with dementia. Potentially fallacious arguments were identified using qualitative content analysis and a coding framework constructed from existing explanatory models of fallacious reasoning. Fallacious arguments were identified in a range of explanations and reasons that participants gave for in answer to questions about initiating, reducing doses of and stopping antipsychotics in dementia. The dominant fallacy was false dichotomy. Appeal to popularity, tradition, consequence, emotion, or fear, and the slippery slope argument was also identified. Fallacious arguments were often formulated to present convincing cases whereby prescribing antipsychotics or maintaining existing doses (versus not starting medication or reducing the dose, for example) appeared as the only acceptable decision but this is not always the case. The findings could help health professionals to recognise and mitigate the effect of logic-based errors in decisions about the prescribing of antipsychotics in dementia. © 2016 Royal Pharmaceutical Society.

A systematic review protocol of educational programs for nursing staff on management of resident-to-resident elder mistreatment in residential aged care homes.

PubMed

Ellis, Julie M; Ayala Quintanilla, Beatriz Paulina; Ward, Louise; Campbell, Fergus; Hillel, Stav; Downing, Carolyn; Teresi, Jeanne; Ramirez, Mildred

2018-05-06

To review evidence concerning educational programs for nursing staff on management of resident-to-resident elder mistreatment with the aim of preventing and reducing this abuse in residential aged care homes. Although elder abuse has received considerable attention, very little is known regarding resident-to-resident elder mistreatment in residential aged care homes and about interventions/programs to prevent and reduce this harm. Nurses play an essential role in identifying and managing aggressive interactions. However, many nurses may not recognize these behaviours as forms of abuse. Thus, it is important to ascertain if educational programs for nursing staff have been developed and implemented. Quantitative systematic review registered on PROSPERO (CRD42017080925). A systematic search of English published studies between 1980 - 2017 will be conducted in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo and Scopus. Risk of bias and quality of the studies will be evaluated by using the Cochrane Collaboration's tool and the Methodological Index for Nonrandomized studies. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data will be summarized by using a narrative description. This study was funded in January 2017. Nursing staff should play a pivotal role in preventing and/or reducing resident-to-resident elder mistreatment. Therefore, it is important to identify available educational programs for nursing staff dealing with this abuse. Consequently, this review may provide evidence-based care for nursing staff to assist them in protecting older residents from experiencing abuse or being abused and in improving their well-being. © 2018 John Wiley & Sons Ltd.

Bringing managed care home to the long-term care population.

PubMed

Nadash, Pamela; Ahrens, Joann

2004-01-01

Managed care has been proposed as a solution to the problems facing long-term care: its high costs, bias towards nursing homes, lack of coordination with acute and primary care, and inflexible service delivery. Kodner and Kyriacou (2003) argue that home care agencies may have considerable advantages in creating managed care systems for this population over traditional managed care organizations because of the experience home care organizations have in caring for older adults as well as people with disabilities. Although home care agencies are likely to better understand the needs of the long-term care population, they may lack the expertise and organizational resources to develop successful managed care organizations. Addressing these deficiencies will be key in order for home care organizations to successfully operate as managed care providers.

Remote home management for chronic kidney disease: A systematic review.

PubMed

He, Ting; Liu, Xing; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

2017-01-01

Background Remote home management is a new healthcare model that uses information technology to enhance patients' self-management of disease in a home setting. This study is designed to identify the effects of remote home management on patients with chronic kidney disease (CKD). Methods A comprehensive search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed in January 2015. The reference listings of the included articles in this review were also manually examined. Randomized controlled trials (RCTs) designed to evaluate the effects of remote home management on patients with CKD were included. Results Eight trials were identified. The results of this study suggest that the quality of life (QOL) enabled by remote home management was higher than typical care in certain dimensions. However, the effects of remote home management on blood pressure (BP) remain inconclusive. The studies that assessed health service utilization demonstrated a significant decrease in hospital readmission, emergency room visits, and number of days in the hospital. Another favorable result of this study is that regardless of their gender, age or nationality, patients tend to comply with remote home management programs and the use of related technologies. Conclusions The available data indicate that remote home management may be a novel and effective disease management strategy for improving CKD patients' QOL and influencing their attitudes and behaviors. And, relatively little is known about BP and cost-effectiveness, so future research should focus on these two aspects for the entire population of patients with CKD.

Home Management House: Reflections of Alumnae

ERIC Educational Resources Information Center

Tifft, Kathleen; Fletcher, Janice; Junk, Virginia W.

2011-01-01

Historically, curriculum for home economics included experiences in home management residences. In this qualitative study, nine alumnae and one advisor who lived in a home management house between 1939 and 1959 were interviewed about how their experiences influenced the quality of their lives in the 40-60 subsequent years. Alumnae of the residence…

Holistic concerns of Chinese stroke survivors during hospitalization and in transition to home.

PubMed

Yeung, Siu Ming; Wong, Frances Kam Yuet; Mok, Esther

2011-11-01

This article is a report of a study conducted to explore the phenomenon of concerns as experienced by Chinese stroke survivors during hospitalization and in transition to home. Stroke is characterized by its sudden onset and prolonged residual problems, which affect survivors' holistic well-being. Many studies have focused on stroke consequences and their correlates with psychosocial outcomes. Very little is known about holistic concerns of stroke survivors, particularly in the transition from hospital to home. We used purposive sampling of 15 stroke survivors who participated in semi-structured interviews after being discharged from stroke wards of a general hospital in Hong Kong from November 2008 to February 2009. The interviews were transcribed verbatim and analysed using Giorgi's phenomenological techniques. Stroke survivors' physical, psychological, socio-cultural and spiritual concerns in hospital and transition to home emerged from the data analysis. The four major themes identified were: (a) dynamic interplay of holistic concerns, (b) cultural expression of illness experiences, (c) social support 'paradox' and (d) caring gaps in clinical management. Understanding the interwoven holistic concerns for the stroke survivors in hospital and after discharged home can help nurses to identify their health needs and plan for appropriate nursing interventions. The findings provide guidance for the development of culture-sensitive holistic care interventions with family involvement in Chinese stroke populations. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Quality management in home care: models for today's practice.

PubMed

Verhey, M P

1996-01-01

In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

Fuels planning: science synthesis and integration; environmental consequences fact sheet 03: structure fires in the wildland-urban interface

Treesearch

Steve Sutherland

2004-01-01

National Fire Protection Association (NFPA) data indicate that wildfires destroyed approximately 9,000 homes between 1985 and 1994 in the United States. The loss of homes to wildfire has had a significant impact on Federal fire policy. This fact sheet discusses the causes of home ignitions in the wildland-urban interface, home ignition zones, how to reduce home...

Practical Problems with Medication Use that Older People Experience: A Qualitative Study

PubMed Central

Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

2014-01-01

Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. PMID:25516030

Development of Home-Based Sleep Monitoring System for Obstructive Sleep Apnea.

PubMed

Wu, Peirong; Chen, Guan-Ting; Cui, Yanyan; Li, Jin-Wei; Kuo, Terry B J; Chang, Polun

2017-01-01

Obstructive Sleep Apnea (OSA) has been proven to increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes. If people would like to know whether they are suffering from this sleep disorder, they need to go to particular hospital with which a sleep center that could perform polysomnography (PSG); however, for most people, this is not convenient. Consequently, the goal of this study is to develop a convenient, lower priced, and easy-to-use home-based sleep monitoring system. The researchers have developed the "Sleep Healthcare Management System" for OSA patients and healthcare providers. It combines smartphone and wearable devices that can perform real-time sleep monitoring. Healthcare providers could apply their professional knowledge to provide customized feedback via a web application. When the patient is diagnosed with an abnormal sleep health condition, healthcare providers may be able to provide appropriate and timely care.

Job strain in nursing homes-Exploring the impact of leadership.

PubMed

Backman, Annica; Sjögren, Karin; Lövheim, Hugo; Edvardsson, David

2018-04-01

To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes. It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts. This study had a cross-sectional design. Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted. Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain. Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff. Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff. © 2017 John Wiley & Sons Ltd.

Alert management for home healthcare based on home automation analysis.

PubMed

Truong, T T; de Lamotte, F; Diguet, J-Ph; Said-Hocine, F

2010-01-01

Rising healthcare for elder and disabled people can be controlled by offering people autonomy at home by means of information technology. In this paper, we present an original and sensorless alert management solution which performs multimedia and home automation service discrimination and extracts highly regular home activities as sensors for alert management. The results of simulation data, based on real context, allow us to evaluate our approach before application to real data.

Nursing Home Staff Characteristics and Knowledge Gain from a Didactic Workshop on Depression and Behavior Management

ERIC Educational Resources Information Center

Meeks, Suzanne; Burton, Elizabeth G.

2004-01-01

Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants…

41 CFR 102-5.35 - Who is authorized home-to-work transportation?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Who is authorized home-to-work transportation? 102-5.35 Section 102-5.35 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK...

[Conceptual self-management analysis of hypertensive individuals].

PubMed

Balduino, Anice de Fátima Ahmad; Mantovani, Maria de Fátima; Lacerda, Maria Ribeiro; Meier, Marineli Joaquim

2013-12-01

This research aimed to analyze the concept of self-management of hypertensive individuals. Theoretical and documentary study based on Walker and Avant's conceptual analysis by means of the Scientific Electronic Library Brazil and the Medical Literature Analysis and Retrieval System Online in the Coordination for Higher Education Personnel Development (CAPES, in Portuguese) and the National Library of Medicine websites. Fourteen (14) articles and one (1) thesis were selected and reviewed in Portuguese and English, in the period January 2007 to September 2012. missing doctor's appointments, non-compliance to blood pressure control treatment to recommendations to proper diet standards and stress. Attributer blood pressure control and disease management Consequences home monitoring of blood pressure with control improvement, accomplishment of disease management, compliance and sharing of the creation process of self-management goals and caring activities by the interdiscplinary team through individualized actions. It was concluded that the self-management concept is a dynamic, active process which requires knowledge, attitude, discipline, determination, commitment self-regulation, empowerment and self-efficiency in order to manage the disease and achieve healthy living.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

PubMed

Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

2016-11-01

To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Adapters, strugglers, and case managers: a typology of spouse caregivers.

PubMed

Davis, Linda Lindsey; Chestnutt, Deborah; Molloy, Margory; Deshefy-Longhi, Tess; Shim, Bomin; Gilliss, Catherine L

2014-11-01

Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case managers' interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver's management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed. © The Author(s) 2014.

Enhancing the role of case managers with specialty populations: development and evaluation of a palliative care education program.

PubMed

Howell, Doris; Prestwich, Catherine; Laughlin, Emmy; Giga, Nasreen

2004-01-01

Palliative home care is an important component of the care system for patients at the end of life and case management is considered an essential element of the Canadian home care system. Case managers play a critical role in allocating resources, thus influencing the costs and the viability of palliative home care. Case management education programs focused on care coordination with specialty palliative care populations are nonexistent. An education program targeted at improving the knowledge and skills of case managers in allocating resources to palliative care populations was developed and pilot-tested in a metropolitan Canadian city home care program. Core curriculum was based on an initial learning needs assessment and used case-based problem solving to enhance case-management skills. An improvement in knowledge was noted on posttests and case managers described increased comfort and confidence in their role as case managers to this patient population. Home care organizations caring for palliative care populations must ensure case managers are prepared for case management roles with specialty populations if the home is to be rendered an appropriate and viable care setting for patients at the end of life.

The Incidence and Wage Consequences of Home-Based Work in the United States, 1980-2000

ERIC Educational Resources Information Center

Oettinger, Gerald S.

2011-01-01

This study documents the rapid growth in home-based wage and salary employment and the sharp decline in the home-based wage penalty in the United States between 1980 and 2000. These twin patterns, observed for both men and women in most occupation groups, suggest that employer costs of providing home-based work arrangements have decreased.…

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

Factors associated with the self-perceived ability of nursing staff to remain working until retirement: a questionnaire survey.

PubMed

Maurits, Erica E M; de Veer, Anke J E; van der Hoek, Lucas S; Francke, Anneke L

2015-09-02

It is important to learn how employers in European countries can prevent nursing staff from changing occupation or taking early retirement in order to counteract expected nursing shortages. However, to date research on nursing staff's ability to remain working until retirement age has been limited. The purpose of this study was to gain insight into the associations between different job and organisational characteristics, job satisfaction, occupational commitment and the self-perceived ability to continue working in the current line of work until the official retirement age. The questionnaire-based, cross-sectional study included 730 nursing staff members employed in Dutch hospitals, nursing homes, organisations for psychiatric care, homes for the elderly, care organisations for disabled people and home care organisations (mean age: 48; 89% female). Linear and logistic regression analyses and mediation analyses were applied to test hypothesised associations. Reducing work pressure and increasing appreciation by senior management in particular have positive consequences for nursing staff's self-perceived ability to continue working until the official retirement age. The job and organisational characteristics of autonomy, work pressure, supportive leadership, educational opportunities, communication within the organisation and appreciation of nursing staff by senior management together have substantial impact on nursing staff's job satisfaction. Job satisfaction in turn is related to the self-perceived ability to continue working until the retirement age. However, job satisfaction mainly summarises the joint effect of job and organisational characteristics and has no supplementary effect on the self-perceived ability to continue working. Employers should primarily focus on work pressure and the appreciation of nursing staff by senior management in order to retain nursing staff even as they get older.

Cue-induced reinstatement of cocaine seeking in the rat "conflict model": effect of prolonged home-cage confinement.

PubMed

Barnea-Ygael, Noam; Yadid, Gal; Yaka, Rami; Ben-Shahar, Osnat; Zangen, Abraham

2012-02-01

Drug addiction is not just the repeated administration of drugs, but compulsive drug use maintained despite the accumulation of adverse consequences for the user. In an attempt to introduce adverse consequences of drug seeking to laboratory animals, we have developed the "conflict model," in which the access of rats to a reinforcing lever allowing self-administration requires passing of an electrified grid floor. In this model, the current intensity leading to complete abstinence from drug seeking can be measured individually. The present study was designed to evaluated whether reinstatement of drug or natural reward seeking, despite the presence of the electrical barrier, can be achieved by presentation of discrete cues that were associated with the reward, and whether prolonged home-cage confinement can facilitate such reinstatement in this model. The "conflict model" was used to test cue-induced reinstatement in the presence of the electrical barrier, after 1 or 14 days of home-cage confinement, in groups of rats that were previously trained to self-administer cocaine or sucrose. Although similar shock intensity was required to suppress sucrose or cocaine self-administration, subjects exhibited significantly lower response to sucrose-associated as compared to cocaine-associated cues, during the reinstatement test. Importantly, cue-induced reinstatement of cocaine seeking was attenuated following 14 days of home-cage confinement. The incorporation of aversive consequence in the self-administration model enable detection of what can be interpreted as a compulsive component unique to drug reinforcers. Moreover, the effect of the aversive consequence seems to increase following home-cage confinement.

Recovery After Stroke: Managing Life at Home

MedlinePlus

Recovery After Stroke: Managing Life at Home Managing life at home is an important part of stroke recovery. Whether your “home” is a house, apartment, ... still want some independence in your everyday activities. Stroke affects each survivor differently. To live well after ...

Care workers' abusive behavior to residents in care homes: a qualitative study of types of abuse, barriers, and facilitators to good care and development of an instrument for reporting of abuse anonymously.

PubMed

Cooper, Claudia; Dow, Briony; Hay, Susan; Livingston, Deborah; Livingston, Gill

2013-05-01

Elder abuse in care homes is probably common but inherently difficult to detect. We developed the first questionnaire to ask care home workers to report abuse anonymously. We held qualitative focus groups with 36 care workers from four London care homes, asking about abuse they had witnessed or perpetrated. The participants reported that situations with potentially abusive consequences were a common occurrence, but deliberate abuse was rare. Residents waited too long for personal care, or were denied care they needed to ensure they had enough to eat, were moved safely, or were not emotionally neglected. Some care workers acted in potentially abusive ways because they did not know of a better strategy or understand the resident's illness; care workers made threats to coerce residents to accept care, or restrained them; a resident at high risk of falls was required to walk as care workers thought otherwise he would forget the skill. Most care workers said that they would be willing to report abuse anonymously. Care workers were sent the newly developed Care Home Conflict Scale to comment on but not to complete and to report whether it was acceptable and relevant to them. Several completed it and reported abusive behavior. Lack of resources, especially care worker time and knowledge about managing challenging behavior and dementia were judged to underlie much of the abuse described. We describe the first instrument designed to measure abuse by care home workers anonymously; field-testing is the logical next step.

‘Doing with …’ rather than ‘doing for …’ older adults: rationale and content of the ‘Stay Active at Home’ programme

PubMed Central

Metzelthin, Silke F; Zijlstra, Gertrud AR; van Rossum, Erik; de Man-van Ginkel, Janneke M; Resnick, Barbara; Lewin, Gill; Parsons, Matthew; Kempen, Gertrudis IJM

2017-01-01

Background: Owing to increasing age, accidents or periods of illness, home care services are provided to community-dwelling older adults. Traditionally, these services focus on doing things for older adults rather than with them; though from a rehabilitative perspective, it is important to assist older adults to attain and maintain their highest level of functioning. Consequently, a re-orientation of home care services is required away from treating disease and creating dependency towards focusing on capabilities and opportunities and maximising independence. To achieve this behavioural change in home care professionals, the ‘Stay Active at Home’ programme was developed. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the ‘Stay Active at Home’ programme by making use of the TIDieR (Template for Intervention Description and Replication) Checklist. Approach: ‘Stay Active at Home’ is a comprehensive training programme that aims to equip home care professionals (i.e. community nurses and domestic support workers) with the necessary knowledge, attitude, skills and social and organisational support to deliver day-to-day services at home from a more rehabilitative perspective. More specifically, home care professionals are expected to deliver goal-oriented, holistic and person-centred services focusing on supporting older adults to maintain, gain or restore their competences to engage in physical and daily activities so that they can manage their everyday life as independently as possible. PMID:29050508

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

PubMed Central

Alhuwail, Dari

2016-01-01

Summary Objectives To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians’ information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients’ cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients’ risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks. PMID:27437035

Managers’ Compensation in a Mixed Ownership Industry: Evidence from Nursing Homes

PubMed Central

Huang, Sean Shenghsiu; Hirth, Richard A.; Smith, Dean G.

2016-01-01

An extensive literature is devoted to differences between for-profit and non-profit health-care providers’ prices, utilization, and quality. Less is known about for-profit and non-profit managers’ compensation and its relationship with financial and quality performance. The aim of this study is to examine whether for-profit and non-profit nursing homes place differential weights on financial and quality performance in determining managers’ compensation. Using a unique 8-year dataset on Ohio nursing homes, fixed-effect regression models of managers’ compensation include financial and quality performance as well as other explanatory variables concerning firm and market characteristics and manager qualifications. Among for-profit nursing homes, compensation of owner-managers and non-owner managers are compared. Compensation of for-profit managers is significantly positively associated with profit margin and return-on-assets, while compensation of non-profit managers does not exhibit any consistent relationship with financial measures. Compensation of neither for-profit nor non-profit managers is significantly related to quality measures. Nursing home size and managers’ years of experience are the only consistent determinants of compensation. Owner-managers earn significantly higher compensation than non-owner managers and their compensation is less related to nursing home performance. Finding that home size and experience are strong determinants of compensation, and the association with ownership and financial performance for for-profit nursing homes are as expected. The insignificant relationship between compensation and quality performance is potentially troublesome. PMID:28083528

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

PubMed

Gorski, Lisa A; Johnson, Kathy

2003-01-01

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

Home Visiting for Intervention Delivery to Improve Rural Family Asthma Management

PubMed Central

Horner, Sharon D.

2010-01-01

The focus of this article is on the use of home visits in an asthma self-management intervention study with rural families who have a school-aged child with asthma. The study design involved randomization of the sample by elementary schools, then baseline (pre-test) and post-intervention data collection. The purpose of this article is to describe challenges in and pose solutions for implementing home visits for asthma self-management in rural areas. Home visiting is a strategy for program delivery that takes advantage of the home context for tailoring services to address the family’s individual needs. The advantages of intervening in the home included being able to (a) use actual home conditions for individualizing the asthma education to meet families’ needs; (b) match home visitors with family in terms of ethnicity and language; (c) retain a high percentage of families over the year-long duration of the study; and (d) not add to family burden of managing asthma. PMID:17064231

Joseph's Story: A Case Study of Late-Onset Necrotizing Enterocolitis From Early Birth to Recovery.

PubMed

Gephart, Sheila M; Martin, Laura B; Kijewski, Amy; Johnson, Scott R

2015-01-01

Although necrotizing enterocolitis (NEC) is often catastrophic among premature infants, most cases occur in the first month after birth. This case study presents Joseph's story about a 24-week surviving twin who developed severe NEC at 5 months of age just days before he was to go home. The purpose of this case study report is to place Joseph and his parents' experience in the context of what is known about NEC risk factors, clinical presentation, and treatment, and then to offer recommendations to healthcare professionals to support families from NEC diagnosis to recovery. Now 5 years old, Joseph continues to manage consequences of NEC including deafness, developmental delay, multiple food allergies, and recurrent gastrointestinal challenges from short gut syndrome. Although NEC struck late and kept Joseph in the neonatal intensive care unit for 228 days, its consequences remain with this resilient child and his family.

Habitat use and preferences of breeding female wood ducks

USGS Publications Warehouse

Hartke, Kevin M.; Hepp, G.R.

2004-01-01

Female wood ducks (Aix sponsa) feed primarily on plant foods in the prelaying period and switch to a diet of mostly invertebrates during egg production. If nutrient acquisition is habitat-specific, then selection and use of habitats may differ between these reproductive stages. A better understanding of these processes is needed to assist future habitat conservation and management efforts. In January-May 1999 and 2000, we monitored movements and habitat use of radiomarked females (n = 47) during the prelaying and egg-production periods of first nests. Home-range size averaged 367 ha and did not vary with reproductive period, year, or female age. Habitat use did not differ between periods of prelaying and egg production; consequently, data were combined. Habitat use varied between years, female age, and periods of nest initiation (i.e., early vs. late). Use of beaver ponds (BP), temporary wetlands (TW), managed impoundments (MI), and lake habitats (LK) declined in 2000 compared to 1999, possibly due to reduced precipitation. Nest initiation date was independent of female age. Adult females used BP more than yearlings, and early-nesting females used BP and MI more than late-nesting females. Females selected habitats nonrandomly when habitat composition of the study area was compared to that of home ranges (second-order selection). Lake-influenced wetlands (LI) and MI were ranked highest in preference. Home-range size was inversely related to percentage of the home range comprised of MI and LI, supporting the idea that MI and LI were high-quality habitats. However, we found no relationship between nest initiation date (an important index to reproductive performance) and the combined area of MI and LI in home ranges. Habitai selection did not differ from random when habitat composition of home ranges was compared to that of radio locations (third-order selection). Although MI and LI were preferred, high-quality habitats, our results suggest that breeding female wood ducks can satisfy requirements for egg production using a variety of wetland habitats. We suggest that providing a diversity of habitat types will increase the probability of meeting needs of breeding females throughout the breeding season, especially in areas where wetland conditions frequently change.

Actualizing Concepts in Home Management: Proceedings of a National Conference.

ERIC Educational Resources Information Center

American Home Economics Association, Washington, DC.

The booklet prints the following papers delivered at a national conference: Actualizing Concepts in Home Management: Decision Making, Dorothy Z. Price; Innovations in Teaching: Ergonomics, Fern E. Hunt; Relevant Concepts of Home Management: Innovations in Teaching, Kay P. Edwards; Standards in a Managerial Context, Florence S. Walker; Organizing:…

A cloud-based home management system for patients with a left ventricular assist device: a case report.

PubMed

Nomoto, Shinichi; Utsumi, Momoe; Minakata, Kenji

2016-07-04

Since implantable left ventricular assist devices (LVAD) with smaller configurations became available for bridge-to-transplant or even destination therapy in patients with end-stage heart failure, an increasing number of patients with these devices are receiving home medical management. However, these patients may be anxious about potential complications such as pump failure, thromboembolism, and infections that may occur during home management. To provide a sense of security during home management of patients with LVAD and to establish an ideal shared-care system, we developed a patient-centered cloud-based home management system for patients with LVAD. In this case report, we describe this system and report a trial of it in a 64-year-old patient with an LVAD.

Institutional and Individual Autonomy: Investigating Predictors of Attitudes toward Institutional Care in China

ERIC Educational Resources Information Center

Guan, Xinping; Zhan, Heying Jenny; Liu, Guangya

2007-01-01

This study examines the institutional and attitudinal changes in elder care homes in Tianjin, China. Based on a survey conducted in 2001 with 61 elder home managers and 265 elder residents, this study examines 1) factors that influence elder home managers' views about elder home development and 2) elders' evaluation of elder home quality and their…

Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study

PubMed Central

2013-01-01

Background Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario. Methods A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences. Results The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death. Conclusions Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring. PMID:23800280

Work demands and health consequences of organizational and technological measures introduced to enhance the quality of home care services--A subgroup analysis.

PubMed

Andersen, Gunn Robstad; Bendal, Synne; Westgaard, Rolf H

2015-11-01

This study of home care workers in a Norwegian municipality aimed to examine the effect of two measures involving organizational (job checklists) and technological (personal digital assistants) job aids on perceived work demands and musculoskeletal health. Questionnaire data was collected in 2009 (n = 138, response rate 76.2%) and 2011 (n = 80, response rate 54%). Forty-six home care workers responded at both waves. Respondents were assigned into 'high', 'moderate' and 'low' strain groups based on their responses to open and closed survey questions regarding impact of the two measures. One-way ANOVA with post-hoc t-tests and regression analyses investigated group differences and examined development in variables. Perceived work demands and health effects over the two-year study period were unchanged overall, yet significant differences between subgroups were highlighted. Work demands and shoulder-neck pain remained high for high-strain workers, but were reduced for low and moderate strain workers. Management should be aware of diversity in worker responses to rationalizations and give priority to supplementary, targeted measures to counteract adverse effects. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Home environmental consequences of commute travel impedance.

PubMed

Novaco, R W; Kliewer, W; Broquet, A

1991-12-01

The physical and perceptual dimensions of commuting travel impedance were again found to have stressful consequences in a study of 99 employees of two companies. This quasi-experimental replication study, which focuses here on home environment consequences, investigated the effects of physical impedance and subjective impedance on multivariate measures of residential satisfaction and personal affect in the home. Both sets of residential outcome measures were significantly related to the two impedance dimensions. As predicted, gender was a significant moderator of physical impedance effects. Women commuting on high physical impedance routes were most negatively affected. Previously found subjective impedance effects on negative home mood, regardless of gender, were strongly replicated with several methods and were buttressed by convergent results with objective indices. The theoretical conjecture that subjective impedance mediates the stress effects of physical impedance was supported by the personal affect cluster but only for one variable in the residential satisfaction cluster. Traffic congestion has increased in metropolitan areas nationwide, and commuters, families, and organizations are absorbing associated hidden costs. The results are reviewed in terms of our ecological model, and the moderating effects of gender are discussed in terms of choice and role constraints.

Resident-to-Resident Aggression in Nursing Homes: Results from a Qualitative Event Reconstruction Study

ERIC Educational Resources Information Center

Pillemer, Karl; Chen, Emily K.; Van Haitsma, Kimberly S.; Teresi, Jeanne; Ramirez, Mildred; Silver, Stephanie; Sukha, Gail; Lachs, Mark S.

2012-01-01

Purpose: Despite its prevalence and negative consequences, research on elder abuse has rarely considered resident-to-resident aggression (RRA) in nursing homes. This study employed a qualitative event reconstruction methodology to identify the major forms of RRA that occur in nursing homes. Design and methods: Events of RRA were identified within…

Consequences of Empowered CNA Teams in Nursing Home Settings: A Longitudinal Assessment

ERIC Educational Resources Information Center

Yeatts, Dale E.; Cready, Cynthia M.

2007-01-01

Purpose: Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study…

Nursing Home Patient Outcomes: The Results of an Incentive Reimbursement Experiment. Long-Term Care Studies Program Research Report.

ERIC Educational Resources Information Center

Thorburn, Phyllis; Meiners, Mark R.

A major demonstration and evaluation project was undertaken to study the consequences of using incentive payments to change admission, discharge, and outcome patterns for Medicaid patients in nursing homes. Thirty-six proprietary, Medicaid-certified, skilled nursing homes in San Diego County with a combined Medicaid inpatient census of…

Cue-induced reinstatement of cocaine seeking in the rat ‘conflict model’: Effect of prolonged home-cage confinement

PubMed Central

Barnea-Ygael, N; Yadid, G; Yaka, R; Ben-Shahar, O; Zangen, A

2011-01-01

Rationale and Objectives Drug addiction is not just the repeated administration of drugs, but compulsive drug use maintained despite the accumulation of adverse consequences for the user. In an attempt to introduce adverse consequences of drug seeking to laboratory animals, we have developed the ‘conflict model’ in which the access of rats to a reinforcing lever allowing self-administration requires passing of an electrified grid floor. In this model, the current intensity leading to complete abstinence from drug seeking can be measured individually. The present study was designed to evaluated whether reinstatement of drug or natural reward seeking, despite the presence of the electrical barrier, can be achieved by presentation of discrete cues that were associated with the reward, and whether prolonged home-cage confinement can facilitate such reinstatement in this model. Methods The ‘conflict model’ was used to test cue-induced reinstatement in the presence of the electrical barrier, after 1 or 14 days of home-cage confinement, in groups of rats that were previously trained to self-administer cocaine or sucrose. Results Although similar shock intensity was required to suppress sucrose or cocaine self-administration, subjects exhibited significantly lower response to sucrose-, as compared to cocaine-, associated cues, during the reinstatement test. Importantly, cue-induced reinstatement of cocaine seeking was attenuated following 14 days of home-cage confinement. Conclusions The incorporation of aversive consequence in the self-administration model enable detection of what can be interpreted as a compulsive component unique to drug reinforcers. Moreover, the effect of the aversive consequence seems to increase following home-cage confinement. PMID:21792542

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

PubMed Central

Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

2016-01-01

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

Feasibility of home management using ACT for childhood malaria episodes in an urban setting

PubMed Central

Nsagha, Dickson S; Elat, Jean-Bosco N; Ndong, Proper AB; Tata, Peter N; Tayong, Maureen-Nill N; Pokem, Francois F; Wankah, Christian C

2012-01-01

Background Over 90% of malaria cases occur in Sub-Saharan Africa, where a child under the age of 5 years dies from this illness every 30 seconds. The majority of families in Sub- Saharan Africa treat malaria at home, but therapy is often incomplete, hence the World Health Organization has adopted the strategy of home management of malaria to solve the problem. The purpose of this study was to determine community perception and the treatment response to episodes of childhood malaria in an urban setting prior to implementation of home management using artemisinin-based combination therapy (ACT). Methods This qualitative exploratory study on the home management of malaria in urban children under 5 years of age used 15 focus group discussions and 20 in-depth interviews in various categories of caregivers of children under 5 years. One hundred and eighteen people participated in the focus group discussions and 20 in the in-depth interviews. The study explored beliefs and knowledge about malaria, mothers’ perception of home management of the disease, health-seeking behavior, prepackaged treatment of malaria using ACT and a rapid diagnostic test, preferred channels for home management of uncomplicated malaria, communication, the role of the community in home management of malaria, and the motivation of drug distributors in the community. Results The mothers’ perception of malaria was the outcome of events other than mosquito bites. Home treatment is very common and is guided by the way mothers perceive signs and symptoms of malaria. Frequent change of malarial drugs by the national health policy and financial difficulties were the main problems mothers faced in treating febrile children. Rapid diagnostic testing and prepackaged ACT for simple malaria in children under 5 years would be accepted if it was offered at an affordable price. Tribalism and religious beliefs might hinder the delivery of home management of malaria. The availability of rapid diagnostic testing and ACT all year round is one of the challenges of home management of malaria. Although radio and television featured among the current sources of information within the community, meetings, churches, schools, and other public gatherings were the best venues for social mobilization, while community health workers and community leaders were the best sensitization agents for positive behavior change to adhere to home management of malaria. Monetary incentives should be offered to community drug distributors. This should be deducted from the combined price of ACT and rapid diagnostic testing. Conclusion For successful implementation of home management of malaria, there should be proper education, social mobilization of the population, and continuous monitoring and evaluation of field activities to ensure adequate stocks of ACT and rapid diagnostic testing within the framework of the intervention. PMID:22328833

Collaboration of hospital case managers and home care liaisons when transitioning patients.

PubMed

Kelly, Margaret M; Penney, Erika D

2011-01-01

Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices, and different levels of experience and training. Consensus regarding the implementation of the hospital's guidelines was achieved through a series of discussions within the workgroup in developing practice guidelines. Multiple revisions and secondary reviews by colleagues and directors took place before the guidelines were accepted and implemented. Recommendations for improving collaboration with liaisons included (1) taking time to become familiar with one another's practices and backgrounds; (2) ensuring clear discussions of roles, responsibilities, and expectations with liaisons related to individual cases and organizational requirements and limitations; (3) providing time and forums for ongoing communication and follow-up; and (4) recognizing that responsibility for certain aspects of the discharge planning process may be shared but that the case manager, in partnership with the multidisciplinary team, is ultimately accountable for the effectiveness and outcomes of the discharge plan.

75 FR 41994 - Federal Management Regulation; Home-to-Work Transportation

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-20

...; Docket 2010-0013, Sequence 1] RIN 3090-AJ05 Federal Management Regulation; Home-to-Work Transportation... clarify existing Home-to-Work Transportation policy. This final rule updates and clarifies who is not... establish policy regarding home-to-work transportation. Section 102-5.20 defines who is not covered by the...

Nurses' reflections on pain management in a nursing home setting.

PubMed

Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

2006-06-01

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.

PubMed

Giordano, Alessandro; Bonometti, Gian Pietro; Vanoglio, Fabio; Paneroni, Mara; Bernocchi, Palmira; Comini, Laura; Giordano, Amerigo

2016-12-07

Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored. This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios. To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider compliance. The results of the economic evaluation could provide information about the cost-effectiveness of the intervention and the effects on quality of life. In case of shown effectiveness and cost effectiveness, the program could be implemented into health services settings. ClinicalTrials.gov ( NCT02487589 ).

Enteral Nutrition Support to Treat Malnutrition in Inflammatory Bowel Disease

PubMed Central

Altomare, Roberta; Damiano, Giuseppe; Abruzzo, Alida; Palumbo, Vincenzo Davide; Tomasello, Giovanni; Buscemi, Salvatore; Lo Monte, Attilio Ignazio

2015-01-01

Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aetiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal-tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or the elderly, and must be combined with oral supplementation or replaced with tube enteral nutrition. In this review, we describe several different approaches to enteral nutrition—total parenteral, oral supplementation and enteral tube feeding—in terms of results, patients compliance, risks and and benefits. We also focus on the home entaral nutrition strategy as the future goal for treating IBD while focusing on patient wellness. PMID:25816159

Management of group b streptococcus-positive pregnant women at maternity homes in JAPAN: a questionnaire survey of compliance among midwives.

PubMed

Yamaguchi, Kotomi; Ohashi, Kazutomo

2018-01-01

Per the 2014 Japanese Midwives Association (JMA) guidelines, midwives were allowed to manage the deliveries for group B streptococcus (GBS)-positive pregnant women in labour at maternity homes without the supervision of a medical doctor if they complied with the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG), wherein midwives working for maternity homes are expected to cooperate with commissioned obstetricians and paediatricians in cooperative medical facilities. We examined the rate of compliance with these JMA and JSOG guidelines regarding the management of GBS-positive pregnant women among midwives at maternity homes in Japan. Between October and December 2015, an anonymous questionnaire was distributed to 337 maternity homes registered with the JMA by mail. The questionnaire obtained information regarding the timing of GBS screening, specimen collection, transfer of GBS-positive pregnant women from a maternity home to a hospital, administration of intrapartum antibiotic prophylaxis, and collaboration between midwives and commissioned obstetricians. Data were analysed using descriptive statistics. We used frequency distribution as the statistical test. Responses were received from 246 (73.0%) maternity homes, of which complete responses from 204 maternity homes (valid response rate, 60.5%) were analysed. Of these 204 maternity homes, only 97 (47.5%) conducted a GBS screening test during 33-37 weeks of gestation as recommended by the JSOG guidelines. Although midwives alone managed GBS-positive pregnant women in labour at 135 maternity homes (66.2%), intrapartum antibiotic prophylaxis, as recommended by the JSOG guidelines, was conducted in only 111 (54.4%). Moreover, only 37.0% (50/135) and 82.2% (111/135) of maternity homes ensured that GBS-positive pregnant women in labour with an elapse of ≥18 h after PROM and a body temperature of ≥38.0 °C, respectively, were transferred to a hospital by ambulance. Only at 58.3% (119/204) of maternity homes did midwives discuss the management of labour for GBS-positive pregnant women with commissioned obstetricians. Some midwives working for maternity homes did not follow the JMA and JSOG guidelines of the management of GBS-positive pregnant women. For improving compliance rates, midwives at maternity homes should discuss the management of GBS-positive pregnant women with commissioned doctors more carefully and concretely per the existing guidelines.

7 CFR Exhibit A to Subpart B of... - Memorandum of Understanding Between the Federal Emergency Management Agency and the Farmers Home...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Emergency Management Agency and the Farmers Home Administration or Its Successor Agency under Public Law 103... Emergency Management Agency and the Farmers Home Administration or Its Successor Agency under Public Law 103... any FmHA or its successor agency under Public Law 103-354 County Office. ...

COSMOS--improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.

PubMed

Husebo, Bettina S; Flo, Elisabeth; Aarsland, Dag; Selbaek, Geir; Testad, Ingelin; Gulla, Christine; Aasmul, Irene; Ballard, Clive

2015-09-15

Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation hybrid trial that combines and implements organization of activities evidence-based interventions to improve staff competence and thereby the patients' quality of life, mental health and safety. The aim of this paper is to describe the development, content and implementation process of the COSMOS trial. COSMOS includes a 2-month pilot study with 128 participants distributed among nine Norwegian nursing homes, and a 4-month multicenter, cluster randomized effectiveness-implementation clinical hybrid trial with follow-up at month 9, including 571 patients from 67 nursing home units (one unit defined as one cluster). Clusters are randomized to COSMOS intervention or current best practice (control group). The intervention group will receive a 2-day education program including written guidelines, repeated theoretical and practical training (credited education of caregivers, physicians and nursing home managers), case discussions and role play. The 1-day midway evaluation, information and interviews of nursing staff and a telephone hotline all support the implementation process. Outcome measures include quality of life in late-stage dementia, neuropsychiatric symptoms, activities of daily living, pain, depression, sleep, medication, cost-utility analysis, hospital admission and mortality. Despite complex medical and psychosocial challenges, nursing home patients are often treated by staff possessing low level skills, lacking education and in facilities with a high staff turnover. Implementation of a research-based multicomponent intervention may improve staff's knowledge and competence and consequently the quality of life of nursing home patients in general and people with dementia in particular. ClinicalTrials.gov NCT02238652.

Determinants of financial performance of home-visit nursing agencies in Japan.

PubMed

Fukui, Sakiko; Yoshiuchi, Kazuhiro; Fujita, Junko; Ikezaki, Sumie

2014-01-09

Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations.

Determinants of financial performance of home-visit nursing agencies in Japan

PubMed Central

2014-01-01

Background Japan has the highest aging population in the world and promotion of home health services is an urgent policy issue. As home-visit nursing plays a major role in home health services, the Japanese government began promotion of this activity in 1994. However, the scale of home-visit nursing agencies has remained small (the average numbers of nursing staff and other staff were 4.2 and 1.7, respectively, in 2011) and financial performance (profitability) is a concern in such small agencies. Additionally, the factors related to profitability in home-visit nursing agencies in Japan have not been examined multilaterally and in detail. Therefore, the purpose of the study was to examine the determinants of financial performance of home-visit nursing agencies. Methods We performed a nationwide survey of 2,912 randomly selected home-visit nursing agencies in Japan. Multinomial logistic regression was used to clarify the determinants of profitability of the agency (profitable, stable or unprofitable) based on variables related to management of the agency (operating structure, management by a nurse manager, employment, patient utilization, quality control, regional cooperation, and financial condition). Results Among the selected home-visit nursing agencies, responses suitable for analysis were obtained from 1,340 (effective response rate, 46.0%). Multinomial logistic regression analysis showed that both profitability and unprofitability were related to multiple variables in management of the agency when compared to agencies with stable financial performance. These variables included the number of nursing staff/rehabilitation staff/patients, being owned by a hospital, the number of cooperative hospitals, home-death rate among terminal patients, controlling staff objectives by nurse managers, and income going to compensation. Conclusions The results suggest that many variables in management of a home-visit nursing agency, including the operating structure of the agency, regional cooperation, staff employment, patient utilization, and quality control of care, have an influence in both profitable and unprofitable agencies. These findings indicate the importance of consideration of management issues in achieving stable financial performance in home-visit nursing agencies in Japan. The findings may also be useful in other countries with growing aging populations. PMID:24400964

How State-Funded Home Care Programs Respond to Changes in Medicare Home Health Care: Resource Allocation Decisions on the Front Line

PubMed Central

Corazzini, Kirsten

2003-01-01

Objective To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. Data Sources/Study Setting Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. Study Design Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N=2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. Data Collection/Extraction Methods Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. Principal Findings Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. Conclusions Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics. PMID:14596390

Experiences of an Engineer working in Reactor Safety and Emergency Response

NASA Astrophysics Data System (ADS)

Osborn, Douglas

2015-04-01

The U.S. Department of Energy's Federal Radiological Monitoring and Assessment Center Consequence Management Home Team (FRMAC/CMHT) Assessment Scientist's roles, responsibilities incorporate the FRMAC with other federal, state, and local agencies during a nuclear/radiological emergency. Before the Consequence Management Response Team arrives on-site, the FRMAC/CMHT provides technical and logistical support to the FRMAC and to state, local, and tribal authorities following a nuclear/radiological event. The FRMAC/CMHT support includes analyzing event data, evaluating hazards that relate to protection of the public, and providing event information and data products to protective action decision makers. The Assessment Scientist is the primary scientist responsible for performing calculations and analyses and communicating results to the field during any activation of the FRMAC/CMHT assets. As such, the FRMAC/CMHT Assessment Scientist has a number of different roles and responsibilities to fill depending upon the type of response that is required. Additionally, the Sandia National Laboratories (SNL) Consequence Assessment Team (CAT) Consequence Assessor roles, responsibilities involve hazardous materials operational emergency at SNL New Mexico facilities (SNL/NM) which include loss of control over radioactive, chemical, or explosive hazardous materials. When a hazardous materials operational emergency occurs, key decisions must be made in order to regain control over the hazards, protect personnel from the effects of the hazards, and mitigate impacts on operations, facilities, property, and the environment. Many of these decisions depend in whole or in part on the evaluation of potential consequences from a loss of control over the hazards. As such, the CAT has a number of different roles and responsibilities to fill depending upon the type of response that is required. Primary consequence-based decisions supported by the CAT during a hazardous materials operational emergency at SNL/NM include: (1) Onsite Protective Actions (2) Offsite Protective Action Recommendations (3) Event categorization (4) Event classification Other consequence-based decisions supported by the CAT include: (1) Response planning and operations (2) Event termination (3) Reentry planning and operations (4) Recovery planning and operations Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration.

Load Balancing Integrated Least Slack Time-Based Appliance Scheduling for Smart Home Energy Management.

PubMed

Silva, Bhagya Nathali; Khan, Murad; Han, Kijun

2018-02-25

The emergence of smart devices and smart appliances has highly favored the realization of the smart home concept. Modern smart home systems handle a wide range of user requirements. Energy management and energy conservation are in the spotlight when deploying sophisticated smart homes. However, the performance of energy management systems is highly influenced by user behaviors and adopted energy management approaches. Appliance scheduling is widely accepted as an effective mechanism to manage domestic energy consumption. Hence, we propose a smart home energy management system that reduces unnecessary energy consumption by integrating an automated switching off system with load balancing and appliance scheduling algorithm. The load balancing scheme acts according to defined constraints such that the cumulative energy consumption of the household is managed below the defined maximum threshold. The scheduling of appliances adheres to the least slack time (LST) algorithm while considering user comfort during scheduling. The performance of the proposed scheme has been evaluated against an existing energy management scheme through computer simulation. The simulation results have revealed a significant improvement gained through the proposed LST-based energy management scheme in terms of cost of energy, along with reduced domestic energy consumption facilitated by an automated switching off mechanism.

Best Practices for Managing Medical Equipment and Supplies Stored in a Vehicle.

PubMed

McGoldrick, Mary

2015-01-01

Home care clinicians often have to transport supplies to patients' homes, and remove and transport items from the home after care is provided. This article will provide guidelines and best practices for the proper methods of managing and storing infection prevention and control supplies and regulated medical waste in a home care clinician's personal vehicle.

Parents' Perspectives: An Evaluation of Case Management Interventions in Home Visiting Programs for Young Children

ERIC Educational Resources Information Center

Allen, Susan F.

2007-01-01

In home visiting programs for children younger than age three, home visitors work with parents to enhance the child's environment. This study examined how the home visitor-parent relationship, amount of contact, and level of need affected the intensity of case management interventions received. Researchers interviewed 90 mothers to measure the…

Technology and medication errors: impact in nursing homes.

PubMed

Baril, Chantal; Gascon, Viviane; St-Pierre, Liette; Lagacé, Denis

2014-01-01

The purpose of this paper is to study a medication distribution technology's (MDT) impact on medication errors reported in public nursing homes in Québec Province. The work was carried out in six nursing homes (800 patients). Medication error data were collected from nursing staff through a voluntary reporting process before and after MDT was implemented. The errors were analysed using: totals errors; medication error type; severity and patient consequences. A statistical analysis verified whether there was a significant difference between the variables before and after introducing MDT. The results show that the MDT detected medication errors. The authors' analysis also indicates that errors are detected more rapidly resulting in less severe consequences for patients. MDT is a step towards safer and more efficient medication processes. Our findings should convince healthcare administrators to implement technology such as electronic prescriber or bar code medication administration systems to improve medication processes and to provide better healthcare to patients. Few studies have been carried out in long-term healthcare facilities such as nursing homes. The authors' study extends what is known about MDT's impact on medication errors in nursing homes.

Treasury > Home

Science.gov Websites

Home Unclaimed Property Investments Cash Management Debt Management Admin Sign-In State of Alaska > provides cash management, investment and portfolio management, debt management and accounting services for investments, establishes and implements policies, and provides administrative and information technology

Research of home energy management system based on technology of PLC and ZigBee

NASA Astrophysics Data System (ADS)

Wei, Qi; Shen, Jiaojiao

2015-12-01

In view of the problem of saving effectively energy and energy management in home, this paper designs a home energy intelligent control system based on power line carrier communication and wireless ZigBee sensor networks. The system is based on ARM controller, power line carrier communication and wireless ZigBee sensor network as the terminal communication mode, and realizes the centralized and intelligent control of home appliances. Through the combination of these two technologies, the advantages of the two technologies complement each other, and provide a feasible plan for the construction of energy-efficient, intelligent home energy management system.

Characteristics of highly rated leadership in nursing homes using item response theory.

PubMed

Backman, Annica; Sjögren, Karin; Lindkvist, Marie; Lövheim, Hugo; Edvardsson, David

2017-12-01

To identify characteristics of highly rated leadership in nursing homes. An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviours and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care. Cross-sectional. From 290 municipalities, 60 were randomly selected and 35 agreed to participate, providing a sample of 3605 direct-care staff employed in 169 Swedish nursing homes. The staff assessed their managers' (n = 191) leadership behaviours using the Leadership Behaviour Questionnaire. Data were collected from November 2013 - September 2014, and the study was completed in November 2016. A two-parameter item response theory approach and regression analyses were used to identify specific characteristics of highly rated leadership. Five specific behaviours of highly rated nursing home leadership were identified; that the manager: experiments with new ideas; controls work closely; relies on subordinates; coaches and gives direct feedback; and handles conflicts constructively. The regression analyses revealed that managers with social work backgrounds and privately run homes were significantly associated with higher leadership ratings. This study highlights the five most important leadership behaviours that characterize those nursing home managers rated highest in terms of leadership. Managers in privately run nursing homes and managers with social work backgrounds were associated with higher leadership ratings. Further work is needed to explore these behaviours and factors predictive of higher leadership ratings. © 2017 John Wiley & Sons Ltd.

“We Are All Gonna Get Diabetic These Days”

PubMed Central

Pyatak, Elizabeth A.; Florindez, Daniella; Peters, Anne L.; Weigensberg, Marc J.

2014-01-01

Purpose The purpose of this study was to investigate how an intergenerational legacy of type 2 diabetes affected the knowledge, attitudes, and treatment strategies of Hispanic young adults with diabetes. Methods Eight Hispanic young adults (ages 18-30 years) participated in a series of in-home longitudinal qualitative interviews, and 11 of their family members completed single in-home interviews, regarding their diabetes management practices. Interview transcripts were analyzed thematically by a team of researchers. Results Five themes emerged that characterized the influence of an intergenerational legacy of diabetes on young adults: food and family (how meal preparation and eating are shared within families), doing together (activity participation is contingent on others’ participation), knowledge and expectations (expectations for the future and understandings of diabetes are shaped by family members), miscarried helping (well-intentioned actions have negative consequences), and reciprocal support (children and parents support each other’s diabetes care). Conclusions Hispanic young adults’ knowledge, attitudes, and self-care practices related to diabetes are strongly influenced by the diabetes management practices of family members with diabetes, which often depart from current standards of diabetes care. Care providers should consider family members as a potentially significant influence, either positive or negative, on the diabetes self-care practices of this population. PMID:24867918

[Quality of care and risk management in hospital at home services].

PubMed

Franzin-Garrec, Martine; Hoden, Romy

2016-04-01

Hospital at home structures are healthcare institutions in their own right, with the same obligations in terms of governance with regard to quality of care and risk management. However, hospital at home services are characterised by the remote management of the activity and the nursing staff, with specific constraints. Copyright © 2016. Published by Elsevier Masson SAS.

Case management considerations of progressive dementia in a home setting.

PubMed

Pierce, Mary Ellen

2010-01-01

Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.

Leadership philosophy of care home managers.

PubMed

Rippon, Daniel; James, Ian Andrew

Care home managers have a significant influence on staff morale and care delivery. Training methods underpinned by transformational leadership theory (TLT) have been used successfully to develop leaders in healthcare services. The aim of this preliminary study was to establish which aspects of TLT were apparent in care home managers' philosophies of leadership. A qualitative research design was used and 25 care home managers in the north-east of England took part. Participants were asked to provide their philosophies of leadership by completing a questionnaire; a thematic analysis of the responses was then conducted. Development of philosophy, enablement and interpersonal impact emerged as key themes. The findings suggested that elements of TLT were apparent in the participants' philosophies of leadership. However, the importance of gaining the support of senior management when attempting to apply a philosophy of eadership in practice was lacking. Aspects of TLT, such as supporting frontline employees to engage in education and establishing trust, were embedded in care home managers' philosophies. To develop leadership skills, managers may benefit from training programmes that involve both structured teaching and guided learning through experience.

When caretaking competes with care giving: a qualitative study of full-time working mothers who are nurse managers.

PubMed

Firmin, Michael W; Bailey, Megan

2008-10-01

The purpose of this study was to explore the motivations and stresses associated with full-time working mothers who practice as nurse managers. Full-time work outside the home for mothers has been recognized as a circumstance which may present certain benefits and risks to family life. Nursing management is recognized as a high-stress occupation, which may be filled by mothers who work full time. Little is known about the specific needs and stresses of full-time nurse managers who are caring for children at home. In-depth interviews were conducted with 13 mothers who worked as nurse managers. Participants expressed challenges in several areas including balancing/separating work and home, self-imposed advancement inhibitions, and constant giving. Challenges were offset by assets, which included complimentary roles, health insurance, added income, and professional and personal fulfilment. Participants 'wanted it all', including the conveniences of part-time employment and the benefits of full-time employment. Full-time nurse managers with children at home experience unique tensions which characterize their work and home environments. Employers may assist nurses by adopting flexible scheduling, educational and child-care support and assistance in negotiating work and home roles.

Pain management in home hospice patients: A retrospective descriptive study.

PubMed

Campbell, Cathy L; Kelly, Meghan; Rovnyak, Virginia

2017-09-01

The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48 hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain. © 2017 John Wiley & Sons Australia, Ltd.

Disparities in home health service providers among Medicare beneficiaries with stroke.

PubMed

Iyer, Medha; Bhavsar, Grishma P; Bennett, Kevin J; Probst, Janice C

2016-01-01

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

Reproductive consequences of farmland heterogeneity in little owls (Athene noctua).

PubMed

Michel, Vanja T; Naef-Daenzer, Beat; Keil, Herbert; Grüebler, Martin U

2017-04-01

The amount of high-quality habitat patches, their distribution, and the resource accessibility therein play a key role in regulating habitat effects on reproductive success. Heterogeneous habitats offer non-substitutable resources (e.g. nest sites and food) and substitutable resources (e.g. different types of food) in close proximity, thereby facilitating landscape complementation and supplementation. However, it remains poorly understood how spatial resource separation in homogeneous agricultural landscapes affects reproductive success. To fill this gap, we investigated the relationships between farmland heterogeneity and little owl (Athene noctua) reproductive success, including potential indirect effects of the heterogeneity-dependent home-range size on reproduction. Little owl home-ranges were related to field heterogeneity in summer and to structural heterogeneity in winter. Clutch size was correlated with the amount of food-rich habitat close to the nest irrespective of female home-range size, suggesting importance of landscape complementation. Nestling survival was positively correlated with male home-range size, suggesting importance of landscape supplementation. At the same time, fledgling condition was negatively correlated with male home-range size. We conclude that decreasing farmland heterogeneity constrains population productivity by two processes: increasing separation of food resources from nest or roost sites results in low landscape complementation, and reduction of alternative food resources limits landscape supplementation. Our results suggest that structural heterogeneity affects landscape complementation, whereas the heterogeneity and management of farmland fields affect landscape supplementation. Thus, to what extent a reduction of the heterogeneity within agricultural landscapes results in species-specific habitat degradation depends on the ecological processes (i.e. landscape complementation or supplementation) which are affected.

Conservation of brown bear in the Alps: space use and settlement behavior of reintroduced bears

NASA Astrophysics Data System (ADS)

Preatoni, Damiano; Mustoni, Andrea; Martinoli, Adriano; Carlini, Eugenio; Chiarenzi, Barbara; Chiozzini, Simonetta; Van Dongen, Stefan; Wauters, Luc A.; Tosi, Guido

2005-11-01

Large carnivores typically need large home ranges containing habitats patches of different quality. Consequently, their conservation requires habitat protection and management at the landscape scale. In some cases, reintroduction might be used to support remnant or restore extinct populations. This is the case for the brown bear ( Ursus arctos) in the Italian Alps. We monitored spacing behavior and settlement of reintroduced brown bears in Adamello-Brenta Natural Park, North-Italy, using radio-tracking. Habitat use, dispersion and survival were studied to evaluate the success of reintroduction and possible conflicts with man. All three males and five of seven females settled in the study area. Most bears roamed widely the first months after release, exploring the new habitat. Patterns of home range overlap between seasons and years revealed that home range use stabilized the year after first hibernation. Home ranges were larger in the mating season (May-July) than in spring or autumn. Home ranges varied between 34 and 1813 km 2 the year after release, but core-areas, where feeding activity was concentrated, were much smaller. Some bears had exclusive core-areas in summer and autumn, but most showed considerable core-area overlap with animals of the same and/or the opposite sex. Bears selected deciduous forests, mixed and conifer forests were used according to availability, and areas with anthropogenic disturbance were avoided. Most bears settled and some reproduced successfully at the release site, causing high initial population growth, suggesting that reintroduction can help to re-establish a brown bear population in the Italian Alps.

Evaluation of the 'Ladder to the Moon, Culture Change Studio Engagement Programme' staff training: Two quasi-experimental case studies.

PubMed

Guzmán, Azucena; Wenborn, Jennifer; Swinson, Tom; Orrell, Martin

2017-09-01

To evaluate the impact of the CCSEP on care home staff in two care settings for older people in one nursing home and one residential home. Care homes provide personal care and accommodation for older people. The English Dementia Strategy aims to improve the quality of service provision for people with dementia. This includes specific mention of improving the quality of life in care homes and as such includes objectives related to developing the workforce knowledge and skills. The Ladder to the Moon Culture Change Studio Engagement Programme (CCSEP) is a staff training approach based on the Positive Psychology framework that uses theatre- and film-based activities. This study used a wait-list controlled design. However, the data analysis plan was amended to reflect difficulties in data collection, and a quasi-experimental case study approach was consequently utilised. Outcome measures for staff attitudes and beliefs were as follows: Sense of Competence in Dementia Care Staff; Approaches to Dementia Questionnaire; Job Satisfaction Index; Brief Learning Transfer System Inventory; and Scale of Positive and Negative Experience. The Quality of Interaction Schedule (QUIS) was used to observe changes in staff-resident interaction. Fifty staff in two care homes completed the questionnaires and forty-one undertook formal CCSEP training. In Home A (nursing home), there was no significant change in any of the measures. In Home B (residential home), the QUIS showed an increase in positive interactions post intervention; a significant increase in the Building Relationship subscale of Sense of Competence; and a significant increase in staff sense of hopefulness towards people with dementia. The Brief Learning Transfer System Inventory showed a significant decrease post-intervention. The intervention did not significantly affect the happiness or job satisfaction of care home staff. The results of this study provide tentative evidence about the efficacy of this staff training programme. Some significant improvement in staff attitudes to people with dementia, staff sense of competence and positive staff-resident interactions were found in one of two homes. It is likely that the organisational problems affecting the other care home limited the implementation and therefore efficacy of the intervention there. The results therefore suggest that when a supportive management structure is in place, CCSEP may be more effective in improving staff attitudes, sense of competence and interactions with residents. © 2017 John Wiley & Sons Ltd.

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

PubMed

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

2016-09-01

Home care recipients are often hospitalized for potentially avoidable reasons. A pilot program (Intervention in Home Care to Improve Health Outcomes (In-Home)) was designed to help home care providers identify acute clinical changes in condition and then manage the condition in the home and thereby avoid a costly hospitalization. Caregivers answer simple questions about the care recipient's condition during a telephone-based "clock-out" at the end of each shift. Responses are electronically captured in the agency management software that caregivers use to "clock-in," manage care, and "clock-out" on every shift. These are transmitted to the agency's care manager, who follows up on the change in condition and escalates appropriately. A description of the In-Home model is presented, and pilot data from 22 home care offices are reported. In the pilot, caregivers reported a change in condition after 2% of all shifts, representing an average of 1.9 changes per care recipient in a 6-month period. Changes in behavior and skin condition were the most frequently recorded domains. Interviews with participating caregivers and care managers suggested positive attitudes regarding the intervention; challenges included resistance to change on the part of home care staff and difficulties in applying a uniform intervention to individuals with varying needs in home care offices with varying capacities. In an ongoing randomized trial, the success of the overall program will be measured primarily according to the potential reduction in avoidable hospitalizations of home care recipients and the effect this potential reduction has on spending and healthcare outcomes. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

What do we know about care home managers? Findings of a scoping review.

PubMed

Orellana, Katharine; Manthorpe, Jill; Moriarty, Jo

2017-03-01

This article reports selected findings from a scoping review of the literature about care home managers in England. The review was undertaken between December 2013 and April 2014, with searches conducted in December 2013, and completed in July 2014. Its aim was to identify the characteristics of care home managers, descriptions of their leadership and managerial roles, their experience, skills and support, and the managers' perceptions of their work and status and to identify knowledge gaps. The databases searched included Web of Knowledge, EBSCO, ASSIA, Embase, AgeInfo, NHS Evidence, Social Care Online and the publication platforms IngentaConnect, Wiley Online and JSTOR together with specialist sites and national information providers. Sixteen relevant studies directly about care home managers, reported in 24 articles, were identified. A further body of literature pertinent to the questions was located (n = 84), including sector reports, professional press, expert opinion, enquiries and reviews, and other material, which also informed the review. A consultation exercise with stakeholders informed the findings of the review. The review found that, despite frequent allusions to their impact on organisational culture, few studies have focused on care home managers, and, such as there are, mainly relate to managers of care homes for older people. This is despite managers' major responsibilities for the care of many frail and disabled people. © 2016 John Wiley & Sons Ltd.

41 CFR 302-10.5 - May I transport a mobile home over water?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May I transport a mobile home over water? 302-10.5 Section 302-10.5 Public Contracts and Property Management Federal Travel... transport a mobile home over water? Yes, you may transport a mobile home over water when both the points of...

41 CFR 302-10.5 - May I transport a mobile home over water?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false May I transport a mobile home over water? 302-10.5 Section 302-10.5 Public Contracts and Property Management Federal Travel... transport a mobile home over water? Yes, you may transport a mobile home over water when both the points of...

Effect of a Consumer-Directed Voucher and a Disease-Management-Health-Promotion Nurse Intervention on Home Care Use

ERIC Educational Resources Information Center

Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Mukamel, Dana; Eggert, Gerald M.

2005-01-01

Purpose: We describe the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management-health-promotion nurse intervention, on the probability of use of two types of home care-skilled home health care and personal assistance services-received by functionally impaired Medicare…

Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial

PubMed Central

Morton, Katherine; Stuart, Beth; Raftery, James; Bradbury, Katherine; Yao, Guiqing Lily; Zhu, Shihua; Little, Paul; Yardley, Lucy

2016-01-01

Introduction Self-management of hypertension, including self-monitoring and antihypertensive medication titration, lowers blood pressure (BP) at 1 year compared to usual care. The aim of the current trial is to assess the effectiveness of the Home and Online Management and Evaluation of Blood Pressure (HOME BP) intervention for the self-management of hypertension in primary care. Methods and analysis The HOME BP trial will be a randomised controlled trial comparing BP self-management—consisting of the HOME BP online digital intervention with self-monitoring, lifestyle advice and antihypertensive drug titration—with usual care for people with uncontrolled essential hypertension. Eligible patients will be recruited from primary care and randomised to usual care or to self-management using HOME BP. The primary outcome will be the difference in mean systolic BP (mm Hg) at 12-month follow-up between the intervention and control groups adjusting for baseline BP and covariates. Secondary outcomes (also adjusted for baseline and covariates where appropriate) will be differences in mean BP at 6 months and diastolic BP at 12 months; patient enablement; quality of life, and economic analyses including all key resources associated with the intervention and related services, adopting a broad societal perspective to include NHS, social care and patient costs, considered within trial and modelled with a lifetime horizon. Medication beliefs, adherence and changes; self-efficacy; perceived side effects and lifestyle changes will be measured for process analyses. Qualitative analyses will explore patient and healthcare professional experiences of HOME BP to gain insights into the factors affecting acceptability, feasibility and adherence. Ethics and dissemination This study has received NHS ethical approval (REC reference 15/SC/0082). The findings from HOME BP will be disseminated widely through peer-reviewed publications, scientific conferences and workshops. If successful, HOME BP will be directly applicable to UK primary care management of hypertension. Trial registration number ISRCTN13790648; pre-results. PMID:27821598

Non-Hispanic Black-White disparities in pain and pain management among newly admitted nursing home residents with cancer.

PubMed

Mack, Deborah S; Hunnicutt, Jacob N; Jesdale, Bill M; Lapane, Kate L

2018-01-01

Racial disparities in pain management persist across health care settings and likely extend into nursing homes. No recent studies have evaluated racial disparities in pain management among residents with cancer in nursing homes at time of admission. Using a cross-sectional study design, we compared reported pain and pain management between non-Hispanic White and non-Hispanic Black newly admitted nursing home residents with cancer (n=342,920) using the de-identified Minimum Data Set version 3.0. Pain management strategies included the use of scheduled analgesics, pro re nata analgesics, and non-pharmacological methods. Presence of pain was based on self-report when residents were able, and staff report when unable. Robust Poisson models provided estimates of adjusted prevalence ratios (aPR) and 95% CIs for reported pain and pain management strategies. Among nursing home residents with cancer, ~60% reported pain with non-Hispanic Blacks less likely to have both self-reported pain (aPR [Black versus White]: 0.98, 95% CI: 0.97-0.99) and staff-reported pain (aPR: 0.89, 95% CI: 0.86-0.93) documentation compared with Non-Hispanic Whites. While most residents received some pharmacologic pain management, Blacks were less likely to receive any compared with Whites (Blacks: 66.6%, Whites: 71.1%; aPR: 0.98, 95% CI: 0.97-0.99), consistent with differences in receipt of non-pharmacologic treatments (Blacks: 25.8%, Whites: 34.0%; aPR: 0.98, 95 CI%: 0.96-0.99). Less pain was reported for Black compared with White nursing home residents and White residents subsequently received more frequent pain management at admission. The extent to which unequal reporting and management of pain persists in nursing homes should be further explored.

Informal care and the self-management partnership: implications for Australian health policy and practice.

PubMed

Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

2010-11-01

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

[Struggling for normal in an instable situation - informal caregivers self-management in palliative home care. A meta-synthesis].

PubMed

Kreyer, Christiane; Pleschberger, Sabine

2014-10-01

Family caregivers play a key role in palliative home care for persons with advanced cancer. Although research has shown numerous burdens and strains of family caregiving, there is a lack of family-oriented support strategies in palliative home care. Little is known about family caregivers' self-management in this context so far. Qualitative research provides insight into families' perspectives of the transition to and management of palliative care at home and can be used as a starting point. The aim of the study was to increase knowledge of family caregivers' self-management in palliative home care by synthesizing evidence from qualitative research. Based on a systematic review of literature a meta-synthesis was conducted following the approach of Noblit and Hare (1988). A total of 13 qualitative studies from six countries, published from 2002 onward, formed the basis for an interpretative synthesis. Caring for a person with advanced cancer at the end of life at home is characterized by an instable transition process in which families are 'struggling for normal'. Six different family self-management strategies to deal with this were identified: acknowledging the transition, restructuring everyday life, maintaining balance in family relationships, taking responsibility for care, using social support, and acquiring caring-skills. Self-management strategies may provide a key for supporting family caregivers in palliative home care by focusing on resources and problem solving skills of families.

Office home care workers' occupational health: associations with workplace flexibility and worker insecurity.

PubMed

Zeytinoglu, Isik U; Denton, Margaret; Davies, Sharon; Plenderleith, Jennifer Millen

2009-05-01

Office home care workers provide support to visiting staff, although their work tends to be invisible in many respects. This paper focuses on managers, supervisors, coor dinators, case managers and office administrative staff in home care. We examine the effects of workplace flexibility and worker insecurity on office home care workers' occupational health, particularly their self-reported stress and musculoskeletal disorders. Data come from our survey of 300 home care office staff in a mid-sized city in Ontario. Results show that workers' perceptions of insecurity are positively associated with musculoskeletal disorders but not workplace flexibility measures. We recommend that managers and other decision-makers in the home care field pay attention to the perceptions of workers' insecurity in initiating workplace flexibility measures.

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

Foslien, Wendy K.; Curtner, Keith L.

Because of growing energy demands and shortages, residential home owners are turning to energy conservation measures and smart home energy management devices to help them reduce energy costs and live more sustainably. In this context, the Honeywell team researched, developed, and tested the Context Aware Smart Home Energy Manager (CASHEM) as a trusted advisor for home energy management. The project focused on connecting multiple devices in a home through a uniform user interface. The design of the user interface was an important feature of the project because it provided a single place for the homeowner to control all devices andmore » was also where they received coaching. CASHEM then used data collected from homes to identify the contexts that affect operation of home appliances. CASHEM's goal was to reduce energy consumption while keeping the user's key needs satisfied. Thus, CASHEM was intended to find the opportunities to minimize energy consumption in a way that fit the user's lifestyle.« less

Predictors and variation of routine home discharge in critically ill adults with cystic fibrosis.

PubMed

Oud, Lavi; Chan, Yiu Ming

2018-06-01

The short-term outcomes of patients with cystic fibrosis (CF) surviving critical illness were not examined systematically. To determine the factors associated with and variation in rates of routine home discharge among ICU-managed adult CF patients. Predictors of routine home discharge and its hospital-level variation were examined in ICU-managed adults with cystic fibrosis in Texas during 2004-2013. Older age, rural residence, and severity of illness decreased odds of routine home discharge, while hospitalization in facilities accredited as part of the Cystic Fibrosis Foundation Care Center Network nearly doubled the odds of routine home discharge. The median (interquartile) adjusted rate of routine home discharge was 62.0% (31.5-82.5). The identified determinants of routine home discharge can inform clinical decision-making, while the demonstrated wide variation in adjusted across-hospital rates of routine home discharge of ICU-managed adults with CF can provide benchmark data for future quality improvement efforts. Published by Elsevier Inc.

Implementation of Discharge Plans for Chronically Ill Elders Discharged Home.

ERIC Educational Resources Information Center

Proctor, Enola K.; And Others

1996-01-01

Addresses the extent to which discharge plans for elderly patients with congestive heart failure were implemented as planned, tested the consequences of implementation problems, and identified factors associated with implementation problems. Implications for hospital discharge planners and home health care are discussed. (KW)

Load Balancing Integrated Least Slack Time-Based Appliance Scheduling for Smart Home Energy Management

PubMed Central

Silva, Bhagya Nathali; Khan, Murad; Han, Kijun

2018-01-01

The emergence of smart devices and smart appliances has highly favored the realization of the smart home concept. Modern smart home systems handle a wide range of user requirements. Energy management and energy conservation are in the spotlight when deploying sophisticated smart homes. However, the performance of energy management systems is highly influenced by user behaviors and adopted energy management approaches. Appliance scheduling is widely accepted as an effective mechanism to manage domestic energy consumption. Hence, we propose a smart home energy management system that reduces unnecessary energy consumption by integrating an automated switching off system with load balancing and appliance scheduling algorithm. The load balancing scheme acts according to defined constraints such that the cumulative energy consumption of the household is managed below the defined maximum threshold. The scheduling of appliances adheres to the least slack time (LST) algorithm while considering user comfort during scheduling. The performance of the proposed scheme has been evaluated against an existing energy management scheme through computer simulation. The simulation results have revealed a significant improvement gained through the proposed LST-based energy management scheme in terms of cost of energy, along with reduced domestic energy consumption facilitated by an automated switching off mechanism. PMID:29495346

"Making Do" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards.

PubMed

Wills, Celia E; Polivka, Barbara J; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-04-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of "making do" decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. © The Author(s) 2015.

“Making Do” Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards

PubMed Central

Wills, Celia E.; Polivka, Barbara J.; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-01-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of “making do” decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. PMID:26669605

Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial.

PubMed

Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe; Damsbo-Svendsen, Signe; Kreinfeldt Skovgaard Møller, Tina; Boll Hansen, Eigil; Keiding, Hans

2014-08-28

Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition. Hence a structured and multidisciplinary approach, focusing on the nutritional risk factors and involving e.g. dieticians, occupational therapists, and physiotherapist, may be necessary to achieve benefits. Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care, identified by screening with the Eating validation Scheme. Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator, the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support. Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality's ordinary assessment and referral system.The primary outcome parameter will be change in quality of life (by means of Euroquol-5D-3L). Secondary outcomes will be: physical performance (chair stand), nutritional status (weight, Body Mass Index and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore, interviews with nursing home and home-care management, nursing staff and nutrition coordinators in both the control and intervention groups, participants in the intervention group and the involved multidisciplinary team will be performed. In this study we will evaluate in a randomized controlled trial whether multidisciplinary nutritional support is cost-effective, in undernourished older adults in home-care and nursing home and contribute to important research. ClinicalTrials.gov 2013 NCT01873456.

Beyond the trigger: The mental health consequences of in-home firearm access among children of gun owners.

PubMed

Kim, Jinho

2018-04-01

The high prevalence of household firearms in the U.S. has ignited a growing body of research seeking to understand its health consequences. While a large number of studies examine the impact of firearm availability on health risks of gun owners in the household, relatively little attention is given to whether and how in-home firearm access may shape psychological outcomes among children of gun owners. This study examined whether and how in-home firearm access is associated with adolescents' depressive symptoms. Given a strong social/cultural association between masculinity and gun possession as well as stark gender differences in perceptions of safety and attitudes toward firearms, this study also investigated whether this association differs for male and female adolescents. Participants were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (n = 14,013). This study used random- and fixed-effects regression analyses as well as propensity-score matching models in order to reduce the chances of bias due to individual-level heterogeneity. The present study showed that gaining access to guns at home was significantly related to increased depressive symptoms among children of gun owners, even after accounting for both observed and unobserved individual characteristics. Both fixed-effects and propensity-score matching models yielded consistent results. In addition, the observed association between in-home firearm access and depression was more pronounced for female adolescents. Finally, this study found suggestive evidence that the perceptions of safety, especially about school (but not neighborhood), are an important mechanism linking in-home firearm access to adolescent depression. As a substantial proportion of U.S. adolescents reported in-home firearm access, the findings of this study suggest that scholars and policymakers must seriously consider mental as well as physical health consequences related to household access to firearms among children of gun owners. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pandemic Influenza Planning in Nursing Homes: Are We Prepared?

PubMed Central

Mody, Lona; Cinti, Sandro

2012-01-01

Avian influenza or Influenza A (H5N1) is caused by a viral strain that occurs naturally in wild birds, but to which humans are immunologically naïve. If an influenza pandemic occurs, it is expected to have dire consequences, including millions of deaths, social disruption, and enormous economic consequences. The Department of Health and Human Resources plan, released in November 2005, clearly affirms the threat of a pandemic. Anticipating a disruption in many factions of society, every segment of the healthcare industry, including nursing homes, will be affected and will need to be self-sufficient. Disruption of vaccine distribution during the seasonal influenza vaccine shortage during the 2004/05 influenza season is but one example of erratic emergency planning. Nursing homes will have to make vital decisions and provide care to older adults who will not be on the initial priority list for vaccine. At the same time, nursing homes will face an anticipated shortage of antiviral medications and be expected to provide surge capacity for overwhelmed hospitals. This article provides an overview of current recommendations for pandemic preparedness and the potential effect of a pandemic on the nursing home industry. It highlights the need for collaborative planning and dialogue between nursing homes and various stakeholders already heavily invested in pandemic preparedness. PMID:17767687

Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes.

PubMed

Tsai, Yun-Fang; Wong, Thomas Ks; Ku, Yan-Chiou

2008-05-01

To explore self-care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan. With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self-care strategies for management of sleep disturbances among elders worldwide. A cross-sectional design was used. Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self-care management of sleep disturbance questionnaire and a demographic form were used to collect data. The prevalence of poor sleep in these older nursing home residents was 46.4%. Only 48.5% of participants used self-care strategies to manage sleep disturbances. The most frequently used strategy was 'take prescribed medicines'. Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep. This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents' inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances. As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.

Optimizing medication safety in the home.

PubMed

LeBlanc, Raeanne Genevieve; Choi, Jeungok

2015-06-01

Medication safety among community-dwelling older adults in the United States is an ongoing health issue impacting health outcomes, chronic disease management, and aging in place at home. This article describes a medication safety improvement project that aimed to: (1) Increase the ability of participants to manage medications, (2) Identify and make necessary medication changes, (3) Create an accurate up-to-date medication list to be available in the home, and (4) Provide communication between the primary care provider, participant, and case manager. An in-home medication assessment was completed for 25 participants using an evidence-based medication management software system. This process was used to review medications; identify medication-related problems; create a shared medication list; and convey this information to the primary care provider, case manager, and client while addressing needed medication changes. Educational interventions on management and understanding of medications were provided to participants to emphasize the correct use of medications and use of a personal medication record. Outcome improvements included provision of an accurate medication list, early identification of medication-related problems, identification of drug duplication, and identification of medication self-management challenges that can be useful for optimizing medication safety-related home healthcare and inform future interventions.

Systematic review of descriptive studies that investigated associated factors with the management of incontinence in older people in care homes.

PubMed

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Shaw, Christine; Williams, Kate; Chung, Alan; Barrett, James

2013-03-01

Incontinence is prevalent among older populations and residents in care homes. This paper is a review of descriptive studies that investigated associated factors related to managing urinary incontinence in older people in care homes. A systematic literature review was undertaken. MEDLINE and CINHAL were searched from 1996-2010 using the Cochrane Incontinence Review Group search strings for urinary and faecal incontinence including all research designs. Sixteen studies were identified that reported on associated factors related to comorbidities, management preferences, policies, staff views and knowledge or methodological studies. Non-invasive methods involving toileting and use of pads were common management approaches. No studies aimed at maintaining continence were identified. Factors associated with incontinence need to also be considered when planning and managing care for individuals, and developing and designing systems of care within care homes. Further study in care home populations to change or inform practice and provide effective care is warranted. Preventive studies that maintain continence are required. Older people and their families should be involved with decisions regarding their preferred care, goals, management and outcomes for managing incontinence, promoting or maintaining continence. © 2011 Blackwell Publishing Ltd.

Organizational and environmental factors associated with nursing home participation in managed care.

PubMed Central

Zinn, J S; Mor, V; Castle, N; Intrator, O; Brannon, D

1999-01-01

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services. PMID:10029508

Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis.

PubMed

Cooper, Jessie; Kierans, Ciara; Defres, Sylviane; Easton, Ava; Kneen, Rachel; Solomon, Tom

2017-09-12

Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis. The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis. The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples' everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems. The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.

Home care nurses' knowledge of evidence-based education topics for management of heart failure.

PubMed

Delaney, Colleen; Apostolidis, Beka; Lachapelle, Leeanne; Fortinsky, Richard

2011-01-01

We primarily sought to evaluate home care nurses' knowledge of evidence-based education topics in managing heart failure (HF). Moreover, we wanted to determine if differences were evident in nurses' knowledge based on education and work experience, and to identify home care nurses' specific educational needs. A cross-sectional survey design was used. Home care nurses (n = 94) were recruited from 4 home care agencies. A previously published 20-item HF knowledge questionnaire was administered to participants, and an open-ended question determined participants' need for further HF-related education. Home care nurses' scores demonstrated a 78.9% knowledge level in overall HF education principles. The mean HF knowledge score was 15.78 (SD, ±1.69) out of a possible 20 points. Nurses scored lowest on knowledge related to asymptomatic hypotension (24.5% answered correctly), daily weight monitoring (26.6% answered correctly), and transient dizziness (30.9% answered correctly). Nurses requested further information on all HF topics addressed in the survey as well as on psychosocial issues, research evidence, and more information from other healthcare providers. Our findings suggest that home care nurses may not be sufficiently knowledgeable in evidence-based education topics for managing HF. The results help confirm the need to develop educational programs for home care nurses in managing HF, which may lead to improved quality of patient education. Further research is needed to address specific deficits in the knowledge of home care nurses, and to determine if HF educational programs for nurses would enhance and sustain nurses' knowledge of HF management education. Copyright © 2011 Elsevier Inc. All rights reserved.

Multimethod Behavioral Treatment of Long-Term Selective Mutism.

ERIC Educational Resources Information Center

Watson, T. Steuart; Kramer, Jack J.

1992-01-01

Conducted single-subject, experimental research to examine efficacy of treating severe, long-term selective mutism in nine-year-old male using shaping, multiple reinforcers, natural consequences, stimulus fading, and mild aversives. Implemented different treatment regimens in home and school environments. Home intervention resulted in increase in…

Electric Energy Management in the Smart Home: Perspectives on Enabling Technologies and Consumer Behavior

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

Zipperer, Adam; Aloise-Young, Patricia A.; Suryanarayanan, Siddharth

2013-11-01

Smart homes hold the potential for increasing energy efficiency, decreasing costs of energy use, decreasing the carbon footprint by including renewable resources, and transforming the role of the occupant. At the crux of the smart home is an efficient electric energy management system that is enabled by emerging technologies in the electric grid and consumer electronics. This article presents a discussion of the state-of-the-art in electricity management in smart homes, the various enabling technologies that will accelerate this concept, and topics around consumer behavior with respect to energy usage.

Electric Energy Management in the Smart Home: Perspectives on Enabling Technologies and Consumer Behavior

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

Zipperer, A.; Aloise-Young, P. A.; Suryanarayanan, S.

2013-08-01

Smart homes hold the potential for increasing energy efficiency, decreasing costs of energy use, decreasing the carbon footprint by including renewable resources, and trans-forming the role of the occupant. At the crux of the smart home is an efficient electric energy management system that is enabled by emerging technologies in the electricity grid and consumer electronics. This article presents a discussion of the state-of-the-art in electricity management in smart homes, the various enabling technologies that will accelerate this concept, and topics around consumer behavior with respect to energy usage.

Improving Nursing Home Staff Knowledge and Attitudes about Pain

ERIC Educational Resources Information Center

Jones, Katherine R.; Fink, Regina; Pepper, Ginny; Hutt, Eveyln; Vojir, Carol P.; Scott, Jill; Clark, Lauren; Mellis, Karen

2004-01-01

Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. Design and Methods: Twelve nursing homes participated in this intervention study: six…

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

PubMed

Fraser, Kimberly D; Estabrooks, Carole; Allen, Marion; Strang, Vicki

2009-03-01

Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor. The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

Diabetes Self-Management Education in the Home.

PubMed

Lavelle, Dianne; Zeitoun, Joanah; Stern, Marianne; Butkiewicz, Elise; Wegner, Elfie; Reinisch, Courtney

2016-07-25

Diabetes self-management education and home visits have been found to improve clinical outcomes in individuals living with diabetes. The purpose of this pilot project was to evaluate the feasibility and effectiveness of conducting self-management education in patients' homes. Baseline biometric data was collected from a cohort of adult patients with diabetes. Home visits to 19 patients were conducted by doctoral students from Rutgers University School of Nursing. The visits included knowledge assessment, review of foods in the home, diabetes self-management education, and teaching the proper use of monitoring tools such as the glucometer and blood pressure monitor. Biomarkers were obtained post-intervention and were compared to baseline biomarkers. Descriptive lifestyle data was collected and opportunities for customized patient education were provided. The biomarkers improved overall during the four months after the education intervention. The mean A1C reduced 12% (p=0.0107), the mean glucose reduced 12% (p=0.0994), the mean BMI reduced 2% (p=0.1490), the systolic pressure reduced 1% (p=0.4196), and the diastolic pressure remained stable. Specific goal setting further increased the improvement in the area the individual planned to address. This project supports prior studies that found that in-home educational programs can improve the self-management of diabetes and lead to improvement in health indicators. The benefits of the study included personal attention in ensuring the correct use of home health monitoring devices, building self-management confidence, and identifying treatment barriers that may not be easily discerned in a clinic setting.

[Management of Uninhabitable Homes - Investigation of 186 Cases of Hoarding, Domestic Neglect and Squalor in Dortmund (Germany)].

PubMed

Lenders, T; Kuster, J; Bispinck, R

2015-07-01

To develop an intervention concept for the management of uninhabitable homes. Retrospective analysis of 186 cases of the community mental health service in Dortmund (Germany) presenting with a destitute situation of the domestic environment as core problem. All patients suffered from psychiatric illnesses, mainly from addiction (F1: 41%), psychosis (F2: 17%), depression (F3: 17%), and hoarding disorder (F63.8: 12%). Main socio-demographic characteristics of our sample are: middle age (45-65 years, 48%), male gender (73%), isolated situation (only 7% married, 84% living alone), normal schooling (only 4% without completion of schooling, 7% attended a school for special needs), after initial integration into employment nearly all patients suffered vocational disintegration (5% employed, 44% unemployment benefit, 7% welfare, 39% pension or invalidity benefit). Psychosocial interventions differed between the 4 main diagnostic groups: F1: treatment of dependence (rehab) and treatment of concomitant somatic diseases; F2: admission to a psychiatric hospital and implementation of guardianship; F3: mediation of conflicts with neighbours/landlords and implementation of guardianship; F63.8: direct practical help by members of the community mental health team and organisation of home help/waste disposal. In all diagnostic groups, acceptance of help was impaired due to social withdrawal, resistance and psychiatric symptoms. At 13%, compliance with help and interventions was lowest in the hoarder group (F1: 27%, F2: 26%, F3: 38%). Consequently, in this group the poor outcome categories "nothing accomplished" and "lost flat/eviction" were more frequent (44%, F1: 27%, F2: 26%, F3: 38%). Concurrent to the deterioration of the domestic situation, patients suffer vocational disintegration as well as family and social isolation. Uninhabitable homes occur in the course of various severe and chronic psychiatric diseases. They don't constitute a syndrome and they are not characteristic for one specific diagnosis. It is important to recognise the underlying psychiatric disease as diagnosis influences acceptance of help, choice of appropriate interventions, outcome and prognosis. Tab. 1 shows our suggestion for a diagnosis differentiated approach, relating appearance of the home and behaviour of the patient to diagnosis, appropriate interventions and prognosis. Hard to reach is the group of hoarders. Patients with a psychotic illness and with hoarding disorder require implementation of long-term outreach help in their homes. © Georg Thieme Verlag KG Stuttgart · New York.

Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design.

PubMed

Kneale, Laura; Choi, Yong; Demiris, George

2016-01-01

Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

Employees' views on home-based, after-hours telephone triage by Dutch GP cooperatives.

PubMed

Backhaus, Ramona; van Exel, Job; de Bont, Antoinette

2013-11-04

Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage.

Employees’ views on home-based, after-hours telephone triage by Dutch GP cooperatives

PubMed Central

2013-01-01

Background Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. Methods The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. Results We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Conclusion Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage. PMID:24188407

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

The Challenges of Managing Transnational Education Partnerships: The Views of "Home-Based" Managers vs "In-Country" Managers

ERIC Educational Resources Information Center

Healey, Nigel Martin

2018-01-01

Purpose: The purpose of this paper is to investigate the challenges of managing transnational education (TNE) partnerships from the perspective of the home university managers. Design/methodology/approach: The study adopts a qualitative, "insider researcher" methodology. It uses a sample set of eight mangers who operate from the home…

Prevalence and management of pain, by race and dementia among nursing home residents: United States, 2004.

PubMed

Sengupta, Manisha; Bercovitz, Anita; Harris-Kojetin, Lauren D

2010-03-01

Data from the National Nursing Home Survey, 2004. About one-quarter of all nursing home residents reported or showed signs of pain. Nonwhite residents and residents with dementia were less likely to report or show signs of pain compared with white residents and residents without dementia. Nonwhite residents with dementia were least likely, and white residents without dementia were most likely to report or show signs of pain. Forty-four percent of nursing home residents with pain received neither standing orders for pain medication nor special services for pain management (i.e., appropriate pain management). Among residents with dementia and pain, nonwhite residents were more likely than white residents to lack appropriate pain management.

75 FR 79278 - Community Reinvestment Act Regulations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... tracts, affected by high levels of loan delinquencies and foreclosures. Among the many consequences of... homes in default or delinquency in each State or unit of general local government. Under NSP1, each of... rates, subprime mortgages, and home mortgage defaults and delinquencies and each State will receive not...

Implementing Universal Maternal Depression Screening in Home Visiting Programs: A Pragmatic Overview

ERIC Educational Resources Information Center

Segre, Lisa S.; Taylor, Darby

2014-01-01

Maternal depression, although prevalent in low-income women, is not an inevitable consequence of poverty. Nevertheless, depression is a double burden for impoverished women: compromising infant development and diminishing mothers' ability to benefit from or effectively use home visiting services. Without universal screening, depression is often…

Home Learning Environment and Concept Formation: A Family Intervention Study with Kindergarten Children

ERIC Educational Resources Information Center

Niklas, Frank; Cohrssen, Caroline; Tayler, Collette

2016-01-01

Children's cognitive development has a neural basis, yet children's learning is facilitated by interactions with more knowledgeable others. Young children experience such interactions in the context of the home learning environment (HLE), when parents support children's thinking and learning during everyday activities. Consequently, one way to…

The moral economy of home construction in late socialist Yugoslavia

PubMed Central

Archer, Rory

2018-01-01

ABSTRACT Housing shortages in Yugoslav cities were a perennial concern for authorities and citizens alike. They disproportionately affected Yugoslav workers who as a consequence were the demographic most likely to independently construct a family home. This article explores how informal builders justified home construction in moral terms, legitimizing it on the basis of physical labour that was invested in home construction. This was couched in both the language register of Yugoslav socialism and patriarchal custom (according to which a male-headed household should enjoy the right to a family home). Construction was also conditioned by the opportunities and constraints of late socialist temporalities. PMID:29503597

[Pain management in home hospice care].

PubMed

Sakai, T; Sato, A

1998-12-01

Among 35 cases with terminal home care cancer patients, 23 (65.7%) cases developed pain. Twenty of these cases (87%) were treated with morphine. MS-contin and Anpec (suppositorium) were given to the patients. The two forms were jointly administered in 20% of them. NSAIDS and other adjuvant analgesics were given to 85% of them. Average dose of morphine were 173.5 +/- 357.5 mg. Adverse morphine side effects were treated with medication. In any case morphine administration was not discontinued due to its adverse effects. Some 82% of the patients died at home. No case dropped out of home care due to unsuccessful pain management. Successful pain management is necessary to implement home terminal care, and both patient and family should fully understand the status and prognosis of the incurable disease. Moreover, medical professionals (home care doctors, home care nurses and hospital doctors) should collaborate to form the temporal, adequate and seamless networking in caring and supporting terminal patients and their families.

Wintering ecology of sympatric subspecies of Sandhill Crane: Correlations between body size, site fidelity, and movement patterns

USGS Publications Warehouse

Ivey, Gary L.; Dugger, Bruce D.; Herziger, Caroline P.; Casazza, Michael L.; Fleskes, Joseph P.

2015-01-01

Body size is known to correlate with many aspects of life history in birds, and this knowledge can be used to manage and conserve bird species. However, few studies have compared the wintering ecology of sympatric subspecies that vary significantly in body size. We used radiotelemetry to examine the relationship between body size and site fidelity, movements, and home range in 2 subspecies of Sandhill Crane (Grus canadensis) wintering in the Sacramento–San Joaquin Delta of California, USA. Both subspecies showed high interannual return rates to the Delta study area, but Greater Sandhill Cranes (G. c. tabida) showed stronger within-winter fidelity to landscapes in our study region and to roost complexes within landscapes than did Lesser Sandhill Cranes (G. c. canadensis). Foraging flights from roost sites were shorter for G. c. tabida than for G. c. canadensis (1.9 ± 0.01 km vs. 4.5 ± 0.01 km, respectively) and, consequently, the mean size of 95% fixed-kernel winter home ranges was an order of magnitude smaller for G. c. tabida than for G. c. canadensis (1.9 ± 0.4 km2 vs. 21.9 ± 1.9 km2, respectively). Strong site fidelity indicates that conservation planning to manage for adequate food resources around traditional roost sites can be effective for meeting the habitat needs of these cranes, but the scale of conservation efforts should differ by subspecies. Analysis of movement patterns suggests that conservation planners and managers should consider all habitats within 5 km of a known G. c. tabida roost and within 10 km of a G. c. canadensis roost when planning for habitat management, mitigation, acquisition, and easements.

Reducing ADHD Children's Management Problems in Out-of-Home Settings.

ERIC Educational Resources Information Center

Kapalka, George M.

This report discusses the outcomes of a study that investigated a procedure designed to help manage children with attention deficit hyperactivity disorder (ADHD) in out-of-home settings. Forty-four parents of children (ages 5-10) diagnosed with ADHD hyperactive-impulsive or combined types participated. Portions of the Barkley Home Situations…

Role for a Labor-Management Partnership in Nursing Home Person-Centered Care

ERIC Educational Resources Information Center

Leutz, Walter; Bishop, Christine E.; Dodson, Lisa

2010-01-01

Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes…

41 CFR 302-14.2 - What is the purpose of a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What is the purpose of a home marketing incentive payment? 302-14.2 Section 302-14.2 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING...

41 CFR 302-14.4 - Must my agency pay me a home marketing incentive?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Must my agency pay me a home marketing incentive? 302-14.4 Section 302-14.4 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING...

41 CFR 302-14.3 - Am I eligible to receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Am I eligible to receive a home marketing incentive payment? 302-14.3 Section 302-14.3 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME...

Depression in Home-Based Care: The Role of the Home Health Nurse.

PubMed

Groh, Carla J; Dumlao, Manuel S

2016-01-01

Depression is a major health issue among older adults receiving home-based services yet is underdiagnosed and undertreated, which can result in negative health outcomes. Despite the recognized need for improved mental health services, significant gaps and barriers exist that contribute to less than optimal home-based depression management interventions. Home healthcare clinicians are well positioned to drive this effort for improving depression care with enhanced learning. Thus, the purpose of this article is to provide guidelines on improving depression care in homebound older adults based on four clinical functions central to home healthcare: screening, assessment, medication management, and patient/family education.

Emergency Response Health Physics

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

Mena, RaJah; Pemberton, Wendy; Beal, William

2012-05-01

Health physics is an important discipline with regard to understanding the effects of radiation on human health; however, there are major differences between health physics for research or occupational safety and health physics during a large-scale radiological emergency. The deployment of a U.S. Department of Energy/National Nuclear Security Administration (DOE/NNSA) monitoring and assessment team to Japan in the wake of the March 2011 accident at Fukushima Daiichi Nuclear Power Plant yielded a wealth of lessons on these difference. Critical teams (CMOC (Consequence Management Outside the Continental U.S.) and CMHT (Consequence Management Home Team) ) worked together to collect, compile, review,more » and analyze radiological data from Japan to support the response needs of and answer questions from the Government of Japan, the U.S. military in Japan, the U.S. Embassy and U.S. citizens in Japan, and U.S. citizens in America. This paper addresses the unique challenges presented to the health physicist or analyst of radiological data in a large-scale emergency. A key lesson learned was that public perception and the availability of technology with social media requires a diligent effort to keep the public informed of the science behind the decisions in a manner that is meaningful to them.« less

Results of a feasibility randomised controlled study of the guidelines for exercise in multiple sclerosis project.

PubMed

Learmonth, Yvonne C; Adamson, Brynn C; Kinnett-Hopkins, Dominique; Bohri, Maria; Motl, Robert W

2017-03-01

There is increasing recognition that exercise is an efficacious strategy for managing many consequences of multiple sclerosis (MS), yet persons with MS are not engaging in sufficient exercise for accruing health benefits. Poor exercise uptake might be associated with the design of previous research. We conducted a randomised controlled trial (RCT) for examining the feasibility of a 4-month home-based, exercise-training program designed based on recent physical activity guidelines for MS and supplemented by behavioural strategies for compliance. Feasibility was assessed in the domains of process (e.g., recruitment), resource (e.g., monetary costs), management (e.g., personnel time requirements) and scientific outcomes (e.g., treatment effect). We recruited persons with mild-to-moderate MS who were randomised into an intervention or wait-list control condition. Intervention participants received a pedometer, elastic resistance bands, DVD, training manual, calendars, log-book, video coaching calls and newsletters. Participants in both conditions completed home-based assessments before and after the 4-month period. Ninety-nine persons with MS were assessed for eligibility, and 57 were randomised. Fifty-one persons completed the study (90%). Total costs of the study were US $5331.03. Personnel time to conduct the study totaled 263h. Participants in the intervention group complied fully with 71% of all exercise sessions. There was a moderate increase in self-reported exercise behaviour of the intervention participants as measured by the Godin Leisure-Time Exercise Questionnaire (d≥0.5). The results support the feasibility and acceptability of a home-based exercise intervention based on physical activity guidelines and supplemented with behavioural strategies for adults with mild-to-moderate MS. Copyright © 2016 Elsevier Inc. All rights reserved.

Older people's involvement in activities related to meals in nursing homes.

PubMed

Grøndahl, Vigdis Abrahamsen; Aagaard, Heidi

2016-09-01

To explore how residents in nursing homes perceive their participation in activities related to food and meals, and possible factors influencing their involvement. Eating and drinking are fundamental human needs and consequently essential parts of nursing and nursing care. Therefore and as part of nursing care, encouraging older people in nursing homes to engage in different mealtime activities could be one way to increase participation in activities of daily living and more optimal nutrition status among older people. A cross-sectional survey design was used. A total of 204 residents (88%) in one Norwegian county agreed to participate and completed a face-to-face interview questionnaire about food and meal experiences. Descriptive and comparative statistics was used. Close to 30% of the residents were vulnerable to malnourishment. None of the residents were involved in menu planning, and more than 90% did not participate in food preparation or setting/clearing tables. Ten per cent were able to choose where they could eat and 5% when they could eat. Older persons living in nursing homes with more than 80 residents and those younger than 65 years of age participated the most, while older people with poor appetites were able to choose more often where they wanted to eat, compared to those with a healthy appetite. The residents in this study appeared to be vulnerable to malnourishment. The results indicated that they only to a limited extent were involved in activities concerning food and meals at the nursing homes. Management and nurses should focus on residents' eating and drinking, which are essentials of nursing care. The residents should be asked whether they would like to participate in different mealtime activities. Further, a person-centred care approach that facilitates activities concerning food and meals should be promoted. © 2016 John Wiley & Sons Ltd.

Relationship between neighborhood context, family management practices and alcohol use among urban, multi-ethnic, young adolescents.

PubMed

Tobler, Amy L; Komro, Kelli A; Maldonado-Molina, Mildred M

2009-12-01

We examined relationships between alcohol-related neighborhood context, protective home and family management practices, and alcohol use among urban, racial/ethnic minority, adolescents. The sample comprised 5,655 youth who were primarily low SES (72%), African American (43%) and Hispanic (29%). Participants completed surveys in 2002-2005 (ages 11-14 years). Items assessed alcohol use, accessibility of alcohol at home and parental family management practices. Neighborhood context measures included: (1) alcohol outlet density; (2) commercial alcohol accessibility; (3) alcohol advertisement exposure; and (4) perceived neighborhood strength, reported by parents and community leaders. Structural equation modeling was used to assess direct and indirect relationships between alcohol-related neighborhood context at baseline, home alcohol access and family management practices in seventh grade, and alcohol use in eighth grade. Neighborhood strength was negatively associated with alcohol use (beta = -0.078, p < or = 0.05) and exposure to alcohol advertisements was positively associated with alcohol use (beta = 0.043, p < or = 0.05). Neighborhood strength and commercial alcohol access were associated with home alcohol access (beta = 0.050, p

Relationship Between Neighborhood Context, Family Management Practices and Alcohol Use Among Urban, Multi-ethnic, Young Adolescents

PubMed Central

Tobler, Amy L.; Komro, Kelli A.; Maldonado-Molina, Mildred M.

2009-01-01

We examined relationships between alcohol-related neighborhood context, protective home and family management practices, and alcohol use among urban, racial/ethnic minority, adolescents. The sample comprised 5,655 youth who were primarily low SES (72%), African American (43%) and Hispanic (29%). Participants completed surveys in 2002–2005 (ages 11–14 years). Items assessed alcohol use, accessibility of alcohol at home and parental family management practices. Neighborhood context measures included: (1) alcohol outlet density; (2) commercial alcohol accessibility; (3) alcohol advertisement exposure; and (4) perceived neighborhood strength, reported by parents and community leaders. Structural equation modeling was used to assess direct and indirect relationships between alcohol-related neighborhood context at baseline, home alcohol access and family management practices in 7th grade, and alcohol use in 8th grade. Neighborhood strength was negatively associated with alcohol use (β=−0.078, p≤.05) and exposure to alcohol advertisements was positively associated with alcohol use (β=0.043, p≤.05). Neighborhood strength and commercial alcohol access were associated with home alcohol access (β=0.050, p≤.05 and β=−0.150, p≤.001, respectively) and family management practices (β=−0.061, p≤.01 and β=0.083, p≤.001, respectively). Home alcohol access showed a positive association with alcohol use (β=0.401, p≤.001). Tests for indirect effects suggest that home alcohol access may partially mediate the relationship between neighborhood strength and alcohol use (β=0.025, p<.062). Results suggest inner-city parents respond to environmental risk, such that as neighborhood risk increases, so also do protective home and family management practices. Parent engagement in restricting alcohol access and improving family management practices may be key to preventive efforts to reduce alcohol use. PMID:19381808

Pain management in the nursing home.

PubMed

Dumas, Linda G; Ramadurai, Murali

2009-06-01

This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).

41 CFR 102-5.50 - May determinations be made in advance for employees who respond to unusual circumstances when...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false May determinations be... 102-5.50 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK TRANSPORTATION Authorizing Home-to-Work...

First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care.

PubMed

Håkanson, Cecilia; Cronfalk, Berit Seiger; Henriksen, Eva; Norberg, Astrid; Ternestedt, Britt-Marie; Sandberg, Jonas

2014-01-01

The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.

Tonsillitis

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Hoarseness

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Sinusitis

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Cholesteatoma

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Telecommunications and disease management in the home environment: new strategies to improve outcomes.

PubMed

Meyer, L C

1997-06-01

This article provides an overview of the issues and effects of principle-centered health care within organized systems of care; portrays a comprehensive disease management framework for home health care; and offers virtual health management, telecommunications, and mobile computing strategies to enable health management enterprises to achieve health and outcomes maximization accountability demands in managed care.

Smoke-Free Policies Among Asian-American Women: Comparisons by Education Status

PubMed Central

Tong, Elisa K; Tang, Hao; Tsoh, Janice; Wong, Candice; Chen, Moon S.

2009-01-01

Background California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women. Methods The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (≤ high school graduate) or higher education status for smoke-free policy adoption and enforcement. Results Lower-educated and higher-educated women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI= 1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms. Conclusions The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments. PMID:19591754

Smoke-free policies among Asian-American women: comparisons by education status.

PubMed

Tong, Elisa K; Tang, Hao; Tsoh, Janice; Wong, Candice; Chen, Moon S

2009-08-01

California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women. The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (

Model medication management process in Australian nursing homes using business process modeling.

PubMed

Qian, Siyu; Yu, Ping

2013-01-01

One of the reasons for end user avoidance or rejection to use health information systems is poor alignment of the system with healthcare workflow, likely causing by system designers' lack of thorough understanding about healthcare process. Therefore, understanding the healthcare workflow is the essential first step for the design of optimal technologies that will enable care staff to complete the intended tasks faster and better. The often use of multiple or "high risk" medicines by older people in nursing homes has the potential to increase medication error rate. To facilitate the design of information systems with most potential to improve patient safety, this study aims to understand medication management process in nursing homes using business process modeling method. The paper presents study design and preliminary findings from interviewing two registered nurses, who were team leaders in two nursing homes. Although there were subtle differences in medication management between the two homes, major medication management activities were similar. Further field observation will be conducted. Based on the data collected from observations, an as-is process model for medication management will be developed.

SymptomCare@Home: Developing an Integrated Symptom Monitoring and Management System for Outpatients Receiving Chemotherapy.

PubMed

Beck, Susan L; Eaton, Linda H; Echeverria, Christina; Mooney, Kathi H

2017-10-01

SymptomCare@Home, an integrated symptom monitoring and management system, was designed as part of randomized clinical trials to help patients with cancer who receive chemotherapy in ambulatory clinics and often experience significant symptoms at home. An iterative design process was informed by chronic disease management theory and features of assessment and clinical decision support systems used in other diseases. Key stakeholders participated in the design process: nurse scientists, clinical experts, bioinformatics experts, and computer programmers. Especially important was input from end users, patients, and nurse practitioners participating in a series of studies testing the system. The system includes both a patient and clinician interface and fully integrates two electronic subsystems: a telephone computer-linked interactive voice response system and a Web-based Decision Support-Symptom Management System. Key features include (1) daily symptom monitoring, (2) self-management coaching, (3) alerting, and (4) nurse practitioner follow-up. The nurse practitioner is distinctively positioned to provide assessment, education, support, and pharmacologic and nonpharmacologic interventions to intensify management of poorly controlled symptoms at home. SymptomCare@Home is a model for providing telehealth. The system facilitates using evidence-based guidelines as part of a comprehensive symptom management approach. The design process and system features can be applied to other diseases and conditions.

Using information technology to improve the management of chronic disease.

PubMed

Celler, Branko G; Lovell, Nigel H; Basilakis, Jim

2003-09-01

Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay.

Impoverishment of practice: analysis of effects of economic discourses in home care case management practice.

PubMed

Ceci, Christine

2006-03-01

Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.

Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus

PubMed Central

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Barrett, James; Chung, Alan; Shaw, Christine; Williams, Kate

2011-01-01

Aim This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Background Incontinence is prevalent among residents of care home populations. Data sources MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. Methods A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007–2009. This is a report of descriptive studies. Results Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Conclusions Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted. PMID:21105895

Swallowing Trouble

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... Programs Professional Development Home AcademyU Home Study Course Maintenance of Certification Conferences & Events Practice Management Home Resources Quality Clinical Data Registry Research Reimbursement ...

Pediatric Sinusitis

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Deviated Septum

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Sinus Surgery

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Mouth Sores

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Nose Surgery

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Stuffy Nose

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A natural fit: home healthcare and biomedical engineering.

PubMed

Damasco, Nestor; Abe, Chris

2010-01-01

The involvement of Biomed in management of home care equipment has become a natural fit for Rady Children's Hospital. Managing all aspects of home care equipment through an in-house biomedical engineering department is cost-effective, efficient, provides excellent customer service, and enhances the relationship with the clinical staff and patients. It develops a sense of security for patients and staff that home care equipment is tested and maintained in a stringent manner that promotes safety.

Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

PubMed Central

Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

2015-01-01

Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

Cleaning and disinfection in home care: A comparison of 2 commercial products with potentially different consequences for respiratory health.

PubMed

Goodyear, Nancy; Markkanen, Pia; Beato-Melendez, Christian; Mohamed, Hagir; Gore, Rebecca; Galligan, Catherine; Sama, Susan; Quinn, Margaret

2018-04-01

Home care aides perform personal care and homemaking services in client homes, including cleaning and disinfection (C&D). Although C&D are performed to remove soil and dust, they are increasingly performed for infection prevention. Many C&D products contain respiratory irritants. The objective of this study was to evaluate 2 commercial products for C&D effectiveness on common household surfaces in seniors' homes. Two C&D visits were conducted in 46 seniors' homes. One visit applied a bleach-containing cleaning product and the other applied an environmentally preferable product. Before and after C&D, the study team performed organic soil bioluminometer measurements on surfaces and collected cotton swab and wipe samples for total bacteria count, Staphylococcus aureus, and Clostridium difficile identification. Both products removed microorganisms from tested surfaces. S aureus was found in 7 households, 1 strain of which was methicillin-resistant. Both products removed S aureus from all surfaces. Bleach-containing products removed somewhat more soil than environmentally preferable products, although results were statistically significant for only 1 surface. The study showed similar, not identical, C&D performance for 2 cleaning products with potentially different consequences for respiratory health. Additional research is needed to develop robust recommendations for safe, effective C&D in home care. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

41 CFR 302-14.6 - How much may my agency pay me for a home marketing incentive?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false How much may my agency pay me for a home marketing incentive? 302-14.6 Section 302-14.6 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME...

Managing World Wide Web Information in a Frames Environment: A Guide to Constructing Web Pages Using Frames.

ERIC Educational Resources Information Center

Gilstrap, Donald L.

1998-01-01

Explains how to build World Wide Web home pages using frames-based HTML so that librarians can manage Web-based information and improve their home pages. Provides descriptions and 15 examples for writing frames-HTML code, including advanced concepts and additional techniques for home-page design. (Author/LRW)

Cochlear-Meningitis Vaccination

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Find an ENT

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Smell and Taste

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Voice and Aging

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Tongue-Tie (Ankyloglossia)

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Tonsils and Adenoids

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Pediatric Thyroid Cancer

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Fine Needle Aspiration

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Ear Plastic Surgery

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Ears and Altitude

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About Your Voice

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Find an ENT

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Spatial and temporal movements in Pyrenean bearded vultures (Gypaetus barbatus): Integrating movement ecology into conservation practice

NASA Astrophysics Data System (ADS)

Margalida, Antoni; Pérez-García, Juan Manuel; Afonso, Ivan; Moreno-Opo, Rubén

2016-10-01

Understanding the movement of threatened species is important if we are to optimize management and conservation actions. Here, we describe the age and sex specific spatial and temporal ranging patterns of 19 bearded vultures Gypaetus barbatus tracked with GPS technology. Our findings suggest that spatial asymmetries are a consequence of breeding status and age-classes. Territorial individuals exploited home ranges of about 50 km2, while non-territorial birds used areas of around 10 000 km2 (with no seasonal differences). Mean daily movements differed between territorial (23.8 km) and non-territorial birds (46.1 km), and differences were also found between sexes in non-territorial birds. Daily maximum distances travelled per day also differed between territorial (8.2 km) and non-territorial individuals (26.5 km). Territorial females moved greater distances (12 km) than males (6.6 km). Taking into account high-use core areas (K20), Supplementary Feeding Sites (SFS) do not seem to play an important role in the use of space by bearded vultures. For non-territorial and territorial individuals, 54% and 46% of their home ranges (K90), respectively, were outside protected areas. Our findings will help develop guidelines for establishing priority areas based on spatial use, and also optimize management and conservation actions for this threatened species.

Merging home and health via contemporary care delivery: program management insights on a home telehealth project.

PubMed

Abraham, Chon; Rosenthal, David A

2008-01-01

This article discusses a home telehealth program that uses innovative informatics and telemedicine technologies to meet the needs of a Veterans Affairs Medical Center. We provide background information for the program inclusive of descriptions for the decision support system, patient selection process, and selected home telehealth technologies. Lessons learned based on interview data collected from the project team highlight issues regarding implementation and management of the program. Our goal is to provide useful information to other healthcare systems considering home telehealth as a contemporary option for care delivery.

Older Women Doing Home Care: Exploitation or Ideal Job?

PubMed Central

Butler, Sandra S.

2013-01-01

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

Parents' experiences of managing their child's postoperative pain at home: an exploratory qualitative study.

PubMed

Longard, Julie; Twycross, Alison; Williams, Anna M; Hong, Paul; Chorney, Jill

2016-09-01

To understand parents' experiences of managing their child's postoperative pain at home. Recent changes in children's health care services often shift the responsibility of managing children's postoperative pain to parents. Although pain management is important for good postoperative outcomes, it can be a challenging task for families, and children's pain is often under-managed. This qualitative study used semi-structured interviews to explore parents' experiences of managing their child's postoperative pain at home. Participants were parents of 10 typically developing 5- and 6-year olds, who underwent (adeno)tonsillectomy, and experienced no complications leading to hospitalisation in the postoperative period. One-on-one interviews were conducted with parents within three months of their child's surgery. Interviews were transcribed verbatim and content analysis was used to identify themes in parents' experiences. All children experienced some postoperative pain. Parents' experiences of managing their child's pain were impacted by balancing the pros and cons of administering analgesic medications, managing the emotional and psychological effects of their child's pain, as well as parents' information needs. Most parents' information needs were met yet they still struggled to manage their child's pain. These findings provide insight into some of the barriers that make this process challenging for many families, and what health care centres can do to help support parents manage their child's postoperative pain at home. The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences. © 2016 John Wiley & Sons Ltd.

Outpatient Management of Emergency Department Patients With Acute Pulmonary Embolism: Variation, Patient Characteristics, and Outcomes.

PubMed

Vinson, David R; Ballard, Dustin W; Huang, Jie; Reed, Mary E; Lin, James S; Kene, Mamata V; Sax, Dana R; Rauchwerger, Adina S; Wang, David H; McLachlan, D Ian; Pleshakov, Tamara S; Silver, Matthew A; Clague, Victoria A; Klonecke, Andrew S; Mark, Dustin G

2017-12-13

Outpatient management of emergency department (ED) patients with acute pulmonary embolism is uncommon. We seek to evaluate the facility-level variation of outpatient pulmonary embolism management and to describe patient characteristics and outcomes associated with home discharge. The Management of Acute Pulmonary Embolism (MAPLE) study is a retrospective cohort study of patients with acute pulmonary embolism undertaken in 21 community EDs from January 2013 to April 2015. We gathered demographic and clinical variables from comprehensive electronic health records and structured manual chart review. We used multivariable logistic regression to assess the association between patient characteristics and home discharge. We report ED length of stay, consultations, 5-day pulmonary embolism-related return visits and 30-day major hemorrhage, recurrent venous thromboembolism, and all-cause mortality. Of 2,387 patients, 179 were discharged home (7.5%). Home discharge varied significantly between EDs, from 0% to 14.3% (median 7.0%; interquartile range 4.2% to 10.9%). Median length of stay for home discharge patients (excluding those who arrived with a new pulmonary embolism diagnosis) was 6.0 hours (interquartile range 4.6 to 7.2 hours) and 81% received consultations. On adjusted analysis, ambulance arrival, abnormal vital signs, syncope or presyncope, deep venous thrombosis, elevated cardiac biomarker levels, and more proximal emboli were inversely associated with home discharge. Thirteen patients (7.2%) who were discharged home had a 5-day pulmonary embolism-related return visit. Thirty-day major hemorrhage and recurrent venous thromboembolism were uncommon and similar between patients hospitalized and those discharged home. All-cause 30-day mortality was lower in the home discharge group (1.1% versus 4.4%). Home discharge of ED patients with acute pulmonary embolism was uncommon and varied significantly between facilities. Patients selected for outpatient management had a low incidence of adverse outcomes. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

3/1/2018: Data Management Plan Webinar | National Agricultural Library

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News Contact Us Search  Log inRegister Home Home 3/1/2018: Data Management Plan Webinar Creating a Data Management Plan Webinar The original broadcast date of this webinar has passed, but you can view learn how to create a data management plan. Creating a Data Management Plan Tuesday, March 20 @ 1:00 PM

Tonsillitis

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Hoarseness

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TMJ

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Sinus Surgery

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Tonsillectomy and Adenoids PostOp

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Effects of Medications on Voice

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Antihistamines, Decongestants, and Cold Remedies

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What is LPR (Laryngopharyngeal Reflux)

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First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care

PubMed Central

Håkanson, Cecilia; Cronfalk, Berit Seiger; Henriksen, Eva; Norberg, Astrid; Ternestedt, Britt-Marie; Sandberg, Jonas

2015-01-01

The aim of this study was to investigate first-line nursing home managers’ views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested. PMID:25628769

Pain medication management processes used by oncology outpatients and family caregivers part II: home and lifestyle contexts.

PubMed

Schumacher, Karen L; Plano Clark, Vicki L; West, Claudia M; Dodd, Marylin J; Rabow, Michael W; Miaskowski, Christine

2014-11-01

Despite the increasing complexity of medication regimens for persistent cancer pain, little is known about how oncology outpatients and their family caregivers manage pain medications at home. To describe the day-to-day management of pain medications from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management in the context of highly individualized home environments and lifestyles. This qualitative study was conducted as part of a randomized clinical trial, in which an embedded mixed methods research design was used. Audio-recorded dialogue among patients, family caregivers, and intervention nurses was analyzed using qualitative research methods. Home and lifestyle contexts for managing pain medications included highly individualized home environments, work and recreational activities, personal routines, and family characteristics. Pain medication management processes particularly relevant in these contexts included understanding, organizing, storing, scheduling, remembering, and taking the medications. With the exception of their interactions with the intervention nurses, most study participants had little involvement with clinicians as they worked through these processes. Pain medication management is an ongoing multidimensional process, each step of which has to be mastered by patients and their family caregivers when cancer treatment and supportive care are provided on an outpatient basis. Realistic patient- and family-centered skill-building interventions are needed to achieve effective and safe pain medication management in the contexts of individual home environments and lifestyles. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Home Health Compare: Find a Home Health Agency

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... page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with " ... widget - Select to show Back to top Footer Home A federal government website managed and paid for ...

76 FR 78343 - HOME Investment Partnerships Program: Improving Performance and Accountability; and Updating...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... their programs and in managing their growing portfolios of older HOME projects. These challenges include... program. Examples of such uses are hospice buildings, nursing homes, foster homes, halfway houses, and...

Safety in home care: A research protocol for studying medication management

PubMed Central

2010-01-01

Background Patient safety is an ongoing global priority, with medication safety considered a prevalent, high-risk area of concern. Yet, we have little understanding of the supports and barriers to safe medication management in the Canadian home care environment. There is a clear need to engage the providers and recipients of care in studying and improving medication safety with collaborative approaches to exploring the nature and safety of medication management in home care. Methods A socio-ecological perspective on health and health systems drives our iterative qualitative study on medication safety with elderly home care clients, family members and other informal caregivers, and home care providers. As we purposively sample across four Canadian provinces: Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS), we will collect textual and visual data through home-based interviews, participant-led photo walkabouts of the home, and photo elicitation sessions at clients' kitchen tables. Using successive rounds of interpretive description and human factors engineering analyses, we will generate robust descriptions of managing medication at home within each provincial sample and across the four-province group. We will validate our initial interpretations through photo elicitation focus groups with home care providers in each province to develop a refined description of the phenomenon that can inform future decision-making, quality improvement efforts, and research. Discussion The application of interpretive and human factors lenses to the visual and textual data is expected to yield findings that advance our understanding of the issues, challenges, and risk-mitigating strategies related to medication safety in home care. The images are powerful knowledge translation tools for sharing what we learn with participants, decision makers, other healthcare audiences, and the public. In addition, participants engage in knowledge exchange throughout the study with the use of participatory data collection methods. PMID:20525363

Ranging pattern and use of space in a group of red howler monkeys (Alouatta seniculus) in a southeastern Colombian rainforest.

PubMed

Palacios, E; Rodriguez, A

2001-12-01

We studied a group of red howler monkeys (Alouatta seniculus) bordering a lake in an eastern Colombian Amazon rainforest for 10 months. The group used an area of 182 ha located mainly on Pleistocene terrace forest and had no overlap with other howler home ranges. Home range use varied through the year as a consequence of fruit and leaf abundance. For example, during the fruit scarcity season the group used an area of flooded forest nearly exclusively, indicating that at least for a portion of the year they are habitat specialists. Two areas intensively used by the group were identified, representing 17.6 % of the home range, and within which 56.9 % of the feeding trees were located. Overall density of feeding trees within the group's home range was very low (1.12 trees/ha). Home range size, as well as mean length of daily ranges (1,150 m), is the largest reported for this species to date, and it is likely a consequence of the diminished productivity of the plant communities on poor soil. Our results give an interesting example of the ranging behavior of this primate, which clearly differs from previous descriptions of red howlers. Copyright 2001 Wiley-Liss, Inc.

Teaching and Maintaining Behavior Management Skills in the Nursing Home.

ERIC Educational Resources Information Center

Burgio, Louis D.; Stevens, Alan; Burgio, Kathryn L.; Roth, David L.; Paul, Penelope; Gerstle, John

2002-01-01

Examines the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants' (CNAs) skill performance in the nursing home. Results reveal improvement in five out of seven communication skills. Although CNAs showed a reduction in the use of ineffective behavior management strategies, they did not…

Management of Giant Sequoia on Mountain Home Demonstration State Forest

Treesearch

Norman J. Benson

1986-01-01

Established in 1946, the Mountain Home Demonstration State Forest, Tulare County, California, is managed by the California Department of Forestry. It is a multiple-use forest with recreation as its primary focus, although timber management has always played an important role. Giant sequoia (Sequoiadendron giganteum [Lindl. ] Buchholz) occurs in...

A Bibliography of Materials on Behavior Management in the Home and Community.

ERIC Educational Resources Information Center

Kupper, Lisa, Ed.

This brief bibliography lists 26 resource materials for managing behavior problems in the home and community. Suggested resources were published between 1985 and 1993 and cover such topics as general behavior management, self-injury, food and behavior, functional communication training, impulsivity, alternatives to punishment, anger, and…

Types of Managed Care Plans

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... AAP Find a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting ... Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Types of Managed Care Plans Family Life Listen ...

Mexican spotted owl home range and habitat use in pine-oak forest: Implications for forest management

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Joseph L. Ganey; William M. Block; Jeffrey S. Jenness; Randolph A. Wilson

1998-01-01

To better understand the habitat relationships of the Mexican spotted owl (Strix occidentalis lucida), and how such relationships might influence forest management, we studied home-range and habitat use of radio-marked owls in ponderosa pine (Pinus ponderosa) Gambel oak (Quercus gambelii) forest. Annual home-range size (95% adaptive-kernel estimate) averaged 895 ha...

Fine Needle Aspiration

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Ear Plastic Surgery

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Cochlear-Meningitis Vaccination

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Earwax and Care

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Post-Nasal Drip

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About Your Voice

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Smell and Taste

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Better Ear Health

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Treatment Options for Adults with Snoring

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Pediatric GERD (Gastro-Esophageal Reflux Disease)

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Vocal Cord Nodules, Polyps, and Cysts

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Sinusitis: Special Considerations for Aging Patients

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Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability.

PubMed

Burkow, Tatjana M; Vognild, Lars K; Østengen, Geir; Johnsen, Elin; Risberg, Marijke Jongsma; Bratvold, Astrid; Hagen, Tord; Brattvoll, Morten; Krogstad, Trine; Hjalmarsen, Audhild

2013-03-05

The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers.This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user's own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home.

Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability

PubMed Central

2013-01-01

Background The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers. This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. Methods We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user’s own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. Results Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. Conclusions The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home. PMID:23496829

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

PubMed

Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus.

PubMed

Roe, Brenda; Flanagan, Lisa; Jack, Barbara; Barrett, James; Chung, Alan; Shaw, Christine; Williams, Kate

2011-02-01

This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Incontinence is prevalent among residents of care home populations. MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007-2009. This is a report of descriptive studies. Results. Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Top management leadership style and quality of care in nursing homes.

PubMed

Castle, Nicholas G; Decker, Frederic H

2011-10-01

The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data). A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality. The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.

Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams

ERIC Educational Resources Information Center

Yeatts, Dale E.; Cready, Cynthia; Ray, Beth; DeWitt, Amy; Queen, Courtney

2004-01-01

Purpose: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and Methods: A quasi-experimental design is underway where certified nurse aide…

Socioeconomic Disparities in the Use of Home Health Services in a Medicare Managed Care Population

PubMed Central

Freedman, Vicki A; Rogowski, Jeannette; Wickstrom, Steven L; Adams, John; Marainen, Jonas; Escarce, José J

2004-01-01

Objective To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans. Data Sources A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period. Study Design We estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees. Principal Findings Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment. Conclusions Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages. PMID:15333109

Productive Urban Landscape In Developing Home Garden In Yogyakarta City

NASA Astrophysics Data System (ADS)

Irwan, S. N. R.; Sarwadi, A.

2017-10-01

Home garden is one type of agroecosystem that supports ecosystem services even in the urban settlement. The studies involved literature references and field survey along with a framework of the productive urban landscape that support ecosystem services in home garden. Productive urban landscape provided environmentally, socially and economically benefits that contained in ecosystem services. Problems on limited space in the urban settlement have to be managed by modified home garden system in order to work for ecosystem service in developing productive landscape. This study aimed to assess home garden (Pekarangan) system in a cluster of high density settlement in Yogyakarta City. Structured interview and vegetation identification of home garden have been conducted on 80 samples in Rejowinangun Kotagede District, Yogyakarta City. People showed enthusiasm in ecosystem services provided by home garden “Pekarangan Produktif” through developing productive urban landscape. Some benefits on ecosystem services of home garden were revealed on this study consisted of food production for sale (4.7%), home industry (7.69%), aesthetics (22.65%), food (14.10%), biodiversity (10.68%), ecosystem (12.82%), education (2.56), social interaction (11.54%), recreation (4.70%), and others (8.55%). Nevertheless, vegetation and other elements of home gardens have been managed irregularly and in particularly, the planned home gardens were only 17.07%. Actually, home gardens provided a large set of ecosystem services including being cultural services those are the category most valued. The urban people almost hided the understanding of the cultural benefit of ecosystem services of home garden, even though Yogyakarta has known the cultural city. Thus, urban home garden, as way as “Pekarangan Produktif” in the limited space that managed and planned sustainably, provide many benefits of ecosystem services in a productive urban landscape.

Snoring and Sleep Apnea

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Ear Infection and Vaccines

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Secondhand Smoke and Children

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How the Ear Works

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Diet and Exercise Tips

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Allergies and Hay Fever

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Genes and Hearing Loss

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Autoimmune Inner Ear Disease

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Dizziness and Motion Sickness

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Children and Facial Trauma

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Common Problems That Can Affect Your Voice

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Your Nose, the Guardian of Your Lungs

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Hyperacusis: An Increased Sensitivity to Everyday Sounds

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Promoting an Alcohol-Free Childhood: A Novel Home-Based Parenting Program

ERIC Educational Resources Information Center

Dickinson, Denise M.; Hayes, Kim A.; Jackson, Christine; Ennett, Susan T.; Lawson, Caroline

2014-01-01

Few alcohol prevention programs focus on elementary school-aged youth, yet children develop expectancies and norms about alcohol use during the elementary school years, and many elementary school children are allowed to have sips or tastes of alcohol at home. Research on consequences of early alcohol use indicates that it can put children at…

Where heart and home reside: changing constructions of place and identity

Treesearch

Daniel R. Williams; Norman McIntyre

2001-01-01

Globalization has expanded the scope and geographic scale of leisure and tourism practices and their consequent impacts on society. Yet studies of such topics as community, home, migration, and tourism remain infused with outdated assumptions of a geographically rooted subject. In the future, the changing nature of employment, retirement, and lifestyles are likely to...

Participating in Science at Home: Recognition Work and Learning in Biology

ERIC Educational Resources Information Center

Zimmerman, Heather Toomey

2012-01-01

This article presents an analysis of the longitudinal consequences of out-of-school science learning with a conceptual framework that connects the intentions of youth to their participation in science. The focus is on one girl's science activities in her home and hobby pursuits from fourth to seventh grade to create an empirical account of how…

Home Care Nursing Improves Cancer Symptom Management

Cancer.gov

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

The benefits of CRM: is your home care agency missing out?

PubMed

Bishop, Adam D

2009-12-01

Home care executives today have at their disposal all the means necessary to manage information and strengthen relationships with customers, thanks to innovative customer relationship management (CRM) tools, Adam D. Bishop explains.

Tonsillectomy and Adenoids PostOp

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Continuous Positive Airway Pressure (CPAP)

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Otolaryngologist: What Is an Otolaryngologist?

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When Your Child Has Tinnitus

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Effects of Medications on Voice

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Antihistamines, Decongestants, and Cold Remedies

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50 Facts about Oral, Head and Neck Cancer

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Sinus Pain: Can Over-the-Counter Medications Help?

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American Academy of Otolaryngology--Head and Neck Surgery

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Factors of subjective heat stress of urban citizens in contexts of everyday life

NASA Astrophysics Data System (ADS)

Kunz-Plapp, Tina; Hackenbruch, Julia; Schipper, Janus Willem

2016-04-01

Heat waves and the consequent heat stress of urban populations have a growing relevance in urban risk management and strategies of urban adaptation to climate change. In this context, social science studies on subjective experiencing of heat as stress by urban citizens are a new emerging field. To contribute to the understanding of self-reported subjective heat stress and its major determinants in a daily life perspective, we conducted a questionnaire survey with 323 respondents in Karlsruhe, Germany, after heat waves in July and August 2013. Statistical data analysis showed that subjective heat stress is an issue permeating everyday activities. Subjective heat stress at home was lower than at work and in general. Subjective heat stress in general, at home, and at work was determined by the health impairments experienced during the heat and the feeling of being helplessly exposed to the heat. For subjective heat stress at home, characteristics of the residential building and the built environment additionally played a role. Although the rate of implemented coping measures was rather high, coping measures showed no uniform effect for the subjective heat stress. We conclude that in terms of urban adaptation strategies, further research is needed to understand how various processes of daily social (work) life enable or limit individual coping and that communication strategies are important for building capacities to better cope with future heat waves.

Adverse Events Associated with Hospitalization or Detected through the RAI-HC Assessment among Canadian Home Care Clients

PubMed Central

Doran, Diane; Hirdes, John P.; Blais, Régis; Baker, G. Ross; Poss, Jeff W.; Li, Xiaoqiang; Dill, Donna; Gruneir, Andrea; Heckman, George; Lacroix, Hélène; Mitchell, Lori; O'Beirne, Maeve; Foebel, Andrea; White, Nancy; Qian, Gan; Nahm, Sang-Myong; Yim, Odilia; Droppo, Lisa; McIsaac, Corrine

2013-01-01

Background: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). Method: A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. Results: The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. Conclusion: The incidence of AEs from all sources of data ranged from 4% to 9%. More resources are needed to target strategies for addressing safety risks in HC in a broader context. Tools such as the RAI-HC and its Clinical Assessment Protocols, already available in Canada, could be very useful in the assessment and management of HC clients who are at safety risk. PMID:23968676

FORESEE™ User-Centric Energy Automation

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

FORESEE™ is a home energy management system (HEMS) that provides a user centric energy automation solution for residential building occupants. Built upon advanced control and machine learning algorithms, FORESEE intelligently manages the home appliances and distributed energy resources (DERs) such as photovoltaics and battery storage in a home. Unlike existing HEMS in the market, FORESEE provides a tailored home automation solution for individual occupants by learning and adapting to their preferences on cost, comfort, convenience and carbon. FORESEE improves not only the energy efficiency of the home but also its capability to provide grid services such as demand response. Highlymore » reliable demand response services are likely to be incentivized by utility companies, making FORESEE economically viable for most homes.« less

(Where) Is Functional Decline Isolating? Disordered Environments and the Onset of Disability.

PubMed

Schafer, Markus H

2018-03-01

The onset of disability is believed to undermine social connectedness and raise the risk of social isolation, yet spatial environments are seldom considered in this process. This study examines whether unruly home and neighborhood conditions intensify the association between disability onset and several dimensions of social connectedness. I incorporate longitudinal data from the National Social Life, Health, and Aging Project, which contains environmental evaluations conducted by trained observers ( N = 1,558). Results from Poisson, ordinal logistic, and linear regression models reveal heterogeneous consequences of disablement: disability onset was associated with reduced core network size, fewer friends, lower likelihood of social interaction, and less overall social connectedness-though mainly when accompanied by higher levels of household disorder. There was limited evidence that neighborhood disorder moderated consequences of disability. Findings point to the importance of the home as an environmental resource and underscore important contextual contingencies in the isolating consequences of disability.

Management of geriatric incontinence in nursing homes.

PubMed Central

Schnelle, J F; Traughber, B; Morgan, D B; Embry, J E; Binion, A F; Coleman, A

1983-01-01

A behavioral management system designed to reduce urinary incontinence was evaluated in two nursing homes with a pretest-posttest control group design with repeated measures. The primary components of the system were prompting and contingent social approval/disapproval which required approximately 2.5 minutes per patient per hour to administer. The frequency of correct toileting for experimental subjects increased by approximately 45%. The experimental groups were significantly different from the control groups on both incontinence and correct toileting measures. The results are discussed in view of the management issues inherent in nursing home settings. PMID:6885672

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

Srivastava, Viraj; Makhmalbaf, Atefe; Parker, Graham B.

The research reported is part of a collaborative with Honeywell, Inc. to bring novel home energy management concepts and technologies to reduce energy consumption, reduce peak electricity demand, integrate renewable energy and storage technology, and change homeowner behavior to manage and consume less energy. The objective of the collaborative is to create a Context-Aware Smart Home Energy Manager (CASHEM) that dynamically schedules major home appliances according to conditions and homeowner convenience of service (CoS) preferences, monitors and analyzes energy consumption of appliances, recommends further energy saving actions, and engages/motivates the homeowner to adopt those recommendations.

Home noninvasive ventilation: what does the anesthesiologist need to know?

PubMed

Brown, Karen A; Bertolizio, Gianluca; Leone, Marisa; Dain, Steven L

2012-09-01

Treatment of chronic respiratory failure with noninvasive ventilation (NIV) is standard pediatric practice, and NIV systems are commonly used in the home setting. Although practice guidelines on the perioperative management of children supported with home NIV systems have yet to be published, increasingly these patients are referred for consultation regarding perioperative management. Just as knowledge of pharmacology underlies the safe prescription of medication, so too knowledge of biomedical design is necessary for the safe prescription of NIV therapy. The medical device design requirements developed by the Organization for International Standardization provide a framework to rationalize the safe prescription of NIV for hospitalized patients supported at home with NIV systems. This review article provides an overview of the indications for home NIV therapy, an overview of the medical devices currently available to deliver it, and a specific discussion of the management conundrums confronting anesthesiologists.

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD.

PubMed

Grosbois, Jean Marie; Gicquello, Alice; Langlois, Carole; Le Rouzic, Olivier; Bart, Frédéric; Wallaert, Benoit; Chenivesse, Cécile

2015-01-01

Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient's home from the PR center and the patient's preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient's exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed.

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD

PubMed Central

Grosbois, Jean Marie; Gicquello, Alice; Langlois, Carole; Le Rouzic, Olivier; Bart, Frédéric; Wallaert, Benoit; Chenivesse, Cécile

2015-01-01

Introduction Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR. Methods Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28). Results No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months. Conclusion Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed. PMID:26445534

Sinusitis: Special Considerations for Aging Patients

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Vocal Cord Nodules, Polyps, and Cysts

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Pediatric GERD (Gastro-Esophageal Reflux Disease)

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Middle Ear Infection (Chronic Otitis Media) and Hearing Loss

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The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial

PubMed Central

Boorsma, Marijke; van Hout, Hein PJ; Frijters, Dinnus H; Ribbe, Miel W; Nijpels, Giel

2008-01-01

Background The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. Methods This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs. Discussion This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. Trail registration number ISRCTN11076857 PMID:18606020

The Impact of Electronic Health Records on Risk Management of Information Systems in Australian Residential Aged Care Homes.

PubMed

Jiang, Tao; Yu, Ping; Hailey, David; Ma, Jun; Yang, Jie

2016-09-01

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in Australia is discussed.

The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial.

PubMed

Boorsma, Marijke; van Hout, Hein P J; Frijters, Dinnus H; Ribbe, Miel W; Nijpels, Giel

2008-07-07

The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs. This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. TRAIL REGISTRATION NUMBER: ISRCTN11076857.

Top Management Leadership Style and Quality of Care in Nursing Homes

ERIC Educational Resources Information Center

Castle, Nicholas G.; Decker, Frederic H.

2011-01-01

Purpose: The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Design and Methods: Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style…

"Between the devil and the deep blue sea": the beliefs of caregivers of people with dementia regarding the use of in-home respite services.

PubMed

Phillipson, Lyn; Jones, Sandra C

2011-04-01

This article details results from qualitative research with caregivers in regard to the beliefs they associate with the use of in-home respite services. Outcomes are perceived by caregivers in relation to care recipient personal safety and the avoidance of negative consequences through the provision of supervision in the caregiver's absence. Use of in-home services challenges normative beliefs for some caregivers, particularly for spousal caregivers who feel it is their role to provide assistance that is needed in the home. Likewise, perceived inflexibility and the inability of in-home services to provide responsive and personalized care make the use of in-home services difficult and may inform control beliefs. Implications are discussed in relation to community care pathways and the promotion and development of in-home respite services to better target caregiver beliefs and respond to caregiver perceived needs.

Managed Care Plans: Getting Good Care for Your Child

MedlinePlus

... AAP Find a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting ... Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Managed Care Plans: Getting Good Care for Your ...

Hyperacusis: An Increased Sensitivity to Everyday Sounds

MedlinePlus

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Common Problems That Can Affect Your Voice

MedlinePlus

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Asthma disease management and the respiratory therapist.

PubMed

Kallstrom, Thomas J; Myers, Timothy R

2008-06-01

The role of the respiratory therapist (RT) is expanding with the growing acceptance and use of the disease-management paradigm for managing chronic diseases. RTs are key members of the asthma disease-management team, in acute-care settings, patients' homes, out-patient clinics, emergency departments, and in the community. Utilizing RTs as disease managers allows patients to be treated faster and more appropriately, discharged to home sooner, and decreases hospital admissions. RT are leaders in the emerging field of asthma disease management.

Psychosocial behaviour management programme for home-dwelling people with dementia: A cluster-randomized controlled trial.

PubMed

Nakanishi, Miharu; Endo, Kaori; Hirooka, Kayo; Granvik, Eva; Minthon, Lennart; Nägga, Katarina; Nishida, Atsushi

2018-03-01

Little is known about the effectiveness of a psychosocial behaviour management programme on home-dwelling people with dementia. We developed a Behaviour Analytics & Support Enhancement (BASE) programme for care managers and professional caregivers of home care services in Japan. We investigated the effects of BASE on challenging behaviour of home-dwelling people with dementia. A cluster-randomized controlled trial was conducted with home care providers from 3 different districts in Tokyo. Each provider recruited persons with dementia aged 65 years or older to receive home care in the BASE programme in August 2016. An online monitoring and assessment system was introduced to the intervention group for repeated measures of challenging behaviour with a total score of the Neuropsychiatric Inventory. Care professionals in both the intervention and control groups evaluated challenging behaviour of persons with dementia at baseline (September 2016) and follow-up (February 2017). A majority of persons with dementia had Alzheimer disease (59.3%). One-hundred and forty-one persons with dementia were included in the intervention group and 142 in the control group. Multilevel modelling revealed a significant reduction in challenging behaviour in the intervention group after 6 months (mean score, 18.3 to 11.2) compared with that of the control group (11.6 to 10.8; P < .05). The implementation of the BASE programme resulted in a reduction of challenging behaviour of home-dwelling people with dementia. Future research should examine the long-term effects of behaviour management programmes on behaviour, nursing home placement, and hospital admission of home-dwelling people with dementia. Copyright © 2017 John Wiley & Sons, Ltd.

Chemical, Biological, Radiological, and Nuclear Consequence Management: Ways to Improve Fixed-Site Decontamination Capability

DTIC Science & Technology

2007-05-10

objective is achieved through consequence management and fixed-site decontamination operations. The effectiveness of CBRN consequence management...decontamination operations. The effectiveness of CBRN consequence management and fixed-site decontamination executed in the Joint Security Area can be...when faced with Chemical, Biological, Radiological, or Nuclear (CBRN) contaminated ports of debarkation. The effectiveness of CBRN consequence

Sinus Pain: Can Over-the-Counter Medications Help?

MedlinePlus

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Supporting care home staff to manage residents' care safely and avoid admissions.

PubMed

Wills, Susan; Ross, Dena

2018-05-31

The community matron care homes team (CHT) was set up in Sandwell, West Midlands in 2011 to support care home staff to manage residents' care safely and reduce unplanned and/or avoidable use of acute health services. The service was reviewed in 2015 and attention focused on care homes with the highest levels of hospital use and emergency 999 services. Working with these care home staff and health professionals, a training and education opportunity to aid staff to manage residents in crisis was sourced, organised and implemented. The outcome of this training was positive: it demonstrated a reduction in hospital attendances and admissions and an increase in the confidence and morale of care home staff. The community matron CHT won the Nursing Older People category of the RCNi Nurse Awards in May 2017. This award has resulted in the team's profile being raised, and the team being asked to participate in further initiatives to provide enhanced support for care homes. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Effect of training and structured medication review on medication appropriateness in nursing home residents and on cooperation between health care professionals: the InTherAKT study protocol.

PubMed

Mahlknecht, Angelika; Nestler, Nadja; Bauer, Ulrike; Schüßler, Nadine; Schuler, Jochen; Scharer, Sebastian; Becker, Ralf; Waltering, Isabel; Hempel, Georg; Schwalbe, Oliver; Flamm, Maria; Osterbrink, Jürgen

2017-01-18

Pharmacotherapy in residents of nursing homes is critical due to the special vulnerability of this population. Medical care and interprofessional communication in nursing homes are often uncoordinated. As a consequence, polypharmacy and inappropriate medication use are common and may lead to hospitalizations and health hazards. The aim of this study is to optimize communication between the involved professional groups by specific training and by establishing a structured medication review process, and to improve medication appropriateness and patient-relevant health outcomes for residents of nursing homes. The trial is designed as single-arm study. It involves 300 nursing home residents aged ≥ 65 years and the members of the different professional groups practising in nursing home care (15-20 general practitioners, nurses, pharmacists). The intervention consists of interprofessional education on safe medication use in geriatric patients, and a systematic interprofessional therapy check (recording, reviewing and adapting the medication of the participating residents by means of a specific online platform). The intervention period is divided into two phases; total project period is 3 years. Primary outcome measure is the change in medication appropriateness according to the Medication Appropriateness Index. Secondary outcomes are cognitive performance, occurrence of delirium, agitation, tendency of falls, total number of drugs, number of potentially dangerous drug-drug interactions and appropriateness of recorded analgesic therapy regimens according to the Medication Appropriateness Index. Data are collected at t 0 (before the start of the intervention), t 1 (after the first intervention period) and t 2 (after the second intervention period). Cooperation and communication between the professional groups are investigated twice by qualitative interviews. The project aims to establish a structured system for monitoring of drug therapy in nursing home residents. The newly developed online platform is designed to systematize and to improve the communication between the professional groups and, thus, to enhance quality and safety of drug therapy. Limitations of the study are the lack of a control group and the non-randomly recruited study sample. DRKS Data Management, DRKS-ID: DRKS00007900.

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

Multiple space-use strategies and their divergent consequences in a nonbreeding migratory bird (Parkesia noveboracensis)

Treesearch

Joseph A.M. Smith; Leonard R. Reitsma; Peter P. Marra

2011-01-01

We investigated the relationships among space-use patterns, home-range attributes, and individual characteristics to determine the consequences of different space-use strategies for the overwinter physical condition of Northern Waterthrushes (Parkesia noveboracensis). We have elsewhere demonstrated that heterogeneity in food availability drives the movement decisions...

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

PubMed

Lang, Ariella; Macdonald, Marilyn; Marck, Patricia; Toon, Lynn; Griffin, Melissa; Easty, Tony; Fraser, Kimberly; MacKinnon, Neil; Mitchell, Jonathan; Lang, Eddy; Goodwin, Sharon

2015-12-12

Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home. There is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.

[Management of Uninhabitable Homes - Investigation of 186 Cases of Hoarding, Domestic Neglect and Squalor in Dortmund (Germany)].

PubMed

Lenders, T; Kuster, J; Bispinck, R

2015-12-01

To develop an intervention concept for the management of uninhabitable homes. Retrospective analysis of 186 cases of the community mental health service in Dortmund (Germany) presenting with a destitute situation of the domestic environment as core problem. All patients suffered from psychiatric illnesses, mainly from addiction (F1: 41 %), psychosis (F2: 17 %), depression (F3: 17 %), and hoarding disorder (F63.8: 12 %). Main socio-demographic characteristics of our sample are: middle age (45-65 years, 48 %), male gender (73 %), isolated situation (only 7 % married, 84 % living alone), normal schooling (only 4 % without completion of schooling, 7 % attended a school for special needs), after initial integration into employment nearly all patients suffered vocational disintegration (5 % employed, 44 % unemployment benefit, 7 % welfare, 39 % pension or invalidity benefit).Psychosocial interventions differed between the 4 main diagnostic groups: F1: treatment of dependence (rehab) and treatment of concomitant somatic diseases; F2: admission to a psychiatric hospital and implementation of guardianship; F3: mediation of conflicts with neighbours/landlords and implementation of guardianship; F63.8: direct practical help by members of the community mental health team and organisation of home help/waste disposal. In all diagnostic groups, acceptance of help was impaired due to social withdrawal, resistance and psychiatric symptoms. At 13 %, compliance with help and interventions was lowest in the hoarder group (F1: 27 %, F2: 26 %, F3: 38 %). Consequently, in this group the poor outcome categories "nothing accomplished" and "lost flat/eviction" were more frequent (44 %, F1: 27 %, F2: 26 %, F3: 38 %). Concurrent to the deterioration of the domestic situation, patients suffer vocational disintegration as well as family and social isolation. Uninhabitable homes occur in the course of various severe and chronic psychiatric diseases. They don't constitute a syndrome and they are not characteristic for one specific diagnosis. It is important to recognise the underlying psychiatric disease as diagnosis influences acceptance of help, choice of appropriate interventions, outcome and prognosis. Tab. 1 shows our suggestion for a diagnosis differentiated approach, relating appearance of the home and behaviour of the patient to diagnosis, appropriate interventions and prognosis. Hard to reach is the group of hoarders. Patients with a psychotic illness and with hoarding disorder require implementation of long-term outreach help in their homes. © Georg Thieme Verlag KG Stuttgart · New York.

Process Analysis of Basic Allowance for Housing (BAH) Within the Military Personnel, Marine Corps (MPMC) Appropriation

DTIC Science & Technology

2005-03-01

contractors and adequate homes are privatized, we purchase the long-term efficient operation , management , maintenance, and recapitalization of the...property. When inadequate homes are privatized, we purchase the initial renovation or replacement of those homes, along with the long-term operation ... management , maintenance, and recapitalization." (Barszewski, personal communication, March 7, 2005) It is important to note that since family housing and

Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.

PubMed

Werner, Nicole E; Jolliff, Anna F; Casper, Gail; Martell, Thomas; Ponto, Kevin

2018-08-01

Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

Work stress among nursing home care attendants in Taiwan: a questionnaire survey.

PubMed

Hsu, Hui-Chuan; Kung, Yuan-Wei; Huang, Hsiao-Chien; Ho, Pei-Yu; Lin, Ya-Ying; Chen, Wen-Shin

2007-07-01

Care attendants constitute the main workforce in nursing homes, but their heavy workload, low autonomy, and indefinite responsibility result in high levels of stress and may affect quality of care. However, few studies have focused of this problem. The aim of this study was to examine work-related stress and associated factors that affect care attendants in nursing homes and to offer suggestions for how management can alleviate these problems in care facilities. We recruited participants from nine nursing homes with 50 or more beds located in middle Taiwan; 110 care attendants completed the questionnaire. The work stress scale for the care attendants was validated and achieved good reliability (Cronbach's alpha=0.93). We also conducted exploratory factor analysis. Six factors were extracted from the work stress scale: insufficient ability, stressful reactions, heavy workload, trouble in care work, poor management, and working time problems. The explained variance achieved 64.96%. Factors related to higher work stress included working in a hospital-based nursing home, having a fixed schedule, night work, feeling burden, inconvenient facility, less enthusiasm, and self-rated higher stress. Work stress for care attendants in nursing homes is related to human resource management and quality of care. We suggest potential management strategies to alleviate work stress for these workers.

Stochastic control of smart home energy management with plug-in electric vehicle battery energy storage and photovoltaic array

NASA Astrophysics Data System (ADS)

Wu, Xiaohua; Hu, Xiaosong; Moura, Scott; Yin, Xiaofeng; Pickert, Volker

2016-11-01

Energy management strategies are instrumental in the performance and economy of smart homes integrating renewable energy and energy storage. This article focuses on stochastic energy management of a smart home with PEV (plug-in electric vehicle) energy storage and photovoltaic (PV) array. It is motivated by the challenges associated with sustainable energy supplies and the local energy storage opportunity provided by vehicle electrification. This paper seeks to minimize a consumer's energy charges under a time-of-use tariff, while satisfying home power demand and PEV charging requirements, and accommodating the variability of solar power. First, the random-variable models are developed, including Markov Chain model of PEV mobility, as well as predictive models of home power demand and PV power supply. Second, a stochastic optimal control problem is mathematically formulated for managing the power flow among energy sources in the smart home. Finally, based on time-varying electricity price, we systematically examine the performance of the proposed control strategy. As a result, the electric cost is 493.6% less for a Tesla Model S with optimal stochastic dynamic programming (SDP) control relative to the no optimal control case, and it is by 175.89% for a Nissan Leaf.

Hepatitis C: Managing Pain

MedlinePlus

... Pain: Entire Lesson Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For Veterans and the Public Veterans and the Public Home Hepatitis A Hepatitis B Hepatitis C Hepatitis C Home Getting ...

Positive and negative consequences of a military deployment.

PubMed

Newby, John H; McCarroll, James E; Ursano, R J; Fan, Zizhong; Shigemura, Jun; Tucker-Harris, Yvonne

2005-10-01

This study determined the perception by 951 U.S. Army soldiers of positive and negative consequences of a peacekeeping deployment to Bosnia. Seventy-seven percent reported some positive consequences, 63% reported a negative consequence, and 47% reported both. Written comments were also provided. Of the 951 soldiers, 478 wrote at least one positive comment and 403 at least one negative comment. Single soldiers were more likely than married soldiers to report positive consequences (82% vs. 72%). Married soldiers were more likely than single soldiers to report negative consequences (70% vs. 55%). Positive consequences included making additional money, self-improvement, and time to think. Negative consequences included the military chain of command, being away from home, and deterioration of marital/significant other relationships.

The development of an integrated care model for patients with severe or very severe chronic obstructive pulmonary disease (COPD): the COPD-Home model.

PubMed

Sunde, Synnøve; Walstad, Rolf Aksel; Bentsen, Signe Berit; Lunde, Solfrid J; Wangen, Eva Marie; Rustøen, Tone; Henriksen, Anne Hildur

2014-09-01

Adherence to guidelines for managing stable chronic obstructive pulmonary disease (COPD) and its exacerbations is inadequate among healthcare workers and patients. An appropriate care model would meet patient needs, enhance their coping with COPD and improve their quality of life (QOL). This study aims to present the 'COPD-Home' as an integrated care model for patients with severe or very severe COPD. One principle of the COPD-Home model is that hospital treatment should lead to follow up in the patient's home. The model also includes education, improved coordination of levels of care, improved accessibility and a management plan. One of the main elements of the COPD-Home model is the clear role of the home-care nurse. Model development is based on earlier research and clinical experience. It comprises: (i) education provided through an education programme for patients and involved nurses, (ii) joint visits and telephone checks, (iii) a call centre for support and communication with a general practitioner and (iv) an individualised self-management plan including home monitoring and a plan for pharmacological and nonpharmacological interventions. The COPD-Home model attempts to cultivate competences and behaviours of patients and community nurses that better accord with guidelines for interventions. The next step in its development will be to evaluate its ability to assist both healthcare workers and planners to improve the management of COPD, reduce exacerbations and improve QOL and coping among patients with COPD. © 2013 Nordic College of Caring Science.

HOME-BASED BLOOD PRESSURE INTERVENTIONS FOR AFRICAN AMERICANS

PubMed Central

Feldman, Penny H.; McDonald, Margaret V.; Mongoven, Jennifer M.; Peng, Timothy R.; Gerber, Linda M.; Pezzin, Liliana E.

2009-01-01

Background Efforts to increase blood pressure (BP) control rates in African Americans, a traditionally underserved, high risk population must address both provider practice and patient adherence issues. The Home-Based BP Intervention for African Americans study is a three-arm randomized controlled trial designed to test two strategies to improve HTN management and outcomes in a decentralized service setting serving a vulnerable and complex home care population. The primary study outcomes are systolic BP, diastolic BP, and BP control; secondary outcomes are nurse adherence to HTN management recommendations, and patient adherence to medication, healthy diet and other self-management strategies. Methods and Results Nurses (N=312) in a nonprofit Medicare-certified home health agency are randomized along with their eligible hypertensive patients (N=845). The two interventions being tested are: (i) a “basic” intervention delivering key evidence-based reminders to home care nurses and patients while the patient is receiving traditional post-acute home health care; and (ii) an “augmented” intervention that includes that same as the basic intervention, plus transition to an ongoing HTN Home Support Program that extends support for 12 months. Outcomes are measured at 3 and 12 months post baseline interview. The interventions will be assessed relative to usual care and to each other. Conclusions Systems change to improve BP management and outcomes in home health will not easily occur without new intervention models and rigorous evaluation of their impact. Results from this trial will provide important information on potential strategies to improve BP control in a low income, chronically ill patient population. PMID:20031844

Explaining Success and Failure in Mainstream Schooling through the Lens of Cultural Continuities and Discontinuities: Two Case Studies

ERIC Educational Resources Information Center

Markose, Susan; Hellsten, Meeri

2009-01-01

This article investigates the home literacy practices of two immigrant families, one each of Lebanese and Chinese descent. It explores the consequences of mismatches between home and school literacy practices in relation to mainstream academic outcomes. Two mothers of the families in this study are interviewed about their beliefs and parenting…

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

PubMed Central

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

1994-01-01

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

Homecare marketing and product management.

PubMed

Wells, J B

1985-09-01

Entirely too much lip service is paid to marketing and product management in the health sector with too little action. Home health to one degree or another is guilty of this. Successful home health organizations will capitalize on the power of traditional marketing and product management approaches. Product, pricing, packaging, position, and penetration may be foreign concepts. But marketing is built on these concepts and they are key to product definition and management.

Managing dental caries in children in Turkey - a discussion paper

PubMed Central

2009-01-01

Background This paper describes the oral healthcare system and disease situation amongst children in Turkey. Considering the high prevalence and severity of dental caries, a proposal for improvement of oral health in this population group is formulated. Discussion A virtual absence of palliative, preventive and restorative care characterises juvenile oral healthcare in Turkey. Consequently, carious cavities remain untreated, which may lead to pain, discomfort and functional limitation and, further, may impact negatively upon general health and cognitive development. As a first step to controlling dental caries, a national health programme including promotional, preventive and minimal intervention approaches for managing dental caries is proposed. The pros and cons of community-oriented caries-preventive measures are discussed. Daily tooth brushing with fluoridated toothpaste at home, in mother- and child-care centres, kindergartens, and schools is highlighted. Summary The dental profession, government, university officials and other stakeholders need to meet and determine how best the oral health of children in Turkey can be improved. The present proposed plan is considered a starting point. PMID:19939240

Managing dental caries in children in Turkey--a discussion paper.

PubMed

Topaloglu-Ak, Asli; Eden, Ece; Frencken, Jo E

2009-11-25

This paper describes the oral healthcare system and disease situation amongst children in Turkey. Considering the high prevalence and severity of dental caries, a proposal for improvement of oral health in this population group is formulated. A virtual absence of palliative, preventive and restorative care characterises juvenile oral healthcare in Turkey. Consequently, carious cavities remain untreated, which may lead to pain, discomfort and functional limitation and, further, may impact negatively upon general health and cognitive development. As a first step to controlling dental caries, a national health programme including promotional, preventive and minimal intervention approaches for managing dental caries is proposed. The pros and cons of community-oriented caries-preventive measures are discussed. Daily tooth brushing with fluoridated toothpaste at home, in mother- and child-care centres, kindergartens, and schools is highlighted. The dental profession, government, university officials and other stakeholders need to meet and determine how best the oral health of children in Turkey can be improved. The present proposed plan is considered a starting point.

Home e-health system integration in the Smart Home through a common media server.

PubMed

Pau, I; Seoane, F; Lindecrantz, K; Valero, M A; Carracedo, J

2009-01-01

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

The home care teaching and learning process in undergraduate health care degree courses.

PubMed

Hermann, Ana Paula; Lacerda, Maria Ribeiro; Maftum, Mariluci Alves; Bernardino, Elizabeth; Mello, Ana Lúcia Schaefer Ferreira de

2017-07-01

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

[Challenges for home care services in the pain management of cancer patients : A qualitative study].

PubMed

Gnass, I; Krutter, S; Nestler, N

2018-03-21

People with cancer are increasingly supported by home care services. Pain is a relevant symptom of these diseases and nurses of home care services are involved in the treatment. The German National Expert Standard "Pain management in nursing" includes evidence-based recommendations for the implementation of adequate pain management. Considering the given structural conditions of home care services, nurses describe both barriers and challenges with the implementation. By means of five guideline-based discussion groups, nurses of 14 home care services were questioned about the challenges they had experienced in pain management. The questioning focuses on the level of implementation of the recommendation for each aspect: pain assessment, pharmacological pain therapy, non-pharmacological pain therapy, pain-related side effects, information, training, and counseling in the care of people with cancer. A qualitative content analysis was conducted. On the one hand, the results illustrate a need for further knowledge and possibilities, e.g., for the assessment of pain as a multidimensional phenomenon and, on the other hand, that the conditions for continuous pain monitoring of cancer patients in home care services are limited. The need for short-term reconciliation with the treatment team and the practitioners proved to be more difficult than the cooperation with the palliative care network. Involvement of family members is important to ensure uninterrupted treatment. Beside knowledge and competencies regarding nursing care, structures and processes for interprofessional pain management need further development and research.

Child maltreatment and pediatric asthma: a review of the literature.

PubMed

Schreier, Hannah M C; Chen, Edith; Miller, Gregory E

2016-01-01

Child maltreatment is a common problem with known adverse consequences, yet its contributions to the development and course of pediatric asthma are only poorly understood. This review first describes possible pathways connecting child maltreatment to pediatric asthma, including aspects of the physical home environment, health behaviors and disease management, and psychological consequences of child maltreatment. We subsequently review existing studies, which generally report an association between maltreatment experiences and asthma outcomes in childhood. However, this literature is in its early stages; there are only a handful studies, most of them rely on self-reports of both child maltreatment and asthma history, and none have investigated the physiological underpinnings of this association. Taken together, however, the studies are suggestive of child maltreatment playing a role in pediatric asthma incidence and expression that should be explored further. Existing data are sparse and do not allow for specific conclusions. However, the data are suggestive of child maltreatment influencing asthma risk and morbidity long before the adult years. Future research should focus on understanding how child maltreatment contributes to asthma disease risk and progression in this highly vulnerable population.

Allowing cigarette or marijuana smoking in the home and car: prevalence and correlates in a young adult sample

PubMed Central

Padilla, Mabel; Berg, Carla J.; Schauer, Gillian L.; Lang, Delia L.; Kegler, Michelle C.

2015-01-01

Given the increased marijuana use, negative health consequences of marijuana secondhand smoke exposure (SHSe) and dearth of research regarding marijuana SHSe in personal settings, we examined the prevalence and correlates of allowing marijuana versus cigarette smoking in personal settings among 2002 online survey respondents at two southeastern US universities in 2013. Findings indicated that 14.5% allowed cigarettes in the home, 17.0% marijuana in the home, 35.9% cigarettes in cars and 27.3% marijuana in cars. Allowing cigarettes in the home was associated with younger age, racial/ethnic minority status, living off campus, personal marijuana use, parental tobacco use and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in the home included older age, not having children, living off campus, positive perceptions of marijuana and personal, parental and friend marijuana use (P < 0.05). Correlates of allowing cigarettes in cars included personal cigarette and marijuana use, parental tobacco and marijuana use, more cigarette-smoking friends and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in cars included being non-Hispanic black; positive perceptions of marijuana; and personal, parental and friend marijuana use (P < 0.05). Interventions must target distinct factors influencing policies regarding cigarette versus marijuana use in personal settings to address the consequences of marijuana and cigarette SHSe. PMID:25214515

Social support is a primary influence on home fruit, 100% juice, and vegetable availability.

PubMed

Baranowski, Tom; Watson, Kathy; Missaghian, Mariam; Broadfoot, Alison; Cullen, Karen; Nicklas, Theresa; Fisher, Jennifer; Baranowski, Janice; O'Donnell, Sharon

2008-07-01

Children tend to eat more fruit and vegetables when more are available in the home. We proposed and tested a model that predicts the availability at home (hereinafter termed "home availability") of fruit, 100% juice, and vegetables, using new measures of frequency of food shopping, purchase, and comparative purchase outcome expectancies (ie, the perceived benefits and costs of purchasing fruit and vegetables), home food pantry management practices, family social support for purchasing fruit and vegetables, food shopping practices, and body mass index (BMI). Participants (N=98) were recruited in 2004 in front of grocery stores and completed two telephone interviews. Cross-sectional hierarchical regression was employed with backward deletion of nonsignificant variables. Despite many statistically significant bivariate correlations between the new variables and home fruit, 100% juice, and vegetable availability, social support was the primary predictor of home fruit availability in multivariate regression. BMI and home 100% juice pantry management were the primary predictors of home 100% juice availability. Social support, BMI, and shopping practices were the primary predictors of home vegetable availability. Social support for purchasing fruit, 100% juice, and vegetables was an important, consistent predictor of home availability. These findings need to be replicated in larger samples.

Consequences of sarcopenia among nursing home residents at long-term follow-up.

PubMed

Henwood, Tim; Hassan, Bothaina; Swinton, Paul; Senior, Hugh; Keogh, Justin

The consequences of and transition into sarcopenia with long-term survival was investigated in the nursing home setting. Eligible residents from 11 nursing homes were followed-up 18-months after their assessment for sarcopenia using the European Working Group on Sarcopenia in Older People criteria, with other demographic, physical and cognitive health measures collected. Of the 102 older adults who consented at baseline, 22 had died and 58 agreed to participate at follow-up, 51.7% of whom had sarcopenic. Sarcopenia at baseline was associated with a depression (p < .001), but not mortality, hospitalization, falls or cognitive decline at follow-up. Age was the strongest predictor of mortality (p = .05) with the relative risk of death increasing 5.2% each year. The prevalence of sarcopenia is high and increases with long-term survival in end-of-life care. However, the risk of sarcopenia-related mortality is not as great as from increasing age alone. Copyright © 2017 Elsevier Inc. All rights reserved.

Does out-of-home placement mediate the relationship between child maltreatment and adult criminality?

PubMed

DeGue, Sarah; Spatz Widom, Cathy

2009-11-01

Existing research on child welfare interventions as mediators of the criminal consequences of child maltreatment has focused on juvenile delinquency rather than adult criminality. This study uses a prospective sample of 772 maltreated youth to examine out-of-home placement as a mediator of adult criminality. Arrest data were collected from official records when the full sample was a mean age of 31.8, having ample opportunity for involvement with the criminal justice system. Overall, out-of-home placement showed a neutral or slightly positive effect on adult criminality compared to no placement, consistent with earlier findings. However, prior delinquency and placement instability were significant risk factors for adult criminality. Gender, not race, was identified as a significant moderator of the relationship between placement and adult criminality, with different patterns of response to placement for males and females. Thus, whether placement experiences influence adult criminal consequences of child maltreatment might depend on prior delinquency, placement stability, and gender.

Nurse Case Management and Housing Interventions Reduce Allergen Exposures: The Milwaukee Randomized Controlled Trial

PubMed Central

Breysse, Jill; Wendt, Jean; Dixon, Sherry; Murphy, Amy; Wilson, Jonathan; Meurer, John; Cohn, Jennifer; Jacobs, David E.

2011-01-01

Objective We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children. Methods Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n=64) or an intervention (n=57) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present. Results For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft2]) to post-intervention (11 mg/ft2) (p<0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly. Conclusion The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust. PMID:21563716

Nursing home report card and performance gap.

PubMed

Kim, Ae-Sook

2016-01-01

With the aging of our society, concerns about the quality of nursing homes have been increasing. The Nursing Home Compare (NHC) report card is believed to reduce information asymmetry between the facility and potential residents and, consequently, improve nursing home quality. However, there is limited evidence about how nursing homes use this publicly disseminated performance information. The aim of this study was to analyze the performance gap between nursing home administrators' self-assessment and the NHC report card performance ratings and explore the factors contributing to the gap. All 515 Medicare- and Medicaid-certified nursing homes in Indiana were surveyed between August and December 2013. The response rate was approximately 45%. The survey data were compared with the NHC data to identify the gap. Ordered logistic regression analysis was conducted. Despite voluntary participation, a reasonably high response rate, and anonymity, this study found that 62% of respondents either under- or overrated their facilities' performance, with the majority overrating their performance. The following factors were associated with a smaller performance gap: nonprofit or government-owned status, higher staffing levels, a higher percentage of hours worked by registered nurses, and a higher market concentration. Longer work experience and greater county occupancy rates were associated with a larger performance gap. The significant gap implies that administrators either do not regularly review the NHC report card or do not concur with the NHC ratings. To reduce the gap and thereby improve performance, it is necessary to stabilize the administrators' position so that administrators know how they stand in the market and are consequently better equipped to successfully respond to the market. Facilities may also need to provide regular training on current technologies and facilitate use of the NHC report card, targeting administrators who are old and have many years of work experience.

EVALUATION OF THE FARM MANAGEMENT PHASE OF THE FARM AND HOME MANAGEMENT PROGRAM IN NEW YORK STATE. EXTENSION STUDY, NUMBER 1.

ERIC Educational Resources Information Center

ALEXANDER, FRANK D.; LONGEST, JAMES W.

THE MAIN PURPOSE OF THIS 1956-60 LONGITUDINAL STUDY WAS TO COMPARE CHANGES IN FARM PRACTICES AND RELATED KNOWLEDGE AND IN INCOME AND RELATED BUSINESS FACTORS AMONG 87 PARTICIPANTS (DAIRYMEN) IN THE FARM MANAGEMENT PHASE OF THE NEW YORK STATE FARM AHD HOME MANAGEMENT PROGRAM, WITH THOSE OF A CONTROL GROUP OF 87 WHO DID NOT PARTICIPATE. IN 1956, THE…

The feasibility of a telephone coaching program on heart failure home management for family caregivers

PubMed Central

Piamjariyakul, Ubolrat; Smith, Carol E.; Russell, Christy; Werkowitch, Marilyn; Elyachar, Andrea

2012-01-01

Objectives To test the feasibility of delivery and evaluate the helpfulness of a coaching heart failure (HF) home management program for family caregivers. Background The few available studies on providing instruction for family caregivers are limited in content for managing HF home care and guidance for program implementation. Method This pilot study employed a mixed methods design. The measures of caregiver burden, confidence, and preparedness were compared at baseline and 3 months post-intervention. Descriptive statistics were used to summarize program costs and demographic data. Content analysis research methods were used to evaluate program feasibility and helpfulness. Results Caregiver (n=10) burden scores were significantly reduced and raw scores of confidence and preparedness for HF home management improved 3 months after the intervention. Content analyses of nurse and caregiver post-intervention data found caregivers rated the program as helpful and described how they initiated HF management skills based on the program. Conclusion The program was feasible to implement. These results suggest the coaching program should be further tested with a larger sample size to evaluate its efficacy. PMID:23116654

Addressing incontinence for people with dementia living at home: a documentary analysis of local English community nursing service continence policies and clinical guidance.

PubMed

Drennan, Vari M; Norrie, Caroline; Cole, Laura; Donovan, Sheila

2013-02-01

To establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England. Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move their residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products. A review by documentary analysis of clinical policies and guidance from a sample of community nursing services in all Strategic Health Authority regions of England. A sample of clinical policy and guidance documents for continence assessment and management from up to four community nursing services in each of the ten Strategic Health Authority regions in England was sought. Documentary analysis was undertaken on the relevance of the documents identified for people with dementia living at home. Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products. Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers. Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home and their family carers. © 2012 Blackwell Publishing Ltd.

Occupational Home Economics Education Series. Housing Management Services. Competency Based Teaching Module.

ERIC Educational Resources Information Center

Lowe, Phyllis; And Others

This module, one of ten competency based modules developed for vocational home economics teachers, is based on a job cluster in the housing management field. It is designed for a variety of levels of learners (secondary, postsecondary, adult) in both school and non-school settings. Focusing on the specific job title of housing management aide,…

Individual Perseverance: A Theory of Home Tutors' Management of Schooling in Isolated Settings

ERIC Educational Resources Information Center

Tynan, Belinda; O'Neill, Marnie

2007-01-01

This article reports a study of parents' management of the education of primary school-aged children in their care in remote and rural locations of Western Australia. It presents a theory of the ways in which these parents, in the role of home tutors, "manage" the schooling of their children in a distance education regime in isolated…

EVALUATION STUDY OF FARM AND HOME MANAGEMENT PROGRAM IN NEW YORK STATE. A SIX-PART REPORT.

ERIC Educational Resources Information Center

ALEXANDER, FRANK D.

IN 1954 CONGRESS EARMARKED FUNDS FOR A FARM AND HOME MANAGEMENT PROGRAM TO OFFER INTENSIVE ON-THE FARM COUNSELING IN MANAGEMENT AND DECISION MAKING. THIS SIX-PART EVALUATION OF THE PROGRAM AS IT WAS CONDUCTED IN NEW YORK STATE, PRIMARILY WITH DAIRY OPERATORS, WAS DESIGNED TO DETERMINE THE PROGRAM'S EFFECTIVENESS RELATIVE TO LESS INTENSIVE…

Responsible Management and Use of a Personal Take-Home Naloxone Supply: A Pilot Project

ERIC Educational Resources Information Center

McAuley, Andrew; Lindsay, George; Woods, Maureen; Louttit, Derek

2010-01-01

Aims: To assess if Scottish drug users, their family and friends could be trained in critical incident management and the safe and effective administration of naloxone. The project also sought to monitor whether drug users can manage their own personal take-home naloxone (THN) supply and use it appropriately in an emergency opiate overdose…

Summer-fall home-range fidelity of female elk in northwestern Colorado: Implications for aspen management

Treesearch

April M. Brough; R. Justin DeRose; Mary M. Conner; James N. Long

2017-01-01

Understanding the degree of spatial fidelity exhibited by individuals within a species increases our ability to manage for desired future outcomes. Elk (Cervus elaphus) is a closely managed species in the Western US, but there is little research evaluating their summer home-range fidelity. Elk summer-fall homeranges overlap considerably with aspen (Populus tremuloides...

Mobile Phone Based System Opportunities to Home-based Managing of Chemotherapy Side Effects.

PubMed

Davoodi, Somayeh; Mohammadzadeh, Zeinab; Safdari, Reza

2016-06-01

Applying mobile base systems in cancer care especially in chemotherapy management have remarkable growing in recent decades. Because chemotherapy side effects have significant influences on patient's lives, therefore it is necessary to take ways to control them. This research has studied some experiences of using mobile phone based systems to home-based monitor of chemotherapy side effects in cancer. In this literature review study, search was conducted with keywords like cancer, chemotherapy, mobile phone, information technology, side effects and self managing, in Science Direct, Google Scholar and Pub Med databases since 2005. Today, because of the growing trend of the cancer, we need methods and innovations such as information technology to manage and control it. Mobile phone based systems are the solutions that help to provide quick access to monitor chemotherapy side effects for cancer patients at home. Investigated studies demonstrate that using of mobile phones in chemotherapy management have positive results and led to patients and clinicians satisfactions. This study shows that the mobile phone system for home-based monitoring chemotherapy side effects works well. In result, knowledge of cancer self-management and the rate of patient's effective participation in care process improved.

Impact of revisions to the F-Tag 309 surveyors' interpretive guidelines on pain management among nursing home residents.

PubMed

Lapane, Kate L; Quilliam, Brian J; Chow, Wing; Kim, Myoung S

2012-05-01

On 31 March 2009, the US Centers for Medicare & Medicaid Services (CMS) provided revised guidance for meeting compliance in the evaluation and management of pain in nursing home residents, known as F-Tag 309. The aim of the study was to estimate the extent to which implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 improved recognition and management of pain among nursing home residents. The impact of the revisions to guidance on F-Tag 309 on pain in nursing home residents was investigated. The study was quasi-experimental in design and included 174 for-profit nursing homes in 19 US states. Nursing home residents with ≥2 Minimum Data Set (MDS) assessments between 1 January 2007 and 30 March 2009 (before the revisions to the guidelines; n = 8449) and between 31 March 2009 and 31 December 2009 (after the revisions; n = 1400) were included. The MDS assessments provided information on pain, analgesic use and cognitive, functional and emotional status. Separate logistic regression models that adjusted for clustering effects of residents residing in nursing homes provided estimates of the relationship between the implementation of the revisions to F-Tag 309 and the prevalence of pain and its management. Pain was more likely to be documented in the period after the revisions were implemented. The odds of pain being documented on at least one of two consecutive MDS assessments increased after the revisions to the guidelines were implemented (adjusted odds ratio [OR] 1.15; 95% confidence interval [CI] 1.01, 1.31). Increases in scheduled analgesic prescription were observed in the post-revision era (adjusted OR 1.38; 95% CI 1.21,1.57). The implementation of revisions to the surveyors' interpretive guidelines for F-Tag 309 improved recognition and management of pain as well as analgesic use in nursing home residents with documented non-cancer pain. Use of directed language as part of the surveyors' interpretive guidelines may be a viable approach to stimulating improvements in pain documentation and management.

How does gatekeeper training improve suicide prevention for elderly people in nursing homes? A controlled study in 24 centres.

PubMed

Chauliac, N; Brochard, N; Payet, C; Duclos, A; Terra, J-L

2016-09-01

The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training "gatekeepers". In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide. The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level. Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Patient-Centered Medical Home Implementation and Burnout Among VA Primary Care Employees.

PubMed

Simonetti, Joseph A; Sylling, Philip W; Nelson, Karin; Taylor, Leslie; Mohr, David C; Curtis, Idamay; Schectman, Gordon; Fihn, Stephan D; Helfrich, Christian D

Burnout is widespread throughout primary care and is associated with negative consequences for providers and patients. The relationship between the patient-centered medical home model and burnout remains unclear. Using survey data from 8135 and 7510 VA primary care employees in 2012 and 2013, respectively, we assessed whether clinic-level medical home implementation was independently associated with burnout prevalence and estimated whether burnout changed among this workforce from 2012 to 2013. Adjusting for differences in respondent and clinic characteristics, we found that burnout was common among primary care employees, increased by 3.9% from 2012 to 2013, and was not associated with the extent of medical home implementation.

Nutritional support at home and in the community.

PubMed

Puntis, J W

2001-04-01

Technical developments in feeding, together with the growth of support structures in the community has lead to a steady increase in the number of children receiving home enteral tube feeding and home parenteral nutrition. In many cases the adverse nutritional consequences of disease can be ameliorated or prevented, and long term parenteral nutrition represents a life saving intervention. Careful follow up of children receiving home nutritional therapy is necessary to establish the ratio of risks to benefits. A considerable burden is sometimes placed on family or other carers who therefore require adequate training and ongoing support. The respective responsibilities of different agencies relating to funding and support tasks require more clear definition.

Pain management for older persons living in nursing homes: a pilot study.

PubMed

Tse, Mimi M Y; Ho, Suki S K

2013-06-01

Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p < .05), and the experimental residents reported significantly lower pain scores and used more nondrug strategies for pain relief compared with the control group (p < .05). Moreover, the psychologic well-being parameters, including happiness, loneliness, life satisfaction, and geriatric depression, had significantly improved among the experimental residents (p < .05). The IPMP was effective in enhancing the knowledge and attitudes of nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England.

PubMed

Hewitt, K A; Nalabanda, A; Cassell, J A

2015-05-01

Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.

Payment reform will shift home health agency valuation parameters.

PubMed

Hahn, A D

1998-12-01

Changes authorized by the Balanced Budget Act of 1997 have removed many of the payment benefits that motivated past home health agency acquisition activity and temporarily have slowed the rapid pace of acquisitions of home health agencies. The act required that Medicare's cost-based payment system be replaced with a prospective payment system (PPS) and established an interim payment system to provide a framework for home health agencies to make the transition to the PPS. As a consequence, realistic valuations of home health agencies will be determined primarily by cash flows, with consideration given to operational factors, such as quality of patient care, service territory, and information systems capabilities. The limitations imposed by the change in payment mechanism will cause acquisition interest to shift away from home health agencies with higher utilization and revenue expansion to agencies able to control costs and achieve operating leverage.

Daily Behavior Report Cards with and without Home-Based Consequences: Improving Classroom Behavior in Low Income, African American Children with ADHD

ERIC Educational Resources Information Center

Jurbergs, Nichole; Palcic, Jennette L.; Kelley, Mary L.

2010-01-01

Daily Behavior Report Cards (DBRC), which typically require teachers to evaluate students' daily behavior and parents to provide contingent consequences, are an effective and acceptable method for improving children's classroom behavior. The current study evaluated whether parent involvement is an essential treatment component or whether teacher…

The Physiological Consequences of Energy Deficiency for Adolescent Girls: Eating Disorders and the Web.

ERIC Educational Resources Information Center

McComb, Jacalyn Robert

2002-01-01

Provides a simplified overview of the glands and hormones involved in menses and highlights the consequences of energy deficiency related to abnormal menstrual cycling. Discusses the promotion of energy deficiency on the Web. Concludes that the prevention framework must incorporate the home, school, and larger community in partnership to promote…

Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

PubMed

Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

2012-01-01

Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

Preventing Rehospitalization through effective home health nursing care.

PubMed

Vasquez, Monica S

2009-01-01

To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare. PRIMARY PRACTICE SETTINGS(S): Primarily for home healthcare but can also be a tool for all other fields in nursing. Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system. The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.

Associations Between Home Death and the Use and Type of Care at Home.

PubMed

McEwen, Rebecca; Asada, Yukiko; Burge, Frederick; Lawson, Beverley

2018-01-01

Despite wishes for and benefits of home deaths, a discrepancy between preferred and actual location of death persists. Provision of home care may be an effective policy response to support home deaths. Using the population-based mortality follow-back study conducted in Nova Scotia, we investigated the associations between home death and formal care at home and between home death and the type of formal care at home. We found (1) the use of formal care at home at the end of life was associated with home death and (2) the use of formal home support services at home was associated with home death among those whose symptoms were well managed.

Delinquent Youth and Family Violence: A Study of Abuse and Neglect in the Homes of Serious Juvenile Offenders.

ERIC Educational Resources Information Center

Guarino, Susan

This report on a study of family violence in the homes of serious juvenile offenders in the Commonwealth of Massachusetts contains a brief introduction and seven substantive sections. Sections 2, 3 and 4 review the literature with regard to the extent of family violence, the consequences of childhood victimization, and societal reaction to the…

Who Says There Is No Life after Abandonment? A Grounded Theory on the Coping of Abandoned Filipino Elderly in Nursing Homes

ERIC Educational Resources Information Center

de Guzman, Allan B.; Lacorte, Jeremy C.; Lacsamana, Andrea Keith G.; Lagac, Mark Lawrence M.; Laguador, Jobel M.; Lapid, Jazminn Jessica R.; Lee, Lyndcie Miriele C.

2012-01-01

Cases of abandoned elderly are increasing worldwide. By and large, this group struggles with the sudden change in living arrangement as well as abandonment by their families. Consequently, many elderly are forced into living in nursing homes for the remainder of their lives. Abandonment among these elderly negatively affects how they view…

The Nursing Home Minimum Data Set Assessment Instrument: Manifest Functions and Unintended Consequences--Past, Present, and Future

ERIC Educational Resources Information Center

Rahman, Anna N.; Applebaum, Robert A.

2009-01-01

The Minimum Data Set (MDS) is a uniform instrument used in nursing homes to assess residents. In January 2008, the Centers for Medicare and Medicaid Services published a draft of a new MDS--version 3.0. This article traces the instrument's development and the design decisions that shaped it, discusses the MDS's manifest functions--data collection…

Bethany Sparn | NREL

Science.gov Websites

Sparn Photo of Bethany Sparn Bethany Sparn Researcher IV-Systems Engineering Bethany.Sparn@nrel.gov , residential HVAC equipment, heat pump water heaters, automated home energy management devices, and whole-house Energy Systems Integration Facility which provides a test bed for evaluating home energy management

Smart wireless continence management system for persons with dementia.

PubMed

Wai, Aung Aung Phyo; Fook, Victor Foo Siang; Jayachandran, Maniyeri; Biswas, Jit; Nugent, Chris; Mulvenna, Maurice; Lee, Jer-En; Kiat, Philp Yap Lian

2008-10-01

Incontinence is highly prevalent in the elderly population, especially in nursing home residents with dementia. It is a distressing and costly health problem that affects not only the patients but also the caregivers. Effective continence management is required to provide quality care, and to eliminate high labor costs and annoyances to the caregivers resulting from episodes of incontinence. This paper presents the design, development, and preliminary deployment of a smart wireless continence management system for dementia-impaired elderly or patients in institutional care settings such as nursing homes and hospitals. Specifically, the mote wireless platform was used to support the deployment of potentially large quantities of wetness sensors with wider coverage and with dramatically less complexity and cost. It consists of an intelligent signal relay mechanism so that the residents are free to move about in the nursing home or hospital and allows personalized continence management service. Preliminary results from a trial in a local nursing home are promising and can significantly improve the quality of care for patients.

Responding to home maintenance challenge scenarios: the role of selection, optimization, and compensation in aging-in-place.

PubMed

Kelly, Andrew John; Fausset, Cara Bailey; Rogers, Wendy; Fisk, Arthur D

2014-12-01

This study examined potential issues faced by older adults in managing their homes and their proposed solutions for overcoming hypothetical difficulties. Forty-four diverse, independently living older adults (66-85) participated in structured group interviews in which they discussed potential solutions to manage difficulties presented in four scenarios: perceptual, mobility, physical, and cognitive difficulties. The proposed solutions were classified using the Selection, Optimization, and Compensation (SOC) model. Participants indicated they would continue performing most tasks and reported a range of strategies to manage home maintenance challenges. Most participants reported that they would manage home maintenance challenges using compensation; the most frequently mentioned compensation strategy was using tools and technologies. There were also differences across the scenarios: Optimization was discussed most frequently with perceptual and cognitive difficulty scenarios. These results provide insights into supporting older adults' potential needs for aging-in-place and provide evidence of the value of the SOC model in applied research. © The Author(s) 2012.

Washington State Nursing Home Administrator Model Curriculum. Final Report.

ERIC Educational Resources Information Center

Cowan, Florence Kelly

The course outlines presented in this final report comprise a proposed Fort Steilacoom Community College curriculum to be used as a statewide model two-year associate degree curriculum for nursing home administrators. The eight courses described are introduction to nursing, home administration, financial management of nursing homes, nursing home…

Remote Health Care Provision in Care Homes.

PubMed

Newbould, Louise; Mountain, Gail; Hawley, Mark; Ariss, Steve

2017-01-01

A survey was developed to map provision, knowledge, attitudes and views towards videoconferencing in care homes in Yorkshire and The Humber. The survey was sent to 859 care homes, with a 14% response rate. Twelve homes reported using videoconferencing. Non-users appeared skeptical, managers using the system reported improvements in outcomes.

48 CFR 970.3102-3-70 - Home office expenses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Home office expenses. 970....3102-3-70 Home office expenses. (a) For on-site work, DOE's fee for management and operating contracts... compensation for home or corporate office general and administrative expenses incurred in the general...

48 CFR 970.3102-3-70 - Home office expenses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Home office expenses. 970....3102-3-70 Home office expenses. (a) For on-site work, DOE's fee for management and operating contracts... compensation for home or corporate office general and administrative expenses incurred in the general...

48 CFR 970.3102-3-70 - Home office expenses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Home office expenses. 970....3102-3-70 Home office expenses. (a) For on-site work, DOE's fee for management and operating contracts... compensation for home or corporate office general and administrative expenses incurred in the general...

48 CFR 970.3102-3-70 - Home office expenses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Home office expenses. 970....3102-3-70 Home office expenses. (a) For on-site work, DOE's fee for management and operating contracts... compensation for home or corporate office general and administrative expenses incurred in the general...

48 CFR 970.3102-3-70 - Home office expenses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Home office expenses. 970....3102-3-70 Home office expenses. (a) For on-site work, DOE's fee for management and operating contracts... compensation for home or corporate office general and administrative expenses incurred in the general...

A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.

PubMed

Clarkson, Paul; Davies, Linda; Jasper, Rowan; Loynes, Niklas; Challis, David

2017-09-01

Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings, including incremental cost-effectiveness ratios, when available, were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings, agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. Of the 151 articles retrieved, 14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses, seven were cost-effectiveness analyses, and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year (£6,696-£207,942 per quality-adjusted life-year). In four studies, interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. Occupational therapy, home-based exercise, and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications, behavior management, physical activity, and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Exploring nursing assistants' roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study.

PubMed

Liu, Justina Y W

2014-05-01

To explore nursing assistants' roles during the actual process of pain management (assessment, reporting, implementation of pain-relieving interventions and re-assessment) for cognitively impaired home residents with pain. Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents' pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants' functions in pain management. This is a descriptive, exploratory qualitative study. Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis. Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions. This study highlights the importance of nursing assistants in successful pain assessment and identifies their possible supporting roles in other aspects of pain management. However, nursing assistants' scope of practice resulted in their functions in pain management being continually undervalued by other healthcare professionals. Continuous in-service training, the use of a standardized pain management protocol and strategies for building coherent work teams in nursing homes are suggested to improve this situation. © 2013 John Wiley & Sons Ltd.

41 CFR 102-5.75 - What circumstances do not establish a basis for authorizing home-to-work transportation for field...

Code of Federal Regulations, 2010 CFR

2010-07-01

... not establish a basis for authorizing home-to-work transportation for field work? 102-5.75 Section 102... (Continued) FEDERAL MANAGEMENT REGULATION GENERAL 5-HOME-TO-WORK TRANSPORTATION Authorizing Home-to-Work Transportation § 102-5.75 What circumstances do not establish a basis for authorizing home-to-work transportation...

An easy to use and affordable home-based personal eHealth system for chronic disease management based on free open source software.

PubMed

Burkow, Tatjana M; Vognild, Lars K; Krogstad, Trine; Borch, Njål; Ostengen, Geir; Bratvold, Astrid; Risberg, Marijke Jongsma

2008-01-01

This paper describes an easy to use home-based eHealth system for chronic disease management. We present the design and implementation of a prototype for home based education, exercises, treatment and following-up, with the TV and a remote control as user interface. We also briefly describe field trials of the system for patients with COPD and diabetes, and their experience with the technology.

A flexible home monitoring platform for patients affected by chronic heart failure directly integrated with the remote Hospital Information System

NASA Astrophysics Data System (ADS)

Donati, Massimiliano; Bacchillone, Tony; Saponara, Sergio; Fanucci, Luca

2011-05-01

Today Chronic Heart Failure (CHF) represents one of leading cause of hospitalization among chronic disease, especially for elderly citizens, with a consequent considerable impact on patient quality of life, resources congestion and healthcare costs for the National Sanitary System. The current healthcare model is mostly in-hospital based and consists of periodic visits, but unfortunately it does not allow to promptly detect exacerbations resulting in a large number of rehospitalization. Recently physicians and administrators identify telemonitoring systems as a strategy able to provide effective and cost efficient healthcare services for CHF patients, ensuring early diagnosis and treatments in case of necessity. This work presents a complete and integrated ICT solution to improve the management of chronic heart failure through the remote monitoring of vital signs at patient home, able to connect in-hospital care of acute syndrome with out-of-hospital follow-up. The proposed platform represents the patient's interface, acting as link between biomedical sensors and the data collection point at the Hospital Information System (HIS) in order to handle in transparent way the reception, analysis and forwarding of the main physiological parameters.

Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement.

PubMed

Ambrosino, Nicolino; Vitacca, Michele; Dreher, Michael; Isetta, Valentina; Montserrat, Josep M; Tonia, Thomy; Turchetti, Giuseppe; Winck, Joao Carlos; Burgos, Felip; Kampelmacher, Michael; Vagheggini, Guido

2016-09-01

The estimated prevalence of ventilator-dependent individuals in Europe is 6.6 per 100 000 people. The increasing number and costs of these complex patients make present health organisations largely insufficient to face their needs. As a consequence, their burden lays mostly over families. The need to reduce healthcare costs and to increase safety has prompted the development of tele-monitoring for home ventilatory assistance.A European Respiratory Society Task Force produced a literature research based statement on commonly accepted clinical criteria for indications, follow-up, equipment, facilities, legal and economic issues of tele-monitoring of these patients.Many remote health monitoring systems are available, ensuring safety, feasibility, effectiveness, sustainability and flexibility to face different patients' needs. The legal problems associated with tele-monitoring are still controversial. National and European Union (EU) governments should develop guidelines and ethical, legal, regulatory, technical, administrative standards for remote medicine. The economic advantages, if any, of this new approach must be compared to a "gold standard" of home care that is very variable among different European countries and within each European country.Much more research is needed before considering tele-monitoring a real improvement in the management of these patients. Copyright ©ERS 2016.

Managing Workplace Violence With Evidence-Based Interventions: A Literature Review.

PubMed

Martinez, Angel Johann Solorzano

2016-09-01

Workplace violence in health care settings is an occupational issue concerning nurses and other health care professionals. Patient aggression against nurses is often the most common form of violence in clinical settings, occurring in emergency departments, inpatient psychiatric settings, and nursing homes. Physical and verbal assaults are the major forms of workplace violence encountered by nurses. Current research has identified staff, environmental, and patient risk factors as the major precursors of workplace violence initiated by patients. Nurses often experience significant physical and psychological negative consequences after an episode of workplace violence. A review of the evidence was conducted to identify current evidence-based interventions that can help nurses minimize the incidence of workplace violence. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 31-36.]. Copyright 2016, SLACK Incorporated.

Additional Cost Because of Pneumonia in Nursing Home Residents: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Resident Study.

PubMed

Costa, Nadège; Hoogendijk, Emiel O; Mounié, Michael; Bourrel, Robert; Rolland, Yves; Vellas, Bruno; Molinier, Laurent; Cesari, Matteo

2017-05-01

Pneumonia is a frequent condition in older people. Our aim was to examine the total healthcare cost related to pneumonia in nursing home (NH) residents over a 1-year follow-up period. This was a prospective, longitudinal, observational, and multicenter study that was a part of the Incidence of Pneumonia and related Consequences in Nursing Home Resident study. Thirteen NHs located in Languedoc Roussillon and Midi-Pyrénées regions in France were included. Resident in NH, older than 60 years and had a group iso-resource score ranging from 2 to 5. Pneumonia events were characterized according to the Observatoire du Risque Infectieux en Geriatrie criteria. Direct medical and nonmedical costs were assessed from the French health insurance perspective. Healthcare resources was retrospectively gathered from the French Social Health Insurance database and valued using the tariffs reimbursed by the French health insurance. Sociodemographic variables, clinical factors, vaccinations, cognition, depression, functional status, frailty index, as well as group iso-resource score were also recorded. Among the 800 patients initially included in the Incidence of Pneumonia and Related Consequences in Nursing Home Resident study, 345 which were listed in the database of the French Social Health Insurance were included in this economic study. Among them, 64 (18%) experienced at least 1 episode of pneumonia during the 1-year follow-up period. Mean annual total additional cost for a patient who experienced at least 1 episode of pneumonia during the 1 year follow-up period is 2813€. On average, total annual costs increased by 60% to 93% when a patient experienced at least 1 episode of pneumonia. NH-acquired pneumonia has a great impact on total cost of care for NH residents. Our results suggest the potential economic savings that could be achieved if pneumonia could be prevented in NHs. Copyright © 2017. Published by Elsevier Inc.

Dementia Home Care Resources: How Are We Managing?

PubMed Central

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

2012-01-01

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

The Effect of Entry Regulation in the Health Care Sector: the Case of Home Health

PubMed Central

Polsky, Daniel; David, Guy; Yang, Jianing; Kinosian, Bruce; Werner, Rachel

2013-01-01

The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined health care markets and frequently cross state boundaries. We find that CON states use home health less frequently, but system-wide rehospitalization rates, overall Medicare expenditures, and home health practice patterns are similar. Removing CON for home health would have negligible system-wide effects on health care costs and quality. PMID:24497648

Beyond inpatient and outpatient care: alternative model for hypertension management.

PubMed

Ho, P Michael; Rumsfeld, John S

2006-10-19

Hypertension is a major contributor to worldwide cardiovascular mortality, however, only one-third of patients with hypertension have their blood pressure treated to guideline recommended levels. To improve hypertension control, there may need to be a fundamental shift in care delivery, one that is population-based and simultaneously addresses patient, provider and system barriers. One potential approach is home-based disease management, based on the triad of home monitoring, team care, and patient self-care. Although there may be challenges to achieving the vision of home-based disease management, there are tremendous potential benefits of such an approach for reducing the global burden of cardiovascular disease.

Managing occupations in everyday life for people with advanced cancer living at home.

PubMed

Peoples, Hanne; Brandt, Åse; Wæhrens, Eva E; la Cour, Karen

2017-01-01

People with advanced cancer are able to live for extended periods of time. Advanced cancer can cause functional limitations influencing the ability to manage occupations. Although studies have shown that people with advanced cancer experience occupational difficulties, there is only limited research that specifically explores how these occupational difficulties are managed. To describe and explore how people with advanced cancer manage occupations when living at home. A sub-sample of 73 participants from a larger occupational therapy project took part in the study. The participants were consecutively recruited from a Danish university hospital. Qualitative interviews were performed at the homes of the participants. Content analysis was applied to the data. Managing occupations were manifested in two main categories; (1) Conditions influencing occupations in everyday life and (2) Self-developed strategies to manage occupations. The findings suggest that people with advanced cancer should be supported to a greater extent in finding ways to manage familiar as well as new and more personally meaningful occupations to enhance quality of life.

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care.

PubMed

Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko

2017-11-01

To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 3 2014-10-01 2014-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

Disease management: a new and exciting opportunity in home healthcare.

PubMed

Huffman, Melinda H

2005-05-01

Disease management programs are beginning to encompass providers across the healthcare continuum, including home healthcare. The premise behind disease management is that coordinated, evidence-based interventions can be applied to the care of patients with specific high-cost, high-volume chronic conditions, resulting in improved clinical outcomes and lower overall costs. Outcomes data (actual results) are central in this approach to patient care.

Initiatives and Challenges in Consequence Management after a WMD Attack

DTIC Science & Technology

2004-08-01

Challenges in Consequence Management people to seek shelter or other protection when possible, to avoid exposure to weapons of mass destruction effects . The...Potential Effects .........................................9 V. Methods for Managing the Consequences of WMD Use.................14 VI. Toward a...mass destruction (WMD). Consequence management1 is a process to mitigate the effects of the use of weapons of mass destruction, including

Homeland Biological Warfare Consequence Management: Capabilities and Needs Assessment

DTIC Science & Technology

2001-04-01

AU/ACSC/105/2001-04 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY HOMELAND BIOLOGICAL WARFARE CONSEQUENCE MANAGEMENT: CAPABILITIES AND NEEDS...Dates Covered (from... to) - Title and Subtitle Homeland biological Warfare Consequence Management: Capabilities and Needs Assessment Contract...FEMA, DoJ, DoD, HHS, etc.) make a comprehensive, organized solution to the problem difficult. Focusing on the consequence management functions

Evaluating methods for estimating home ranges using GPS collars: A comparison using proboscis monkeys (Nasalis larvatus)

PubMed Central

Vaughan, Ian P.; Ramirez Saldivar, Diana A.; Nathan, Senthilvel K. S. S.; Goossens, Benoit

2017-01-01

The development of GPS tags for tracking wildlife has revolutionised the study of home ranges, habitat use and behaviour. Concomitantly, there have been rapid developments in methods for estimating habitat use from GPS data. In combination, these changes can cause challenges in choosing the best methods for estimating home ranges. In primatology, this issue has received little attention, as there have been few GPS collar-based studies to date. However, as advancing technology is making collaring studies more feasible, there is a need for the analysis to advance alongside the technology. Here, using a high quality GPS collaring data set from 10 proboscis monkeys (Nasalis larvatus), we aimed to: 1) compare home range estimates from the most commonly used method in primatology, the grid-cell method, with three recent methods designed for large and/or temporally correlated GPS data sets; 2) evaluate how well these methods identify known physical barriers (e.g. rivers); and 3) test the robustness of the different methods to data containing either less frequent or random losses of GPS fixes. Biased random bridges had the best overall performance, combining a high level of agreement between the raw data and estimated utilisation distribution with a relatively low sensitivity to reduced fixed frequency or loss of data. It estimated the home range of proboscis monkeys to be 24–165 ha (mean 80.89 ha). The grid-cell method and approaches based on local convex hulls had some advantages including simplicity and excellent barrier identification, respectively, but lower overall performance. With the most suitable model, or combination of models, it is possible to understand more fully the patterns, causes, and potential consequences that disturbances could have on an animal, and accordingly be used to assist in the management and restoration of degraded landscapes. PMID:28362872

The providers' profile of the disability support workforce in New Zealand.

PubMed

Jorgensen, Diane; Parsons, Matthew; Reid, Michelle Gundersen; Weidenbohm, Kate; Parsons, John; Jacobs, Stephen

2009-07-01

To understand one of the predominant groups supporting people with disabilities and illness, this study examined the profile of New Zealand paid caregivers, including their training needs. Paid caregivers, also known as healthcare assistants, caregivers and home health aides, work across several long-term care settings, such as residential homes, continuing-care hospitals and also private homes. Their roles include assisting with personal care and household management. New Zealand, similar to other countries, is facing a health workforce shortage. A three-phased design was used: phase I, a survey of all home-based and residential care providers (N = 942, response rate = 45%); phase II, a targeted survey of training needs (n = 107, response = 100%); phase III, four focus groups and 14 interviews with 36 providers, exploring themes arising from phases I and II. Findings on 17,910 paid caregivers revealed a workforce predominantly female (94%), aged between 40 and 50, with 6% over the age of 60. Mean hourly pay NZ$10.90 (minimum wage NZ$10.00 approx. UK3.00 at time of study) and 24 hours per week. The national paid caregiver turnover was 29% residential care and 39% community. Most providers recognised the importance of training, but felt their paid caregivers were not adequately trained. Training was poorly attended; reasons cited were funding, family, secondary employment, staff turnover, low pay and few incentives. The paid caregiver profile described reflects trends also observed in other countries. There is a clear policy direction in New Zealand and other countries to support people with a disability at home, and yet the workforce which is facilitating this vision is itself highly vulnerable. Paid caregivers have minimum pay, are female, work part-time and although it is recognised that training is important for them, they do not attend, so consequently remain untrained.

Energy Management Checklist for the Home.

ERIC Educational Resources Information Center

Pifer, Glenda

This booklet contains a checklist of equipment and activities for the individual's use in home energy management. The categories covered include: (1) insulation; (2) windows; (3) temperature control; (4) lighting; (5) heating water; (6) laundry; (7) cleaning and maintenance; (8) cooking; (9) refrigeration; (10) dishwashing; (11) recreation; and…

Home Management and Human Service Competencies.

ERIC Educational Resources Information Center

Regional Learning Service of Central New York, Syracuse.

Faculty representatives from five postsecondary institutions having human service/human ecology programs and two members of the Regional Learning Service staff comprised a task force whose objectives were to identify competencies acquired through home management which relate to undergraduate course objectives, to recommend ways to assess these,…

Risks, consequences, and prevention of falls of older people in oral healthcare centers.

PubMed

de Baat, Cees; de Baat, Paul; Gerritsen, Anneloes E; Flohil, Karien A; van der Putten, Gert-Jan; van der Maarel-Wierink, Claar D

2017-03-01

One-third of community-dwelling people older than 65 years of age fall each year, and half of them fall at least twice a year. Older care home residents are approximately three times more likely to fall when compared to community-dwelling older people. Risk indicators for falls are related to the older people's body, environment, behavior, and activities. An important health risk indicator is (orthostatic or postprandial) hypotension, which may induce cerebral hypoperfusion. Although the majority of falls remain without major consequences, 10% to 25% of falls in care homes result in bodily trauma. Prevalent fall-related injuries are brain injury, lower extremity fracture including hip fracture and forearm/wrist fracture, facial fracture, humeral fracture, and rib/scapular fracture. As fall accidents by older people can have severe consequences, prevention of falls is of paramount importance. Healthcare providers, including oral healthcare providers, should inform older people on risks of falling and draw attention to potentially hazardous arrangements. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

Decision Factors Nurses Use to Assess Pain in Nursing Home Residents With Dementia.

PubMed

Monroe, Todd B; Parish, Abby; Mion, Lorraine C

2015-10-01

Nurses caring for older people with various psychiatric illnesses face many obstacles when treating pain. One setting with a high percentage of psychiatric conditions is long-term care where more than half of residents have some form of dementia, and behavioral symptoms of dementia (BSDs) may mimic behavioral displays of pain. Furthermore, two-thirds of nursing home residents have pain. Thus, many nursing home residents with dementia have pain that may be confounded by BSDs. Since many people with dementia are at risk for poor pain management, determining current methods in which nurses assess and manage pain in nursing home residents will aid in recognizing potential barriers to using current pain management guidelines and help develop strategies to enhance nurses' assessment and management of pain in this vulnerable population. The aim of this study was to explore nursing home nurses' cues and practices to identify and alleviate pain in nursing home residents with dementia. Nurses use the constructs of 'comfort' and 'quality of life' as key components in their overall pain assessment strategy in people with dementia. Indeed, the extensive process they use involving frequent reassessment and application of interventions is geared towards "appearance of comfort." Nurses reported difficulty in ascertaining whether a person with dementia was in pain, and they expressed further difficulty determining the intensity associated with resident pain. Nurses further reported that residents with dementia who are not well know by the staff were are greater risk of poor pain management. It was not unusual for nurses to discuss the importance of conflict resolution among family members as well as allowing for open expression of family's concerns. Nurses had to focus not only on the resident's comfort, but also the families' level of comfort with pain management, especially at the end-of-life. Findings support further use and development of discomfort behavior scales to help manage pain. Published by Elsevier Inc.

Cost implications of organizing nursing home workforce in teams.

PubMed

Mukamel, Dana B; Cai, Shubing; Temkin-Greener, Helena

2009-08-01

To estimate the costs associated with formal and self-managed daily practice teams in nursing homes. Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers. A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors. Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports. Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians. Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes.

PubMed

Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick

2014-01-01

Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, 'Action Alliance Pain-Free City Muenster', the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.

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

PubMed

2006-08-01

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

38 CFR 51.60 - Standards applicable for payment of per diem.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.60 Standards... facility management must meet for the State to receive per diem for nursing home care. ...

38 CFR 51.60 - Standards applicable for payment of per diem.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.60 Standards... facility management must meet for the State to receive per diem for nursing home care. ...

38 CFR 51.60 - Standards applicable for payment of per diem.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.60 Standards... facility management must meet for the State to receive per diem for nursing home care. ...

38 CFR 51.60 - Standards applicable for payment of per diem.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.60 Standards... facility management must meet for the State to receive per diem for nursing home care. ...

38 CFR 51.60 - Standards applicable for payment of per diem.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.60 Standards... facility management must meet for the State to receive per diem for nursing home care. ...

Caring for Depression in Older Home Health Patients.

PubMed

Bruce, Martha L

2015-11-01

Depression is common in older home health patients and increases their risk of adverse outcomes. Depression screening is required by Medicare's Outcome and Assessment Information Set. The Depression Care for Patients at Home (CAREPATH) was developed as a feasible strategy for home health nurses to manage depression in their patients. The protocol builds on nurses' existing clinical skills and is designed to fit within routine home visits. Major components include ongoing clinical assessment, care coordination, medication management, education, and goal setting. In a randomized trial, Depression CAREPATH patients had greater improvement in depressive symptoms compared to usual care. The difference between groups was significant at 3 months, growing larger and more clinically meaningful over 1 year. The intervention had no impact on patient length of stay, number of home visits, or duration of visits. Thus, nurses can play a pivotal role in the long-term course and outcomes of patients with depression. Copyright 2015, SLACK Incorporated.

Anticipatory prescribing at the end of life in Lothian care homes.

PubMed

Finucane, Anne M; Stevenson, Barbara; Gardner, Hilary; McArthur, Dorothy; Murray, Scott A

2014-11-01

Common symptoms at the end of life include pain, breathlessness, anxiety, respiratory secretions and nausea. National end-of-life care strategies advocate anticipatory prescribing for timely management of these symptoms to enhance patient care by preventing unnecessary distress. This study investigated the extent to which residents in eight Lothian care homes had anticipatory medications prescribed prior to death. Data were collected as part of a service development project to improve palliative care in nursing care homes in Edinburgh. Of the 77 residents who died in the care homes, 54% had anticipatory medicines prescribed. Only 15% had prescriptions for all four nationally recommended anticipatory medications. Many care home residents do not have the recommended anticipatory medications in place in the last days of life and thus may experience inadequate symptom control. Interventions that increase the availability of anticipatory medicines to manage common symptoms at the end of life for care home residents are required.

Safety of union home care aides in Washington State.

PubMed

Schoenfisch, Ashley L; Lipscomb, Hester; Phillips, Leslie E

2017-09-01

A rate-based understanding of home care aides' adverse occupational outcomes related to their work location and care tasks is lacking. Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides' demographic and work characteristics. Injury narratives and focus groups provided contextual detail. Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern. Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides' improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce. © 2017 Wiley Periodicals, Inc.

A multi-method review of home-based chemotherapy.

PubMed

Evans, J M; Qiu, M; MacKinnon, M; Green, E; Peterson, K; Kaizer, L

2016-09-01

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes. © 2015 John Wiley & Sons Ltd.

Analysis of California Condor (Gymnogyps californianus) use of six management units using location data from global positioning system transmitters, southern California, 2004-09-Initial report

USGS Publications Warehouse

Johnson, Matthew; Kern, Jeffrey; Haig, Susan M.

2010-01-01

This report provides an analysis of California Condor (Gymnogyps californianus) space use of six management units in southern California (Hopper Mountain and Bitter Creek National Wildlife Refuges, Wildlands Conservancy-Wind Wolves Preserve, Tejon Mountain Village Specific Plan, California Condor Study Area, and the Tejon Ranch excluding Tejon Mountain Village Specific Plan and California Condor Study Area). Space use was analyzed to address urgent management needs using location data from Global Positioning System transmitters. The U.S. Fish and Wildlife Service provided the U.S. Geological Survey with location data (2004-09) for California Condors from Global Positioning System transmitters and Geographic Information System data for the six management units in southern California. We calculated relative concentration of use estimates for each management unit for each California Condor (n = 21) on an annual basis (n = 39 annual home ranges) and evaluated resource selection for the population each year using the individual as our sampling unit. The most striking result from our analysis was the recolonization of the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units during 2008. During 2004-07, the home range estimate for two (25 percent) California Condors overlapped the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units (n = 8), and use within the annual home range generally was bimodal and was concentrated on the Bitter Creek and Hopper Mountain National Wildlife Refuges. However, 10 (77 percent) California Condor home ranges overlapped the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units during 2008 (n = 13), and by 2009, the home range of every condor carrying a Global Positioning System transmitter (n = 14) overlapped these management units. Space use was multimodal within the home range during 2008-09 and was concentrated on Hopper Mountain Refuge in the south, Bittercreek Refuge and the Wind Wolves Preserve in the northwest, and the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units in the northeast. Recolonization of the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units reestablished traditional condor movement and foraging patterns in southern California and provides the travel corridor (approximately 20 kilometers wide) for recolonization of the northeastern part of the species historical range.

Titles of Doctoral Dissertations in Home Economics, 1975

ERIC Educational Resources Information Center

Home Economics Research Journal, 1976

1976-01-01

A listing is made of 149 titles of 1975 doctoral dissertations submitted by institutions to the American Home Economics Association. There are 4 titles in Housing, Furnishings, Home Management; 12 in Textiles and Clothing; 31 in Home Economics Education; 60 in Family Relations and Child Development; 30 in Food and Nutrition; and 1 in Institution…

Perceptions of rewards among volunteer caregivers of people living with AIDS working in faith-based organizations in South Africa: a qualitative study.

PubMed

Akintola, Olagoke

2010-06-14

Volunteer caregivers are a critical source of support for the majority of people living with HIV and AIDS in southern Africa, which has extremely high HIV/AIDS prevalence rates. While studies have shown that volunteer caregiving is associated with negative health and socio-economic outcomes, little is known about the positive experiences of volunteers in the home-based care context in South Africa. The purpose of this study is to explore the perception of rewards among volunteers working in home-based care settings. This study uses a qualitative design. Qualitative interviews were conducted with a purposively selected sample of 55 volunteer caregivers using an interview schedule containing open-ended questions. Volunteer caregivers derived intrinsic rewards related to self-growth and personal (emotional and psychological) development on the job; they also derived satisfaction from community members taking a liking for them and expressing a need for their services. Volunteers felt gratified by the improvements in their health behaviours, which were a direct consequence of the experiences of caring for terminally ill patients with AIDS. Extrinsic rewards came from appreciation and recognition shown by patients and community members. Extrinsic rewards also accrued to volunteers when the services they rendered made their patients happy. Perhaps the greatest sources of extrinsic rewards are skills and competencies acquired from training and experience while caring for their patients, and volunteers' ability to make a difference in the community. Insights into volunteer caregiver rewards provide opportunities for policy makers and programme managers to develop a model of home-based care that facilitates the accrual of rewards to volunteers alongside volunteers' traditional duties of patient care. Programme managers could employ these insights in recruiting and assisting volunteers to identify and reflect on rewards in the caregiving situation as a means of reducing the burden of care and sustaining volunteer interest in caregiving.

Perceptions of rewards among volunteer caregivers of people living with AIDS working in faith-based organizations in South Africa: a qualitative study

PubMed Central

2010-01-01

Background Volunteer caregivers are a critical source of support for the majority of people living with HIV and AIDS in southern Africa, which has extremely high HIV/AIDS prevalence rates. While studies have shown that volunteer caregiving is associated with negative health and socio-economic outcomes, little is known about the positive experiences of volunteers in the home-based care context in South Africa. The purpose of this study is to explore the perception of rewards among volunteers working in home-based care settings. Methods This study uses a qualitative design. Qualitative interviews were conducted with a purposively selected sample of 55 volunteer caregivers using an interview schedule containing open-ended questions. Results Volunteer caregivers derived intrinsic rewards related to self-growth and personal (emotional and psychological) development on the job; they also derived satisfaction from community members taking a liking for them and expressing a need for their services. Volunteers felt gratified by the improvements in their health behaviours, which were a direct consequence of the experiences of caring for terminally ill patients with AIDS. Extrinsic rewards came from appreciation and recognition shown by patients and community members. Extrinsic rewards also accrued to volunteers when the services they rendered made their patients happy. Perhaps the greatest sources of extrinsic rewards are skills and competencies acquired from training and experience while caring for their patients, and volunteers' ability to make a difference in the community. Conclusions Insights into volunteer caregiver rewards provide opportunities for policy makers and programme managers to develop a model of home-based care that facilitates the accrual of rewards to volunteers alongside volunteers' traditional duties of patient care. Programme managers could employ these insights in recruiting and assisting volunteers to identify and reflect on rewards in the caregiving situation as a means of reducing the burden of care and sustaining volunteer interest in caregiving. PMID:20546580

Subjective time pressure: general or domain specific?

PubMed

Kleiner, Sibyl

2014-09-01

Chronic time pressure has been identified as a pervasive societal problem, exacerbated by high demands of the labor market and the home. Yet time pressure has not been disaggregated and examined separately across home and work contexts, leaving many unanswered questions regarding the sources and potentially stressful consequences of time pressure. Using data collected in the United States General Social Survey waves 2002 and 2004, this study disaggregates time pressure into the domains of home and work, and asks whether considering time pressures within distinct work and home contexts reveals distinct predictors or associations with stress. Findings show that both predictors and stress associations differ across work and home pressures, revealing both methodological and theoretical implications for the study of time pressure and work and family life more generally. Copyright © 2014 Elsevier Inc. All rights reserved.

An overview of New Zealand's trauma system.

PubMed

Paice, Rhondda

2007-01-01

Patterns of trauma and trauma systems in New Zealand are similar to those in Australia. Both countries have geographical considerations, terrain and distance, that can cause delay to definitive care. There are only 7 hospitals in New Zealand that currently manage major trauma patients, and consequently, trauma patients are often hospitalized some distance from their homes. The prehospital services are provided by one major provider throughout the country, with a high level of volunteers providing these services in the rural areas. New Zealand has a national no-fault accident insurance system, the Accident Compensation Corporation, which funds all trauma-related healthcare from the roadside to rehabilitation. This insurance system provides 24-hour no-fault personal injury insurance coverage. The Accident Compensation Corporation provides bulk funding to hospitals for resources to manage the care of trauma patients. Case managers are assigned for major trauma patients. This national system also has a rehabilitation focus. The actual funds are managed by the hospitals, and this allows hospital staff to provide optimum care for trauma patients. New Zealand works closely with Australia in the development of a national trauma registry, research, and education in trauma care for patients in Australasia (the islands of the southern Pacific Ocean, including Australia, New Zealand, and New Guinea).

Teleworking: Benefits and Pitfalls as Perceived by Professionals and Managers.

ERIC Educational Resources Information Center

Baruch, Yehuda

2000-01-01

Interviews with 60 British teleworkers showed that working at home did not change their employee identity; time management skills were crucial; reduction of distractions was a prime benefit; and the home environment provided better relationships and support. Telecommuting resulted in changed attitudes, satisfaction, less stress, and better…

Life Management Skills, 8230. Home Economics Education.

ERIC Educational Resources Information Center

Loudoun County Public Schools, Leesburg, VA.

The middle school home economics curriculum on Life Management Skills I (eighth grade) meets the needs of the early adolescent. It is based upon three major concepts: (1) basic skills; (2) self-knowledge/understanding/decision making; and (3) independence/interdependence. Emphasis on the basic skills of reading, writing, communicating, using…

Public Use Cabins

Science.gov Websites

State of Alaska Skip to main content myAlaska Departments State Employees Statewide Links Recreation Search DNR State of Alaska Home Menu Parks Home Alaska State Trails Boating Safety Design and Information Strategic Plan Division Organization Chart State Parks History Park Management Management Plans

Home Management and Consumer Education.

ERIC Educational Resources Information Center

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

Designed for use in consumer and homemaking education in Texas, this curriculum guide is on the subject of home management and consumer education. An introduction to the guide, covering its use and program and curriculum planning, provides a list of suggested reading. Information on teaching handicapped and disadvantaged students follows. The…

[Strengthening Cooperation between Medical and Nursing Care(Part 2) - A Collaborative Meeting of Home Care Doctors, Dentists, and Care Managers in Shinjuku City].

PubMed

Nakamura, Junko; Watanabe, Yurie

2016-12-01

In order to strengthen the cooperation between medical and nursing care, Shinjuku Ward held a collaborative meeting for home care doctors and care managers in 2014. Because cooperation with the dentist was also necessary in elderly care from the viewpoint of eating deglutition and oral health care, Shinjuku Ward held a collaborative meeting for home care doctors, dentists, and care managers in 2015. A questionnaire was given to the participants, and almost all respondents answered "Helpful"when asked if the meeting was useful. Besides, all respondents answered that their"understanding of each other's areas and perspectives has deepened."Therefore, this collaborative meeting was suggested to promote cooperation and mutual understanding among doctors, dentists, and care managers.

A Phenomenology Study of First-Year Teachers Looking at the Shared Lived Experience of Learning to Grade

ERIC Educational Resources Information Center

Yost, Brandon Lee

2015-01-01

This study describes the phenomenon of how first-year teachers learn to evaluate students learning by (letter) grades. Grades seem simple enough; but in reality, each grade carries serious consequences with it--for either good or bad. For example, grades affect benefits/consequences at home; they affect placement in remedial or advanced courses;…

Devolution and Geographies of Education: The Use of the Millennium Cohort Study for "Home International" Comparisons across the UK

ERIC Educational Resources Information Center

Taylor, Chris; Rees, Gareth; Davies, Rhys

2013-01-01

Following political devolution in the late 1990s and the establishment of the governments for Wales and Scotland, the education systems of the four home countries of the UK have significantly diverged. Consequently, not only does that mean that education research in the UK has to be sensitive to such divergence, but that the divergence of policy…

[Strengthening Cooperation between Medical and Nursing Care - A Collaborative Meeting of Home Care Doctors and Care Managers in Shinjuku-City].

PubMed

Watanabe, Yurie; Itatani, Tomoya

2015-12-01

The number of elderly patients requiring home care is expected to increase as a result of the aging population and a decrease in the average length of hospital stay in Shinjuku Ward. Therefore, cooperation between medical and nursing staff is increasingly important. According to research on care managers conducted by Shinjuku Ward, care managers have little opportunity to discuss plans of care with doctors, which requires improvement. In order to strengthen the cooperation between medical and nursing staff, Shinjuku Ward conducted a collaborative meeting for home care doctors and care managers. In the results of the questionnaire given to participants, all respondents answered"Helpful"when asked if the meeting was useful, and 95% of respondents indicated that"understanding and perspective of each other's area has deepened."Therefore, additional collaborative meetings were suggested to promote cooperation and mutual understanding between doctors and care managers.

Allowing cigarette or marijuana smoking in the home and car: prevalence and correlates in a young adult sample.

PubMed

Padilla, Mabel; Berg, Carla J; Schauer, Gillian L; Lang, Delia L; Kegler, Michelle C

2015-02-01

Given the increased marijuana use, negative health consequences of marijuana secondhand smoke exposure (SHSe) and dearth of research regarding marijuana SHSe in personal settings, we examined the prevalence and correlates of allowing marijuana versus cigarette smoking in personal settings among 2002 online survey respondents at two southeastern US universities in 2013. Findings indicated that 14.5% allowed cigarettes in the home, 17.0% marijuana in the home, 35.9% cigarettes in cars and 27.3% marijuana in cars. Allowing cigarettes in the home was associated with younger age, racial/ethnic minority status, living off campus, personal marijuana use, parental tobacco use and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in the home included older age, not having children, living off campus, positive perceptions of marijuana and personal, parental and friend marijuana use (P < 0.05). Correlates of allowing cigarettes in cars included personal cigarette and marijuana use, parental tobacco and marijuana use, more cigarette-smoking friends and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in cars included being non-Hispanic black; positive perceptions of marijuana; and personal, parental and friend marijuana use (P < 0.05). Interventions must target distinct factors influencing policies regarding cigarette versus marijuana use in personal settings to address the consequences of marijuana and cigarette SHSe. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Decision Makers' Allocation of Home-Care Therapy Services: A Process Map

PubMed Central

Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine

2013-01-01

ABSTRACT Purpose: To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario. Method: An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method. Results: The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation. Conclusion: Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care. PMID:24403672

Discharge planning, nursing home placement, and the Internet.

PubMed

Collier, Eric J; Harrington, Charlene

2005-01-01

Effective discharge planning and well-coordinated case management related to nursing home (NH) placement are key services in acute-care hospitals. (1) identify the individuals and important factors involved in the discharge planning process; (2) describe the types/sources of information used by discharge planners to recommend specific nursing homes for patients and families; and (3) determine which methods are used to evaluate the quality of US nursing homes (NHs). Descriptive study, with a convenience sample of 41 discharge planners and case managers from California acute-care hospitals. This study found that patients, families, friends, and physicians are all involved in the discharge planning process along with discharge planners and/or case managers. Discharge planners/case managers were generally concerned about NH bed availability, geographic location, and financial considerations. Although the discharge planners and case managers were able to articulate important indicators of quality in NHs, such information was not routinely considered during discharge planning activities. Discharge planners and case managers need to play a more central role in the decision-making process related to the selection of a NH, especially because decisions are time-limited and can benefit from a well-planned discharge planning program that uses a variety of data on quality and costs. The widespread use of Internet-based information sources can be expanded to aid this process.

Older Adults’ Satisfaction with a Medication Dispensing Device in Home Care

PubMed Central

Demiris, George; Marek, Karen D.

2014-01-01

Introduction Older adults with multiple chronic conditions face the complex task of medication management involving multiple medications of varying doses at different times. Advances in telehealth technologies have resulted in home-based devices for medication management and health monitoring of older adults. We examined older adults’ perceptions of a telehealth medication dispensing device as part of a clinical trial involving home health care clients, nurse coordination and use of the medication dispensing device. Methods Ninety-six frail older adult participants who used the medication dispensing device for 12 months completed a satisfaction survey related to perceived usefulness and reliability. Results were analyzed and grouped by themes in the following areas: Ease of Use, Reliability, Medication Management Assistance, Routine Task Performance and Acceptability. Results Nearly all participants perceived the medication dispensing device as very easy to use, very reliable and helpful in management of their medications. Eighty-four percent of participants expressed a desire to use the machine in the future. Conclusion The technology-enhanced medication management device in this study is an acceptable tool for older adults to manage medication in collaboration with home care nurses. Improved usability and cost models for medication dispensers are areas for future research. Trial Registration clinicaltrials.gov identifier: NCT01321853 PMID:23323721

How Technology in Care at Home Affects Patient Self-Care and Self-Management: A Scoping Review

PubMed Central

Peeters, José M.; Wiegers, Therese A.; Friele, Roland D.

2013-01-01

The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits. PMID:24173139

Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial.

PubMed

Dorresteijn, Tanja A C; Zijlstra, G A Rixt; Ambergen, Antonius W; Delbaere, Kim; Vlaeyen, Johan W S; Kempen, Gertrudis I J M

2016-01-06

Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs. ClinicalTrials.gov, NCT01358032. Registered 17 May 2011.

Seeing the Elephant -- Consequence Management Policy for the Department of Defense

DTIC Science & Technology

2001-05-01

required for effective Consequence Management. The three response tiers allows the DoD to provide a predesignated level of support to the appropriate Federal...recommendation is the creation of a tiered response capability that balances time and tasks required for effective Consequence Management. The three...the response required for toxic chemical events. The third tier is reserved for the actions required for the Consequence Management for a biological

Nursing staff stress from challenging behaviour of residents with dementia: a concept analysis.

PubMed

Hazelhof, T J G M; Schoonhoven, L; van Gaal, B G I; Koopmans, R T C M; Gerritsen, D L

2016-09-01

Provide insight into the concept of stress in the context of challenging behaviour of nursing home residents with dementia and its causes and consequences. Challenging behaviour is frequent in residents with dementia, but consequences for nursing staff are unclear. Challenging behaviour of residents can be enervating for nurses and may lead to stress. Although stress in general is associated with negative outcomes, an overview of stress in this context would be a welcome addition to the field. Concept analysis according to Walker and Avant. Identified antecedents of stress: physical and verbal aggression, conflicts, excessive demands and being unresponsive (residents), age, experience, tenure, nursing level and training (nursing staff). Defining attributes: disturbed homoeostasis and the personal appraisal of the situation. Identified consequences regard health, psychological aspects and behaviour. Intervening in the identified factors may contribute to prevention of stress in nursing staff. Given a lack of strong empirical studies, our analysis is not based on a high level of evidence and needs to be tested. Papers from before 1990 might have been missed. The concept analysis revealed that nursing staff stress in the context of challenging behaviour may result from resident and nursing staff factors. Besides health and psychological consequences, behavioural consequences can enormously impact the well-being of residents. Application in daily care to support teams in influencing resident and nursing staff factors could prevent stress, for instance using behavioural management training or recruiting higher educated nursing staff. Given the increasing complexity of care, creating specialized units with specifically trained staff for different groups of people with dementia may be desirable. © 2016 International Council of Nurses.

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

PubMed

Honma, Katsuaki; Sakai, Ritsuko; Takeshima, Akiko; Shimamori, Yoshimitsu; Hayase, Yukitoshi

2004-10-01

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

[Vision on and use of physical restraints and 'smart technology' in nursing homes in Flanders].

PubMed

Carlassara, V; Lampo, E; Degryse, B; Van Audenhove, C; Spruytte, N

2017-04-01

The STAFF-project investigates in what way 'smart technology' can offer an alternative for physical restraints in nursing homes. A survey is realized aimed at gaining more insight into the vision on and the use of physical restraints and 'smart technology'. Two partly overlapping structured questionnaires were developed and sent to nursing home staff in Flanders (Belgium). One hundred fifty six administrators (managers or assistant-managers) and 238 caregiving staff (nurses, nursing aids, paramedical staff and other) completed the online questionnaire. In general there is a low acceptability of physical restraint use, however, a more nuanced picture of acceptability is present depending on the specific motivation for using physical restraints and on the specific means of physical restraints. About half of the administrators say they use smart technology in the nursing home. The two main reasons for not applying (yet) smart technology are 'too high price for smart technology' and 'inadequate infrastructure of the nursing home'. All respondents underscore the importance of multiple strategies to diminish the use of physical restraints in nursing homes. Physical restraint use is a complex theme and needs a nuanced analysis and management. This study shows that there is still room for improvement in diminishing the use of physical restraints and that nursing homes in Flanders are open to use smart technology.

High-performance workplace practices in nursing homes: an economic perspective.

PubMed

Bishop, Christine E

2014-02-01

To develop implications for research, practice and policy, selected economics and human resources management research literature was reviewed to compare and contrast nursing home culture change work practices with high-performance human resource management systems in other industries. The organization of nursing home work under culture change has much in common with high-performance work systems, which are characterized by increased autonomy for front-line workers, self-managed teams, flattened supervisory hierarchy, and the aspiration that workers use specific knowledge gained on the job to enhance quality and customization. However, successful high-performance work systems also entail intensive recruitment, screening, and on-going training of workers, and compensation that supports selective hiring and worker commitment; these features are not usual in the nursing home sector. Thus despite many parallels with high-performance work systems, culture change work systems are missing essential elements: those that require higher compensation. If purchasers, including public payers, were willing to pay for customized, resident-centered care, productivity gains could be shared with workers, and the nursing home sector could move from a low-road to a high-road employment system.

Safe medication management in specialized home healthcare - an observational study.

PubMed

Lindblad, Marléne; Flink, Maria; Ekstedt, Mirjam

2017-08-24

Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

Delivering team training to medical home staff to impact perceptions of collaboration.

PubMed

Treadwell, Janet; Binder, Brenda; Symes, Lene; Krepper, Rebecca

2015-01-01

The purpose of this study was to explore whether an evidence-based educational and experiential intervention to develop team skills in medical homes would positively affect team members' perceptions of interprofessional collaboration. The study population consisted of primary care medical home practices associated with the health plan sponsor of this research. All practices were located within the greater Houston region of Texas and had more than 500 patients. A cluster design experimental study was conducted between August 2013 and June 2014. Fifty medical home practices, 25 intervention and 25 attention control, were recruited as study sites. Results indicate that individual team members in the medical homes receiving the intervention were significantly more likely than the individual team members in the attention control groups to report higher levels of positive perception of team collaboration after the 12-week intervention. This research indicates that educating teams about interprofessional collaboration tools and supporting technique use may be an effective strategy to assist medical homes in developing collaborative environments. Case management experience in collaboration supports the role facilitating team training. Transforming culture from hierarchical to team-based care supports the case management approach of collaborative practice. In addition, role satisfaction attained through the respect and communication of team-based care delivery may influence retention within the case management profession. As case managers in primary care settings assume roles of embedded care coordinators, program leaders, and transition facilitators, an understanding of collaboration techniques is needed to support the entire care team to achieve desired outcomes.

CAREGIVERS' KNOWLEDGE AND HOME MANAGEMENT OF FEVER IN CHILDREN.

PubMed

Koech, P J; Onyango, F E; Jowi, C

2014-05-01

Fever is one of the most common complaints presented to the Paediatric Emergency Unit (PEU). It is a sign that there is an underlying pathologic process, the most common being infection. Many childhood illnesses are accompanied by fever, many of which are treated at home prior to presentation to hospital. Most febrile episodes are benign. Caregivers are the primary contacts to children with fever. Adequate caregivers' knowledge and proper management of fever at home leads to better management of febrile illnesses and reduces complications. To determine the caregivers' knowledge and practices regarding fever in children. A cross-sectional study. Peadiatric Emergency Unit at Kenyatta National Hospital (KNH) SUBJECTS: Two hundred and fifty caregivers of children under 12 years presenting with fever in August to October 2011 to the PEU. Three quarters of the caregivers' defined fever correctly. Their knowledge on the normal body was at 47.6%. Infection was cited as the leading cause of fever (95.2%). Brain damage (77.6%) and dehydration (65.6%) were viewed as the most common complication. Fever was treated at home by 97.2% of caregivers, most of them used medication. Fever was defined correctly by 75.2% of the study participants and a majority of them used touch to detect fever. Fever was managed at home with medications. Public Health Education should be implemented in order to enlighten caregivers on fever and advocate for the use of a clinical thermometer to monitor fever at home.

Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community: a mixed studies review.

PubMed

Aston, Lydia; Hilton, Andrea; Moutela, Tiago; Shaw, Rachel; Maidment, Ian

2017-10-18

Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management. A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods). Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers' knowledge of the importance of managing medication and healthcare professionals' understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication. This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes.

Nursing perception of patient transitions from hospitals to home with home health.

PubMed

Smith, Shannon Bright; Alexander, Judith W

2012-01-01

The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

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

Del Bianco, M.; Wiehagen, J.; Wood, A.

Residential quality management systems have most often been designed for new home construction. To address quality in existing homes in the form of Scopes of Work (SOW), the NAHB Research Center began with a new construction scope of work and applied it to an existing home project. This document is intended to outline the steps of translating a new home construction SOW to SOW for retrofit.

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

ERIC Educational Resources Information Center

Feller, Barbara A.

1986-01-01

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

Nurse-led disease management for hypertension control in a diverse urban community: a randomized trial.

PubMed

Hebert, Paul L; Sisk, Jane E; Tuzzio, Leah; Casabianca, Jodi M; Pogue, Velvie A; Wang, Jason J; Chen, Yingchun; Cowles, Christine; McLaughlin, Mary Ann

2012-06-01

Treated but uncontrolled hypertension is highly prevalent in African American and Hispanic communities. To test the effectiveness on blood pressure of home blood pressure monitors alone or in combination with follow-up by a nurse manager. Randomized controlled effectiveness trial. Four hundred and sixteen African American or Hispanic patients with a history of uncontrolled hypertension. Patients with blood pressure ≥150/95, or ≥140/85 for patients with diabetes or renal disease, at enrollment were recruited from one community clinic and four hospital outpatient clinics in East and Central Harlem, New York City. Patients were randomized to receive usual care or a home blood pressure monitor plus one in-person counseling session and 9 months of telephone follow-up with a registered nurse. During the trial, the home monitor alone arm was added. Change in systolic and diastolic blood pressure at 9 and 18 months. Changes from baseline to 9 months in systolic blood pressure relative to usual care was -7.0 mm Hg (Confidence Interval [CI], -13.4 to -0.6) in the nurse management plus home blood pressure monitor arm, and +1.1 mm Hg (95% CI, -5.5 to 7.8) in the home blood pressure monitor only arm. No statistically significant differences in systolic blood pressure were observed among treatment arms at 18 months. No statistically significant improvements in diastolic blood pressure were found across treatment arms at 9 or 18 months. Changes in prescribing practices did not explain the decrease in blood pressure in the nurse management arm. A nurse management intervention combining an in-person visit, periodic phone calls, and home blood pressure monitoring over 9 months was associated with a statistically significant reduction in systolic, but not diastolic, blood pressure compared to usual care in a high risk population. Home blood pressure monitoring alone was no more effective than usual care.

Comforts of Home: Home Care of the Terminally Ill

PubMed Central

Fraser, Jacqueline

1990-01-01

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

From the kitchen to the bedroom: frequency rates and consequences of sexual harassment among female domestic workers in Brazil.

PubMed

DeSouza, Eros R; Cerqueira, Elder

2009-08-01

Sexual harassment has been investigated mostly in developed countries. The authors examined frequency rates and consequences of sexual harassment among female domestic workers in Brazil. Twenty-six percent had been sexually harassed at work during the past year. Live-in workers were at significantly greater risk for experiencing sexual harassment than those residing in their own homes, when controlling for participants' age, race, and social class. Women residing in their employers' residences used more alcohol and drugs than their counterparts. Harassed women had significantly higher self-esteem impairment and anxiety and depression than nonharassed women. Nonharassed women residing in their own homes had the best physical well-being. Concerning participants' worst sexually harassing experiences, the perpetrators were likely to be men (75%), who also engaged in more severe types of sexual harassment than female perpetrators. The emotional reactions to such incidents were significantly more negative when perpetrated by men than by women. Implications for foreign in-home workers employed by Europeans and North Americans are discussed.

"The way we do things around here": an international comparison of treatment culture in nursing homes.

PubMed

Hughes, Carmel M; Donnelly, Ailis; Moyes, Simon A; Peri, Kathy; Scahill, Shane; Chen, Charlotte; McCormack, Brendan; Kerse, Ngaire

2012-05-01

In this study, we sought to measure treatment culture (beliefs, values, and normative practices associated with medication prescribing and administration) in two samples of nursing homes (in Northern Ireland and New Zealand) and to document the range of scoring achieved by staff in both countries. Responses between nurse managers and registered nurses were also compared. A cross-sectional study using an adapted treatment culture questionnaire was distributed by mail (in June and September 2008) to 159 nursing homes in Northern Ireland and completed by the nurse manager and registered nurses. In New Zealand, staff in 14 facilities participated and questionnaires were distributed by a research assistant who visited the homes (March to November 2008). Completed questionnaires were scored using a prespecified scoring system, with a higher score indicating a more resident-centered treatment culture and a lower score indicating a more traditional approach to care. The maximum score possible was 75. Scores were compared between countries and between different categories of staff. Views were also sought and knowledge tested (from structured questions) on the use of psychotropic prescribing in the nursing home environment. The response rates for nurse managers and nurses in Northern Ireland were 35.5% and 10.1%, respectively; in New Zealand, the response rate was 90.9% for managers and 71% for nurses. The mean score for the Northern Ireland and New Zealand homes was 39.5 and 39.1, respectively (P > .05). There were also no differences between scores achieved by nurse managers and registered nurses between and across both countries. There were some cross-country differences on the approach to challenging behavior in residents and nurses (in both countries) were more likely than nurse managers to report (incorrectly) that haloperidol is indicated for short-term insomnia. This quantitative assessment has raised interesting issues in relation to the measurement of treatment culture in the nursing home setting in two countries. Further insights into the importance of treatment culture will be pursued in qualitative studies. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

ERIC Educational Resources Information Center

Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.

2006-01-01

Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…

Uncovered Coping Strategies Adopted by Children Living in Homes with Marital Conflicts for Their Own Survival

ERIC Educational Resources Information Center

Lawuo, Ebenezer A.; Machumu, Haruni J.; Kimaro, Anathe R.

2015-01-01

Research indicates that marital conflict pertains to three particular dimensions of communication including affect, conflict behaviours and conflict management and these affect conflict choice of management strategies. This paper explored the problems and coping strategies of children from homes with marital conflicts in Tanga City, Tanzania. An…

41 CFR 302-14.100 - How should we administer our home marketing incentive payment program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false How should we administer our home marketing incentive payment program? 302-14.100 Section 302-14.100 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

41 CFR 302-14.5 - Under what circumstances will I receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Under what circumstances will I receive a home marketing incentive payment? 302-14.5 Section 302-14.5 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

Balancing Work and Family: How Female Superintendents Succeed at Work and Home

ERIC Educational Resources Information Center

Olesniewicz, Julie

2012-01-01

Women leaders in education struggle to balance work and family life. Historically, this struggle has stemmed from attempts to manage societal expectations of balancing work and family. In managing these expectations, women leaders face many challenges, which have made it difficult to maintain home responsibilities and deal with increasing demands…

Evaluation of a Behavior Management Training Program for Nursing Home Caregivers.

ERIC Educational Resources Information Center

Marsiske, Michael; And Others

This study examined the effectiveness of a new skills training program designed to increase nurse aides' knowledge of behavior management. The training program, designed as five 90-minute group learning modules, was implemented in two Western Pennsylvania nursing homes over a 5-month period. Topics covered within the training program included…

Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections.

PubMed

Fajardo-Bernal, Luisa; Aponte-Gonzalez, Johanna; Vigil, Patrick; Angel-Müller, Edith; Rincon, Carlos; Gaitán, Hernando G; Low, Nicola

2015-09-29

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.

Adherence of pain assessment to the German national standard for pain management in 12 nursing homes

PubMed Central

Osterbrink, Jürgen; Bauer, Zsuzsa; Mitterlehner, Barbara; Gnass, Irmela; Kutschar, Patrick

2014-01-01

BACKGROUND: Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic/acute pain-affected persons and highly recommended for practice. OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain. PMID:24851238

Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care

PubMed Central

Jackson, Carlos; Kasper, Elizabeth W.; Williams, Christianna

2016-01-01

Abstract Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P < 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. (Population Health Management 2016;19:163–170) PMID:26431255