2008 SNRS abstracts -- M. 2008

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Abuse and violence during home care work as predictor of worker depression. Geiger-Brown, J., C. Muntaner, K. McPhaul, J. Lipscomb and A. Trinkoff. 2007

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Objectives: Home care workers provide care without the normal protections afforded in the hospital. This study describes the prevalence of abuse and violence experienced by home care workers and its relationship to workers' depression. Methods: A two-wave telephone survey (N = 1,643) was conducted to assess the prevalence of abuse and prevalence/incidence of workers' depression. Results: Abuse was significant for elevated odds for depression, with a dose effect. Violence was highly associated with depression. Conclusions: Preventive and early intervention measures should be taken to reduce mental health consequences of abuse and violence among home care workers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Acceptance of telemonitoring to enhance medication compliance in patients with chronic heart failure. Schmidt, S., S. Sheikzadeh, B. Beil, M. Patten and J. Stettin. 2008

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Noncompliance with medication often leads to a deterioration of health status in patients with chronic heart failure (CHF). The aim of this pilot study was to test a telemonitoring intervention that can increase compliance and prevent readmissions in order to improve patients' quality of life. The study's purpose was to identify processes and outcomes of telemonitoring as well as factors associated with its acceptance. Sixty-two (n = 62) CHF patients participated in a controlled, longitudinal study. Medication intake was monitored with a medication box transferring data to an electronic health record. Physicians, nurses, or pharmacists monitored signals and, in case of absence of signal transfers, initiated interventions. Patients were assessed regarding their medication intake, clinical status, and health status, as well as acceptance of medication monitoring. There was a significant improvement in mental and physical health status from study intake to 1-month follow-up. Self-reported noncompliance and mental health were significantly lower in study patients. Mental health of controls did not improve in the course of the study. The acceptance of the tool was high, however, 47% of patients did not consider it necessary to continue monitoring after study termination. Medication telemonitoring might prove an effective method to improve medication intake and health in home care in a subset of patients with self-reported noncompliance.

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Access to home-based hospice care for rural populations: Identification of areas lacking service. Virnig, B. A., H. Ma, L. K. Hartman, I. Moscovice and B. Carlin. 2006

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Background: Many persons dying of cancer enroll in home-based hospice prior to death. It is established in the literature that persons in rural settings are less likely to use hospice than persons living in urban areas. We examine whether this is due, in part, to a lack of hospice providers serving rural areas. Methods: The 100% Medicare enrollment and hospice files for 2000-2002 were the basis for this study. We used a Bayesian smoothing technique to estimate the ZIP-code-level service area for each Medicare-certified hospice in the United States. These service areas were combined to identify ZIP codes not served by any hospice. Results: Overall, approximately 332,000 elders (7.5% of ZIP codes) reside in areas not served by home-based hospice. Each year over 15,000 deaths occur in these unserved areas. There was a strong association between lack of service and urban/rural gradient. One hundred percent of the ZIP codes in the most urban areas (>1,000,000 people) are served by hospice and only 2.8% of the ZIP codes in urban areas of less than 1,000,000 are unserved. In rural areas adjacent to urban areas, over 9% of ZIP codes are unserved and in rural areas not adjacent to an urban area almost 24% of ZIP codes are not served by hospice. Conclusions: While the majority of the elderly population of the US resides in areas currently served by Medicare-certified hospice, there is a geographically large area that lacks home-based hospice services. Current payment policies may need to be adjusted to facilitate hospice availability to these rural populations. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Accountability agenda must include home and community based care. Shamian, J., E. Shainblum and J. Stevens. 2006

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Wait times and the wait times agenda are on the Canadian schedule. Although most Canadians support our healthcare system, they are concerned about access. Resolving the wait times agenda might help increase Canadian confidence in the system's ability to provide timely access to care. While the paper by Trypuc, MacLeod and Hudson demonstrates well how quickly governments can mobilize tools and resources to address pressing policy needs, it also reveals the limited and narrow approach taken by governments to the wait times agenda. The Ontario government should recognize that a more integrated and comprehensive approach can significantly advance the wait times agenda and make the system more accountable. Only a broad-based approach will ultimately succeed in reducing wait times and building a sustainable system. A shift in values needs to take place away from the current emphasis on acute care and toward an inclusive vision of home- and community-based care that puts more emphasis on disease management, chronic care and independent living, if there is ever to be any real progress in the battle. Governments will ultimately be held accountable by Canadian healthcare consumers if they fail to make this important shift.

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Achieving change in the NHS: A study to explore the feasibility of a home-based cancer chemotherapy service. Kelly, D., S. Pearce, E. Butters, W. Stevens and S. Layzell. 2004

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A major focus of current health policy in the United Kingdom is the development of services that meet the public's expectations. To achieve this there is a need to evaluate current provision to ensure that the best use is made of finite resources. The study reported here adopted an interview approach to examine an existing outpatient chemotherapy service, and to consider the feasibility of introducing a home based model. Following a review of literature on this topic data were obtained from in-depth interviews with patients and professionals regarding the present service. These were then combined with an analysis of service contracts and financial estimates. The poor quality of much of the cost-related information limited the conclusions which could be drawn, and emphasised the need for access to more accessible and robust financial information upon which to base change. The study also illustrated the benefits of feasibility studies; especially when cost-effectiveness and patient satisfaction are the driving forces behind proposed changes to clinical services. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

The addition of a psychological intervention to a home detoxification programme. Alwyn, T., B. John, R. Hodgson and C. Phillips. 2004

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Aims: Home detoxification is a recognized method of treating problem drinkers within their own home environment. The aim of this research is to determine whether a relatively brief psychological intervention adds to its effectiveness. Methods: A pragmatic trial with 91 participants randomly assigned to either the psychological intervention or treatment as usual. Community Psychiatric Nurses were trained to administer the brief psychological intervention involving motivational interviewing, coping skills training and social support. A manual was developed in order to standardize the training and implementation. Results: At the 3 month and 12 month follow-up the psychological intervention resulted in significant positive changes in alcohol consumption, abstinent days, social satisfaction, self-esteem and alcohol-related problems. Further, a cost analysis confirmed that the psychological intervention was a ninth of the cost of inpatient treatment. Conclusions: Adding a psychological intervention to a home detoxification programme was successful and cost-effective. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Adherence to a home-based experience program and incidence of cardiovascular disease in type 2 diabetes patients. Shinji, S., M. Shingeru, U. Ryusei, M. Mitsuru and K. Shigehiro. 2007

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The aim of this study was to examine the association between adherence to a home-based exercise program and the incidence of cardiovascular disease (CVD) in patients with type 2 diabetes. We investigated 102 patients with type 2 diabetes aged 35 to 75 years, and followed them prospectively for 17.2 months. Before enrollment, all patients received a traditional exercise prescription. The exercise program consisted of a daily walking exercise at home for 20 - 30 minutes. Self-reported adherence to the exercise program and the incidence of CVD were confirmed by information obtained from telephone interviews. There were 38 dropouts among the patients in the exercise program. Dropouts were significantly younger than completers. The rate of obesity was significantly higher among the dropouts than among the completers. No differences were observed between the two groups for gender, history of CVD and other clinical characteristics. During the follow-up, we documented 8 new cases of CVD. The incidence of CVD during the follow-up was 1.56 percent among the program completers and 18.4 percent among the dropouts. Adherence to the home-based exercise was inversely related to the incidence of CVD (p < 0.01). These associations persisted after adjustment for age and other covariates. In conclusion, adherence to an exercise program is associated with a reduced incidence of CVD among patients with type 2 diabetes.

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Application of the Integrative Harmony paradigm and Model. Haley, J. and C. Ratliffe. 2006

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Medically-fragile children at home with technologic equipment to support their vital organs place extraordinary demands on the parent caregiver. An ethnographic study was conducted following 12 Pacific Island families in their homes who cared for their medically-fragile child from hospital discharge over a period of two and a half years. Results showed the 'strengths' parents needed and the 'stressors' encountered in caring for their child. Based on the 'strengths' and 'stressors,' the Integrative Harmony Model was introduced as a new nursing model to bring a sense of harmony/balance into the lives of these parents challenged by extreme conditions. This article explains the Integrative Harmony Model and demonstrates its application with a Pacific Island mother and her medically-fragile child. This new and unique nursing model views individuals from an inclusive, non-dualistic world view. In this model, strengths and stressors are not opposed but are melded together in such a way that a sense of harmony is approached. This model challenges the nurse and others to leave behind the usual boundaries and adapt an integrative perspective connecting with clients/others at a level where it is not a case and someone else's life-it is all our lives.

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Assessing caregivers for team interventions (ACT): a new paradigm for comprehensive hospice quality care. Demiris, G., D. P. Oliver and E. Wittenberg-Lyles. 2009

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This article provides a framework labeled ACT that aims to successfully integrate family caregivers and patients into one unit of care, as dictated by the hospice philosophy. ACT (assessing caregivers for team interventions) is based on the ongoing assessment of the caregiver background context, primary, secondary, and intrapsychic stressors as well as outcomes of the caregiving experience and subsequently, the design and delivery of appropriate interventions to be delivered by the hospice interdisciplinary team. Interventions have to be tailored to a caregiver's individual needs; such a comprehensive needs assessment allows teams to customize interventions recognizing that most needs and challenges cannot be met by only one health care professional or only one discipline. The proposed model ensures a holistic approach to address the multifaceted challenges of the caregiving experience.

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Assisted peritoneal dialysis as a method of choice for elderly with end-stage renal disease. Dimkovic, N. and D. G. Oreopoulos. 1143

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In the last two decades, most developed countries have seen a continuous growth in the number of elderly patients with end-stage renal disease commencing renal replacement therapy. Despite the many advantages that peritoneal dialysis (PD) offers to elderly patients with ESRD, it is still underutilized in older patients. Older patients are much more vulnerable to the problems associated with aging, which may affect their level of independence and their long-term prognosis. Those patients have physiological changes related to aging and common health problems such as anxiety, depression, dementia, visual impairment, and cognitive impairment, all of which interfere with self-performing PD. Assistance with home-care nurses and assistance by a family member may overcome this problem. Some old but also more recent literature data justifies the idea that assisted PD may significantly contribute to increase the overall number of elderly patients who can be treated with PD at home. With assisted PD, free choice can be offered to patients with high comorbidity index who cannot perform their peritoneal exchanges by themselves. Automated peritoneal dialysis is the ideal treatment modality for elderly patients with end-stage renal disease who require assistance since this limits home-care nurse visits to only two a day. As expected, the elderly have a higher mortality rate than younger patients treated by assisted PD, but technique failure rate, overall peritonitis rate, and most quality-of-life (QoL) measures are comparable with those of younger patients. Peritoneal dialysis in nursing homes offers treatment for elderly patients without family support. In this regard, automated PD or nightly PD keeps the patient's daytime free for nursing home activities, increases socialization, and enables better rehabilitation that improves their QoL. Although withdrawal from dialysis is more frequent among nursing-home dialysis patients, this high discontinuation rate is not due to dialysis per se but rather to associated social and medical circumstances. Better communication between nursing staff and renal team is crucial for improving staff confidence and will contribute to higher utilization of PD in nursing homes. copyright Springer Science+Business Media, B.V. 2008.

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Attendance and graduation patterns in a group-model health maintenance organization alternative cardiac rehabilitation program. Ratchford, A. M., R. F. Hamman, J. G. Regensteiner, D. J. Magid, S. B. Gallagher and J. A. Merenich. 2004

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PURPOSE: Poor rates of participation in cardiac rehabilitation programs are well documented, especially among women and older patients. The Colorado Kaiser Permanente Cardiac Rehabilitation (KPCR) program is a home-based, case-managed, goal-oriented program with an active recruitment process and unlimited program length. This study evaluated the participation rates for the program and the predictors of attendance and graduation. METHODS: Patients hospitalized with acute myocardial infarction, coronary artery bypass graft, and percutaneous coronary intervention from June 1999 to May 2000 (n = 1030) were identified from the administrative database, and the proportion captured by the KPCR staff was determined. Subsequent attendance and graduation patterns were evaluated. RESULTS: Nearly 94% of patients with one of the three aforementioned conditions were identified by the rehabilitation staff, and 41% of all patients attended the KPCR program. More than 75% of the patients who participated went on to graduate from the program. Gender comparisons showed no difference in participation between men (66.8%) and women (59.7%) (P =.07). Participation rates were inversely associated with age, yet age was not associated with graduation from the program. Surgical interventions and two or more events experienced within the first 4 weeks of the index event were the strongest predictors of attendance and graduation from the KPCR program. CONCLUSIONS: Innovative approaches for the capture and retention of patients in cardiac rehabilitation programs are urgently needed. The alternative program evaluated in this study showed little difference in participation between men and women, yet participation among older patients remained poor. Overall, patients who underwent surgical interventions or multiple events were more likely to attend and graduate from the program.

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Barriers to home and community-based service referrals: the physician's role. Reder, S., S. Hedrick, M. Guihan and S. Miller. 2009

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The purpose of this study was to obtain information about Department of Veteran Affairs (VA) long-term care (LTC) referrals that could be used to develop interventions that increase the likelihood of referrals to home and community-based services (HCBS) instead of institutional care. This primarily qualitative study was conducted at five VA Medical Centers. The study used three linked methods: interviews with patients and informal caregivers; focus groups with LTC administrators, providers, and social workers; and written rankings of the barriers to HCBS referrals. We unexpectedly identified a cluster of findings indicating the importance of physicians' role in the LTC referral process and the need for more LTC training, particularly about HCBS.

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Barriers to hospice enrollment among lung cancer patients: a survey of family members and physicians. Ford, D. W., P. J. Nietert, J. Zapka, J. S. Zoller and G. A. Silvestri. 2008

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OBJECTIVE: Most patients diagnosed with lung cancer present with advanced stage disease and have a poor chance of long-term survival. Despite the advantages of hospice care for lung cancer patients, many are enrolled late in the course of their illness or not at all. We sought to identify reasons for this pattern. METHOD: A list of perceived barriers to hospice enrollment was generated and used to create two self-administered surveys, one for physicians and one for caregivers. After focus group testing, the finalized instruments were mailed to physicians in South Carolina and to caregivers of lung cancer patients who died under hospice care with a local hospice between 2000 and 2004. RESULTS: Fifty-three caregivers and 273 physicians responded to the survey. From the caregivers' perspectives, leading reasons for deferred hospice enrollment included patients' unanticipated rapid transition from well to sick and a belief that hospice means giving up hope. From the physicians' perspectives, impediments to earlier hospice enrollment included patients and caregivers overestimating survival from lung cancer and an (incorrect) assumption that patients need to be "DNR/DNI" prior to hospice enrollment. SIGNIFICANCE OF RESULTS: Lung cancer patients may benefit from earlier introduction to the concepts of hospice care and more education regarding prognosis so that an easier transition in goals of care could be achieved. A smaller proportion of lung cancer patients may benefit from earlier hospice enrollment.

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A "basket of care" for heart failure patients managing at home: evaluating a community-based nursing intervention from a patient's perspective. Young, B., M. Purden, N. Sauve, L. Dufour and C. Common. 2008

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BACKGROUND: Patients with heart failure (HF) in the community represent a large and growing patient population whose complex care requires implementation of innovative care modalities. The Centre Hospitalier--Centre de Sante et de Services Sociaux--Corridor of Service for Heart Failure Patients (CH-CSSS-CSHFP) represents a novel approach to address the challenges of delivering comprehensive care to HF patients in the community. PURPOSE: In this study, the researchers aimed to answer the question: What is the patient's perception of care received in the CH-CSSS-CSHFP? METHOD: A descriptive qualitative design and semistructured interviews guided the inquiry. SAMPLE: A convenience sample (n=5) of HF patients was recruited from five community health centres. RESULTS: Themes that arose from analysis included "Staying home": A shared goal of the patient and service, "Checking on": Health-related monitoring, and "Being connected": Ties to the health care system. CONCLUSION: Results of this study provide insight into the patient's unique perspective on how this service has impacted his/her HF management and may assist health care professionals in designing more effective community-based services.

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A before and after study of the impact of Specialist Workers for Older People. Fletcher, K. and J. Mant. 2009

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Background Case management of vulnerable older people by Community Matrons has been introduced into the UK.Alocally designed case management approach, The Specialist Workers for Older People (SWOP) Service, was implemented by a Central England Primary Care Trust. Here we report an evaluation of this service. Methods Before and after study of 418 people (207 before; 211 after) aged > or =75 at high risk of emergency hospital admission. SWOPs carry out assessments of social and medical needs, produce individual care plans, coordinate care and refer to appropriate agencies. Univariable analysis was used to determine the association of SWOPs on changes in hospital admission rates and primary care workload. Results There was a non-significant reduction in hospital admissions from 0.91 to 0.67 per patient. There was a significant increase in routine GP surgery visits, from an average 1.3 to 2.6 per patient. The number of emergency home visits decreased from an average 2.8 to 1.1 per patient (P < 0.001). Conclusions Case management might reduce hospital admissions and is potentially a cost-effective service. However, not all case management schemes are successful.With the introduction of Community Matrons, it is important to understand what elements of the SWOP service contributed to its success.

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Befriending Excluded Families in Tower Hamlets: The Emotional Labour of Family Support Workers in Cases of Child Protection and Family Support. Gray, B. 2009

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This paper describes the befriending of severely excluded families, particularly Bangladeshi and Somali families, in Tower Hamlets, East London by Family Support Workers (FSWs). Tower Hamlets is one of the most deprived boroughs in the UK. The study is derived from an evaluation of the Family Welfare Association's (FWA's) Tower Hamlets Family Support Services (FSSs) conducted by South Bank University. A key finding is that engaging the emotions of families enables high-quality and effective support in the family home. FSWs win trust and elicit narratives from families, particularly from mothers and children. The narratives of families are a rich source of informing better practice. In line with government objectives, the participatory work of FSWs helps to balance understanding on family support, health and child protection. The early identification of child protection issues is particularly important in mitigating their worst effects. FSWs gain trust and early disclosure on child protection cases. This prevents child-care problems from deteriorating into child protection issues. FSWs also act as informal advocates and help to balance social service assessments with the views of families. FSWs take a proactive, non-stigmatizing, non-intrusive approach to families. FSWs are sensitive and responsive to the emotions, ethnicity, gender and specific needs of families.

Behavioral disorders in dementia patients and their impact on the stress of caregiving relatives: The 'ARAD' questionnaire. Savorani, G., V. Vulcano, S. Boni, G. Sarti and G. Ravaglia. 1998

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The questionnaire of the Association for Research and Assistance for Dementia (ARAD) has been formulated to evaluate the relationship between dementia, elderly patients, family and the environment, in order to establish the best approach to improve quality of life and quality of assistance, based on the information collected from the patient-carer dyad. In Bologna, 83% of the elderly affected by some form of cognitive disorder, live at home, 23% alone and 52% has some degree of dependency in activities of daily living (bathing, dressing, toileting, transfer, continence, feeding) versus 8% in the remaining population. The behavioral and psychological disturbances of dementia, reducing further the independency, are largely responsible for the stress of both the relatives and the professional carers, and also for the institutionalization of demented patients. We analyzed 140 relative caregivers, 36% of them spouse (mostly women), 39% child and 25% other relatives. They ranked the self-perceived, most stressing problems deriving from the behavioral disturbances of the demented family members as follows: sleeping; delusions; aggressivity: agitation; incontinence. Seventy-five % of the relatives had to tackle 3 or more disruptive behaviors at the same time. It is concluded that formal and informal assistance could be improved by better use of pharmaceutical treatments, at least for some symptoms, together with educational, informative and practical courses.

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Being there: Parenting the child with acute lymphoblastic leukaemia. Kars, M. C., M. S. Duijnstee, A. Pool, J. J. van Delden and M. H. Grypdonck. 2008

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Aims and objectives: To gain insight into the lived experience of parenting a child with leukaemia during treatment. Background: Diagnosis of leukaemia in children leads to an existential shock for parents and a reversal of normal family life. Today, in the Netherlands, after diagnosis, children stay at home most of the time. Therefore, their parents face considerable responsibilities for administering home-based treatment and for the support of their child during illness and treatment. Methods: A grounded theory study was undertaken at a Dutch University Hospital and involved one-time individual in-depth interviews with 12 mothers and 11 fathers (n = 23) of 12 children. Findings: 'Being there', was identified as the core concept. It means: 'I'll be there for you; I will never let you down'. 'Being there' is described as a parental response to the perceived vulnerability of the child and the parental need to give meaning to parenthood. It serves two purposes: protection and preservation. Protection means guarding the child against the negative aspects of illness and treatment. Preservation refers to the way parents influence the child's perception of his/her life, thus contributing to his/her coping and willingness to undergo treatment, to maximise the chances for survival. Six aspects were identified: a trusting relationship, presence, emotional support, advocacy, routines and rituals and effacing oneself. Conclusions: The concept provides a theoretical frame for parenting the child with cancer. It clarifies the actions and reactions of parents and increases insight into the underlying force that enables parents to provide continuing care despite their personal burden. Relevance to clinical practice: The concept offers an essential insight into parenting the child with acute lymphoblastic leukaemia and has relevance for nursing practice and education. Understanding of the concept would improve the ability to understand, communicate and work pro-actively in partnership with parents. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Bridging the information gap between hospitals and home care services: experience with a patient admission and discharge form. Satzinger, W., S. Courté-Wienecke, S. Wenng and B. Herkert. 2005

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Hospital care and ambulatory care are institutionally and financially so deeply separated in Germany that discontinuity of individual treatment and, hence, losses in both the quality and efficiency of care are all too often the consequences of this widely deplored systemic defect. In order to improve the communication between home care services and hospitals during admission or discharge of patients in need of long-term nursing care, the research project 'aski' has developed an innovative instrument and procedure for the reciprocal transfer of information between these institutions. After successful testing, the Patient Accompanying Form was offered for public use. Two years later, a written and telephone survey was conducted among the somewhat disappointingly small number of its users. Based on their experience, issues surrounding the implementation of such instruments in the health care system are discussed as well as the chances of enhancing integrative care by promoting coordinated communication between the providers.

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Bringing managed care home to the long-term care population. Nadash, P. and J. Ahrens. 2004

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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.

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Burden of Caregivers of People with Stroke: Evolution and Predictors. Vincent, C., J. Desrosiers, P. Landreville, L. Demers and B. Grp. 2009

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Background: Caregiver burden differs according to the amount of care, but no study has really focused on that point. This study compares the evolution of burden of two groups of caregivers of people with a recent stroke who returned home after discharge from two different types of health care facilities. Methods: Burden was assessed at 3 weeks and 3 and 6 months after discharge. The two groups of people with stroke and their caregivers were recruited from acute care (n = 69) and rehabilitation facilities (n = 89). Caregivers completed a questionnaire with three dimensions. In addition to sociodemographic characteristics, we assessed variables pertaining to the clinical, physical and cognitive functioning of the people with stroke. Results: Differences in burden were noted. The best predictors of burden were the caregivers' characteristics, i.e. gender (female), occupation (retired), schooling (low), age (older) and hours of care given, and the stroke survivors' characteristics, i.e. depressive symptoms, poor motor function (leg), verbal comprehension deficits, difficulty walking and neurological deficits. Conclusion: These results reinforce the view that services (information, training and support) should be tailored to the needs of caregivers, depending on whether or not the recipient of care has received rehabilitation services. Copyright (C) 2009 S. Karger AG, Basel

Burden of illness in painful diabetic peripheral neuropathy: the patients' perspectives. Gore, M., N. A. Brandenburg, D. L. Hoffman, K. Tai and B. Stacey. 2006

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Our goal was to assess the patient-level burden among subjects with painful diabetic peripheral neuropathy (DPN). Community-based physicians recruited patients with painful DPN (N = 255) between April and October 2003. Patients completed a survey on pain experience (Brief Pain Inventory-DPN [BPI-DPN]), health status (EuroQoL [EQ-5D]), healthcare utilization (consults, prescription [Rx], and over-the-counter [OTC] medications), and work productivity/functioning. Patients were 61 +/- 12.8 years old and had diabetes for 12 +/- 10.3 years and painful DPN for 6.4 +/- 6.4 years; 25.5 and 62.7% had other neuropathic and musculoskeletal pain conditions. Average and worst pain scores (BPI-DPN, 0-10 scales) were 5.0 +/- 2.5 and 5.6 +/- 2.8. The mean EQ-5D utility was .5 +/- .3 (range = -.594-1). A majority (87.4%) took pain medications (Rx/OTC) in the preceding week: an average of 3.8 +/- 3.9 Rx and 2.1 +/- 1.3 OTC medications. Nearly half (46.7%) received NSAIDs. Other frequently reported medications were short/long-acting opioids (43.1%), anticonvulsants (27.1%), selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors (18%), and tricyclic antidepressants (11.4%). During the preceding 3 months, 59.6% had >/=2 health professional consults; 59% reported decreased home productivity; 85.5% reported activity limitations; and 64.4% of patients who worked (N = 73) reported missing work/decreased work productivity due to painful DPN. Our results underscore a substantial patient-level burden among subjects with painful DPN. PERSPECTIVE: Information on the patient-level burden among painful DPN sufferers in the U.S. was previously lacking. Our results suggest that this burden is significant, evidenced by moderate-to-high pain levels, polypharmacy, health resource use, and work/activity limitations. Results also suggest suboptimal pain management and low levels of satisfaction with treatments.

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Cancer Education for Home Health Care Workers: A Process Evaluation. Moadel, A. B., A. Skamai, J. Carter, J. V. Carey and C. Morgan. 2005

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Background: In this article, we evaluate adoption of cancer education into the mandatory in-service training of home health attendants (HHA) comprised predominantly of African American and Hispanic women. Methods: Three home health care training agencies in Bronx, NY, incorporated cancer prevention and outreach education into HHA training. Results: Across 3 years, 87% (n = 2513) of HHAs received the intervention and disseminated it to 1600 clients/family/friends. HHAs reported high program satisfaction (98%) and interest (82%) in cancer outreach. Agency staff reported more benefits than costs to implementation. Conclusions: The home health care training agency appears an accessible and effective bridge for disseminating cancer education to the underserved. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Darkins, A., P. Ryan, R. Kobb, L. Foster, E. Edmonson, B. Wakefield and A. E. Lancaster. 1118

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Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrollment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings. copyright Copyright 2008, Mary Ann Liebert, Inc.

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Caregiving burden, acculturation, familism, and Mexican American elders' use of home care services. Crist, J. D., M. M. McEwen, A. P. Herrera, S. Kim, A. Pasvogel and J. T. Hepworth. 2009

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Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

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Caring and sleep disruption among women in Italy. Bianchera, E. and S. Arber. 2007

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Drawing on qualitative research with 27 Italian women aged between 40 and 80 years, this article examines how family structure, gender role expectations and caring roles impact on women's sleep at different points in their life course. Care work shapes sleep quality and duration for the majority of these women. High levels of sleep disturbance were found among women who cared for older frail or disabled relatives. Women caring for young children and adult children living at home also experience decreased sleep quality. When informal care is unsupported, very demanding and stress provoking, sleep disturbance is greater, with women experiencing insomnia, frequent awakenings and light sleep. The article discusses the implications of inadequate welfare provision in Italy, which increases women's unpaid domestic caring work resulting in adverse effects on sleep quality and their overall well being.

Caring for a family member with Alzheimer's disease: coping with caregiver burden post-nursing home placement. Garity, J. 2006

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Most nursing home research has focused on predictors for placement, the placement decision-making process, or the effects of placement on the nursing home resident. Little research is available on family caregivers' experiences after placing their loved ones in a nursing home. The purpose of this qualitative study was to identify how family caregivers coped with the burden of post-nursing home placement of a family member with Alzheimer's disease (AD). Several factors that positively or negatively affected coping among family caregivers were identified. Family caregivers' interactions with their loved one, other nursing home residents, family and friends, nursing staff, and the nursing home-sponsored support group all contributed positively to their coping with the burden of post-nursing home placement. Factors that decreased family caregivers' coping were role disruption, guilt over placement, and uncertainty about the future.

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Caring for older people in the 21st century: 'notes from a small island'. Milligan, C. 2006

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Drawing on carer narratives from research undertaken in New Zealand, this paper considers the interrelationship between place and the care-giving experience. In doing so, it considers: first, how informal carers of older people experience the transition in the place of care from the home to care homes; second, how they negotiate new identities for themselves as carers in these new care settings; and third, carers' views on how we might develop more inclusive models of care in care home settings. While much current work on care-giving in the home highlights the blurring of the boundaries between formal and informal care-giving, this paper suggests that the blurring of the boundaries of care may also be manifest in an increased penetration of informal care-giving within the semi-public space of the residential care home.

EBSCOhost; rzh

Caring for patients dying at home from heart failure: a new way of working. Pooler, J., A. Yates and S. Ellison. 2007

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This article explores the difficult journey that heart failure patients frequently experience when trying to access palliative care. It describes how a team of Macmillan and heart failure nurse specialists attempted to address the problem using the specialist role to effect change. Individual and group learning needs were identified and addressed while the use of reflective practice and group working helped the nurses to manage and implement change. This project, with management support, empowered the specialist teams to think creatively about nursing practice and improve patient care. It has encouraged working with clinical nurse specialists from other disciplines, thus avoiding a narrowness of outlook. Although this project initially focused on a small number of patients, it has enabled the teams to become established in partnership working; the collaborative approach to providing palliative care for end-stage cardiac failure patients has since continued to grow and flourish. It is hoped that, in the future, further studies can take place to gain more detailed information from patients and their families about how partnership working can continue to meet the needs of this group.

Ovid Technologies; Ovid MEDLINE(R)

Changes in Medicare home health care use and practices in rural communities: 1997 to 2001. Lin, C. J. and M. Meit. 2005

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Objectives: This research was designed to examine the impact of the interim and prospective payment systems on home health agencies and Medicare beneficiaries in rural communities. Methods: Data were collected from two complementary studies: (a) fiscal and use data collected from 10 rural agencies in northwest Pennsylvania and (b) a statewide survey of rural home health agencies in Pennsylvania. Results: The findings show that the implementation of interim and prospective payment systems had a profound affect on the home health agencies' financial vulnerability, staffing management, and service delivery. As a result, Medicare beneficiaries were also affected. The total number of home health visits per episode in rural Pennsylvania was 16 visits, whereas the national estimate was 22 visits. Physical therapy services increased 8% and occupational therapy services increased 1%, whereas visits for other disciplines decreased or remain unchanged. Discussion: Future studies are needed to examine the health outcomes of beneficiaries in rural communities.

EBSCOhost; rzh

Characteristics of referral to a multidisciplinary palliative home care team. Drieskens, K., J. Bilsen, L. van den Block, R. Deschepper, S. Bauwens, W. Distelmans and L. Deliens. 2008

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Introduction: Until now, in Belgium at least, no scientific information has been available about which patients are referred to multidisciplinary palliative home care teams (MHCT) and by which caregivers, nor about timing of referral and factors associated with it. Methods: A prospective cohort study was carried out during a nine-month period in the oldest Flemish MHCT, and included all patients for whom a palliative care trajectory had been initiated. Results: In total, 325 patients (54% male, mean age 71 years, 83% cancer patients) were referred: 25% by their GP, 24% by hospital social workers, and 22% by the patient's family. Median timing of referral was 26 days (IQR 8-78) before death. Patients of 75 years or older were more likely to have been referred later by comparison with younger patients. Discussion: Timely referral to a MHCT seems to be difficult and not equal for all patients. Referral timing varies largely by age groups and diseases. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Children with special health care needs in foster care in the United States. Szilagyi, M. 2009

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(from the chapter) The United States (USA), like the United Kingdom (UK), has children for whom out-of-home care is deemed essential for issues of safety or health. Out-of-home care in both countries is intended to be a time of healing for children and families and a window of opportunity during which families can acquire services they need to successfully reunite with their children. The governments of both countries have responded in recent years to the growing body of evidence about what children need to thrive, passing legislation intended to provide for the needs of children in out-of-home care, protect them and foster permanency for them. In the USA, there is, of course, a subset of children and adolescents in foster care whose health issues are so significant as to place them in that unique category, called for the purposes of this book, disabled children. As in the UK, the number of children with severe developmental, behavioural and/or emotional conditions dwarfs those with complex physical health issues, sometimes also referred to as multiply-disabling conditions. The overall health status of the 510 000 children and adolescents in foster care in the USA is so poor that the American Academy of Pediatrics (AAP) now recognizes the entire foster care population as a population of 'children with special health care needs'. Given the high prevalence of chronic medical (35-60%), mental health (60-80% of children over age 4 years), developmental (60% of children under age 5 years), educational (45% of children 6-11 years) and dental (30-40%) health conditions, this designation is well-warranted, although it has yet to be translated into coherent policy or result in any re-allocation of health resources. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Chronic obstructive pulmonary disease within LTC families. Mann, J. L. and T. S. Evans. 2005

Not relevant

The objective of this study was to compare the management of chronic obstructive pulmonary disease in LTC facilities with the drug management recommendations set forth by guidelines, to evaluate whether patients were receiving optimal pharmaceutical therapy.

EBSCOhost; rzh

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel. Iecovich, E. 2007

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In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with "live-in" home care workers and those with "live-out" workers, and explores some differences in sociodemographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service. Reprinted by permission of the publisher.

A clinical comparison of an oscillating/rotating powered toothbrush and a manual toothbrush in patients with chronic periodontitis. McCracken, G. I., L. Heasman, F. Stacey, N. Steen, M. deJager and P. A. Heasman. 2004

Not relevant

OBJECTIVES: PRIMARY OBJECTIVE: To compare the relative efficacy of an oscillating/rotating powered toothbrush to that of a conventional manual toothbrush in a group of periodontal patients over a 16-month period with respect to plaque control. SECONDARY OBJECTIVE: To compare differences in pocket depth (PD) and bleeding index (BI) between the two groups over a 16-month period. MATERIAL AND METHODS: Forty patients were recruited to a 16-month, single-blind, two-group, randomised, parallel group clinical trial to compare the effects of manual and oscillating/rotating powered toothbrushes in a cohort of patients with chronic periodontitis. None of the patients had previous experience of using an oscillating/rotating brush and had a mean plaque index (PI) of > 2.0 (modified Quigley and Hein index) at baseline. Patients were stratified by gender, age and smoking status then randomised to using a manual or an oscillating/rotating brush for the duration of the study. Conventional non-surgical periodontal therapy was undertaken within the first month after baseline. PI was the primary outcome measure with PDs and BI also recorded at baseline and months 3, 6, 10 and 16. RESULTS: Mean full-mouth (FM) scores at baseline for oscillating/rotating brushing and manual brushing groups were as follows: PI, 3.4 and 3.5; BI, 1.7 and 1.5; and PD, 3.4 and 3.3. The mean reduction in FM scores from baseline to 16 months were: PI, 0.72 and 0.75; PD, 0.43 and 0.57; and BI, 0.74 and 0.83, respectively. Repeated measures ANOVA were used to compare differences between groups (adjusted for baseline levels) at months 3, 6, 10 and 16 and showed no statistically significant difference between groups for PI and PD (p > 0.05). A difference of 0.2 BI units was detected in favour of the manual brushing group (p = 0.04). CONCLUSION: Over a 16-month period, there were no differences in PI reduction or PD reduction between patients who underwent non-surgical management of chronic periodontal disease and used either an oscillating/rotating powered toothbrush or a conventional manual toothbrush. A difference in gingival bleeding reduction was detected in favour of the patients allocated the manual brush.

EBSCOhost; rzh

A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer. Moorey, S., E. Cort, M. Kapari, B. Monroe, P. Hansford, K. Mannix, M. Henderson, L. Fisher and M. Hotopf. 2009

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BACKGROUND: Cognitive behaviour therapy (CBT) has been shown to reduce psychological morbidity in people with cancer, but no randomized controlled trial (RCT) exists in palliative care. We aimed to determine whether home care nurses could be taught to deliver basic cognitive behavioural techniques and so reduce symptoms of anxiety and depression. METHOD: Clinical nurse specialists (CNSs) at St Christopher's Hospice were randomly allocated to receive training in CBT or continue their usual practice. At the end of the trial, nurses were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Home care patients who scored as possible cases on the Hospital Anxiety and Depression Scale (HADS) entered the trial. Participants received home care nursing visits. Assessments were carried out at baseline, 6, 10 and 16 weeks. RESULTS: Eight nurses received CBT training and seven continued practice as usual. The mean CTFARS scores were 35.9 for the CBT nurses and 19.0 for the controls (p=0.02). A total of 328 patients (54%) were possible cases and 80 entered the trial; most of those excluded were too ill to participate. There was an interaction between group and time: individuals receiving CBT had lower anxiety scores over time [coefficient -0.20, 95% confidence interval (CI) -0.35 to -0.05, p=0.01]. No effect of the training was found for depression. CONCLUSIONS: It is possible to conduct a randomized trial of psychological interventions in palliative care but there is considerable attrition from physical morbidity and mortality. Nurses can learn to integrate basic CBT methods into their clinical practice. This training may be associated with better outcomes for symptoms of anxiety.

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Collaborative therapeutic homework model in occupational therapy. Luboshitzky, D. and L. B. Gaber. 2000

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Difficulties in generalization and transfer of learning often characterize clients suffering from mental health disorders. Occupational therapists must address their clients' generalization process in order to ensure the applicability of the skills taught and practiced in therapy to other clients' various environments. Systematic use of homework in a collaborative client-therapist relationship can provide a useful and efficient therapeutic strategy for addressing generalization and transfer of learning within the context of mental health. This paper describes the guidelines for practice of a collaborative therapeutic homework model and its potential contribution to occupational therapy. A case report is used to illustrate this treatment method.

Ovid Technologies; Embase

Combined effect of factors associated with burdens on primary caregiver. Makizako, H., T. Abe, H. Shimada, T. Ohnuma, T. Furuna and Y. Nakamura. 2009

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Background: It is argued that a multidimensional approach is necessary for burden assessment. Reducing caregiver burden is a social problem in the ageing Japan society. We examined the combined effect of factors affecting the care burden among community-dwelling handicapped people and their caregivers. Methods: The participants were 49 handicapped people (aged 53-104 years) who received home-visit rehabilitation, and their 49 caregivers (age 42-85 years). Caregivers were provided questionnaires consisting of questions on social support, subjective well-being, self-efficacy with regard to care continuation, the Motor Fitness Scale and caregiver burden. Care recipients were assessed using the Bedside Mobility Scale and the Barthel Index. Results: We prepared the hypothesis model using structural equation modeling with the bootstrap method within outcome measures. The hypothesis model did not fit the data well. The impact of the Motor Fitness Scale was shifted from the caregiver burden to care self-efficacy and well-being, having a cooperator for care and variable of spouse caregiver or others associated with caregiver well-being in the revised model. The fit of the revised model was acceptable (goodness of fit index, 0.903; comparative fit index, 0.998; root mean square error of approximation, 0.017). In the revised model, the care recipients' disabled state was associated with caregiver burden. In addition, higher burden and poor motor fitness of caregivers might lead to lower care self-efficacy in providing continuous care and lower caregiver well-being. Conclusion: These findings suggested that the program to reduce caregiver burden should focus on aspects of the care recipients' disabled state, the caregivers' well-being, fitness, and care self-efficacy. copyright 2009 Japan Geriatrics Society.

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The community case management program: for 12 years, caring at its best. Luzinski, C. H., E. Stockbridge, J. Craighead, D. Bayliss, M. Schmidt and J. Seideman. 2008

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One of the most complex issues currently under debate in this country is how best to provide health care for our society. Since 1995, Poudre Valley Hospital in Fort Collins, Colorado, has been effectively addressing one facet of this national crisis by providing services to a population of primarily elderly, chronically ill individuals perpetually caught in the gaps between acute and end-of-life services. Community case managers link program participants with appropriate health care services and providers that enhance physiological and functional status, identify resources that enrich quality of life, and encourage relationships and skills which foster self-efficacy. By emphasizing timely access to health-maximizing services, this program documented an impressive 81% reduction in financial losses to the organization during 2006 for emergency and inpatient services provided to a specific sample from this population.

Ovid Technologies; Ovid MEDLINE(R)

Community elder-care in Tasmania: examining whether caregivers believe they "make-a-difference" in an urban and rural island. Ferrari, J. R., M. Kapoor, M. J. Bristow and H. W. Bowman. 2006

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Adult caregivers (n = 184;Mage = 43.9 years old) working at a non-profit, eldercare program at five geographically diverse sites located in the self-contained, island state of Tasmania, Australia, completed a set of self-report measures. Results across the five sites indicated that respondents experienced a relatively strong sense of self-efficacy toward making a difference in their local community. However, there were significant differences (controlling for social desirability) when comparing caregivers from rural northern (n = 45) with urban southern (n = 139) communities, with rural caregivers claiming stronger sense of common mission with others, reciprocal responsibility to help others, and caregiver satisfaction, plus lower disharmony with other members and caregiver stress in helping the elderly than urban caregivers. Implications suggest that community self-efficacy may be high among eldercare staff, but their sense of community and caregiving perceptions may reflect geographic differences, especially in Tasmania.

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Community powers under the Mental Health Act: care or control? Griffith, R. and C. Tengnah. 2005

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District Nursing Sister Janet Jones had been visiting a young patient, Peter James, 20, at his bedsit on a weekly basis to assist him with the management of his diabetes. However some 6 months ago Peter stopped eating and began refusing to take his insulin because he believed that they had been contaminated by alien dust. Sister Jones and the GP also noticed that Peter was drinking considerable quantities of alcohol and there were reports of him engaging in bizarre sexual rituals. Concern about Peter's mental health and refusal of treatment resulted in him being detained under the Mental Health Act 1983. Sister Jones has now received a request from the mental health unit to visit Peter at his home during a period of leave he has been granted by his responsible medical officer (RMO) and to continue visiting as part of his aftercare arrangements when he is discharged. Sister Jones wonders if the mental health team will be able to manage Peter in the community given his previous reluctance to accept treatment and how Peter will afford the aftercare package of home care support and meals on wheels provided by the local authority.

EBSCOhost; rzh

Community use of intranasal midazolam for managing prolonged seizures. Kyrkou, M., M. Harbord, N. Kyrkou, D. Kay and K. Coulthard. 2006

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BACKGROUND: Until a few years ago, rectal diazepam (RD) was the only option available to parents and carers managing prolonged seizures. However, its use in the community was limited due to the requirement for privacy, and because education staff in South Australia are not permitted to carry out invasive procedures. METHOD: Following a literature review, a seizure management training package was developed to enhance the implementation of a trial treatment protocol for the administration of intranasal midazolam (INM). Parents, carers and education staff were later surveyed about their experiences and perceptions. RESULTS: Intranasal midazolam was administered to 131 people (51 children and 80 adults), with 96.9% control of seizures, and only one minor adverse event. Parents expressed a preference for INM over RD because of the shorter time it took to take effect and wear off, and the ability to administer it in public if necessary. CONCLUSION: Intranasal midazolam is a safe and practical alternative to rectal diazepam for managing prolonged seizures in the community.

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Community-based treatment of venous thromboembolism with a low-molecular-weight heparin and warfarin. Hyers, T. M. and A. C. Spyropoulos. 2007

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This multicenter, prospective, open label, observational study evaluated practice patterns of physicians using tinzaparin, a low-molecular-weight heparin (LMWH), and warfarin for the treatment of deep venous thrombosis (DVT) with or without pulmonary embolism (PE). Short-term recurrence of venous thromboembolism (VTE) and safety were also evaluated. Patients with an objective diagnosis of DVT, with or without PE, were invited by their physician to participate in this study. Treatment was given according to the approved U.S. package inserts for tinzaparin (175 IU/kg SQ QD) and warfarin and the clinical judgment of the prescribing physician. Baseline patient history including demographic information and the results of tests to confirm the diagnosis of DVT, with or without PE, were collected. Follow-up information included the treatment setting in which each dose of tinzaparin was administered, medical training of the person administering tinzaparin doses, timing of initiation of warfarin with respect to that of tinzaparin, length of overlap of tinzaparin and warfarin therapy, and adverse experiences. A total of 334 patients were enrolled at 65 sites. Patients across a wide age (range 18-93 years old) and body weight (range 40-261 kg) were included. Overall, 27.3% of patients had cancer, and 50% of the overall study population reported more than one VTE risk factor. Mean duration of tinzaparin treatment was 7.61 days. Therapy at home was more common in suburban and rural settings than in urban settings. High proportions of patient, even among the small group with concurrent PE, were treated at home with self-injection. Severity of disease was the primary reason for hospitalization. Home treatment of DVT, with or without PE, with self administration of tinzaparin at 175 IU SQ once-daily was safe and resulted in an acceptably low rate of recurrent venous thromboembolism and adverse events. Home therapy in the usual practice setting should achieve substantial overall cost savings in the treatment of DVT.

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Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial. Ciechanowski, P., E. Wagner, K. Schmaling, S. Schwartz, B. Williams, P. Diehr, J. Kulzer, S. Gray, C. Collier and J. LoGerfo. 2004

Not relevant

Examined community-integrated home-based depression treatment in 138 older adults (mean age 73 yrs), in a randomized controlled trial using the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS). Ss were adults aged 60+ yrs or older who were receiving services from senior service agencies or living in public housing with DSM-IV minor depression or dysthymia diagnostic criteria. The Primary Care Evaluation of Mental Disorders screening tool was completed. Ss were interviewed by trainer researcher using the Structured Clinical Interview for DSM-IV. Health-related quality of life, physical, social, and emotional functioning were assessed at baseline and 12 months. Health-care utilization was assessed in three 6 month periods from 6 mo before to 12 mo after baseline. Results revealed that the PEARLS intervention resulted in significantly lower severity and greater remission of depression compared with usual care at 6 and 12 months. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

A comparative analysis of short stays versus long stays in adult day health care programs. Dabelko, H. I. 2005

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The purpose of this study is to identify challenges to continual use of adult day services. Individuals who stayed in five adult day health care programs for four weeks or less are compared to those who stayed enrolled more than four weeks. Data were gathered from new intake files recorded January 1, 1999 to December 31, 2000 at five adult day programs operating in central Ohio. This study is based on 143 clients who disenrolled during this study period. Short stay participants were significantly different from long stay participants in race, educational level, mental health, and in financial and social resources. The findings support the important partnerships between informal and formal care resources in the utilization of adult day services and ultimately community-based living.

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Comparison of clinic-based home assessment to a home visit in demented elderly patients. Ramsdell, J. W., J. E. Jackson, H. J. Guy and M. J. Renvall. 2004

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Home visits assessing demented elderly patients yield important information but are perceived to be expensive. We investigated the utility of a home assessment during a clinic visit. A total of 200 demented subjects attending an outpatient geriatric assessment program were enrolled in a prospective, repeated-measures design study comparing the yield of a structured clinic-based home assessment with the yield of a home visit (the criterion standard). A total of 172 subjects completed the protocol. The average age was 76 +/- 7 years, 68% were female, 48% married, and the average Mini-Mental Status Examination score was 21 +/- 7 points. Only 3 subjects had complete agreement by site, 162 subjects had at least one problem identified only at the home visit, and 7 subjects had at least one problem identified only at the clinic. There were 376 problems identified at both sites, 422 identified only by the home visit, and 478 identified only in the clinic. Problems related to patient safety and caregiver issues were the two most common general categories. Eighty-four percent of the problems identified only at the home visit were potentially serious and 24% of problems identified at both sites were rated as more serious at the home visit. A clinic-based home assessment is not comparable to a home visit for assessing the home environment of demented elderly patients.

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Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care. Leff, B., L. Burton, S. L. Mader, B. Naughton, J. Burl, W. B. Greenough, S. Guido and D. Steinwachs. 2009

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OBJECTIVES: To compare differences in the functional outcomes experienced by patients cared for in Hospital at Home (HaH) and traditional acute hospital care. DESIGN: Survey questionnaire of participants in a prospective nonrandomized clinical trial. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbations of chronic heart failure or chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in HaH and 130 in an acute care hospital. INTERVENTION: Treatment in a HaH care model that substitutes for care provided in the traditional acute care hospital. MEASUREMENTS: Change in activity of daily living (ADL) and instrumental activity of daily living (IADL) scores from 1 month before admission to 2 weeks post admission to HaH or acute hospital and the proportion of groups that experienced improvement, no change, or decline in ADL and IADL scores. RESULTS: Patients treated in HaH experienced modest improvements in performance scores, whereas those treated in the acute care hospital declined (ADL, 0.39 vs -0.60, P=.10, range -12.0 to 7.0; IADL 0.74 vs -0.70, P=.007, range -5.0 to 10.0); a greater proportion of HaH patients improved in function and smaller proportions declined or had no change in ADLs (44% vs 25%, P=.10) or IADLs (46% vs 17%, P=.04). CONCLUSION: HaH care is associated with modestly better improvements in IADL status and trends toward more improvement in ADL status than traditional acute hospital care.

EBSCOhost; rzh

A Comparison of General Public and Physician Attitudes Towards Use of Home Health Care Services at End-of-Life. Kakuma, T., Y. Yada, Y. Kono, N. Ikegami and A. Schreiner. 2004

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An abstract of a study examining attitudes towards home health care among adult community residents and physicians by Kakuma et al is presented. Findings suggest that concern over family caregiver burden and uncertainty over the degree of support are major barriers to the development of home care services.

CSA Social Services Abstracts

A comparison of reports of caregiver burden between foster family care providers and staff caregivers in other settings. McCallion, P., T. Nickle and M. McCarron. 2005

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There has been increasing concern about the impact of dementia symptoms on the lives and on the care being provided for persons with intellectual disability (ID) in out-of-home settings. One such setting that has received little attention is foster family care homes. These settings in the USA replicate family living and while some supports and resources are provided, they are not designed to meet intensive care needs. As a preliminary step in understanding family experiences and to expand the range of interest in Alzheimer's disease (AD) in persons with ID beyond traditional out-of-home settings, a pilot study was initiated that included aging persons with ID and symptoms of AD who were living in foster family care settings in two regions of New York State as well as more traditional out-of-home care subjects. Comparisons of matched samples on subjective and objective burden measures suggest that there are few differences in experiences. The limitations of these findings are considered and recommendations made for future, related research.

EBSCOhost; rzh

Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care. Leff, B., L. Burton, S. L. Mader, B. Naughton, J. Burl, D. Koehn, R. Clark, W. B. Greenough, III, S. Guido, D. Steinwachs and J. R. Burton. 2008

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OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care. DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. INTERVENTION: Treatment in a substitutive HaH model. MEASUREMENTS: Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care. RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean +/- standard deviation 1.7 +/- 1.8 vs 4.3 +/- 3.1, P<.001; median 1 vs 4, P<.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05-0.30). CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.

EBSCOhost; rzh

Comparisons of hypertension-related costs from multinational clinical studies. Mullins, C. D., M. Sikirica, V. Seneviratne, J. Ahn and K. S. Akhras. 1001

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Background: This study identifies and compares the individual cost components of hospital and ambulatory services that manage the care of hypertensive patients in eight countries: the US, the UK, France, Spain, Germany, Italy, Canada and Australia. Methods: Hypertension-related costs are classified according to four major cardiovascular events: (i) acute myocardial infarction; (ii) congestive heart failure; (iii) stroke; and (iv) renal failure, which was subdivided into renal failure treated by dialysis and renal failure treated by kidney transplantation. To make cross-country costs comparisons, we used the DRG codes used in the US and ERG-like codes from each country. US cost information was obtained from hypertension data available from the literature and health economics researchers. For costs in other countries, we consulted with national health economics experts in each country, used analyses by the Research Triangle Institute, and performed Medline and international literature searches. When available, we obtained information from the countries' public and private nationally representative data sources. For cross-country currency adjustments, all currencies were converted using the Purchasing Power Parities from the Organisation for Economic Cooperation and Development, and then converted into inflation-adjusted year 2000 US dollars. Results: There exists considerable variation in hypertension-related costs from multinational clinical studies. This study documents that costs are generally higher in the US than in other countries; however, this is not always true. In particular, costs of treating heart failure in France and the costs of renal failure without transplantation in Germany and the UK are relatively high. Discussion: While analysing multinational hypertensive cost data, this study also addresses the impact of cross-country cost variations on cost analyses. During the last decade, drug-development researchers have drawn extensively upon multinational trials to resolve enrolment problems and drug-registration issues. At the same time, formulary decision-makers are increasingly demanding multinational cost-effectiveness analyses of the clinical differences found between drug-treatment regimens. Since these data are typically not captured by randomised clinical trials, standard cost estimates must be applied to the clinical trials' resource data, although such standardised calculations do not necessarily account for clinical and cost variations between countries. Conclusion: This paper serves as an instrument for identifying which national and event cost data are comparable for analysis as well as highlighting specific problem areas for cost data integration. Although the study focuses on hypertension-related costs, its results may provide insight for multinational cost comparisons of other diseases where similar hospitalisation costs may be analysed.

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Compressing "the sandwiched": an examination of reductionist health policies on women in Canada. Jegen, D. A. 2008

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Worldwide, policymakers are critically examining the escalating costs of health care. One proposed solution has been to move away from a centralized "general hospital"-type of treatment in favor of a family-based model emphasizing health as well as treatment. While I agree that such approaches constitute an innovative outlook on health care, I draw on a social ecological approach in order to attract attention to and lay out the argument for future research examining the unacknowledged and unstudied impact that such proposed policies will have on women. Undoubtedly, it is they who will bear the brunt of the proposed health-related responsibilities offloaded by governments. I examine the implications of such proposed policies on Canadians, particularly Canadian women, although the Canadian system is but an exemplar of the changing dynamics of caregiving in a broader world situation.

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Computer-assisted treatment of word retrieval deficits in aphasia. Fink, R. B., A. Brecher, P. Sobel and M. F. Schwartz. 2005

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Background: There are now numerous experimental studies demonstrating successful treatment of word retrieval deficits in aphasia. Technological advances allow us to implement many of these approaches on the computer and target the underlying impairment (e.g., in phonologically vs semantically based retrieval deficits). These computer-assisted treatments have the potential to facilitate the work of clinicians and, if geared towards independent or volunteer-assisted usage, extend the rehabilitation process beyond the period of formal therapy. Aims: Our aim is to review the benefits and limitations of computer-assisted treatment for word retrieval deficits, focusing on the lessons we have learned from a computerised therapy system, developed in our laboratory, which was designed to be used in the clinical setting, as well as by patients working independently. Contributions: We review relevant single and multiple case studies that use computer-assisted treatment programmes in various clinical and home settings. We then describe an outcome study that used the therapy system developed in our laboratory to deliver a hierarchical, multi-modality cueing protocol under clinician-guided and self-guided instruction. Through the use of mini case studies, we exemplify the system's application in the clinical setting and in home usage. Additionally we present use and satisfaction data which impact on clinical and home use. Conclusions: Theoretically motivated, computer-assisted treatments for naming impairments can be beneficial as an adjunct to one-on-one speech/ language therapy, and are an effective way to intensify and continue the rehabilitation process. While many of our patients are capable of working independently or with minimal assistance to achieve their goals, computers still represent an unfamiliar and intimidating technology for the majority of our patients and families; and access in the home remains limited. One way to provide needed support is through a computer lab, staffed by trained volunteers working under the supervision of a speech-language pathologist. Additional research is needed to replicate these findings with a larger and more diverse group of individuals with aphasia and to evaluate the effectiveness of the Multi-modality Matching Module of MossTalk WordsR software in the treatment of semantically based anomia. This could potentially provide pilot data for a large scale clinical trial. copyright 2005 Psychology Press Ltd.

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The concept of care-related quality of life. Pieper, R. and M. Vaarama. 2008

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(from the chapter) In gerontology, there is a substantial and increasing body of theoretical and empirical research on quality of life (QoL) in old age, especially in psychology and health-related research. However, a specific focus on QoL of frail older persons or older persons with permanent need of external help is rare, and even more neglected is the role of care for their QoL. In addition, the question of how much the existing definitions really reflect the opinions of older people themselves has got too little attention (Bowling, Gabriel, Banister, & Sutton, 2002). These notions motivated the Care Keys research to search for a better understanding of the role of homecare and institutional care for the QoL of frail older persons. Applying the production of welfare approach, the aim was to produce information on the specific life situations of these older persons, and on the linkages between care and QoL. By providing a model of care-related QoL we aimed at a concept that would allow for the evaluation of care practices in view of their outcomes for frail older persons, thus supporting development of care practices as well as quality management of (long-term) care. Searching for a theoretical model of QoL of frail older persons we found suitable starting points, but also encountered unresolved issues and open questions. This situation prompted the Care Keys research to proceed in two directions. First, we selected concepts and instruments that were available in the literature, introduced some preliminary adaptations to the life circumstances of frail older persons receiving care, and investigated the relation of care quality to QoL as an outcome. Second, we took a closer look at the theoretical issues and their relevance for a concept of care-related QoL. The results of the theoretical reflections on QoL are presented and discussed in this chapter. We will distinguish three different sub-models that combine objective circumstances and subjective interpretations (structural model), ask for the role of the client and the role of care (production model) and reflect on the "negotiation of order" in care processes (normative model). (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Concerns of terminally ill cancer patients in their home environment. Rolf, C. and G. Pool. 2006

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In this letter to the editor, the authors reveal their findings about the concerns of Dutch terminally ill cancer patients who stayed in their home environment to pass away. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Connection, regulation, and care plan innovation: a case study of four nursing homes. Colón-Emeric, C. S., D. Lekan-Rutledge, Q. Utley-Smith, N. Ammarell, D. Bailey, M. L. Piven, K. Corazzini and R. A. Anderson. 2006

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We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of staff connection were associated with higher care plan specificity and innovation. Connection of the frontline nursing staff was crucial for (1) implementation of the formal care plan and (2) spontaneous informal care planning responsive to changing resident needs. Although regulations could theoretically improve cognitive diversity and information flow in care planning, we observed instances of regulatory oversight resulting in less specific care plans and abandonment of an effective care planning process. Interventions which improve staff connectedness may improve resident outcomes.

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Continuous mobile services for healthcare: The health wear project. Malliopoulos, C., A. Milsis, T. Vavouras, R. Paradiso, A. Alonso and D. Cianflone. 2008

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Contemporary advances in information, communication and human-computer interaction technologies are prompting the redesign of healthcare provision. A number of disease management strategies, especially those targeting chronic conditions, could benefit from the application of wearable computing facilities and mobile data access. Prime examples of this are programmes supporting home hospitalisation, early discharge or prevention of exacerbations in patients with chronic diseases. HealthWear is a European project aimed at evaluating health-monitoring services based on wearable garments consisting of special textiles with knitted sensory devices. The garments allow patients to continue with their everyday activities whilst providing remote and ubiquitous monitoring of physiological parameters such as heart rate, oxygen saturation, temperature and breathing rate. Devices collect the data and transmit it to a central processing centre using wireless telecommunications. The service is designed to be used for three main clinical scenarios: rehabilitation of patients following an acute event, e.g. a heart attack, early discharge of chronic disease patients, e.g. those with chronic obstructive pulmonary disease, and promotion of physical activity in ambulatory stable cardio-respiratory patients. In this paper we elaborate on the technical aspects of the service describing the technologies used and the system architecture. We also briefly discuss the commercial aspects of the service. copyright The Journal on Information Technology in Healthcare.

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Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses. Goldschmidt, D., M. Groenvold, A. T. Johnsen, A. S. Strömgren, A. Krasnik and L. Schmidt. 2005

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BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced by 91%, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory. Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance cooperation.

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Coping strategies in the presence of one's own impending death from cancer. Sand, L., M. Olsson and P. Strang. 2009

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An incurable cancer is a threat to life itself. This study focused on how native-born Swedes, who define themselves as nonreligious, actually reflect and act when they try to create helpful strategies in the presence of their own impending deaths and how the strategies serve their purposes. Twenty patients were interviewed in depth. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed and analyzed with a qualitative, hermeneutic interpretative method. The informants' efforts to develop useful strategies to restrain death could be symbolized as a cognitive and emotional pendulum, swinging between the extremes of life and death. During the swings of the pendulum, the informants used every means available: their own resources, other people, animals, nature, a transcendent power, hope, imagination and magical thinking. They strove to find factors that fitted their conceptual system and supported their inner balance and structure, all to keep death at a discreet distance and preserve their links to life. These links were togetherness, involvement, hope and continuance, and they served as a shield against hurtful feelings connected to their impending death. The new knowledge about how strategies in the presence of one's own impending death can develop and be used is perhaps the most novel and clinically relevant contribution of this study. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Cost of outpatient medical care for children and youth with special health care needs: investigating the impact of the medical home. Damiano, P. C., E. T. Momany, M. C. Tyler, A. J. Penziner and J. G. Lobas. 2006

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OBJECTIVE: Our goal was to evaluate the impact of having a medical home on the outpatient medical costs of children and youth with special health care needs. DESIGN: Data from 2 sources were matched at the individual level: (1) the 2002 Iowa Consumer Assessment of Health Plans Study survey of Medicaid enrollees and (2) Iowa Medicaid administrative claims, encounter, and enrollment files. PARTICIPANTS: The subjects were 1140 children aged 6 months to 12 years for whom both sources of data were available. MAIN OUTCOME MEASURE(S): Outcomes measures included medical homeness, as developed by a scale of items in the Consumer Assessment of Health Plans Study survey, and outpatient costs, as determined from Medicaid administrative data. RESULTS: From the regression models, we found that (1) for all Medicaid-enrolled children, outpatient costs were significantly higher for female children and children and youth with special health care needs, (2) for children and youth without special health care needs, costs were significantly higher for female children, those with a personal doctor or nurse, and those with more of a medical home, and (3) for children and youth with special health care needs, costs were significantly higher for those in a lower health state, for those in health maintenance organization 2, and for older children. CONCLUSIONS: Although the degree of medical homeness was not related to outpatient costs for children and youth with special health care needs, medical homeness may affect inpatient costs more than outpatient costs for children and youth with special health care needs and should be investigated further.

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Cost-effectiveness analysis of current practice and parent intervention for children under 3 years presenting with expressive language delay. Gibbard, D., L. Coglan and J. MacDonald. 2004

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BACKGROUND: Parents and professionals can both play a role in improving children's expressive language development and a number of alternative models of delivery exist that involve different levels of input by these two groups. However, these alternative treatments have not been subject to rigorous comparative analysis in terms of both cost and clinical effectiveness. AIMS: To compare, from the viewpoint of the healthcare provider, parent-based intervention (PBI) for preschool children presenting with expressive language delay with current practice observed in an actual healthcare setting where parents of the child follow a professional's advice on a review basis. METHODS & PROCEDURES: Two groups of children were compared on a variety of expressive and receptive language assessment measures. One group (n=10) received standard individual general care. The comparison group (n=12) received PBI. OUTCOMES & RESULTS: After the 6-month study, the results indicated that children who received PBI made significantly greater language gains that children who received current practice. In addition, a cost-effective analysis was conducted. This showed that although the language gains delivered by PBI did incur some additional costs for the healthcare provider, there was no significant increase in cost per outcome gain over general care. CONCLUSIONS: Options in the implementation of PBI are discussed that could potentially save costs for the healthcare providers and increase the value of a PBI-based approach.

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Costs and quality of life of patients with multiple sclerosis in Europe. Kobelt, G., J. Berg, P. Lindgren, S. Fredrikson and B. Jonsson. 2006

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Objective: To assess overall resource consumption, work capacity and quality of life of patients with multiple sclerosis in nine European countries. Methods: Information on resource consumption related to multiple sclerosis, informal care by relatives, productivity losses and overall quality of life (utility) was collected with a standardised pre-tested questionnaire from 13,186 patients enrolled in national multiple sclerosis societies or followed up in neurology clinics. Information on disease included disease duration, self-assessed disease severity and relapses. Mean annual costs per patient (Euro, 2005) were estimated from the societal perspective. Results: The mean age ranged from 45.1 to 53.4 years, and all levels of disease severity were represented. Between 16% and 29% of patients reported experiencing a relapse in the 3 months preceding data collection. The proportion of patients in early retirement because of multiple sclerosis ranged from 33% to 45%. The use of direct medical resources (eg, hospitalisation, consultations and drugs) varied considerably across countries, whereas the use of non-medical resources (eg, walking sticks, wheel chairs, modifications to house and car) and services (eg, home care and transportation) was comparable. Informal care use was highly correlated with disease severity, but was further influenced by healthcare systems and family structure. All types of costs increased with worsening disease. The total mean annual costs per patient (adjusted for gross domestic product purchasing power) were estimated at Euro 18,000 for mild disease (Expanded Disability Status Scale (EDSS) <4.0), Euro 36,500 for moderate disease (EDSS 4.0-6.5) and Euro 62,000 for severe disease (EDSS >7.0). Utility was similar across countries at around 0.70 for a patient with an EDSS of 2.0 and around 0.45 for a patient with an EDSS of 6.5. Intangible costs were estimated at around Euro 13,000 per patient. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Costs of home assistance for peritoneal dialysis: Results of a European survey. Dratwa, M. 2008

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Assisted peritoneal dialysis (aPD) was 'invented' in France in 1977 and was immediately very well reimbursed. This has since helped to maintain a high French peritoneal dialysis (PD) penetration rate among elderly dependent patients who might enjoy a better quality of life by remaining in their own environment. The aim of this study was to investigate the present status of aPD funding in European countries through a questionnaire sent in 2006 to health authorities and commercial PD providers asking about reimbursement modalities (in euros ([euro]) per patient per year) for nurse aPD. Specific funding for aPD only exists in Belgium, Denmark, France, Switzerland, and one region of Spain (Canary Islands). Germany and the United Kingdom are testing pilot schemes. Compared to France, all other countries exhibit significant differences in reimbursement for similar services (performing bag exchanges or disconnections from/to a cycler, exit site care, monitoring weight as well as blood pressure and ultrafiltration, and also including transportation costs) both for continuous ambulatory peritoneal dialysis (CAPD) (23 400 vs 7280 [euro] per patient per year in Spain) and automated peritoneal dialysis (APD) (18 200 vs 5356 [euro] per patient per year in Belgium); these differences are difficult to understand and might reflect disparities in cost of living, national health-care budget, and/or mean nurses' salaries. Also, there is no correlation between these rates and the reimbursement for PD therapy itself. Only France and Belgium differentiate assisted CAPD and APD, but these differences do not reflect the time really spent at the patient's home. It is concluded that high reimbursement rates for assistance add significant extra cost to PD, but allow granting many dependent patients all the advantages of home therapy, instead of treating them with in-center hemodialysis which in any case still remains more expensive for our societies. copyright 2008 International Society of Nephrology.

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The cost-utility of a care coordination/home telehealth programme for veterans with diabetes. Barnett, T. E., N. R. Chumbler, W. Vogel, R. J. Beyth, P. Ryan and S. Figueroa. 2007

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We examined the cost-effectiveness of a care coordination/home telehealth (CCHT) programme for veterans with diabetes. We conducted a retrospective, pre-post study which compared data for a cohort of veterans (n = 370) before and after the introduction of the CCHT programme for two periods of 12 months. To assess the cost-effectiveness, we converted the patients' health-related quality of life data into Quality Adjusted Life Year (QALY) utility scores and used costs to construct incremental cost-effectiveness ratios (ICERs). The overall mean ICER for the programme at one-year was $60,941, a value within the commonly-cited range of cost-effectiveness of $50,000-100,000. The programme was cost-effective for one-third of the participants. Characteristics that contributed to cost-effectiveness were marital status, location and clinically relevant co-morbidities. By targeting the intervention differently in future work, it may become cost-effective for a greater proportion of patients. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Creating a continuum of care for chronically underserved children. McKee, J., J. Storrs and S. Humphrey. 2007

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Background: Grandfather Home for Children, a nonprofit residential treatment center in North Carolina, serves children with histories of abuse who exhibit sexual behavior problems and acute physical aggression. In June 2000, it launched an initiative to create placement resources for children who had been identified as chronically underserved--foster care, adoption services, and other appropriate community services.

Methods: A total of 638 children served by Grandfather Home for Children were included in this study. The data were collected during a six-year period (October 1999-September 2005). The data to assess the agency's goals was collected through the agency's general performance indicators that are gathered on a quarterly and yearly basis, based on the agency's fiscal year. Performance improvement activities included substantive changes in administrative, staffing, training, and information systems.

Results: Between 1999 and 2005 the agency's initiative achieved a 342% increase in the number of children it was able to serve, a 33% decrease in the average length of stay for children in care and a 721% increase in the percentage of children served in their home community, and 100% of the foster children had two or fewer placements.

Discussion: The initiative to create a continuum of care has enabled the agency to successfully provide step-down opportunities and serve more children in the least restrictive environment for a shorter period of time with fewer placement changes than observed in comparative statistics at both the federal or state level.

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Creating gender egalitarian societies: An agenda for reform. Gornick, J. C. and M. K. Meyers. 2008

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In this article, we describe the social and economic changes that have contributed to contemporary problems of work-family conflict, gender inequality, and risks to children's healthy development. We draw on feminist welfare state scholarship to outline an institutional arrangement that would support an earner-carer society-a social arrangement in which women and men engage symmetrically in paid work and unpaid caregiving and where young children have ample time with their parents. We present a blueprint for work-family reconciliation policies in three areas-paid family-leave provisions, working-time regulations, and early childhood education and care-and we identify key policy design principles. We describe and assess these work-family reconciliation policies as they operate in six European countries widely considered to be policy exemplars: Denmark, Finland, Norway, Sweden, Belgium, and France. We close with an analysis of potential objections to these policies.

Defining and measuring service awareness among elders and caregivers of Mexican descent. Crist, J. D., C. Michaels, D. E. Gelfand and L. R. Phillips. 2007

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Mexican American elders' and their caregivers' awareness of available home care services is one of nine factors hypothesized to be associated with underuse of home care services. Previous instruments did not fully measure service awareness. The objective of this study was to explore the conceptual foundation of service awareness, generate items, and establish language equivalence in Spanish and English for the Service Awareness Scale. A hybrid use of the literature and fieldwork were used to develop the concept and generate items. The team used back-translation and community collaboration to test for language equivalence. Concept development and language equivalence were achieved for the Service Awareness Scale. Teaching/learning theories contributed to the definition and inductive validity of service awareness and item generation and can shape future interventions. Bicultural/bilingual community and research team partners refined its measure. The scale will be usable in research and practice designed to promote equity in health care use.

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Delivery of high-tech home care by hospital-based nursing units in Quebec: clinical and technical challenges. Lehoux, P., L. Richard, R. Pineault and J. Saint-Arnaud. 2006

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BACKGROUND: The role that hospital-based nurses should play in the delivery of high-tech home care, and how they should be supported in that role, are topics that remain understudied. Our research objective was to document how hospital-based nursing teams perceive and deal with the clinical and technical challenges associated with the provision of high-tech home care. METHODS: Four home care interventions were selected: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. A self-administered survey was sent to all hospital-based units providing these interventions in the province of Quebec, Canada (n = 154; response rate: 70.8%). We used descriptive statistical analyses to derive mean values for scores on either a five- or a six-level Likert scale. RESULTS: Despite variation across the four interventions, our results indicate that while nursing teams believe these interventions increase patients' autonomy, they also recognize that they generate anxiety and impose constraints on patients' lives. Nurses must increase efforts to deal with both clinical and technical challenges and help patients overcome the barriers to appropriate use of home care technologies. CONCLUSIONS: While nursing teams generally perceive high-tech home care as beneficial, they still experience significant technical and clinical challenges. Some of these challenges could be addressed by strengthening professional training initiatives, while others require broader home care policy interventions.

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Demographics of wheelchair users in France: Results of national community-based handicaps-incapacites-dependance surveys. Vignier, N., J. F. Ravaud, M. Winance, F. X. Lepoutre and I. Ville. 2008

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Objective: To highlight the prevalence of manual and/or powered wheelchair use within the general French population living at home or in institutions, to describe the users and to identify factors determining wheelchair use. Methods: Data were obtained from national community-based Handicaps-Incapacites-Dependance surveys on disability and dependency carried out on 2 representative samples of the French population in institutions (n = 15,288) and at home (n = 16,945). Results: The prevalence of wheelchair use is 62 per 10,000 people living in France. Forty-three percent of users live in institutions. They frequently show multiple impairments and severe disabilities. They have a mean age of 70 years and 64% are women. After taking confounding factors into account, results show that wheelchair use is not sex-related and decreases slightly with age. On the other hand, wheelchair use is related to widowhood, to the extent of impairments and disabilities, to confinement, to exposure to environmental obstacles and to institutional life. Conclusion: Sociodemographic studies on the use of wheelchairs need to pay greater attention to people living in institutions. The prevalence of wheelchair use in France appears to be far lower than in other western countries, and this observation needs to be examined further with intercultural comparisons. copyright 2008 The Authors. Journal Compilation copyright 2008 Foundation of Rehabilitation Information.

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Depression among surviving caregivers: does length of hospice enrollment matter? Bradley, E. H., H. Prigerson, M. D. Carlson, E. Cherlin, R. Johnson-Hurzeler and S. V. Kasl. 2004

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OBJECTIVE: Many terminally ill patients enroll in a hospice late in their illness, and recent data indicate decreasing lengths of hospice enrollment, yet we know little about the impact of hospice enrollment length on surviving caregivers. This is the first study the authors know of that examines the association between hospice enrollment length and subsequent major depressive disorder among surviving caregivers. METHOD: The authors conducted a prospective cohort study with 174 primary family caregivers of consecutively enrolled hospice patients with cancer between October 1999 and September 2001. Using data from in-person interviews at the time of enrollment and 6-8 months after the patient's death, they estimated with logistic regression the adjusted risk of major depressive disorder with the Structured Clinical Interview for the DSM-IV axis I modules based on the number of days of hospice care before death. RESULTS: Caregivers of patients enrolled with hospice for 3 or fewer days were significantly more likely to have major depressive disorder at the follow-up interview than caregivers of those with longer hospice enrollment (24.1% versus 9.0%, respectively), adjusted for baseline major depressive disorder and other potential confounders. CONCLUSIONS: The findings identify a target group for whom bereavement services might be most needed. The authors also suggest that earlier hospice enrollment may help reduce the risk of major depressive disorder during the first 6-8 months of bereavement, which raises concerns about recent trends toward decreasing lengths of hospice enrollment before death.

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A description of adverse events in home healthcare. Madigan, E. A. 2007

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Patient safety has taken on increasing importance in the American healthcare system, yet there is little information on patient safety in home healthcare. The current study aimed to describe the most frequent adverse events defined by the Centers for Medicare & Medicaid Services among the national population of patients receiving home healthcare in 2003, and to compare characteristics between patients who experience adverse events and those who do not. The findings show that 13% of all home healthcare patients had an adverse event, with 80% experiencing only 1 adverse event. More than three fourths of the adverse events were associated with discharge to the community and required continued assistance. Patients who experienced adverse events were older, had more depressive symptoms and behavioral problems, and were more functionally impaired. Women had a slightly lower relative risk of an adverse event (.98), whereas patients of minority ethnicity had a slightly higher relative risk (1.06). These findings suggest that home healthcare agencies may need to spend more time on discharge planning after home healthcare and work with existing community providers. The findings also raise questions regarding the appropriateness of these adverse events and whether there are additional adverse events that warrant monitoring and follow-up evaluation.

EBSCOhost; rzh

Designing a technology enhanced practice for home nursing care of patients with congestive heart failure. Casper, G. R., B. T. Karsh, C. K. Or, P. Carayon, A. S. Grenier and P. F. Brennan. 2005

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This paper describes the process we used to design the HeartCare website to support Technology Enhanced Practice (TEP) for home care nurses engaged in providing care for patients with Congestive Heart Failure (CHF). Composed of communication, information, and self-monitoring functions, the HeartCare website is aimed at supporting best practice nursing care for these patients. Its unique focus is professional practice, thus the scope of this project is greater and more abstract than those focusing on a task or set of activities. A modified macroergonomic analysis, design work system analysis, and focus groups utilizing participatory design methodology were undertaken to characterize the nursing practice model. Design of the HeartCare website required synthesizing the extant practice model and the agency's evidence-based heart failure protocols, identifying aspects of practice that could be enhanced by supporting technology, and delineation of functional requirements of the Enhanced HeartCare technology. Validation and refinement of the website and planning for user training activities will be accomplished through a two-stage usability testing strategy.

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Designing sexual health services for young people: a methodology for capturing the user voice. Jerome, S., C. Hicks and S. Herron-Marx. 2009

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The aim of the study was to assess the suitability of the Thurstone paired comparison method for capturing the user voice, through a survey of young people's views on the most salient priorities for a sexual health service. A convenience sample of 161 12-24 year olds was used. A psychometrically robust questionnaire was developed from a review of the relevant literature and from the information provided by three focus groups. The data derived from both stages were distilled into seven themes, and adapted to a Thurstone paired comparison format, in which each theme was paired with every other theme, with an 8-point scale between each pairing (21 pairings in total). Respondents were required to indicate their preference for one theme over the other in each pairing. The questionnaire was completed by 161 young people between April and July 2007, and the results were analysed using the Kendall coefficient of concordance to establish the degree of within-group agreement. The results suggested that there was significant agreement as to the essential desirable features of a sexual health service, both within the whole sample as well as within sub-samples (i.e. gender, age group and previous sexual health service use). The priorities were privacy, and a dedicated service close to home, with a drop-in facility and male and female staff being next most important, and an informal service and young staff being lowest priorities. The feedback from the pilot study, the 40% return and absence of spoiled questionnaires together indicated that the respondents found the method acceptable, while the actual findings corroborated those from other studies. Taken together, these results suggest that the Thurstone method offers a quick and simple method of capturing the user voice, with the results having sufficient validity to inform the planning of a local sexual health service.

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Designing the Cash and Counseling Demonstration and Evaluation. Doty, P., K. J. Mahoney and L. Simon-Rusinowitz. 2007

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Objective: The Cash and Counseling Demonstration and Evaluation (CCDE) was designed as an experiment in shifting the paradigm in home and community-based long-term care from a professional/bureaucratic model of service delivery to one emphasizing consumer choice and control. The experimental intervention was an individualized budget offered in lieu of traditional Medicaid-covered services, such as agency-delivered aide services or a plan of care developed and coordinated by a professional case-manager, which typically involves authorization for several different providers to deliver a range of services. Within the spending limits established by their budgets, program participants were largely free to choose the types and amounts of paid services and supports they judged best able to meet their disability-related personal assistance needs. Study Population: Medicaid beneficiaries in selected states who volunteered to participate. In all of the participating state Medicaid programs, beneficiaries eligible to participate included elders and younger adults with chronic disabilities and, in one state, adults and children with mental retardation/developmental disabilities could also participate. Minor children and adults with cognitive impairment could participate via representatives (family or friends who agreed to assist them in managing their services or to act as their surrogate decision-makers). Data Sources: Members of the CCDE management team describe the rationale for and implications of key design decisions. Study Design: Key design decisions included the choice of research methodology (random assignment of CCDE participants in each state to treatment and control groups), selection of the state sites (AR, FL, NJ, NY), and the need for the CCDE to comply with federal waiver requirements for Medicaid research and demonstration projects. Principle Findings: The CCDE design was successfully implemented in three of the four state Medicaid programs selected for participation. Conclusions: The successful implementation of the CCDE (results from the evaluation are reported elsewhere) led to replication efforts in other states. The CCDE also inspired changes in Medicaid law and policy, including the 2002 "Independence Plus" Initiative by the Centers for Medicare and Medicaid and sections of the Deficit Reduction Act of 2005 intended to promote consumer-direction in Medicaid. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Determining care management activities associated with mastery and relationship strain for dementia caregivers. Connor, K. I., D. K. McNeese-Smith, B. G. Vickrey, G. M. van Servellen, B. L. Chang, M. L. Lee, S. D. Vassar and J. Chodosh. 2008

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OBJECTIVES: To identify specific care management activities within a dementia care management intervention that are associated with 18-month change in caregiver mastery and relationship strain. DESIGN: Exploratory analysis, using secondary data (care management processes and caregiver outcomes) from the intervention arm of a clinic-level randomized, controlled trial of a dementia care management quality improvement program. SETTING: Nine primary care clinics in three managed care and fee-for-service southern California healthcare organizations. PARTICIPANTS: Two hundred thirty-eight pairs: individuals with dementia and their informal, nonprofessional caregivers. MEASUREMENTS: Care management activity types extracted from an electronic database were used as predictors of caregiver mastery and relationship strain, which were measured through mailed surveys. Multivariable linear regression models were used to predict caregiver mastery and relationship strain. RESULTS: For each care manager home environment assessment, caregiver mastery increased 4 points (range 0-100, mean+/-standard deviation 57.1+/-26.6, 95% confidence interval (CI)=2.4-5.7; P=.001) between baseline and 18 months. For every action linking caregivers to community agencies for nonspecific needs, caregiver mastery decreased 6.2 points (95% CI=-8.5 to -3.9; P<.001). No other care management activities were significantly associated with this outcome, and no specific activities were associated with a change in caregiver relationship strain. CONCLUSION: Home assessments for specific needs of caregivers and persons with dementia are associated with improvements in caregivers' sense of mastery. Future work is needed to determine whether this increase is sustained over time and decreases the need for institutionalization.

EBSCOhost; rzh

Developing Student Knowledge and Skills for Home-Based Social Work Practice. Allen, S. F. and E. M. Tracy. 2008

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Providing social work services for clients in their homes is often a distinguishing feature of social work practice. The home environment affects the intervention process at each stage of contact with a family. Home-based practice requires specific skills to deal with clients' presenting concerns as well as safety, boundary, confidentiality, and ethical challenges. This article offers practical tips for integrating content regarding home-based social work into courses throughout the curriculum to better prepare social work students for home-based practice. It discusses how home-based content in both master's and baccalaureate courses supports current Educational Policy and Accreditation Standards requirements. Adapted from the source document.

CSA Social Services Abstracts

Development and iterative refinement of an internet-based service for Chinese family caregivers of people with Alzheimer Disease. Chiu, T. and D. Lottridge. 2005

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This poster reports on the developmental phase of a new internet-based support services (ICSS) for Chinese caregivers of people with Alzheimer Disease (AD): a specialized email application and an informational website. Bilingual Chinese caregivers wanted internet-based information in both Chinese and English. Usability testing and heuristic evaluation results revealed that the interface successfully supported the core functionality, but can be refined to improve usability.

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Development and testing of a caring-based intervention for older adults with heart failure. Duffy, J. R., L. M. Hoskins and S. Dudley-Brown. 2005

Not relevant

The clinical and cost burdens of heart failure (HF) continue to rise, creating an immediate need for cost-effective interventions geared toward improving health outcomes. This article describes the development and testing of a caring-based nursing intervention for older adults with advanced HF who have been recently discharged from acute care. The developmental process and components of the intervention are presented. A methodology for testing the intervention is also introduced. Through a phased development process including research, this intervention can be refined and used to guide clinicians, administrators, and policymakers in the provision of high-quality care to older adults with HF.

Ovid Technologies; Ovid MEDLINE(R)

Dialysis in the elderly. Roake, J. 1195

Not relevant

Ovid Technologies; Embase

The different faces of care work: understanding the experiences of the multi-cultural care workforce. Doyle, M. and V. Timonen. 2009

Not relevant

An increased demand for long-term care services coupled with the decreased availability of informal (family) carers in many industrialised countries has led to the employment of growing numbers of 'migrant care workers'. Little is known about this heterogeneous group or of their experience of employment in long-term care. Providing an important insight into a hitherto little researched and poorly understood topic, this article presents the findings of a qualitative study in Ireland that sought greater understanding of migrant carers' experience of care work and of the intra-group differences among them. The findings suggest that sonic members of the long-term care workforce are more likely to confront obstacles and discrimination than others. The data indicate that the experiences of European, South Asian and African carers are significantly different and that. relationships may exist between carers' region of origin and their experience of care work, employment mobility and long-term plans for remaining in the sector. The findings underscore the significance of acknowledging the unique barriers and obstacles raced by particular populations of care workers. A better understanding of the changing demographic profile and needs of both care recipients and their paid (migrant) care-givers is required to ensure that appropriate policy and practical interventions are developed to support both groups.

The differential impact of Medicare home health care policy on impaired beneficiaries. Davitt, J. K. and S. C. Marcus. 2008

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The Balanced Budget Act of 1997 (BBA'97) dramatically decreased reimbursements in the Medicare home health program. The first phase of BBA'97, the Interim Payment System (IPS), slashed reimbursements to 1993 levels and established a new capitated reimbursement. To identify potential moderating influences of these changes on the relation-ship between patient impairment and home care use, we compared 1996 and 1998 Medicare Current Beneficiary Survey data. Using multivariate regressions controlling for health/functional, predisposing and enabling characteristics, we demonstrate dramatic decreases in home health use post IPS by persons with ADL, health, and memory impairments. The IPS encouraged agencies to cut services to more impaired patients who might exhaust the per-beneficiary cap. Similar policies may be adopted for other health systems. Thus, it is critical to understand the differential impact of sweeping changes on vulnerable populations.

EBSCOhost; rzh

Digital pens and pain diaries in palliative home health care: Professional caregivers' experiences. Lind, L., D. Karlsson and B. Fridlund. 2007

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Frequent pain assessment by the use of pain diaries for the follow-up of pain treatment can facilitate the caregivers' work with pain control in home health care. The aim was to explore and describe professional caregivers' experiences of palliative home health-care patients' use of pain diaries and digital pen technology for frequent pain assessment. A system for the follow-up of pain treatment was implemented in routine care and evaluated by means of a qualitative content analysis. Three nurses, two physicians and one secretary were interviewed. Additional analysis data were collected from patients' medical records, and the system log. The caregivers showed a shifting outlook towards the pain-assessment method, an initial cautious outlook due to low expectations of the patients' abilities to use the pain assessment method. Despite this, the caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security, and improved changes in pain treatment as a response to reported pain assessments. Pain assessment by the use of pain diaries and digital pen technology has positive influences on palliative home-care patients and supports the caregivers' focus on the pain.

EBSCOhost; rzh

Disabled Children and Their Families in Ukraine: Health and Mental Health Issues for Families Caring for Their Disabled Child at Home. Bridge, G. 2004

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In the Eastern European countries included in the communist system of the USSR, parents of disabled children were encouraged to commit their disabled child to institutional care. There were strict legal regulations excluding them from schools. Medical assessments were used for care decisions. Nevertheless many parents decided to care for their disabled child at home within the family. Ukraine became an independent country in 1991, when communism was replaced by liberal democracy within a free market system. Western solutions have been sought for many social problems existing, but 'hidden,' under the old regime. For more of the parents of disabled children, this has meant embracing ideas of caring for their disabled children in the community, and providing for their social, educational, and medical needs, which have previously been denied. The issue of disability is a serious one for Ukraine where the nuclear disaster at Chernobyl in 1986 caused extensive radiation poisoning. This almost certainly led to an increase in the number of disabled children being born and an increase in the incidence of various forms of cancer. This paper is based on a series of observation visits to some of the many self-help groups established by parents, usually mothers, for their disabled children. It draws attention to the emotional stress experienced both by parents and their disabled children in the process of attempting to come to terms with the disabling conditions, and the denial of the normal rights of childhood resulting from prejudice, poor resources, ignorance, and restrictive legislation. Attempts have been made to identify the possible role and tasks of professional social workers within this context. International comparisons show that many parents and their children do not benefit from the medical model of disability, and that serious consequences include the development of depressive illness among those who find that little help is available from public services. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Disregarded use of herbal medical products and dietary supplements among surgical and medical patients as estimated by home inspection and interview. Glintborg, B., S. E. Andersen, E. Spang-Hanssen and K. Dalhoff. 2005

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PURPOSE: More and more patients use herbal medical products (HMP) and dietary supplements (DS). Due to the possibility of drug interactions and side effects, it is important that physicians are aware of the use. The aim of the present cross sectional survey was to analyse the consumption of HMP and DS among patients recently discharged from two hospital departments. METHODS: Patients were visited within 1 week after discharge and interviewed about their use of HMP and DS. Stored products were inspected and registered. Hospital files and discharge letters were examined to establish the frequency of registration. RESULTS: Totally, 83 surgical and 117 medical patients were included (n = 200), 139 patients (70%) were women. 53 patients (27%) stored no HMP or DS, whereas the home inventories of 147 patients (74%) comprised 343 products. 116 patients (58%) used HMP or DS daily and 25 patients (13%) used the products on demand. The most frequently used product was multivitamins (82 patients = 41%). Totally, 61% of the products were used on the patients' own initiative. In 3% of the used products, patients were aware of possible side effects. No patients were aware of possible drug interactions. Only 21% of the 211 HMP and DS used daily prior to admission were recorded in the hospital files. CONCLUSIONS: The use of HMP and DS was frequent among surgical and medical patients. The use was often not recorded in the hospital files and patients' knowledge of possible side effects and drug-interactions was minimal.

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The DizzyFix: initial results of a new dynamic visual device for the home treatment of benign paroxysmal positional vertigo. Bromwich, M. A. and L. S. Parnes. 2008

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OBJECTIVE: To develop and test a completely new dynamic visual device for the home treatment of benign paroxysmal positional vertigo (BPPV). DESIGN: Randomized, controlled, prospective trial. SETTING: Tertiary care hospital. METHODS: We designed and manufactured a new device (the DizzyFix) to assist in the performance of the particle repositioning manoeuvre (PRM). Fifty healthy volunteers were taught the PRM, half using the new device. At 1 week, we compared the PRM performance between the device and nondevice user groups. MAIN OUTCOME MEASURES: Performance of the PRM as graded on an 11-point scale. RESULTS: DizzyFix users in phase I scored significantly higher on their PRM performance compared with controls (p = .0001). CONCLUSIONS: The use of this new device enables volunteers to conduct a correct PRM on their own. This is a significant improvement from written instructions or in-office training.

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Do spinal cord injury patients always get the best treatment for neuropathic bladder after discharge from regional spinal injuries centre? Vaidyanathan, S., G. Singh, B. M. Soni, P. L. Hughes, P. Mansour, T. Oo, J. Bingley and P. Sett. 2004

Not relevant

OBJECTIVE: To draw attention to inadequate care received by some spinal cord injury patients after discharge from the regional spinal injury center. SETTING: Regional Spinal Injuries Centre, Southport, UK. METHODS: Presence of the urethral stricture was not recognised in a 69-year-old male with T-3 paraplegia, who attended a health-care facility with a urinary infection. A Foley catheter was inserted into the urethra only half-way and the catheter balloon was then inflated in the urethra distal to the stricture. In a 68-year-old male with T-8 paraplegia, a long-term indwelling catheter was eroding the urethra and he developed a severe degree of hypospadias while being managed in the community. A 49-year-old male with C-4 tetraplegia developed recurrent urine infections. He received several courses of antibiotics, which were prescribed by community health professionals. But he continued to be unwell. Subsequently, the patient was admitted to a district general hospital, where he was diagnosed to have mild chest infection and was about to be sent home. However, his wife was not happy, and then ultrasound of abdomen was taken, which revealed pyonephrosis. He was then transferred to a spinal unit. RESULTS:: These patients were not seen promptly in a regional spinal injury centre when they developed medical problems. The complications, which ensued, might have been prevented if expert medical treatment had been provided without delay. CONCLUSION: In order to meet the needs of a growing population of persons living in the community with spinal cord injury, more beds are required in spinal units. Provision of day surgery wards within spinal units, out-reach clinics and home visits by spinal cord clinicians may reduce the demand for admission in a spinal unit. Education of community health professionals on delayed complications of spinal cord injury, and good communication between spinal cord clinicians, patients, carers, and community health professionals by telephone, e-mail or conventional postal system are likely to improve the care of spinal cord injury patients after discharge from spinal injury centres. Spinal cord clinicians should adopt a patient-centred care instead of the traditional, paternalistic, doctor-centred care.

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Early intervention for speech impairment in children with cleft palate. Scherer, N. J., L. L. D'Antonio and H. McGahey. 2008

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OBJECTIVE: This study explored the effectiveness of a parent-implemented, focused stimulation program on the speech characteristics of children younger than 3 years with cleft lip and palate. The research questions included the following: (1) Can parents be trained to deliver an early intervention (EI) program for children with cleft palate? (2) Does a parent-implemented EI program result in positive changes in speech characteristics? PARTICIPANTS: Ten mother-child pairs in which the child had cleft lip and palate (CLP) and 10 mother-child pairs in which the child did not have a cleft (NCLP). The children ranged in age from 14 to 36 months of age and were matched between the CLP and the NCLP groups for vocabulary size, age, and socioeconomic status. MAIN OUTCOME MEASURES: Group differences (CLP and the NCLP) for preintervention and postintervention language and speech measures were compared. RESULTS: The results of this study showed that the mothers could be trained to deliver the intervention reliably. Furthermore, the results indicated that the intervention resulted in increased sound inventories, increased speech accuracy, and reduced use of glottal stops for the children with clefts. CONCLUSIONS: While the intervention resulted in speech gains for the children with clefts, speech measures did not exceed those made by the children without clefts. The results of the study have implications for service delivery models where the services of speech-language pathologists are limited.

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Early outcomes of a care coordination-enhanced telehome care program for elderly veterans with chronic heart failure. Schofield, R. S., S. E. Kline, C. M. Schmalfuss, H. M. Carver, J. M. Aranda, Jr., D. F. Pauly, J. A. Hill, B. I. Neugaard and N. R. Chumbler. 2005

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Veterans with chronic heart failure (HF) are frequently elderly, have numerous comorbid chronic medical illnesses, frequent hospitalizations, and have high rates of cardiovascular events. Within the Veterans Health Administration (VHA), primary care providers are required to manage the majority of HF patients because access to cardiac specialty care within the VHA may be limited. We designed and implemented a care-coordinated, nurse-directed home telehealth management program for veterans with difficult-to-manage or new onset chronic systolic HF. An in-home telehealth message device was provided to the patient at enrollment, and patients received daily HF-specific education via the nurse coordinator and/or the device throughout their continuum of care. We collected demographic characteristics, clinical characteristics, and outcome data at the time of enrollment and at nearly 6 months after enrollment. A total of 92 patients were enrolled, with complete data available on 73. The mean patient age was 67 years, the mean left ventricular ejection fraction (LVEF) was 23%, and nearly all patients (99%) were men. After enrollment, significant improvements were found in blood pressure (129/73 to 119/69 mm Hg, p < 0.05), weight (196 to 192 pounds, p < 0.01), and shortness of breath rating (0-10 scale, 4.0 to 2.7, p = 0.02). Average daily doses of fosinopril (24 to 35 mg/d, p < 0.01) and metoprolol (84 to 94 mg/d, p = 0.05) were also improved. The total number of inpatient hospital days were reduced while on the home telehealth program (from 630 for the previous year to 122 for the duration of the program) with only 31% of the hospitalizations related to HF while on the program. Our nurse-directed, care coordinated home telehealth management program was associated with improved early outcomes in a group of elderly male veterans with chronic HF.

Ovid Technologies; Ovid MEDLINE(R)

Effect of a residential respite admission for older people on regional Queensland family carers. Neville, C. C. and G. J. Byrne. 2008

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OBJECTIVE: This study undertaken in regional Queensland aimed to determine the effect of a residential respite care (RRC) admission for older people on family carers. METHOD: The study used a repeated measures, prospective design. The participants were 100 family carers and their older dependants who were studied before and after the RRC admission. RESULTS: Family carer psychological distress increased after a period of RRC [F(1, 57) = 250.9, p < .001] as did the level of caregiver burden [F(1, 57) = 189.8, p < .001]. The presence of dementia and hearing problems in the RRC recipients, the psychological distress of the family carer, being younger and a spouse of the RRC recipient all predicted carer burden. CONCLUSIONS: It is not surprising that RRC, once over, does not necessarily reduce psychological distress and carer burden if this is associated with ongoing caring responsibilities that are resumed after RRC. Nurses need to discuss these issues with family carers and inform them of the likely outcomes of RRC and how they may better utilise the 'break' provided by RRC to counteract some of this response.

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Effect of an evidence-based education programme on ED discharge advice for febrile children. Considine, J. and D. Brennan. 2007

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AIMS: This study aimed to examine the effect of an educational intervention on discharge advice given to parents leaving the emergency department with a febrile child. BACKGROUND: Childhood fever is a common reason to seek emergency care. Many children are discharged from the emergency department with fever as a significant component of their illness; therefore, it is vital that emergency department medical and nursing staff provide accurate and reliable information about childhood fever management. DESIGN: A pre/post-test design was used. The outcome measure was parental advice regarding paediatric fever management and the intervention for the study was an educational intervention for emergency department nursing staff that consisted of two tutorials. Data were collected using structured telephone interviews. RESULTS: Data were collected from 22 families during the pretest period and 18 families during the post-test period. The number of parents leaving the emergency department with no advice decreased by 48% (p = 0.002). Reports of written advice increased by 69.7% (p < 0.001) and there was a 38.4% increase in reports of verbal advice (p = 0.014). Parents leaving the emergency department with both written and verbal advice increased from 0 to 55.6% (p < 0.001). Reports of advice by nursing staff increased by 52% (p < 0.001) and there were significant increases in specific instructions related to oral fluid administration (22.7 vs. 77.8, p = 0.001) and use of antipyretic medications (27.2 vs. 77.8, p = 0.001). CONCLUSION: Evidence-based education of emergency nurses improved both the amount and quality of discharge advice for parents of febrile children. RELEVANCE TO CLINICAL PRACTICE: Parents and health care professionals alike need to better understand the physiological benefits of fever and the potential harmful effects of aggressive and often unwarranted treatment of fever.

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The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Godley, M. D., S. H. Godley, M. L. Dennis, R. R. Funk and L. L. Passetti. 2007

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Aims: This study compared assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1-3) and longer-term (months 4-9) abstinence. Design: Two-group randomized design. Setting: Eleven counties surrounding a community-based residential treatment program in the Midwestern section of the United States. Participants: A total of 183 adolescents, ages 12-17 years, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment. Intervention: Prior to discharge from residential treatment, participants were assigned randomly to receive either UCC, available at outpatient clinics in the 11-county study area, or ACC via home visits. Measurements: Self-reported interview data were collected at intake, 3, 6 and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months. Findings: ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. Conclusions: ACC appears to be an effective alternative to UCC for linking, retaining and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Effect of childhood eczema and asthma on parental sleep and well-being: a prospective comparative study. Moore, K., T. J. David, C. S. Murray, F. Child and P. D. Arkwright. 2006

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BACKGROUND: The psychological impact of childhood atopic eczema on parents and carers is poorly quantified. Objectives To compare the impact of caring for a child with atopic eczema vs. asthma on parents' sleep and well-being. METHODS: Ninety-two parents of 55 children who had moderate to severe atopic eczema or asthma took part in this prospective, questionnaire-based study. It was conducted at regional eczema and asthma outpatient clinics within a U.K. tertiary paediatric hospital. The main outcome measures were the number and duration of parents' sleep disturbances, as well as their anxiety and depression scores. RESULTS: Mothers caring for children with atopic eczema lost a median of 39 min of sleep per night and fathers lost 45 min sleep per night. This compared with a median of 0 min sleep lost by parents who had children with asthma (P < 0.001). These differences were independent of the age of the children, and whether the child came from a single-parent or two-parent family. There was a direct correlation between the severity of sleep disturbance and the level of maternal anxiety (rho = 0.58; P = 0.002) and depression (rho = 0.73; P < 0.001), as well as the level of paternal anxiety (rho = 0.59; P = 0.01). CONCLUSIONS: Compared with looking after a child with chronic asthma, caring for a child with chronic atopic eczema was associated with greater parental sleep disturbances. Disruption to parental sleep correlated with anxiety levels and, in the case of mothers, depression scores.

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Effect of education on school-age children's and parents' asthma management. Homer, S. D. 2004

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ISSUES AND PURPOSE: Asthma affects 7.4% of school-age children, with poor children or members of ethnic minorities disproportionately affected. DESIGN AND METHODS: A quasiexperimental, year-long pilot study tested the effectiveness of an intervention that included school-based small-group education for children with home-based education for parents. Pretest and two posttest measures were collected. RESULTS: Forty-four families completed the study (41% African American, 36% European American, 23% Mexican American), with 46% coming from poor or working-class families. Asthma management in the treatment group was lower than the comparison group at baseline, but improved significantly at 6 months and stabilized at 12 months, a trend that was most pronounced among the poorer children. PRACTICE IMPLICATIONS: Improvements in asthma management point to the need for ongoing asthma education to address learning needs of the children and families.

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Effect of PaO2 and social circumstances on outcomes in out-patient treatment of COPD exacerbations. Khalid, S., A. C. Elliott, A. Pilling and R. J. Wolstenholme. 2007

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The current British Thoracic Society guidelines on COPD recommend that patients with COPD exacerbations should be admitted to hospital if they either have partial pressure of arterial oxygen of <7.0 kilopascals (kPa) or if they are living alone. This study was carried out to see if either of these factors have any effect on the outcome in patients presenting with COPD exacerbation in the setting of well established COPD services. This study was to see if patients with PaO2 < 7.0 kPa or those living alone were readmitted more frequently or had higher mortality than other patients discharged through the same scheme. A retrospective analysis was carried out on 1078 patients with acute exacerbation of COPD who were discharged home through Wigan "hospital at home" scheme in the period between November 1999 and February 2004 prior to the introduction of the new guidelines. This study found that there was no statistically significant difference in the rates of readmissions in patients with low PaO2 or those living in adverse social circumstances compared to other groups of patients. The number of patients dying in this period was too small to analyse with adequate power. This study indicates that such patients can be safely managed at home in the context of well established COPD services.

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Effect of pharmaceutical care services on outcomes for home care patients with heart failure. Triller, D. M. and R. A. Hamilton. 2244

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PURPOSE: The effect of pharmaceutical care services for home care patients with heart failure on death and rehospitalization rates was studied. METHODS: Eligible patients had to be at least 21 years old and included those with a primary or secondary diagnosis of heart failure who were referred to receive skilled nursing services. Patients were then randomized to receive usual care or pharmaceutical care. Patients assigned to the usual care group received the services typically provided by the visiting nurses association, while patients in the pharmaceutical care group received usual care plus standardized services from a clinical pharmacist. Pharmaceutical care services consisted of an initial comprehensive in home medication assessment and two follow-up visits. Throughout the three-week intervention period, the clinical pharmacist accessed and reviewed all pertinent physician notes and laboratory test values and interacted with prescribers on behalf of the patients as necessary. RESULTS: A total of 154 patients met all criteria and participated in the study. The pharmacist made 79 specific therapy recommendations, 47 (60%) of which were related directly to drug therapy for heart failure or cardiovascular disease. Overall, 14 therapy recommendations were fully implemented, and 10 heart failure-specific recommendations were fully implemented. Patients for whom the pharmacist had made recommendations that were followed by the prescriber had a reduced rate of the composite primary endpoint, but this difference did not reach statistical significance. CONCLUSION: A home-based pharmaceutical care model for recently hospitalized patients with heart failure did not significantly improve the combined rate of death or rehospitalization.

Ovid Technologies; Ovid MEDLINE(R)

The effects of a dementia nurse care manager on improving caregiver outcomes outcomes. Specht, J., A. Bossen, G. R. Hall, B. Zimmerman and J. Russell. 2009

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Iowa's Administration on Aging's Alzheimer's Disease Demonstration Grant to the States was a project to implement and evaluate a nurse care management model of service delivery for persons with dementia or care recipient and their family caregiver that was integrated with the case management system. The goal of the nursing service delivery model was to maintain persons with dementia safely in their homes, by connecting them with appropriate services and providing support to the care recipient and caregivers. Outcomes measures were evaluated over time. This article defines the role of dementia nurse care management and shares the results of the outcomes measurements. The evaluation showed that caregivers assisted by nurse care managements were more likely to show improvement in their stress levels, endurance potential, and well-being. This improvement was consistent over time.

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Effects of a psychosocial family-based preventive intervention on cortisol response to a social challenge in preschoolers at high risk for antisocial behavior. Brotman, L. M., K. K. Gouley, K. Y. Huang, D. Kamboukos, C. Fratto and D. S. Pine. 2007

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CONTEXT: Salivary cortisol levels during social challenge relate to adaptive functioning in children and adults. Low cortisol levels have been related to conduct problems and antisocial behavior. Although studies in rodents implicate early-life social experience in cortisol regulation, no studies with humans have examined the effects of an experimentally manipulated early-life social experience on cortisol regulation. OBJECTIVE: To examine the effects of experimental manipulations of social experience on cortisol response to a social challenge in preschoolers at risk for antisocial behavior. DESIGN: Randomized controlled trial. SETTING: Department of Child and Adolescent Psychiatry, New York University School of Medicine. PARTICIPANTS: Ninety-two preschool-age siblings of youths adjudicated for delinquent acts. Intervention Family-based intervention included 22 weekly group sessions for parents and preschoolers and 10 biweekly home visits conducted during a 6- to 8-month period. MAIN OUTCOME MEASURES: Salivary cortisol levels before and after a social challenge (entry into an unfamiliar peer group). RESULTS: Relative to controls, children in the intervention condition had increased cortisol levels in anticipation of the peer social challenge. Increases were relative to both preintervention cortisol levels during the challenge and cortisol levels in the home, which were not altered by the intervention. CONCLUSIONS: A family-based preventive intervention for children at high risk for antisocial behavior alters stress response in anticipation of a peer social challenge. The experimentally induced change in cortisol levels parallels patterns found in normally developing, low-risk children.

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Effects of home massage rehabilitation therapy for the bed-ridden elderly: A pilot trial with a three-month follow-up. Hirakawa, Y., Y. Masuda, T. Kimata, K. Uemura, M. Kuzuya and A. Iguchi. 2005

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Objectives: To assess the effects of home massage rehabilitation therapy on the bed-ridden elderly. Design: Alternatively allocated trial. Setting: Subjects' homes, three home nursing stations, 13 visit care stations and one day service centre in Aichi prefecture, Japan. Subjects: Bed-ridden patients who were 65 years and above, no dementia, stable general condition, and receiving no rehabilitation therapy. Intervention: Thirty-minute sessions of home massage rehabilitation therapy by a massage practitioner 2 or 3 days a week for three consecutive months or usual care. Main measurements: Barthel Index (BI), Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score. Results: Fifty-three subjects were recruited, 26 in the home massage rehabilitation group (HMG) and 27 in the routine care group without massage (RCG). The protocol was completed for 40 subjects, 22 in the HMG and 18 in the RCG. There were no significant differences between the baseline characteristics of both groups; age, presence of spouse, diseases associated with disabilities and use of day care rehabilitation (p=0.76, 0.36, 0.94 and 0.71, respectively). The total BI score of the HMG (15.27+/-4.51) at baseline was nonsignificantly lower (p=0.03) than those of the RCG (11.44+/-5.90). Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score of both groups at baseline were matched (p=0.12, 0.32 and 0.89, respectively). There were no statistical differences between the intergroup changes over time in BI, Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score (p=0.35, 0.08, 0.70 and 0.55, respectively). Conclusion: Home massage rehabilitation therapy did not show a positive effect on the bed-ridden elderly, either mentally or physically. We would require large-size trials to determine whether it is effective. copyright 2005 Edward Arnold (Publishers) Ltd.

Ovid Technologies; Embase

The effects of patient function and dependence on costs of care in Alzheimer's disease. Zhu, C. W., C. Leibman, T. McLaughlin, N. Scarmeas, M. Albert, J. Brandt, D. Blacker, M. Sano and Y. Stern. 2008

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OBJECTIVES: To estimate incremental effects of patients' dependence and function on costs of care during the early stages of Alzheimer's disease (AD) and to compare strengths of their relationships with different cost components. DESIGN: Multicenter, cross-sectional, observational study. SETTING: Three university hospitals in the United States. PARTICIPANTS: One hundred seventy-nine community-living patients with probable AD, with modified Mini-Mental State Examination scores of 30 or higher. MEASUREMENTS: Patients' dependence was measured using the Dependence Scale (DS). Functional capacity was measured using the Blessed Dementia Rating Scale (BDRS). Total cost was measured by summing direct medical costs and informal costs. Direct medical costs included costs of hospitalization, outpatient treatment and procedures, assistive devices, and medications. Informal costs were estimated from time spent helping with basic and instrumental activities of dally living for up to three caregivers per patient using national average hourly earnings as wage rate. RESULTS: DS and BDRS were associated with higher total cost, a 1-point increase in DS was associated with a $1,832 increase in total cost, and a I-point increase in BDRS was associated with a $3,333 increase. Examining component costs separately identified potential differences between DS and BDRS. A I.-point increase in BDRS was associated with a $1,406 increase in direct medical cost. A 1-point increase in DS was associated with a $1,690 increase in informal cost. CONCLUSION: Patients' dependence and function related differently to direct medical and informal Cost, Suggesting that measures of function and dependence provided unique information for explaining variations in cost of care for patients with AD, highlighting the value in measuring both constructs.

Efficacy of an in-home nursing intervention following short-stay breast cancer surgery. Wyatt, G. K., L. F. Donze and K. C. Beckrow. 2004

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This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing career or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p < .001) and report improved social/family QOL (p < .05), with fewer home visits (p < .001). These findings suggest that a targeted nursing protocol may, at reasonable cost, improve QOL and enhance health-related knowledge. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Eldercare and employed caregivers: a public/private responsibility? Koerin, B. B., M. P. Harrigan and M. Secret. 2008

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The National Alliance for Caregiving (NAC) and the American Association of Retired Persons (AARP, 2004) have reported that 21% of the U.S. population provides family caregiving services to someone over 18 years old. Seventy-nine percent (79%) of these caregivers provide care for someone aged 50 or older. The majority of caregivers work full or part-time, and nearly two-thirds of employed caregivers make work-related adjustments in order to provide care (NAC & AARP, 2004). This article examines eldercare issues of employed caregivers, identifies current public and private policies addressing caregiver needs, presents a process model to assist organizations in creating family-friendly workplaces, and suggests social work roles that support family caregiving.

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Elderly Home Health Clients Who Abuse Alcohol. Thobaben, M. 2006

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This article examines the issues of elderly home health care clients who abuse alcohol. The author discusses both early onset and late onset alcoholism. This is followed by a discussion on the need of health care staff to aware of alcoholism in the elderly and the need to screen for it. Recommendations for home care nurses working with alcohol abusing clients are provided. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Elderly Long-Term Care: A Historical Comparative Analysis of Policy Decisions and "Policy Lags". Silver, K. W. 4365

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This research project analyzes four policy decisions: the Kerr-Mills Act of 1960, The Omnibus Budget Reconciliation Act of 1981, the 1999 United States Supreme Court decision in Olmstead v. L.C., and the Older Americans Act Amendments of 2000. The issue of long-term care for the elderly is examined in relation to these four policy decisions. The Kerr-Mills Act of 1960 constitutes a benchmark in policy because it legislated federal and state matching funding for the assistance of community-based home care for the elderly. The Omnibus Budget Reconciliation Act of 1981 resulted in broadening community-based services in the form of the social services block grant and the home and community-based services waiver program. The 1999 United States Supreme Court decision in Olmstead v. L.C. was a landmark case for institutionalized disabled persons. The Older Americans Act Amendments of 2000 (amendments of a law originally enacted in 1965) brought forth the National Family Caregiver Support Program which marks another benchmark in policy legislation: the first time that the Federal government has officially recognized the role of informal, unpaid family caregivers. The historical comparative research method is used to examine these four policy decisions. Primary and secondary archival data and historical documents are used to analyze the policies. Five research questions are posed regarding each policy decision. The concept of the social construction of aging is used to analyze the influence it had on policy outcomes. During the time frame of 1960 to 2000, other policies were enacted that impacted the lives of the elderly but were not the subject of this investigation. A paucity of policies were enacted that attempted to ameliorate the plight of the elderly in seeking the provision of community-based long-term care. There was a mismatch between needs and the policies intended to ameliorate the situation, ultimately resulting in policy lags. New comprehensive policies are called for that will resolve the community-based long-term care needs of the elderly.

CSA Sociological Abstracts

Emerging technology for at-risk chronically ill veterans. Huddleston, M. and R. Kobb. 2004

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Patients are exposed to iatrogenic injury when hospitalized. In the Tech Care Coordination Program, older veterans with chronic diseases and high healthcare utilization were followed with an in-home technology device, the Health BUDDY, and risk management software. Program staff could identify at-risk patients based on their responses to a series of questions about symptoms, behavior, and knowledge. Patients followed in the program for at least 6 months experienced a 45% decrease in hospital admissions, 67% decrease in nursing home admissions, 54% decrease in emergency room visits, and 38% decrease in pharmacy prescriptions. The patients also demonstrated improved compliance with treatment regimens and both patients and providers reported high levels of program satisfaction.

EBSCOhost; rzh

An employee assistance program for caregiver support. Mains, D. A., T. J. Fairchild and A. A. Rene. 2006

Not relevant

The Comprehensive Caregiver Choices Program provided support for employee caregivers of elderly people for employees at a hospital in Fort Worth, Texas. Key informant interviews and focus groups provided direction for program development and implementation. A full-time MSW and professionals with expertise in gerontology/geriatrics provided education and care coordination services to caregivers. Approximately 4% of the hospital's workforce participated in the program. Attendees evaluated educational sessions and follow-up interviews were conducted with program participants. Caregiver support programs must continue to seek innovative and creative marketing and service delivery methods to reach out and assist working caregivers in need of support.

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Empowering the patient with ICT-tools: The unfulfilled promise. Meijer, W. and P. Ragetlie. 2007

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Objective: To identify how ICT (Information and Communication Technology) tools can help patients cope with their individual illnesses and to evaluate if currently available ICT tools empower them. Setting: ICT tools should be able to assist patients with their coping strategies anywhere in the world. Methods: The study was conducted in 2 parts. In the first part in-depth interviews were conducted with 8 diabetic patients to identify their desired coping strategies with respect to information and communication. In the second part of the study a number of ICT tools in use in clinical practice at home, were evaluated to see how closely they met the coping strategies identified by patients. Results: Identified coping strategies that information and communication should support included contact with fellow patients, greater choice of care and enhanced collaboration with caregivers. Six tools currently used in the Netherlands were evaluated to determine their ability to satisfy these coping strategies. In general it was found that these tools supported the business processes of healthcare providers and provided little support to assist patients with their chosen coping strategies, e.g. choice of treatment and caregiver. Conclusion: The potential which ICT offers patients to help them cope with and manage chronic diseases is only being partly exploited. New ICT tools need to be devised to better empower patients. In addition healthcare providers will need to change their working practices and the conditions under which care is provided. copyright The Journal on Information Technology in Healthcare.

Ovid Technologies; Embase

End-of-life care in community hospitals: the perceptions of bereaved family members. Hawker, S., C. Kerr, S. Payne, D. Seamark, C. Davis, H. Roberts, N. Jarrett, P. Roderick and H. Smith. 2006

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OBJECTIVES: The perceptions of bereaved family members were obtained to evaluate the nature and quality of end-of-life care in community hospitals. DESIGN: During organizational case studies in six community hospitals in the South East and South West of England, bereaved family members were asked to participate in semi-structured interviews. PARTICIPANTS: Fifty-one interviews were conducted with family members of patients who had received end-of-life care in a community hospital within the previous year. RESULTS: Respondents were very positive about the care they and the patient had received. They valued the convenience of access for frequent and long-stay visiting and the familiarity of the local hospital. Comparisons were made with more negative experiences at their nearest District General Hospital. Issues raised included the noise at the community hospitals, and the lack of contact with qualified nurses. DISCUSSION: The results of this study have implications for UK government initiatives, such as the National Framework for Older People, and the Department of Health's 'Keeping the NHS Local'.

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End-of-life care with the heart failure patient in home health: a case study. Quinn, C. 2005

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The diagnosis of congestive heart failure accounts for a large proportion of hospital admissions and multiple readmissions over the course of the disease. During the end stage of their disease process, patients often are prescribed many complex medications such as inotropic infusion therapy. For a patient to receive an intravenous medication at home, there must be a collaborative approach between nurse, family, patient, and physician. This palliative approach can result in decreased hospital admissions and an improved quality of life for patients with end-stage congestive heart failure.

Ovid Technologies; Ovid MEDLINE(R)

End-of-life caregiving. Nelson, C. A. 0336

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Over the past decade, changes in health, economic, and social policies have shifted the dying process out of hospitals and into the community. This exploratory, hypothesis-generating study investigated positive and negative caregiving as well as care management resources of community-based end-of-life caregivers and how they related to caregivers' personal growth following the death of the care receiver. Retrospective, cross-sectional survey data were collected from 144 respondents in Lane County, Oregon who reported having provided care for at least one terminally ill person. Data were analyzed using an adapted stress process conceptual framework. Factor analyses determined whether internally consistent measures could be obtained from two new indices related to end-of-life care: a caregiving inventory and a care management resource index. Hierarchical multiple regression analysis examined the mediational relationships between care management resources and positive and negative caregiving in predicting personal growth of end-of-life caregivers following bereavement. Factor analyses verified that the investigator-developed caregiving inventory was comprised of two conceptually distinct factors, negative caregiving and positive caregiving, and the care management resource index was comprised of a single factor, care management resources. Factor scores were generated as a last step in factor analyses. Hierarchical multiple regression analysis was then undertaken with personal growth as the dependent variable. Control variables (age, gender, ethnicity, education, income, and level of caregiving) were entered first, the care management factor score was entered next, and the positive and negative caregiving factor scores were entered last. As predicted, higher levels of care management resources were associated with more positive caregiving and higher levels of positive caregiving were associated with greater personal growth. There was no relationship between negative caregiving and personal growth, nor was negative caregiving related to care management resources. The regression analysis did not support a mediational model. Results from this study add to the evidence that positive and negative aspects of caregiving should be treated separately and demonstrate the influence of positive perceptions of end-of-life caregiving experiences on long-term bereavement outcomes. Findings suggest the value of interventions designed to promote and enhance positive aspects of the end-of-life caregiving experience. Copies of dissertations may be obtained by addressing your request to ProQuest, 789 E. Eisenhower Parkway, P.O. Box 1346, Ann Arbor, MI 48106-1346. Telephone 1-800-521-3042; email: disspub@umi.com

CSA Social Services Abstracts

End-of-life in a Swedish population: demographics, social conditions and characteristics of places of death. Jakobsson, E., T. Johnsson, L. O. Persson and F. Gaston-Johansson. 2006

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The objectives of this study were to identify and describe the demographics and social conditions as well as characteristics of the places of death in a randomly selected sample that died in a county in Sweden during 2001. The present study reports part of the findings from a larger study undertaken during 2003 using a survey design of retrospective reviews of death certificates, medical records, and nursing records. Among several noteworthy findings are: first, an examination of these individuals' living arrangements reveal not only a large and vulnerable group that lives alone at the end-of-life but also a group living separated from their partners near end-of-life; second, individuals differ with respect to residence prior to death, that is private homes versus residential care facilities, imparting highly different contexts of care at the end-of-life; and third, a high prevalence of institutionalized deaths demonstrates that places of death other than hospitals and residential care facilities are uncommon, if not rare. It is concluded that increased attention to the social circumstances of the time period surrounding individuals' at the end-of-life is essential. There is need to develop more integrated models of care for dying people. Contemporary services available are not designed to meet a wide range of peoples' needs at the end-of-life. Home-based care, residential care and hospital care must be adapted to the changing patterns of dying. The services available should be organized to the benefit of the users rather than around the providers. This is the first study of its kind of a Swedish sample and while the data are limited to one county in Sweden its findings may contribute to a deeper understanding of demographic and social patterns at the end-of-life in general.

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The ethics and politics of home care. Bjornsdottir, K. 2009

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BACKGROUND: In the dominant health-care policy, commonly referred to as New Public Management, primary emphasis is placed on the reduction of costs in health care. This development threatens to increase inequality in society based on levels of health or impairment and on gender. AIM: The aim of this paper is therefore to raise awareness among nurses about the impact of New Public Management and explore how they might develop services that meet the diverse needs and wishes of those being served. THEORETICAL APPROACH AND METHOD: Although this policy has been criticised by nurses, it has also been observed that they are key players in its realisation. This discussion paper explores the impact of different discourses upon the practice of home-nursing care. It was developed within the post-structural tradition, where discourses are considered of key importance in shaping practice. Discourses represent different viewpoints and interests, and determine what can be considered meaningful and possible. The empirical studies which form the base for many of the main arguments presented were identified through an extensive review of published ethnographic research of home care in the years 2000-2008. RESULTS: A review of studies conducted in a number of countries both in North America and Europe showed that home-care services have in many ways been diminished. Clients and their caregivers experience insecurity and wish for more assistance. With New Public Management the focus has shifted from an ethical discourse to an economic one, although this shift has not been clearly articulated and critiqued. By understanding the impact of New Public Management, nurses can better focus their practice to meet the diverse needs of patients and their caregivers. CONCLUSION: In order to be able to respond to retrenchment in health services, nurses need to understand the complex ethical and political issues of New Public Management. A number of practices can be developed for working with patients and their families in such a way that their needs and wishes are respected.

EBSCOhost; rzh

Ethnic variation in timing of hospice referral: does having no informal caregiver matter? Chung, K., E. Essex and L. F. Samson. 2008

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BACKGROUND: The length of hospice stay, as an indicator of timing of hospice referral, is an important outcome to examine in end-of-life care because it is relevant to the quality and cost efficiency of end-of-life care that patients receive. Although the majority receives nonmedical care from informal caregivers, many elderly hospice users rely on paid caregivers or staff of residential facilities. OBJECTIVE: This study examined whether availability of informal primary caregiver interact with ethnicity to affect length of hospice stay. DESIGN: A retrospective cross-sectional study. SETTING/SUBJECTS: Data on 3024 hospice patients aged 65 and older discharged between 1997 and 2000 was extracted from the National Center for Health Statistics' National Home and Hospice Care Survey (NHHCS). MEASUREMENTS: Length of hospice stay prior to death or discharge. RESULTS: Survival analysis revealed that among patients with formal caregivers, minority patients were likely to have significantly shorter hospice stays than non-Hispanic whites. There were no significant ethnic differences in length of stay among patients with informal caregivers. CONCLUSIONS: Our findings suggest that ethnic differences in length of stay should be discussed in terms of type of caregiver, not just type of setting, since patients in residential facilities can have informal primary caregivers who are vigilant advocates for their dying relatives. We discuss possible reasons for the influence of having formal caregivers on length of stay of minority elders.

EBSCOhost; rzh

Evaluating Medical Home constructs for children with special needs: integrating theory and logic models. Livingood, W. C., N. L. Winterbauer, Q. McCaskill and D. Wood. 2007

Not relevant

The Medical Home model for providing services to children with special healthcare needs has strong philosophical foundations, but the science supporting this theoretical model is not as well developed. The use of logic models and mixed method design provide systematic and rigorous approaches to observation while retaining the complexity, which tends to be lost with research designs intended to control and reduce the number of variables impacting a desired outcome, such as randomized controlled trials. This application provides a historical basis for applying logic models of evaluation and illustrates the utility of logic models.

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Evolution of evidence-based guidelines for home care: Wisconsin's experience. Spitz, B., C. Fraker, C. P. Meyer and T. Peterson. 2007

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In a pay-for-performance home health system, achieving superior patient outcomes becomes the key to agency success. Evidence-based guidelines help in the achievement of exceptional patient outcomes. In this article, the Wisconsin Homecare Organization (WHO) describes its journey toward basing its home health practice on evidence-based guidelines.

EBSCOhost; rzh

Evolution of medication use in Jerusalem elders: results from the Jerusalem Longitudinal Study. Steinman, M. A., Y. Maaravi, L. C. Walter, R. Hammerman-Rozenberg and J. Stessman. 2007

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BACKGROUND: While overall rates of medication use have been increasing over time, less is known about how medication use changes within individuals as they age. OBJECTIVE: The aim of this study was to evaluate changes in medication use and predictors of medication accrual among community-dwelling elders followed for a 7-year period, from age 70 +/- 1 years to age 77 +/- 1 years. METHODS: The study was a community-based, longitudinal, cohort study. The study group consisted of 280 patients from the Jerusalem Longitudinal Study, a population-based sample of Jerusalem residents born in 1920-1 who underwent extensive evaluation in 1990-1 and again in 1997-8. The main outcome measure of the study was the change in the total number of medications taken between baseline and follow-up. Medication use was assessed by home interviews. RESULTS: Half of the sample were men. Medication use more than doubled over the 7-year study period, from a mean of 2.0 to 5.3 medications per patient (p < 0.001), and 57 patients (20%) increased their total drug use by six or more medications. Vitamins, minerals and cardiovascular medications were the most commonly prescribed medications at follow-up, and accounted for approximately half of the total increase in medication use. On multivariable logistic regression analyses, decline in self-rated health was the strongest predictor of above-median increases in medication use (odds ratio [OR] 3.2; 95% CI 1.8, 6.2). The only nonclinical predictor of above-median increases in medication use was good social engagement at baseline (OR 1.8; 95% CI 1.1, 3.1). CONCLUSION: Medication use in Jerusalem elders grew rapidly over the 1990s, more than doubling in volume over a 7-year period. While health status was the factor most strongly predictive of the degree of change, the magnitude of increase for elders as a whole suggests major changes in prescribing practices over this interval.

EBSCOhost; rzh

Examples from the road: Mindlessness in-home. Fernando, A. D. 2008

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In-home therapy, provided to both families and individuals, has been a staple among modes of intervention for many years, particularly for social workers. The literature notes the successful application of a variety of in-home therapies for children and adolescents, in working with substance-abusing and delinquent adolescents, adolescent mothers and in lessening the number of out-of-home placements of children. The demand for community-based, in-home psychotherapeutic services continues to grow to meet the needs of children and families who would otherwise not receive any mental health services. In the situation of the in-home therapist, there is an experience of being both victim and victimizer: a victim of the rejecting family who places unreasonable expectations and demands upon the therapist; a victim of the agency who forces the therapist to do the impossible work of in-home therapy with little support and little guidance; a victimizer of the child and the family by forcing oneself into a home when he or she is unwanted; a victimizer potentially enacting the racial discrimination easily found in our culture, our institutions, and in our field of psychology--a predominantly white, upper middle-class clinic forcing mental health diagnosis and help in the form of psychotherapy onto a mostly African American group of children who may not want to engage or have little choice. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Exercise self-efficacy in older women with diastolic heart failure: results of a walking program and education intervention. Gary, R. 2006

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The purpose of this study was to evaluate exercise self-efficacy in older women with stable New York Heart Association Functional Class II and III heart failure who were enrolled in a 12-week, home-based, low- to moderate-intensity combined walking and education program. Findings indicate that participation in a 12-week, home-based walking program improved self-efficacy for exercise adherence and workload physical function. Women in the program also improved in 6-minute walk distance, depressive symptoms, and quality of life at 12 weeks, while control participants had no change on any measures. These results support that an exercise intervention that progresses gradually has potential to improve exercise self-efficacy, physical function, depressive symptoms, and quality of life in women with heart failure compared to education alone.

Ovid Technologies; Ovid MEDLINE(R)

Experience with planned and coordinated care using telemedicine. Taylor, D. M. and L. Capamagian. 2007

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In 2006 a telehealth project was implemented in Medway for people with multi-morbidity problems, such as unstable blood pressure. Home monitors were provided to measure vital signs. The information was transmitted to a secure server where an electronic patient record was accessed by clinicians. If the monitored variables exceeded preset limits, an automatic alert was sent to the monitoring centre where trained operators took appropriate action, for example notifying a patient's clinician. In nursing home settings, monitoring was thought to have saved 127 hospital bed days and 112 nursing hours. In participants' own homes, monitoring was thought to have saved 133 hospital days and 117 nursing hours. There were also cost- and time-savings for general practitioners (GPs), practice and community nurses. Increased involvement in their own management gives patients a better understanding of their condition, resulting in increased reassurance and reducing the need for GP visits.

EBSCOhost; rzh

Experiences of and attitudes toward mental health services among older youths in foster care. Lee, B. R., M. R. Munson, N. C. Ware, M. T. Ollie, L. D. Scott, Jr. and J. C. McMillen. 2006

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OBJECTIVES: This study explored the experiences of youths in the Missouri foster care system who were receiving mental health services in order to identify characteristics that they valued in relationships with mental health professionals and in the services they received and to examine whether their attitudes toward services were associated with their experiences with services. METHODS: As part of a larger study, 389 youths aged 17 years were asked open-ended questions about their experiences with mental health providers. The qualitative responses were classified through thematic analysis, and the frequencies of themes were assessed. Service use was measured, and the confidence subscale of the Attitude Toward Seeking Professional Psychological Help scale was used to measure attitudes. RESULTS: Youths' comments generally centered on three aspects of their mental health care: their relationship with their mental health provider, the level of professionalism of their provider, and the effects of the treatment, including medication management. Youths who reported only negative experiences had less positive attitudes toward services than other youths, but they were not any more likely to have experienced changes in service use or medication six months later. CONCLUSIONS: Soliciting feedback from youths about mental health services is important to the provision of high-quality care. In addition to themes identified in similar studies, this study suggests that medication management plays an important role in the acceptability of the treatment that youths receive.

EBSCOhost; rzh

An exploration looking at the impact of domiciliary and day hospital delivery of stroke rehabilitation on informal carers. Low, J. T., P. Roderick and S. Payne. 2004

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OBJECTIVES: To explore the impact of two methods of post-hospital stroke rehabilitation on both carers' perceptions of the health services offered and their quality of life. SETTING: East Dorset Health Authority. SUBJECTS: Forty-six informal carers were recruited from a sample of 106, initially identified from stroke patients participating in a larger randomized controlled trial. DESIGN: Qualitative methods. METHODS: Semi-structured interviews were used at baseline and six months to explore carers' perception of a good therapy, the advantages and disadvantages of the different services and their fulfilment with the services. In-depth thematic analysis was carried out to explore the impact of the two different methods of service delivery on carers' quality of life. RESULTS: Day hospitals provided carers with respite opportunities, whilst domiciliary stroke teams provided carers with better educational opportunities to be involved in therapy. No qualitative difference was found in the impact that the different services had on carers' quality of life, which were influenced by factors such as the degree of disruption that caring had on their lives, the loss of a shared life and the availability of social support. Ultimately, carers saw the services as providing benefit for survivors and not themselves. CONCLUSIONS: Domiciliary stroke teams provided informal stroke carers with skills that could help improve postdischarge stroke rehabilitation amongst stroke survivors. Informal carers also benefited from the respite elements of day hospital. A mixed model using both domiciliary care and day hospital care, could provide carers with the benefits of education, convenience and respite.

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An exploration of nurse practitioner care to homebound frail elders. Dick, K. and S. C. Frazier. 2006

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Purpose: To identify and classify care activities of nurse practitioners (NPs) providing primary care for frail homebound elders and to describe NPs' perceptions of the outcomes of their care activities. Data sources: Three focus groups were held with 24 NPs with at least 1-year experience in caring for frail homebound elders to elicit NPs' descriptions of their practice. In addition, individual interviews with 10 NPs and participant observation of 2 NPs visiting elders in their homes validated the data. The total sample size was 36 NPs. Field notes and audiotapes were transcribed for analysis and coded using Brykczynski's existing domains and competencies of NP practice. Conclusions: Most of the care activities of NPs providing primary care to frail elders in their home involve management of patient health and illness, case management, and the teaching-coaching function. The NP informants believe that they prevent medication errors, falls, emergency room visits, hospitalizations, and even death. They reported that they improve their patients' quality of life and help to provide a peaceful death when death is imminent. Implications for research: Further refinement of the proposed model is needed in order to examine the effectiveness of NP care on clinically relevant patient outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Factors related to institutionalization among disabled older people; A two-year longitudinal study. Sasaki, M., A. Arai and Y. Arai. 2008

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Nursing home placement among disabled older people means discontinuing home care provision by family caregivers. The present study is a two-year follow-up study. This longitudinal study aimed to identify factors related to institutionalization among community-dwelling disabled older people. Four hundred and twelve pairs of community-dwelling disabled older adults who used visiting nursing services under the public Long-Term Care insurance system in Japan and their co-residing family caregivers participated in the study. In the present study, potentially harmful behaviors (PHB) towards disabled older people by family caregivers at the previous time point was the only factor associated with institutionalization among disabled older people at the follow-up. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Families discovering asthma in their high-risk infants and toddlers with severe persistent disease. Koenig, K. 2006

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Interpretive phenomenology was used to discover the earliest experiences of families of children younger than 4 years hospitalized for severe persistent asthma. The children who were African American or Latino and living in poverty were at highest risk of morbidity and mortality. Three families with distinctly varied responses to early symptoms were chosen from an investigation of 11 families for this study. Each gave three home interviews and participated in home observations. All families experienced life-changing responses to their children's distressed breathing. All had experienced asthma in themselves or others that shaped their beliefs and management patterns. Family experiences prior to and following diagnosis are discussed. Findings suggest that understanding these experiences and respecting families' earliest responses will help clarify established family management patterns for severe asthma in infants and toddlers and will enhance the ability of providers to guide the care of these families and children.

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Family and family-like interactions in households with round-the-clock paid foreign carers in Israel. Ayalon, L. 2009

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This paper reports a Study of family and family-like interactions and transfers, or exchanges of goods and resources, between paid, round-the-clock, Filipino home carers and those they care For in a sample of households in Israel. Qualitative interviews about their experiences and attitudes concerning the care role were conducted With 22 family members and 29 Filipino home-care workers. A thematic analysis of the interview data identified three major themes: the structure and internal dynamics of the adapted family or family-like system of care; the role of family members; and the role of Filipino home-care workers in the new system of care. Sons and daughters tended to appropriate: the care-management positions and to reduce their social and emotional Support for the care recipient. In contrast, spouse care-givers continued to provide some of the personal and emotional care even when a Filipino home-care worker was employed. Filipino home-care workers were made responsible for daily care and domestic routines and provided emotional and social care. It was found that family members do not relinquish their role as care-givers when round-the-clock foreign carers are on hand, but the nature of their role changes. The results Suggest that foreign home-care workers' job description needs to be redefined to acknowledge the substantial social and emotional care that they provide.

Family structure and mothers' caregiving of children with cystic fibrosis. Gayer, D. and L. Ganong. 2006

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The purpose of this investigation is to examine differences in the experiences of mothers of children with cystic fibrosis who are in diverse family structures (first-marriage families, stepfamily households, single-parent households). In particular, mothers' perceptions of children's health, adherence to prescribed treatments, and help received from others were compared and predictors of treatment adherence were examined. Children's health and adherence to treatment regimens were not related to family structure. Mothers had the major responsibility for seeing that cystic fibrosis treatments were followed, regardless of family structure. Single mothers received less help than married and repartnered mothers. Married fathers helped with treatments more than nonresidential divorced fathers and stepfathers. Implications for nursing practice and suggestions for future research are offered.

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Female caregivers of sexually abused children: A repeated measures study of caregiver psychological functioning with implications for treatment. Aguila, J. C. School of Intercultural Studies, Biola University, 2004

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This study evaluated whether biological mothers of sexually abused children begin their child's treatment with greater disturbance in their own psychological functioning than relative caregivers or foster parents. Specifically, two instruments, the BDI-II and TSI were used to assess psychological symptoms associated with depression and Post Traumatic Stress Disorder, respectively. Tests were administered to 102 female adult caregivers at intake, 6-months, and 12-months. Results showed that biological mothers endorsed more depression and posttraumatic stress than relative and foster caregivers at intake. Secondly, caregivers who endorsed symptoms of depression and posttraumatic stress were especially vulnerable to dropping out of treatment prematurely. Thirdly, ethnic differences among biological mothers suggest that minority caregivers do not uniformly respond to trauma. Biological mothers endorsed symptoms based on personal characteristics (caregiver age, abuse history, ethnicity, and length in treatment), as well as the offender's age, but not as a function of abuse characteristics associated with their child's abuse. Results indicated no significant impact on caregivers regarding (a) the number of sexual abuse incidents experienced by the child, (b) the age at which the child's sexual abuse began, (c) the intra- versus extra-familial relationship of the abuser to the child, and (d) whether their child experienced penetration.

Figuring out whether they can be trusted: older widows' intentions relative to hired non-professional home-care helpers. Porter, E. J., S. Lasiter and E. Poston. 2005

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The purpose of this phenomenological study was to describe the experience of older women relative to trusting hired non-professional home-care helpers. Open-ended interviews were done about the home-care experience with 25 women over three years, and 14 women (age 80-93) shared data about hiring and trusting helpers. The women perceived risks to personal safety that adversely influenced willingness to seek new helpers. After hiring a helper, the women were still trying to discern whether the helper could be trusted. Primary-care providers should enable older women to recognize and reduce the risk of having helpers and to monitor helpers' behavior, as well as assessing the psychosocial status of women who have such helpers.

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Flying under the radar: Engagement and retention of depressed low-income mothers in a mental health intervention. Beeber, L. S., C. Cooper, B. E. Van Noy, T. A. Schwartz, H. C. Blanchard, R. Canuso, K. Robb, C. Laudenbacher and S. L. Emory. 2007

No relevant

A randomized trial of in-home psychotherapy for depressive symptoms that targeted low-income mothers of infants and toddlers used innovative design features to reduce stigma and enhance acceptability. Despite these features, advanced practice psychiatric mental health nurses used specialized, relationship-based strategies to engage and retain these high-risk mothers in the intervention. Data revealed that the nurses needed to diligently maintain contact, provide encouragement, use empathy for rapid assessment and response, and control the intensity of the relationship-based contacts in order to retain mothers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Formal support of stroke survivors and their informal carers in the community: a cohort study. Simon, C., S. Kumar and T. Kendrick. 2008

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This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarason's social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.

EBSCOhost; rzh

Foster carer strain and its impact on parenting and placement outcomes for adolescents. Farmer, E., J. Lipscombe and S. Moyers. 2005

Not relevant

EBSCOhost; rzh

French district nurses' opinions towards euthanasia, involvement in end-of-life care and nurse-patient relationship: a national phone survey. Bendiane, M. K., A. Galinier, R. Favre, C. Ribiere, J. M. Lapiana, Y. Obadia and P. Peretti-Watel. 2007

Not relevant

OBJECTIVES: To assess French district nurses' opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients. DESIGN AND SETTING: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses. PARTICIPANTS: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate (response rate 75%). MAIN OUTCOME MEASURES: Opinion towards the legalisation of euthanasia (on a five-point Likert scale from "strongly agree" to "strongly disagree"), attitudes towards terminal patients (discussing end-of-life issues with them, considering they should be told their prognosis, valuing the role of advance directives and surrogates). RESULTS: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients (70%), who consider competent patients should always be told their prognosis (81%) and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients (68% and 77% respectively). Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny. CONCLUSIONS: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care.

EBSCOhost; rzh

Functional improvement of the Australian health care system - Can rehabilitation assist? New, P. W. and C. J. Poulous. 2008

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* Strategies for managing increasing health system demand have focused on the acute sector and chronic disease management in the community, with little attention on the role of rehabilitation. * There were over 53000 inpatient rehabilitation episodes in Australia in 2006. We argue that rehabilitation can improve patient flow and outcomes in acute care if engaged early. * The effectiveness of rehabilitation can be enhanced by increasing the intensity of therapy and developing models of rehabilitation that provide alternatives to inpatient care. * Factors that reduce the efficiency of rehabilitation services include the location of many services in small, stand-alone hospitals without acute support; the lack of options for managing younger people with acquired disability in the community; and deficiencies in government programs for the supply of aids, equipment and home modifications. * Improving the organisation of rehabilitation services should improve access to acute and rehabilitation inpatient beds, improve patient outcomes and reduce costs.

Ovid Technologies; Embase

Functional interdependence. Del Aguila, M., L. Cox and L. Lee. 2006

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Objective: The interrelationship between functional capacity, informal networks and the physical environment of the residence and residential location is used to describe age-care service utilisation and non-utilisation. Methods: Fifty-two applicants for home-care services were matched with 52 non-applicants, and 40 applicants for day-care services were matched with 40 non-applicants according to age, gender, mental status, and physical functioning. Results: Discriminant Function Analyses indicated home-care applications are related to network isolation within existing neighbourhoods and that day-care applicant networks were insufficient to accommodate challenges presented by the immediate physical environment of the residence. The physical environment of the residence also distinguished home-care applicants from day-care applicants. Conclusion: The findings support the proposed model of functional interdependence that describes service utilisation and non-utilisation as a function of the interrelationship between functional capacity and the capacity of family friends, neighbours and communities of interest to accommodate challenges present in the elder persons residence and residential context.

Generalization in a child's oppositional behavior across home and school settings. Wahler, R. G., V. A. Vigilante and P. S. Strand. 2004

Not relevant

A 9-year-old clinic-referred boy, his mother, and his teacher were observed in 38 home and 38 school sessions on the same days. Categories of the boy's oppositional behavior and the inappropriate social attention of his mother and teacher were graphed to visually inspect changes during baseline, a parent-training phase, a follow-up phase, and a final parent-training booster phase. Parent-training phases produced reductions in the mother's inappropriate attention and in the boy's oppositional behavior, whereas the follow-up and baseline phases were associated with higher rates of these categories. Generalization occurred in the school across these home phases, as seen in the increase in rates of the boy's problem behavior, despite the lack of change in his teacher's attention. Correlational analyses of proportion scores reflecting the boy's home-school oppositional behavior and mother-teacher social attention suggested his responsiveness to relative changes in adult social contingencies across settings.

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Going home from hospital: the postdischarge experience of patients and carers in rural and remote Queensland. Williams, C., R. Thorpe, N. Harris, H. Dickinson, C. Barrett and F. Rorison. 2006

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OBJECTIVE: This paper reports on a study of the experiences of patients and carers discharged from the Townsville General Hospital into rural and remote communities in North Queensland. DESIGN: The findings presented in this paper are drawn from post-discharge in-depth, qualitative interviews of both patients and carers. RESULTS: The findings indicate the importance of examining the lived experience of both patients and carers in attempting to understand the impact of current discharge practices. CONCLUSION: We conclude that carers are providing the bulk of post-discharge care of patients - a difficult role in which the difficulties are exacerbated when the patient or the carer or both is a long way from the home community.

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Grey nomads--health and health preparation of older travellers in remote Australia. Tate, J., J. Mein, H. Freeman and G. Maguire. 2006

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BACKGROUND: Many older Australians now tour remote Australia (so called 'grey nomads'). Anecdote suggests they place a burden on limited remote health services, however, this burden is poorly documented. METHODS: Two groups were approached to participate in the survey: travellers aged 50 years or over and staying in caravans, motor homes or tents at Fitzroy Crossing, Western Australia; and local primary health care providers. RESULTS: All 260 travellers approached responded. The prevalence of chronic diseases in those aged 65 years or over was 68%; 57% had sufficient chronic medications for the entire trip; 19% had a list of long term medications; and 9% of those with chronic diseases had a health summary from their usual general practitioner. Sixty-four local health providers responded: 95% rated health summaries highly (particularly if they included an active problem list, past history, current medications, and allergies). DISCUSSION: Older patients are poorly prepared for travel in remote Australia. They have a chronic disease rate no less than the national prevalence and could represent a drain on local health resources. Solutions might include GP review before travel, bringing sufficient medication for the trip, review of vaccination requirements, and a health summary.

EBSCOhost; rzh

Handheld computers and paper diaries for documenting the use of factor concentrates used in haemophilia home therapy: a qualitative study. Arnold, E., N. Heddle, S. Lane, J. Sek, T. Almonte and I. Walker. 2005

Not relevant

A recently published randomized controlled trial (RCT) showed that adherence to infusion diary record keeping was improved by the use of handheld computers. In this study, attitudes to record keeping were explored and patient preferences regarding the method of recording determined for the patients who participated in the trial. Qualitative study consisting of individual semi-structured interviews with 20 severely affected patients with haemophilia who participated in an RCT. Individuals were purposefully sampled based on their recent method of record keeping and whether child or adult. Analysis employed a constant comparative method to identify key themes from the data. Most individuals (19 of 20, 95%) considered record keeping to be important. They readily identified reasons to keep records: to benefit themselves, their families, clinical staff, product distributors and manufacturers. Keeping records helps them: feel a part of the health care team; have confidence they would be notified of product recalls; review their past history; improve their ability to advocate for themselves and improve communication among all parties. Record keeping, particularly when using paper diaries, can be burdensome and a challenge to maintain consistently. All 10 individuals (100%) who had used both paper diaries and handheld computers preferred the latter. Most patients understand that record keeping can be of benefit to them. Clinics can use this knowledge to inspire other patients by developing educational programmes that de-emphasize authority. In addition, given the evidence of both patients' preference for handheld computers, and the effectiveness of this approach documented in an RCT, switching to handheld computers is likely to improve record keeping.

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Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home-based intervention program. Lie, I., H. Arnesen, L. Sandvik, G. Hamilton and E. H. Bunch. 2009

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Objective: The aim of this study was to evaluate the impact of a home based intervention program (HBIP) on health related quality of life (HRQoL) after coronary artery bypass grafting (CABG). To strengthen the clinical interpretation, HRQoL data were compared to the general population. Methods: In a randomised controlled trial (RCT), a total of 185 CABG patients (93 vs 92) completed the study. The intervention group received a HBIP 2 and 4 weeks after surgery. HRQoL was measured by the Seattle Angina Questionnaire (SAQ) and the Short Form 36 (SF-36) in both patient groups before surgery, at 6 weeks and 6 months after surgery. Results: Significant improvements were found in both groups for the majority of subscales of HRQoL at 6-week and 6-month follow-up. However, these improvements did not differ significantly between the groups. Compared to the general population, significant differences (P < 0.05) were found for the SF-36 subscales: role physical, role emotional and bodily pain. Conclusions: HRQoL after CABG improved markedly over time, but no significant or clinically important differences were found when compared with controls. Thus, work to further develop and test the effect of a HBIP on HRQoL in patients undergoing rehabilitation following CABG is warranted. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Hemodialysis for end-stage renal disease: A cost-effectiveness analysis of treatment options. Gonzalez-Perez, J. G., L. Vale, S. C. Stearns and S. Wordsworth. 2005

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Background: During 2001, over 32,000 patients in the United Kingdom received renal replacement therapy (RRT). Approximately half had a functioning transplant, with the remainder receiving dialysis therapy. The main form of dialysis is hemodialysis (HD), which is provided to 37.1 percent of the RRT population. HD is provided in three main settings: hospital (24.5 percent), satellite (10.9 percent), or home (1.7 percent). The objective of this study is to explore the cost-effectiveness of these different modalities. Methods: By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the three different modalities. The model included direct health service costs and quality-adjusted life years (QALYs). Sensitivity analyses were performed to assess the robustness of the results. Results: Satellite HD has lower costs [pounds]46,000 and [pounds]62,050 at 5 and 10 years than home HD [pounds]47,660 and [pounds]63,540. The total effectiveness of home HD was slightly greater than for satellite HD, so the incremental cost per QALY of home versus satellite HD was modest at [pounds]6,665 at 5 years and [pounds]3,943 at 10 years. Both modalities dominated hospital HD. Conclusions: Results from the study reveal that satellite HD was less costly than home HD, and home HD was less costly than hospital HD. The lack of robust data on the effectiveness and new dialysis equipment, which were not included in this review, throws some caution on these results. Nonetheless, the results are supportive of a shift from hospital HD to satellite and home HD.

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High dose levo-methadone treatment for cancer pain in a patient with a history of drug addiction. Ostgathe, C., J. Gaertner, F. Nauck and R. Voltz. 2008

Not relevant

A 39-year-old woman had been receiving levo-methadone maintenance therapy (3 mg/day) for 12 years because of heroin addiction. Within these 12 years, her state of health and social situation stabilized. Two years before admission, a squamous cell carcinoma of the uterine cervix was diagnosed. On admission, the patient suffered from moderate to severe cancer-related somatic, nociceptive, and neuropathic pain. During the inpatient stay on the surgical ward, levo-methadone had been increased up to 40 mg/day. Within the next three weeks, pain intensity declined successively. The daily opioid dosage stabilized at 180 mg levo-methadone, and the patient rated pain intensity as NRS 1 at rest and 4 on movement. The patient was discharged home and supported by a specialized palliative home care service. The patient was almost pain-free for the rest of her stay and required only 15 mg/ day of levo-methadone. She was discharged to a hospice. To our knowledge the maximum levo-methadone doses needed for the treatment of pain in the case presented exceeds all methadone doses published so far. Levo-methadone is an enantiomer and used as a second or third-line opioid in cancer pain management in Germany. This case illustrates how challenging pain management in terminally ill levo-methadone maintained patients can be. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

High-performing and low-performing nursing homes: a view from complexity science. Forbes-Thompson, S., T. Leiker and M. R. Bleich. 2007

Not relevant

Background: There continues to be concern for the quality of care and quality of life for nursing home residents. Some scientists have turned their attention to viewing nursing homes as complex adaptive systems to inform our understanding of organizational performance.

Purpose: The purpose of this study was to describe the working conditions in four nursing homes-two high performing and two low performing-through the lens of complexity science theory.

Methods: A qualitative case study approach was used to examine four nursing homes. Extreme case examples-high- and low-performing nursing homes-were purposefully selected. More than 100 hr of observation, 70 formal interviews, numerous informal interviews, and document review were the primary data collection methods.

Findings: Using select complexity science principles added richness to the analysis, highlighting the stark contrast between the high- and low-performing nursing homes. Leaders in the high-performing homes behaved congruently with the nursing home's stated and lived mission by fostering connectivity among staff, ample information flow, and the use of cognitive diversity. In contrast, leadership in low-performing homes behaved disharmoniously with the stated mission, which confused and eroded trust and relationships among staff members, contributed to poor communication, and fostered role isolation and discontinuity in resident care.

Practice Implications: The study offers insights into the importance of mission- and values-based leadership behaviors, suggesting that an overuse of mechanistic, linear command-and-control approaches to improving care, such as punitive measures to insist on regulatory compliance, will do little to ultimately improve care. Rather, relationship-centered leadership that embraces comanagement and mutual shaping of resident care complements doing the right thing for residents from a values-based shared experience. Examples of practice implications include developing a strong, coherent organizational mission; having fewer, more flexible rules to foster creativity; and allowing lateral decision making.

EBSCOhost; rzh

HIV/AIDS, declining family resources and the community safety net. Heymann, J. and R. Kidman. 2009

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Families play central roles in the HIV/AIDS pandemic, caring for both orphaned children and the ill. This extra caregiving depletes two family resources essential for supporting children: time and money. We use recent data from published studies in sub-Saharan Africa to illustrate deficits and document community responses. In Botswana, parents caring for the chronically ill had less time for their preschool children (74 versus 96 hours per month) and were almost twice as likely to leave children home alone (53% versus 27%); these children experienced greater health and academic problems. Caregiving often prevented adults from working full time or earning their previous level of income; 47% of orphan caregivers and 64% of HIV/AIDS caregivers reported financial difficulties due to caregiving. Communities can play an important role in helping families provide adequate childcare and financial support. Unfortunately, while communities commonly offer informal assistance, the value of such support is not adequate to match the magnitude of need: 75% of children's families in Malawi received assistance from their social network, but averaging only US$81 annually. We suggest communities can strengthen the capacity of families by implementing affordable quality childcare for 0-6 year olds, after-school programming for older children and youth, supportive care for ill children and parents, microlending to enhance earnings, training to increase access to quality jobs, decent working conditions, social insurance for the informal sector, and income and food transfers when families are unable to make ends meet.

EBSCOhost; rzh

Home and Community-Based Services: Costs, Utilization, and Outcomes. Lakin, K., A. Hewitt, S. A. Larson and R. J. Stancliffe. 2005

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(from the chapter) Medicaid Home and Community-Based Services (HCBS) Waiver programs have become the most widely used and by far the most rapidly growing programs for financing long-term services and supports for individuals with intellectual and developmental disabilities in the United States. HCBS Waiver programs are intended to support people in their homes and communities as an alternative to more costly institutional care. This chapter, based on comprehensive evaluation by the University of Minnesota, describes Minnesota's HCBS Waiver program and participants and those living in Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR), factors associated with variations in HCBS utilization and expenditures, and the association between service costs and quality-of-life outcomes. It discusses the implication of the findings for HCBS policy in Minnesota, in particular, and for long-term care systems, in general. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Home care as a complex experience: a chronological case study. Porter, E. J. 2008

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This case study of an older woman with macular degeneration describes her experience of dispensing daily medications over a 3-year period, during which a home care nurse began and continued visits. Using a phenomenological method, I analyzed data of 9 interviews, discerning the structure of her experience and depicting it in 7 diagrams. The home care experience can have unintended outcomes influenced by family and provider perceptions of clients' abilities, especially when family members and practitioners assume tasks that older women have managed alone. Minimizing intergenerational ambivalence about the need for home care and maximizing client agency should be preeminent foci of home care providers.

EBSCOhost; rzh

Home care as a family matter? Discursive positioning, storylines and decision-making in assessment talk. Olaison, A. and E. Cedersund. 2008

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Home care arrangements for older people are coordinated via a client-centred assessment process. This article describes how storylines and discursive positioning are used among older people and their relatives when divergent opinions of care needs are expressed. Eleven assessment interviews were studied using discourse analysis. The results show that relatives and older people advanced three major storylines, and positioned themselves within them with respect to the need for help. These storylines were based on whether the persons viewed home care as an intrusion into daily routines and relationships, or as a complement and support in everyday life, or as a right. The content of the storylines and the ways in which positions were shaped within them illustrate how positioning is incorporated as part of the ongoing reflexive process in interaction in which participants form an image of the older person's needs. Assessments clarify the views of the participants on home care, but they also reflect the discourses that are prevalent in the aged care community and in society in general. The article raises questions about strengthening older people's participation in the decision making process and also whether a new communicative practice is needed for assessments, i.e., one that proceeds on the basis of a broader family perspective.

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Home care as an option in worsening chronic heart failure -- a pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness. Patel, H., M. Shafazand, I. Ekman, S. Hojgard, K. Swedberg and M. Schaufelberger. 2008

Not relevant

BACKGROUND: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. AIM: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. METHODS: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. RESULTS: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p=0.05). CONCLUSION: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution.

Ovid Technologies; Ovid MEDLINE(R)

Home care on the geriatrics service: a medical student's perspective. Annas, G. D. 2007

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A physician recounts the invaluable experience he gained as a medical student "meeting people where they are," in their home environments surrounded by many factors that can affect a patient's health--a grab bar in a shower, a phone with Braille for a vision-impaired patient, the sanitary condition of a house--things that are hidden when patients are seen in a clinical setting.

EBSCOhost; rzh

Home care personnel's perspectives on successful discharge of elderly clients from hospital to home setting. Eija, G. and P. Marja-Leena. 2005

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The successful discharge of elderly patients from hospital to home care is a process requiring co-operation between health and social care personnel in addition to their commitment and skills. During the discharge process it is important that health and social care professionals have a shared view of the health and mental status and needs of the patient so that appropriate plans for meeting these needs can be made. The aim of the study was to investigate home care personnel's (health and social care workers) views of which practices between the discharging hospital and home care are associated with the successful discharge of clients. Home care personnel in 22 Finnish municipalities (n = 1890, response rate 63%) received a questionnaire in spring 2001. When the respondents' background factors were standardized, the best predictors of successful discharge from the home care personnel's point of view were adequate information received about the treatment of the patient's illnesses and their functional ability and cognitive potentials, timely information about the discharge, and good co-operation between the discharging hospital, and the home care, social care and health care workers working in home care. There were differences in the opinions of social care workers and health care workers working in home care. From the home care personnel's point of view the most important correlates of an elderly client's discharge from hospital to a home setting were factors associated with how they can best plan their work. Their perspective on the discharge process may diverge from clients and their informal care givers point of view. To ensure the successful discharge process we must take them all into account.

Ovid Technologies; Ovid MEDLINE(R)

Home care: A key to the future of family medicine? Landers, S. H. 2006

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This essay is about my transition from family medicine residency into house call/home-based primary care practice. Though some aspects of making home visits have been difficult and uncomfortable, I have found a higher level of satisfaction and sense of purpose than I had as a resident in a traditional outpatient clinic. This enhanced satisfaction is, in part, due to my discovery that a lower-volume, time-intensive house call practice is a more appropriate way than the brief office visit to care for older patients who have multiple morbidities. In light of the aging population, advances in portable medical technology, and changes in Medicare reimbursement, home care could become a key to the future success and ongoing relevance of family medicine.

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Home health care challenges and avian influenza. Gershon, R. R. M., K. A. Qureshi, P. W. Stone, M. Pogorzelska, A. Silver, M. R. Damsky, C. Burdette, K. M. Gebbie and V. H. Raveis. 2007

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Recent public health disasters, both nationally and internationally, have underscored the importance of preparedness in effectively responding to these events. Within the home health care sector, preparedness is especially critical, as home care patients may be at increased risk of disaster-related morbidity and mortality because of their age, disability, or other vulnerability. Importantly, the home health care population is growing, with an estimated 7 million patients currently receiving home health care services. Yet the degree of preparedness at all levels of the home care sector (agency, health care worker, and patient and/or family) is largely unknown. Without this knowledge, important first steps toward development and implementation designed to address barriers to preparedness cannot be taken. To help address some of these knowledge gaps, one aspect of preparedness, namely the willingness of home health care workers to respond during an avian influenza outbreak, was recently examined. Findings revealed very low levels of willingness. Preliminary recommendations designed to address this issue are presented following a general discussion of the issue.

EBSCOhost; rzh

Home treatment of pain for children and adolescents with sickle cell disease. Beyer, J. E. and L. E. Simmons. 2004

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This ethnographic study examined family caregivers' perceptions of the effectiveness of comfort measures used at home for children with vaso-occlusive episodes (VOE) of sickle cell disease. Interviews were conducted in the hospital while children experienced VOE. Oral analgesics and most nonpharmacologic pain relief methods were rated by caregivers as only partly effective. Major themes that emerged from interview information reflected caregivers' efforts on behalf of their children in avoiding pain episodes, keeping a normal routine, "catching" the pain, getting their minds off the pain, helping the child get through the episode, and staying out of the hospital. Understanding the role of the family caregiver in home settings may assist health care professionals to provide more empathetic care to children with VOE and to their families when children are admitted to the hospital. Findings may encourage professionals to design the most effective methods of home pain management for these families.

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Home Visitor Competence, Burnout, Support, and Client Engagement. Gill, S., M. T. Greenberg, C. Moon and P. Margraf. 2007

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Home visitor characteristics, on-the-job training and support, job satisfaction, burnout, and turnover were examined over a five-year period. Home visitors were adequately trained, and scored high on measures of knowledge, competence, psychological functioning (indicated by measures of burnout and depression), and job satisfaction at program entry. Over time, home visitation was associated with higher emotional exhaustion and lower job satisfaction. Staff turnover was high during periods of program reorganization but had a positive impact on client engagement in that families served by more than one home visitor stayed in the program longer. Implications for program implementation are discussed. Adapted from the source document. COPIES ARE AVAILABLE FROM: HAWORTH DOCUMENT DELIVERY CENTER, The Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580

CSA Sociological Abstracts

Home-based support for disadvantaged adult mothers. Bennett, C., G. M. Macdonald, J. Dennis, E. Coren, J. Patterson, M. Astin and J. Abbott. 2007

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BACKGROUND: Babies born to socio-economically disadvantaged mothers are at higher risk of a range of problems in infancy. Home visiting programs are thought to improve outcomes, both for mothers and children, largely through advice and support. OBJECTIVES: To assess the effectiveness of home visiting programmes for women who have recently given birth and who are socially or economically disadvantaged. SEARCH STRATEGY: We searched the following electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2006); MEDLINE (1966 to March 2006); EMBASE (1980 to 2006 week 12); CINAHL (1982 to March week 4 2006); PsycINFO (1872 to March week 4 2006); ASSIA (1987 to March 2006); LILACS (1982 to March 2006); and Sociological Abstracts(1963 to March 2006). We searched grey literature using ZETOC (1993 to March 2006); Dissertation Abstracts International (late 1960s to 2006); and SIGLE (1980 to March 2006). We also undertook communication with published authors about ongoing or unpublished research. SELECTION CRITERIA: Included studies were randomised controlled trials investigating the efficacy of home visiting directed at disadvantaged adult mothers. DATA COLLECTION AND ANALYSIS: Two reviewers (EC and JP or CB) independently assessed titles and abstracts identified in the search for eligibility. Data were extracted and entered into RevMan (EC, JP and CB), synthesised and presented in both written and graphical form (forest plots). Outcomes included in this review were established at the protocol stage by an international steering group. The review does not report on all outcomes reported in included studies. MAIN RESULTS: We included 11 studies with 4751 participants in this review. Data show no statistically significant differences for those receiving home visiting, either for maternal outcomes (maternal depression, anxiety, the stress associated with parenting, parenting skills, child abuse risk or potential or breastfeeding) or child outcomes (preventive health care visits, psychosocial health, language development, behaviour problems or accidental injuries. Evidence about uptake of immunisations is mixed, and the data on child maltreatment difficult to interpret. AUTHORS' CONCLUSIONS: This review suggests that for disadvantaged adult women and their children, there is currently no evidence to support the adoption of home visiting as a means of improving maternal psychosocial health, parenting or outcomes for children. For reasons discussed in the review, this does not amount to a conclusion that home visiting programmes are ineffective, but indicates a need to think carefully about the problems that home visiting might influence, and improvements in the conduct of outcome studies in this area.

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The homeless in America: adapting your practice. Montauk, S. L. 2006

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In 2004, the National Guidelines Clearinghouse placed eight guidelines from the National Health Care for the Homeless Council on its Web site. Seven of the guidelines are on specific disease processes and one is on general care. In addition to straightforward clinical decision making, the guidelines contain medical information specific to patients who are homeless. These guidelines have been endorsed by dozens of physicians who spend a large part of their clinical time caring for some of the millions of adults and children who find themselves homeless each year in the United States. In one guideline, physicians are prompted to keep in mind that someone living on the street does not always have access to water for taking medication. Another guideline points out the difficulty of eating a special diet when the patient depends on what the local shelter serves. As the number of homeless families and individuals increases, family physicians need to become aware of medically related information specific to this population. This can help ensure that physicians continue to offer patient-centered care with minimal adherence barriers.

EBSCOhost; rzh

How to start or change a daily insulin regimen without a specialist in diabetes. Effectiveness and RAND assessment of practical schemes for in-hospital or hospital-based home care services use. Ciardullo, A. V., M. M. Daghio and C. Carapezzi. 2006

No relevant

When the diabetic patient is hospitalised or assisted by a hospital-based home care service, as a rule he/she is not cared for by a diabetologist all day long. The aim of the present work was to perform a RAND assessment of practical schemes to start or change a daily insulin regimen without a diabetologist. We created an expert panel of seven internists and two diabetologists. They judge the appropriateness of each practical scheme using the RAND method. We produced 21 clinical scenarios divided into two groups. The first group of 9 clinical scenarios - i.e., for diabetic patients who 'eat/not-always-eat' and are 'normal-weight/obese/underweight' or with 'renal failure' or 'defedated/end-of-life' or 'vomiting' or on 'parenteral nutrition' - useful for starting a daily insulin regimen without a diabetologist had a median RAND score of 8 (range 7-9). The second one - formed by 12 clinical scenarios useful to change the daily insulin dosage without a diabetologist based on low or high capillary glucose level monitoring - had a median RAND score of 9 (range 7-9). There was a high level of agreement between panellists in judging 'appropriate' the practical schemes to start or change a daily insulin regimen without a diabetologist.

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Impact of changes in Medicare home health care reimbursement on month-to-month home health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures. FitzGerald, J. D., C. M. Mangione, J. Boscardin, G. Kominski, B. Hahn and S. L. Ettner. 2006

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BACKGROUND: Beginning October 1, 1997, Medicare implemented a series of major changes to the Home Health (HH) reimbursement system. Reimbursements were first significantly reduced under the Interim Payment System (IPS) and then relaxed slightly until implementation of the HH Prospective Payment System (PPS) on October 1, 2000. OBJECTIVE: The objective of this study was to examine the impact of reimbursement policy on HH care utilization. RESEARCH DESIGN: We postulated that in response to the initial changes, there would be reductions in both the probability of any HH use and the number of HH visits per HH user. Under PPS, we postulated there would be further reduction in number of HH visits. We tested whether the policy response differed by HH agency structure and whether subgroups of patients were differentially affected. An interrupted time-series analysis was conducted to examine month-to-month probability of HH selection and the number of HH visits among users. SUBJECTS: A 100% sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected. RESULTS: Under the IPS, the probability of any HH use and number of visits per episode of HH care fell until the IPS was refined in October 1998. With implementation of the PPS, HH visits fell commensurately. Differentially larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals. CONCLUSIONS: Changes in month-to-month utilization of HH services were sharp and well correlated with policy implementation dates, strengthening the evidence for a causal association between policy and patient care in the midst of a sea of concurrent policy changes. Greater reductions in HH visits were noted for vulnerable groups.

EBSCOhost; rzh

The impetus for family-centred early childhood intervention. Carpenter, B. 2007

Not relevant

In this article, the current climate of early intervention is considered, advocating the necessity for it to remain a cutting-edge service that attends to the changing needs profiles of children and their families. The article reviews the difficulties experienced by families in the UK, where, as the government acknowledges, life chances are still unequal. It emphasises that early interventions can increase the likelihood of the family being able to engage or re-engage with mainstream societal services, thus reducing the long-term costs to society. It discusses the past and present UK policy context from 2004, when Sohns reported that the UK was the only country without a national policy of infrastructure in relation to early childhood intervention, until the present when, a raft of legislation is in place acknowledging its importance and the need for priority. Central to many effective early intervention programmes is the goal of establishing shared communication in the infant-key carer dyad, using alternative communication and therapy-based interventions. The article discusses parent-inclusive programmes which meet the needs of both parents and children, and receive endorsement from parents. Finally, the article considers evaluation of early childhood services, and the necessity of increasing the centrality of the family in service delivery in order to provide services which are integrated, relevant and efficacious.

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Implementation of capecitabine (XELODA) into a cancer centre: UK experience. Faithfull, S. and P. Deery. 2004

Not relevant (reference to informal caregiver not evident)

Switching patients from intravenous 5-FU/LV to oral capecitabine (Xeloda) for the treatment of metastatic colorectal cancer is associated with a reduction in the need for hospitalisations to manage 5-FU-associated delivery and complications, with resulting healthcare savings. However, implementing oral therapy with capecitabine within a cancer centre in the UK has required a considerable change in attitude within healthcare services. The resulting need for patients to take an active role in their treatment, and the co-ordination and monitoring of such a service at home has raised issues for chemotherapy services. To enhance patient involvement and compliance with medication a patient guide was developed to educate, and support individuals and enable them to understand the rationale for treatment and when to seek help. In addition, patients are encouraged to monitor and record symptoms in a diary. This change in service focus has required an investment in time educating and informing patients, community health workers and hospital practitioners. This change has been co-ordinated through the chemotherapy outpatient clinic. Effective communication between hospital and home has been important in implementing oral chemotherapy. While the initial challenge of monitoring and educating patients receiving capecitabine has been met, the Primary Care team and cancer centre need to continue to assess side effects and patient compliance in order to improve knowledge of capecitabine among healthcare professionals and ensure safe practice.

EBSCOhost; rzh

Implementing & Validating Guidelines to Facilitate the Involvement of Carers in the Care of People with Dementia and Other People Requiring Long Term Care. Studies, F. o. N. 2002

Not relevant (pre '2004)

Improvement in the outcome indicator of readmission of patients with heart failure: a case analysis. Hoskins, L. M. and J. R. Duffy. 2005

Not relevant (Reference to caregiver not evident)

This article describes the process used by one performance improvement committee to analyze comprehensive assessment data, including OASIS data, and relate it to nursing activities described in the clinical nursing notes. The end goal was to improve, or decrease, the hospital readmission rate of their patients with heart failure. The fit between patient characteristics and the plan of care described and delivered in two groups was evaluated. Differences in patient characteristics and nursing documentation of outcomes provided the data for remediation and for testing of a new intervention.

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Improving cancer pain management by homecare nurses. Vallerand, A. H., C. Riley-Doucet, S. M. Hasenau and T. Templin. 2004

Not relevant (Reference to caregiver not evident)

PURPOSE/OBJECTIVES: To demonstrate the effects of a program, directed at homecare nurses, of structured educational interventions on the management of pain and opioid-related side effects in homecare patients with cancer. DESIGN: A longitudinal multilevel, randomized, controlled clinical trial. SETTING: Midwestern region in the United States. SAMPLE: 202 nurses caring for patients with cancer recruited from homecare agencies. METHODS: The two-tiered educational program focused on basic and advanced pain management strategies, particularly in the area of pharmacologic options and assertive communication skills. Instruments used were the Nurses' Knowledge and Attitudes Survey Regarding Pain, the barriers questionnaire, perception of control over pain, and a demographic questionnaire. MAIN RESEARCH VARIABLES: Knowledge and attitudes about pain management, barriers to pain management, and perception of control over pain. FINDINGS: Nurses in the intervention group had a significant increase in their knowledge, a more positive attitude about pain management, fewer perceived barriers to pain management, and an increase in perceived control over pain compared to the nurses who did not receive the intervention. CONCLUSIONS: The educational program Power Over Pain has beneficial effects for homecare nurses caring for patients with cancer pain. IMPLICATIONS FOR NURSING: A need exists for homecare nurses to gain more insight into pain management strategies and enhance their advocacy skills to improve pain management for patients with cancer treated in the home.

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Improving client-centred care and services: the role of front/back-office configurations. Broekhuis, M., C. de Blok and B. Meijboom. 2009

Not relevant (Reference to caregiver not evident)

Aim. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Background. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Method. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). Findings. The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. Conclusions. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.

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IMPROVING THE QUALITY OF RESEARCH OUTPUTS IN HIGHER EDUCATION THROUGH KNOWLEDGE SHARING AND COLLABORATION: A CASE STUDY. 2005

Not relevant (South Africa)

The article highlights some drawbacks of not managing knowledge in academia and suggests knowledge-sharing strategies that can be used to leverage knowledge on research procedures. The study investigated the research procedures used by Master of Information Studies students at the University of Natal in South Africa between 1982 and 2002. The results indicated that there was no uniformity in the research procedures used in the theses. For instance, issues relating to sampling, validating survey protocols and summarising research findings were not always handled according to established methodological standards. The variability in research processes that were employed partly implied that the levels of knowledge of research supervisors differed. It is evident from the research outputs that knowledge that is scattered among research supervisors is not easily accessible. In that regard, this article provides a model for academic institutions interested in bridging existing knowledge gaps and enhancing performance of research supervisors. [ABSTRACT FROM AUTHOR]

Copyright of Mousaion is the property of University of South Africa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Increasingly distant from life: problem setting in the organization of home care. Ceci, C. 2008

Not relevant (Reference to caregiver/informal not evident)

The analysis undertaken in this paper explores the significance of a central finding from a recent field study of home care case management practice: a notable feature of case management work is the preparation of an orderly, ordered space where care may be offered. However, out of their encounters with an almost endless variety of situations, out of people's diverse narratives of need, case managers seem able to pick out only limited range of recognized needs to which to respond and demonstrate a series of responses themselves equally limited. Though this observation suggests a kind of efficiency that is currently highly valued within healthcare systems, it also underlines the system's inability to engage difference and variability in a meaningful way. This inability or limitation in effectively engaging difference is conceptualized here as, in some sense, a problem, and the nature of this problem is explored through the rhetorical process of problem setting. The central question becomes how might we develop and deploy an orderly and coherent system of care without essentializing people's experiences, without treating these experiences reductively, without, in a Foucaultian frame of reference, allowing what can be understood as similarity or resemblance among clients and situations to be folded back into sameness? As we encounter complexity, variability and difference in practice, how should we treat it?

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Infection control. The quest for best practice in caring for the home care patient with an indwelling urinary catheter: the New Jersey experience. Sienkiewicz, J., G. Wilkinson and K. D. Emr. 2008

Not relevant (Reference to caregiver/informal not evident)

This article describes the development of a urinary tract infection (UTI) benchmarking project by the Home Care Association of New Jersey for New Jersey's home care agencies. In the quest for best practice in caring for the home care client with an indwelling urinary catheter, identification of an acceptable UTI rate for indwelling catheter patients was needed to use as a benchmark for care practices. A literature search showed a paucity of evidence. Therefore, the Association agreed to lead a project aimed at identifying what was currently happening in home care settings as a beginning benchmark.

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Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry. Verger, C., M. Duman, P. Y. Durand, G. Veniez, E. Fabre and J. P. Ryckelynck. 2007

Not relevant (France)

Background. In France, 48% of home-based peritoneal dialysis (PD) patients require assistance to perform their exchange and manage their treatment. A total of 7% are aided by their family, and 41% by a private nurse. Of all the continuous ambulatory peritoneal dialysis (CAPD) patients, 61.7%, and among automated peritoneal dialysis (APD) patients 23%, are assisted at home for their bag exchanges and connections. Assisted APD patients (AAPD) are more comorbid and elderly so that a home helper is not always available: this explains why most helpers at home are private visiting nurses paid by the National Social Security. In addition to the home helper (nurse or family), 58% of centres make regular additional home visits to check the respect of procedures previously taught during the initial training of the nurse or the family helper. The aim of this study was to evaluate whether the type of home assistance received by dependent patients had an influence on peritonitis rates, and if home visits done by nurses of training centres may improve results. Methods. Peritonitis rates and the probability of being peritonitis free were analysed for 1624 new APD patients recorded in the French PD Registry (RDPLF) between 2000 and 2004, and followed-up until early 2005. Results. Nurse-assisted APD patients had a peritonitis rate of one episode every 36 months, and family-assisted patients one episode every 45 months; using Poisson analysis this trend was not significant (P = 0.11). However, the probability of being peritonitis free was significantly higher for family-assisted (69.8% at 2 year) compared with home nurse-aided persons (54.4%) after adjustment for age, diabetes and the Charlson comorbidity index. This difference disappeared when nurses from the training centre regularly visited PD patients at their home in the presence of their helper, whichever type of assistance they received. In addition, when the nurses from the training centres visited private nurse-assisted patients, the probability of being peritonitis free was significantly improved in comparison with those persons who did not receive home visits, from 33.9% to 50.8% at 3 years (P = 0.028). Conclusions. APD patients assisted at home by a private nurse have a higher risk of developing peritonitis than family-assisted patients, unless additional regular home visits are organized by the original training centre. Therefore, we recommend that home visits be regularly made for dependent PD patients to optimize the quality of care provided by the helper. copyright 2007 Oxford University Press.

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Informal caregiver training on home care and cancer symptom management prior to hospital. Cc Hendrix, C. R. Google Scholar, 2006

Not relevant (Duplicate)

Cristina C. Hendrix, DNS, APRN-BC, GNP, FNP, is an assistant pro- fessor in the School of Nursing at Duke University Medical Center and a senior fellow at the Duke Center for Aging and Charlene Ray, BSN, RN, is an oncology nurse ...

Purpose: To determine the feasibility of individualized caregiver training for home care and symptom management conducted at the bedside of older patients with cancer prior to hospital discharge.

Design: Pilot study.

Setting: The Extended Care Rehabilitation Center at the Durham Veterans Affairs Medical Center in North Carolina.

Sample: 7 female informal caregivers with a mean age of 56 (range = 26-76). More than half were African American. Most commonly, caregivers were spouses of the patients with cancer.

Methods: Individualized and experiential training on home care and cancer symptom management was conducted at the bedside of patients before hospital discharge. Caregiver demographic data were collected. An informal interview at the end of the training asked about the usefulness of the training in preparing for home caregiving.

Main Research Variables: Feasibility of the training.

Findings: Individualized bedside training to caregivers prior to hospital discharge is feasible. All caregivers noted the relevance of the content as well as the approach to the training.

Conclusions: When given an opportunity for training on symptom management and home care, informal caregivers were very interested in participating. The individualized approach gave caregivers an opportunity to have their particular needs met. The flexibility of when to conduct the training proved to be crucial when soliciting attendance. The biggest challenge was in recruiting caregiver subjects through patients with cancer.

Implications for Nursing: The impetus now is to look at the effects of the training on caregiver-patient variables as well as the cost-effectiveness and sustainability of such an approach to caregiver training.

In-home cognitive training with older married couples: individual versus collaborative learning. Margrett, J. A. and S. L. Willis. 2006

Not relevant (Reference to caregiver/informal not evident)

Research has demonstrated that older adults' cognitive performance can be enhanced via formal intervention, as well as more informal intervention including collaboration or working with a partner. The current study investigated the effects of an inductive reasoning training program adapted for in-home use among older adults assigned to individual training (n = 30), collaborative training (n = 34), or a no-treatment control group (n = 34). The training consisted of 10 sessions, and all participants completed a pretest followed by a post-test 6 weeks later. Findings suggest that older adults could effectively "train themselves" without the guidance of a formal instructor. The results, however, did not indicate immediate added benefit in reasoning performance for collaborative versus individual training using the current reasoning program.

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Initiation and management of home mechanical ventilation. [French]. Gonzalez, J., J. Macey, C. Cracco, T. Similowski and J. P. Derenne. 2004

Not relevant (France)

Introduction: Effective initiation and optimal monitoring of treatment are essential elements for successful home mechanical ventilation (HMV). State of knowledge: Ventilation is best initiated in a hospital setting. There is an enormous range of equipment available but there is little evidence pointing to the superiority of one device over another. Many problems can arise that lead to an interruption in HMV but often these can be resolved simply as discussed in this article. Perspectives: Unfortunately a number of pitfalls in management remain, the main one being the absence of accurate data about the sleep of patients on ventilators, which hinders optimal nocturnal management. Another problem is the lack of adaptation of equipment for use by handicapped patients. Finally the transfer of responsibility and workload to home carers including family members with disengagement by the hospital can also be a major milestone. Conclusion: Successful initiation and supervision is the key to effective home mechanical ventilation. Treatment is often abandoned because of pitfalls, mistakes and lack of knowledge. This article proposes means to improve these two important areas.

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Innovation, science, and institutional change. Hage, J., M. T. H. Meeus and MyiLibrary. Oxford University Press, 2006

Not relevant (more info needed)

Innovative pediatric nursing role: public health nurses in child welfare. Schneiderman, J. U. 2006

Not relevant

The role of a pediatric public health nurse (PHN) practicing health case management in a child welfare agency was developed to meet the increasing health care demands and severe health problems of children in foster care. Federal and state government appropriated monies to fund this role to alleviate the difficulties in coordinating health care between the child welfare system and health care providers. Informal observations of the PHN in a large metropolitan child welfare agency in California were categorized using the Minnesota Public Health Intervention Model. Nurses functioning in this role are part of a team, with social workers, to promote the safety of children in foster care and to assure that health is part of a safe environment.

Insight into the management and diffusion strategies of HIV/AIDS Information in institutions of Higher Education in South Africa. Dube, L. and D. N. Ocholla. 2005

Not relevant (South Africa)

The study focuses on the management and diffusion of HIV/AIDS information in institutions of higher learning in South Africa. The HIV/AIDS Policy for Educators, Learners and Students provided a strong foundation on government involvement on HIV/AIDS management in Higher Education. Both Qualitative and quantitative research design and methodologies were employed largely through survey, observation and document analysis. The findings reveal that the response of the higher education sector to HIV/AIDS is not uniform, but there is a positive move towards strong management of HIV/AIDS and information diffusion. The study recommends further research on feasibility, applicability and effectiveness of the centralized coordination of the higher education HIV/AIDS response. Other hidden issues have been unearthed and a model for effective HIV/AIDS management and information diffusion in the sector suggested. [ABSTRACT FROM AUTHOR]

Copyright of South African Journal of Library & Information Science is the property of Forum Press International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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An integral care telemedicine system for HIV/AIDS patients. Caceres, C., E. J. Gomez, F. Garcia, J. M. Gatell and F. del Pozo. 2006

Not relevant (Spain)

Objective: In this article we will describe a new approach to improve the quality of care of chronic HIV/AIDS patients, combining the integral care approach with a telemedicine system. Methods: Following the integral care approach, we included the patient in a multidisciplinary care team, covering the whole process of care with a telemedicine system that allows the patient to improve his/her self-care and to be remotely followed-up by the healthcare professionals. Results: This challenge has been met by the creation of the "VIHrtual Hospital" project. Its main goal is the definition, development, clinical routine installation and evaluation of a telemedicine service that complements standard care with a telecare follow-up for treating stable HIV infected patients, in a chronic stage of their disease, and study if that improves the quality of assistance and the expense per patient compared to the conventional control (without telemedicine service) that patients usually have. Although the study is not yet finished, in the discussion the main benefits and drawbacks of this telemedicine system are described. Conclusions: The main conclusion of the article is that a new home telecare model for chronic HIV/AIDS patients has been created and has been implemented through the "VIHrtual Hospital" in the Clinic Hospital in Barcelona (Spain). The architecture of this web-based system fulfills the demanding security and integration requirements of the IT department of the hospital. An easy-to-use graphical interface for both patients and professionals has also been developed. The low costs of the system allow us to cover a wide range of patients and promising results are being obtained regarding the use of telemedicine systems for improving the follow-up care of chronic HIV/AIDS patients and for creating a new care model for this disease. copyright 2006 Elsevier Ireland Ltd. All rights reserved.

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Integration of a palliative and terminal care center into a comprehensive pediatric oncology department.[see comment]. Golan, H., B. Bielorai, D. Grebler, S. Izraeli, G. Rechavi and A. Toren. 2008

Not relevant (Duplicate)

BACKGROUND: The sharp division between curative cancer therapy and palliative care results in the late introduction of palliative care and a high incidence of suffering in children with cancer. We established a Palliative Care Unit (PCU) that is fully integrated with the Pediatric Hematology Oncology Department (PHOD). We wished to explore the impact of such integrative model on patterns of hospitalizations and exposure to palliative care of pediatric oncology patients. PROCEDURES: Retrospective search of medical records of patients admitted to the PHOD since PCU establishment in 1999, and of children who died from progressive disease between 1990 and 2005 was performed. Differences in clinical and prognostic variables between PCU and non-PCU patients, and differences in location of death before and after PCU establishment were evaluated. RESULTS: The majority (59%) of patients, who were hospitalized after the PCU establishment, were hospitalized in the PCU, including 49% of the good prognosis patients and 91% of the poor prognosis patients. Poor prognosis patients were hospitalized in the PCU earlier and with higher frequency compared to children with curable disease. After PCU opening there was a significant decline in the percentage of patients who died in the general pediatric ward, hematology-oncology ward, and at home from 40%, 26% and 28% to 4%, 8%, and 16%, respectively. CONCLUSIONS: Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care. (c) 2008 Wiley-Liss, Inc.

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Introduction to the special topic section: Knowledge management in Asia. Al-Hawamdeh, S. 2005

Not relevant (Asia)

The article focuses on knowledge management in Asia. While most Asian countries share the common goal of moving toward the knowledge economy, the infrastructure development and technology vary from one country to another. Countries like Singapore, Malaysia, Taiwan, Hong Kong, and Korea have invested heavily in information infrastructure, while others like Indonesia, the Philippines, and Thailand are still catching up, and many are behind when it comes to the use of the Internet and information technology. In Singapore, for example, the government launched IT2000 initiatives, which laid the groundwork for the first international and nationwide commercial broadband infrastructure. An empirical study that involved 32 final-year business students reading an elective module entitled Knowledge Management Systems in one of the higher education institutes in Singapore was carried out. The results of the study showed that the simulation game is an effective instructional tool for imparting knowledge to the participants.

EBSCOhost; lxh

Investing in parents' development as an investment in primary prevention. Bond, L. A. and C. E. Burns. 1998

Not relevant (Pre '2004)

Primary prevention and health promotion initiatives for young children have increasingly incorporated parents in their programs, but often within limited contexts of training narrowly defined parenting 'skills'. It is argued that prevention efforts must increasingly focus upon promoting parents' own development if we hope to achieve enduring influences that will have direct and indirect enduring, self-sustaining effects upon the child, family and community. This article presents arguments for focusing upon promoting parents' development and examples of prevention and promotion programs that have successfully done so.

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[Isolated health professionals in paediatric palliative care]. [French]. Schell, M. and M. Castaing. 2006

Not relevant (France)

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Knowledge Sharing in a Collaborative Networked Environment. Cormican, K. and L. Dooley. 2007

Not relevant

Knowledge is a key resource that must be managed within organisations and across collaborative enterprise networks. In particular, the two major challenges that such organisations face are ensuring that they have the appropriate knowledge to support their operations and ensuring that they optimise these knowledge resources available to them. In recent years, researchers, consultants and industrialists have developed approaches in an attempt to address these requirements. Most of these approaches have been technology oriented. In other words, the implementation of information technology systems is seen as the solution to enterprise knowledge management problems. However, research indicates that organisations are still failing to convert individual skills and competencies into tangible products and services. Knowledge management is an emerging discipline and it is still not very well understood or managed in industry. Consequently, new knowledge initiatives are not exploited to their full potential. In other words, companies are not reaping the full benefits of knowledge management projects. This paper explores the key constituents to managing knowledge and examines the main problems with sharing knowledge across teams and organisational boundaries. Findings from a qualitative study suggest that the key problems to managing knowledge across a collaborative network are person centric and consequently managers should focus their efforts on improving critical areas such as motivation and trust as well as people oriented methods and tools. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Information & Knowledge Management is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Learning disabilities and the new mental health act. Picton, T. 2008

Not relevant (Reference to caregiver/informal not evident)

The new Mental Health Act 2007 creates more rights for people with learning disabilities through its amendment of the Mental Capacity Act 2005, It introduces safeguards for deprivation of liberty, both for patients lacking capacity in hospital and residents of care homes. This is surely a good thing, and may finally end the confusion following the Bournewood case, where the case of a patient without capacity being kept in hospital was challenged. The private sector has perhaps stolen a march on much of the National Health Service by creating expensive specialist services for these people. With the advent of the new Act, is it time to start catching up? (PsycINFO Database Record (c) 2009 APA, all rights reserved).

A learning perspective on caring: a view from the ground up. Bowerman, J. K. 2004

Not relevant (Reference to caregiver/informal not evident)

In an interview, an adult learner with the Canadian School of Management discusses her research proposal aimed at strengthening the capability of the facility where she works to deal with clients suffering from Alzheimer's disease (AD) and other forms of dementia. The learner describes her motivation for this kind of work. She describes how she will apply some of the action learning principles recently learned to bring a mix of people together to discuss and work through issues relating to the care of clients residing in the Alzheimer unit. Canadian statistics suggest that at this time, one in three adults over the age of 85 and 1 in 13 over the age of 65 is affected with Alzheimer's or other forms of dementia. These numbers are expected to grow significantly as the population ages. The learner explains how, through her initiative, the facility will be more equipped to both meet the needs of current clients and those in the future.

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Life-threatening hemorrhage after dalteparin therapy in a patient with impaired renal function. Egger, S. S., M. G. Sawatzki, J. Drewe and S. Krahenbuhl. 2005

Not relevant (Reference to caregiver/informal not evident)

Dalteparin and other low-molecular-weight heparins are frequently used for the treatment of deep vein thrombosis and for other indications. Unlike unfractionated heparin (UFH), dalteparin is mainly cleared through the kidney; therefore, it can accumulate in patients with impaired renal function, increasing the risk of hemorrhage. An 84-year-old woman with chronic renal failure was hospitalized because of stenosis of a femorofibular bypass in her right leg. Peripheral transluminal angioplasty was performed successfully. Later the same day, Doppler sonography revealed deep vein thrombosis of the left lower leg. Treatment with dalteparin was started. The patient was discharged home 3 days later, with dalteparin to be continued at home. One day later, the patient was rehospitalized because of a pronounced hematoma on her flank. Her hemoglobin level had dropped to 5.5 g/dl. Treatment with dalteparin was stopped, and protamine 2500 U and two transfusions of packed red blood cells were administered. Treatment with UFH and oral anticoagulants were started because of a persistent risk for venous thrombosis. Thereafter, the patient's hemoglobin level remained stable, and no further bleeding episodes occurred. As long as systematic studies of the efficacy and safety of dalteparin in patients with severe renal impairment are lacking, dalteparin should be avoided or used only with close monitoring of antifactor Xa activity in these patients. As an alternative, UFH can be used because monitoring of UFH is well established and easier than it is with dalteparin. Renal impairment does not notably influence the short elimination half-life of UFH, which unlike that of dalteparin or other low-molecular-weight heparins allows for rapid dosage adjustments to prevent hemorrhage.

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Maintenance of effects of a home-based physical activity program among breast cancer survivors. Pinto, B. M., C. Rabin, G. D. Papandonatos, G. M. Frierson, J. J. Trunzo and B. H. Marcus. 2008

Not relevant (Reference to caregiver/informal not evident)

PURPOSE: Although physical activity (PA) adoption improves fitness and psychological well-being among cancer survivors, PA maintenance has not been examined. This paper presents follow-up of a home-based PA program for women treated for early-stage breast cancer. MATERIALS AND METHODS: Eighty-six sedentary women (mean age = 53.14 years, SD = 9.70) were randomly assigned to a PA or contact control group. The PA group received a 12-week telephone counseling program to adopt PA. Assessments were conducted at baseline, end-of-intervention (12 weeks), 6, and 9 months post-baseline. RESULTS: When comparing change from end-of-intervention (12 weeks) between groups, a significant reduction was observed in minutes of PA at 6 months (t = -2.10, p < 0.05), but there was no decrease in intervention effect at 9 months (t = -0.19, p = 0.84). Similarly, post-intervention reductions in fatigue were lost at 6 months (t = 3.27, p < 0.01), but remained present at 9 months (t = 1.65, p = 0.10). PA group's fitness improvements were maintained at both follow-ups (t = 1.04, p = 0.30 and t = 0.05, p = 0.96). The previously significant intervention effect on vigor was maintained at 6 months (t = 1.32, p = 0.19) but was significantly reduced at 9 months (t = -2.15, p < 0.05). PA participants were more likely to progress in motivational readiness at 6 (OR = 5.95, 95% CI = 2.30, 15.36) and 9 months (OR = 4.09, 95% CI = 1.69, 9.87); however, group differences in meeting PA guidelines were not maintained. CONCLUSION: Some positive effects of a home-based PA intervention for breast cancer patients were maintained at 6 and 9 months.

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Managing knowledge : an essential reader. Little, S. E., T. Ray and U. Open. SAGE Publications, 2005

Not relevant

Mental health act assessments: Does a community treatment team make a difference? Dunn, L. M. 2001

Not relevant (Pre '2004)

There is an extensive body of research into home treatment for acute mental illness, but this is the first one to examine any association with Mental Health Act Assessments. It examines the question of whether there is any impact of a home treatment team on the numbers and circumstances of Mental Health Act Assessments in its area. The 1983 Mental Health Act created the role of the Approved Social Worker, among whose duties is that of ensuring that any disposal is the least restrictive possible. For this duty to be carried out meaningfully, as wide a range of alternatives as possible needs to be available. The move from institutional to community care for the mentally ill which has been the 'big idea' of recent decades has given rise to intense interest in home treatment for acute mental illness, which can offer a potential alternative at a time of crisis for ASWs and thus patients. This study examined over 200 reports written by ASWs following Mental Health Act Assessments in the two areas, and it was found that the home treatment team appeared to have an impact. It was hypothesised that such a team might have an effect on the sorts people presenting for assessment. It was concluded that area with the team had an absolute and a relative reduction in the numbers of assessments. It was also found that there was a decrease in the likelihood of detention under Section 3 of the Act for people living in the area of the team. Finally it was found that the involvement of the team in an assessment reduced the likelihood of a Section 3 decision even further. Analysis indicated that the home treatment team was able to absorb some of the people, mainly male, who were suffering from a psychotic illness, and who were inclined to re-present on more than one occasion.

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Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients. Boter, H. 2004

Not relevant (Netherlands)

BACKGROUND AND PURPOSE: Many stroke patients and informal carers experience a decreased quality of life after discharge home and are dissatisfied with the care received. We assessed the effectiveness of an outreach nursing care program. METHODS: In a multicenter trial, 536 stroke patients were randomized at discharge to standard care (n=273) or standard care plus outreach care (n=263). The outreach care consisted of 3 telephone calls and 1 home visit within 5 months after discharge by 1 of 13 stroke nurses. Patients were masked for the trial objectives. Six months after discharge, they assessed the 2 primary outcomes: quality of life (Short Form 36 [SF-36]) and dissatisfaction with care. Secondary measures of outcome were disability, handicap, depression, anxiety, and use of health care services and secondary prevention drugs. Informal carers assessed strain, and social support. Analysis was by intention to treat. RESULTS: Twelve patients died before follow-up, 38 declined outcome assessment, and 486 completed the primary outcome assessments. Outreach care patients had better scores on the SF-36 domain "Role Emotional" than controls (mean difference 7.9 [95% confidence limit, 0.1 to 15.7]). No statistically significant differences were found on the other primary outcome measures. For secondary outcomes, no statistically significant differences were found, except that intervention patients used fewer rehabilitation services (relative risk, 0.66 [0.44 to 1.00]) and had lower anxiety scores (median difference 1 [0.19 to 2.79]). CONCLUSIONS: This outreach nursing stroke care was not effective in improving quality of life and dissatisfaction with care of recently discharged patients.

EBSCOhost; rzh

Music therapy with a woman who was hurt by a cowboy. Lee, J. 2007

Not relevant (Reference to caregiver/informal not evident; Not a private home setting)

This case study describes the use of songwriting in music therapy with a woman in her thirties living with multiple sclerosis in a care home and involved in a relationship with a verbally and physically abusive partner. Over the course of ten individual songwriting sessions with a music therapy student, she was able to explore some of her personal issues and develop some insight into her situation. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Neither rain nor hail nor sleet nor snow: Provider perspectives on the challenges of weather for home and community care. Skinner, M. W., N. M. Yantzi and M. W. Rosenberg. Pergamon-Elsevier Science Ltd, 2008

Not relevant (duplicate)

This paper contributes to the literature on the geographies of care and caregiving by examining the implications of weather for providing home and community care for children and older adults. Integrating research from two previous qualitative studies of formal and informal care provisioning in Ontario, Canada. the authors re-analyzed semi-structured interviews with 83 directors, managers, paid staff, volunteers and family members to examine the challenges they faced when providing care during the winter season. Similar to other settings where winter conditions like snow, ice and cold temperatures are commonplace, the studies were set within a health policy context in which there is not enough recognition of the difficulties of weather for coordinating, managing and providing care to disabled, injured, chronically ill and frail individuals. The re-analysis focused on how winter conditions translate into geographical, administrative, economic, operational, physical, social and psychological barriers within and across different 'scales of care'. The findings indicate that the problems posed by weather are crucial yet often underestimated aspects of home and community care provided by formal and informal caregivers. The analysis of weather-related challenges for care provisioning needs to be extended to other seasonal conditions (e.g., the challenges of delivering care in extreme heat), to the developing world and even to the burgeoning debates on the health implications of global environmental change. (C) 2008 Elsevier Ltd. All rights reserved.

Next-of-kin caregivers in palliative home care - from control to loss of control. Munck, B. F. B. M. J. British Library Direct, 2008

Not relevant (duplicate)

munck b., fridlund b. &martensson j. (2008) Next-of-kin caregivers in palliative home care - from control to loss of control. Journal of Advanced Nursing 64(6), 578-586 Abstract Title. Next-of-kin caregivers in palliative home care - from control to loss of control. Aim. This paper is a report of a study to describe situations influencing next-of-kin caregivers' ability to manage palliative care in the home. Background. Palliative home care often involves major resources from next-of-kin, municipal and county personnel. Next-of-kin caregivers' situation is depicted as so demanding and exhausting that it can affect their mental health and limit their ability to continue as a caregiver. Methods. A qualitative study using the Critical Incident Technique was conducted. Nine next-of-kin caregiv...

OBRA 1987 and the quality of nursing home care. Kumar, V., E. C. Norton and W. E. Encinosa. 2006

Not relevant (References 'nursing homes' as opposed to 'private home')

Because minimum government standards for quality regulate only part of the market failure, they may have unintended effects. We present a general theory of how government regulation of quality of care may affect different market segments, and test the hypotheses for the nursing home market. OBRA 1987 was a sweeping government reform to improve the quality of nursing home care. We study how the effect of OBRA on the quality of nursing home care, measured by resident outcomes, varied with nursing home profitability. Using a semi-parametric method to control for the endogenous effects of regulation, we found that this landmark legislation had a negative effect on the quality of care in less profitable nursing homes, but improved the quality in more profitable nursing homes during the initial period after OBRA. But, this legislation had no statistically significant effect in the later period when the regulation was weakly enforced.

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Occupational therapy for community dwelling elderly people: A systematic review. Steultjens, E. M. J., J. Dekker, L. M. Bouter, S. Jellema, E. B. Bakker and C. H. M. van den Ende. 2004

Not relevant (Netherlands; Reference to caregiver/informal not evident)

Objective: occupational therapy might play an important role in maintaining independent living for community dwelling elderly people. The aim of this systematic review is to determine whether occupational therapy improves outcome for people who are [greater-than or equal to]60 years and are living independently. Methods: an extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH until July 2002 was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis, based on the type of design, the methodological quality, type of outcome measures and statistical significance of findings. Results: 17 studies were included, ten of which were randomised clinical trials. Six randomised clinical trials had a high methodological quality. Strong evidence is present for the efficacy of advising on assistive devices as part of a home hazards assessment on functional ability. There is some evidence for the efficacy of training of skills combined with a home hazard assessment in decreasing the incidence of falls in elderly people at high risk of falling. Some evidence is available for the efficacy of comprehensive occupational therapy on functional ability, social participation and quality of life. Insufficient evidence is present for the efficacy of counselling the primary caregiver of dementia patients about maintaining the patient's functional abilities. Conclusion: this review shows that occupational therapy interventions for community dwelling elderly people results in positive outcomes. Future research in the efficacy of occupational therapy in elderly patient groups such as people with dementia is recommended. Furthermore, research into tailoring interventions to the needs of elderly patients is recommended. copyright British Geriatrics Society 2004; all rights reserved.

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Office-based vs home-based behavioral treatment for obsessive-compulsive disorder: a preliminary study. Rowa, K., M. M. Antony, L. J. Summerfeldt, C. Purdon, L. Young and R. P. Swinson. 2007

Not relevant (Reference to caregiver/informal not evident; OCD may not be the focus of this Project)

The current study investigated whether exposure with response prevention (ERP) for obsessive compulsive disorder (OCD) is more effective when administered in a participant's home or other natural environments where symptoms tend to occur, than in a therapist's office. Twenty-eight outpatients with a principal diagnosis of OCD were randomly assigned to receive ERP in their therapist's office vs. wherever their symptoms usually occur (e.g., at home, at work, in public places, in the car, etc.). Participants received 14, 90-min sessions of ERP with an individual therapist. Participants were assessed at pretreatment, post-treatment, and at 3- and 6-month follow-up. Assessments included both self-report as well as clinician-rated indicators of OCD symptom severity, depression, and functional impairment. Results suggested that participants improved significantly, regardless of where treatment occurred. There were no differences in efficacy between the home-based and office-based treatment for OCD. Implications of these findings are discussed.

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Old age psychiatry home treatment team - Preliminary audit of a service improvement project. Fraser, K., M. Clark, S. M. Benbow, G. Williams and I. Burchess. 2009

Not relevant (Reference to 'old age psychiatry home'; Reference to caregiver/informal not evident)

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Older widow's expectations of home care nurses. Porter, E. J. 2005

Not relevant (home care nurses as opposed to informal caregivers)

The concept of expectations has been integral to research on home care satisfaction, but little is known about expectations of home care. The aim of this longitudinal phenomenological study was to describe part of the personal-social context of older widows' experience of home care-that of holding expectations of home care nurses. Data were drawn from interviews over three years with the 11 women who had home care nurses. The context of the home care experience was featured by leaning on helpers more at this stage and by expecting the nurse to do what the nurse is supposed to do, with its five parts including expecting the nurse to know how to do what needs to be done. Findings exemplified conceptual overlap among standard realms of expectations, such as behaviors and outcomes, and revealed the relevance of such data in appraisals of home care quality.

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Older widows' speculations and expectancies concerning professional home-care providers. Porter, E. J. and L. H. Ganong. 2005

Not relevant (References 'home-care professionals')

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

EBSCOhost; rzh

An overview of methods and applications to value informal care in economic evaluations of healthcare. Koopmanschap, M. A., J. N. van Exel and W. B. Brouwer. 2008

Not relevant (Looks like a duplicate)

EBSCOhost; rzh

Overworked? Understaffed? Don't stop marketing! Olson, C. A. and S. S. Moseman. 1997

Not relevant (Pre 2004)

Discusses how savvy marketing can streamline library operations, decrease workload while increasing visibility and customer support. Basics of marketing; Understanding of customers; Packaging of products; Pricing of customer services; Support of promotion efforts; Public relations messages and library's image

[Palliative care in chronic obstructive pulmonary disease]. [Review] [40 refs] [Polish]. Modlinska, A., T. Buss and M. Lichodziejewska-Niemierko. 2007

Not relevant (Poland)

Traditionally focusing on terminally ill cancer patients, palliative care services have recently attempted to involve patients with other chronic, life - threatening diseases, e.g. chronic obstructive pulmonary disease (COPD). In this group of patients both quality of life and life expectancy is poor. Unfortunately, patients with COPD don't receive adequate special medical service, although this progressive disease causes almost as many deaths as lung cancer. The suffering of patients dying from COPD is not smaller than cancer patients. The major symptoms are usually dyspnoe, cough, fatigue, depression, emotional and psychosocial problems. In fact, their needs are really palliative, so we try to pay attention to the quality of life of people suffering from COPD. It is important to underline that medical palliation of these patients falls not only to the management of the main clinical symptoms, but also to adopt a holistic, multiprofessional approach and working with their families and caregivers. [References: 40]

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Parental education, time in paid work and time with children: an Australian time-diary analysis. Craig, L. 2006

Not relevant (Reference to caregiver/informal for 'health care' purposes not evident)

How does parental education affect time in the paid workforce and time with children? Potentially, the effects are contradictory. An economic perspective suggests higher education means a pull to the market. Human capital theory predicts that, because higher education improves earning capacity, educated women face higher opportunity costs if they forego wages, so will allocate more time to market work and less to unpaid domestic labour. But education may also exercise a pull to the home. Attitudes to child rearing are subject to strong social norms, and parents with higher levels of education may be particularly receptive to the current social ideal of attentive, sustained and intensive nurturing. Using data from the Australian Bureau of Statistics Time-use Survey 1997, this study offers a snapshot of how these contradictory pulls play out in daily life. It finds that in Australia, households with university-educated parents spend more daily time with children than other households in physical care and in developmental activities. Sex inequality in care time persists, but fathers with university education do contribute more time to care of children, including time alone with them, than other fathers. Mothers with university education allocate more daily time than other mothers to both childcare and to paid work.

Parental satisfaction with a nurse-led emergency assessment unit. Aitken, P. and M. Wiltshire. 2005

Not relevant (Pertains to institutional care experience and discharge)

Parents of children discharged from the paediatric emergency assessment unit of a large regional children's unit were surveyed to discover their perceptions of the care experience and post discharge support. Data from 40 parents revealed that the family journey through the unit was generally positive, although not without problems. The majority of children were referred from their general practitioner, and most were seen by a paediatrician within an hour of arrival. Morning-after phone calls and 24-hour access after discharge increased family satisfaction. However, nearly a third of families reported they were not shown the facilities of the unit and just under half mentioned lack of privacy as a concern. An action plan to address these issues has been subsequently implemented and will be evaluated periodically.

EBSCOhost; rzh

[Patients with severe dementia living at home]. [French]. Meret, T. and M. Floccia. 2005

Not relevant (France)

Few studies have been devoted to patients with severe dementia living at home. Therefore their rate is difficult to evaluate, and their conditions too heterogeneous to allow a standard management. In these patients, suffering from severe cognitive deficits and psychobehavioral disturbances, interfering pathologies may alter the course of the disease. Environment must be adapted to ensure security, sustain perceptual and physical activity and back up space and time orientation. The role of the main caregiver is crucial for the psychological and physical support of the patient. Thus, he/she must be sustained by giving information about the disease and available practical and financial support, and by listening to his/her suffering. Consequently, the general practitioner is involved not only in medical decisions but also in family support. Too often, the general practitioner is alone to face complex and time-consuming situations. However, the setting of geriatric networks should allow him/her to be included in the elaboration of a global care project with nurses and physiotherapists. Nevertheless, various factors, such as caregivers' exhaustion, major behavioral disorders, or the end of life when coping with pain becomes a priority, can eventually make necessary the patient's transfer into a geriatric facility.

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Patterns and predictors of service use and unmet needs among aging families of adults with severe mental illness. Smith, G. C. 2003

Not relevant (Pre '2004)

Objective: This study examined patterns and predictors of use of and unmet need for support services among aging families of adults with severe mental illness by using an expanded version of the Andersen Behavioral Model. Methods: Mailed surveys were completed by 157 mothers from 41 states who lived with and, provided care to adult offspring with serious mental disorders, primarily schizophrenia or schizoaffective disorders. The mean age of the mothers was 6 7 ye airs (range, 50 to 88 years). Results: Although unique patterns were observed among individual services, overall service use was low despite high perceived need for services. The greatest unmet needs were for social or recreational programming training in behavior management, and information on planning for the future. Regression analyses based on the expanded Andersen model revealed that greater service use occurred when offspring spent their days away from home, mothers received higher levels of informal support, and offspring were in poorer physical health. Greater unmet. needs for services were reported when mothers experienced higher burden, perceived more age-related. changes in themselves, and had offspring who typically spent their days at home. Conclusions: The needs and resources of the entire family, including access to informal social support, should be considered in attempts to identify predictors of the use of and need for services among persons with chronic and severe mental illness. The findings of this study also point to the need for family education in how to locate community services as well as for better and more sensitive community services intended for the entire aging family.

PD in the elderly - A challenge for the (pre)dialysis team. Ho-dac-Pannekeet, M. M. 2006

Not relevant (Netherlands)

Peritoneal dialysis in elderly patients is not widely applied, although data show that PD is often preferred by elderly patients. This paper describes current restrictions to the application of PD in elderly patients and their possible solutions. This includes (contra) indications to PD as well as data on patients' preference, quality of life specific for elderly patients and data on outcome of PD in older patients. The possibility of assisted peritoneal dialysis is offered as a challenge to the dialysis team. copyright 2006 Oxford University Press.

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[Pediatric palliative medicine]. [Review] [0 refs] [German]. Fuhrer, M., A. Duroux and G. D. Borasio. 2008

Not relevant (Germany)

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Pediatric to adult mental health service use of young people leaving the foster care system. McMillen, J. C. and R. Raghavan. 2009

Not relevant (Foster care youth)

PURPOSE: To assess and predict changes in mental health service use as older youth leave the foster care system. METHODS: Participants were 325 19-year-olds participating in a longitudinal study of older youth leaving the foster care system in Missouri. All were in the foster care system at age 17. Participants were interviewed nine times between their 17th and 19th birthdays using the Service Assessment for Children and Adolescents and a history calendar to improve recall of service history. Analyses included Cox proportional hazards regression to predict time to service stoppage and McNemar's test to assess difference in rates of service use between age 17 and 19. RESULTS: Mental health service use dropped dramatically across the study period for all services. Service rates dropped most steeply for youth who left the foster care system. Service use rates declined by roughly 60% from the month prior to leaving the foster care system to the month after leaving the system. Most young adults who stopped pharmacotherapy following discharge from foster care reported they did so of their own volition. CONCLUSIONS: Practitioners should be aware of the possibility of patient-initiated mental health service discontinuation following exit from the foster care system and plan accordingly.

EBSCOhost; rzh

Pilot study of a home-based aerobic exercise program for sedentary cancer survivors treated with hematopoietic stem cell transplantation. Wilson, R. W., P. B. Jacobsen and K. K. Fields. 2005

Not relevant (Reference to caregiver/informal not evident)

We report a pilot study of a home-based aerobic exercise program in a group of 17 adult hematopoietic stem cell transplant (HSCT) recipients. Participants had received no cancer treatment for at least 6 months and reported leisure time physical activity less than 20 min per day and fewer than three times a week during the previous month. Following baseline assessments of aerobic fitness, fatigue symptoms, and quality of life, participants were placed on home-based aerobic exercise programs consisting of 20-40 min of activity in the target heart rate zone (40-60% predicted heart rate reserve) delivered in three to five sessions per week for 12 weeks. Subjects were supplied with electronic heart rate monitors and we encouraged program adherence using weekly telephone contacts and exercise diaries. In all, 32 of the 42 qualified candidates consented (acceptance=76%). Of these, 17 kept appointments for baseline assessments, four did not complete the study (attrition=46%), and no exercise-related adverse events were reported. Scores on measures of aerobic fitness, fatigue severity, and physical well-being improved (signed ranks test; P<0.05) during program participation. Our findings suggest that individually prescribed, home-based aerobic exercise is an acceptable, safe, and potentially effective intervention for improving physical functioning and fatigue in sedentary HSCT recipients.

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Place of death: Hospital-based advanced home care versus conventional care: A prospective study in palliative cancer care. Ahlner-Elmqvist, M., M. S. Jordhoy, M. Jannert, P. Fayers and S. Kaasa. 2004

Not relevant (Reference to caregiver/informal not evident)

The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Polypharmacy and health beliefs in older outpatients. Rossi, M. I., A. Young, R. Maher, K. L. Rodriguez, C. J. Appelt, S. Perera, E. R. Hajjar and J. T. Hanlon. 2007

Not relevant (Reference to caregiver/informal not evident)

BACKGROUND: Polypharmacy is a significant problem among older adults. Patient-related characteristics and beliefs have not been the focus of prior research in this area, which has primarily evaluated the effects of patients' health status and health care system factors. OBJECTIVE: The goal of this research was to determine the prevalence and predictors of unnecessary drug use in older veteran outpatients, with a focus on patient-related factors and health beliefs. METHODS: Community-dwelling veterans aged > or =60 years, with > or =5 self-administered medications per day, not cognitively impaired, able to speak and/or write English, and receiving primary care and medications from a large urban Veterans Affairs Medical Center were eligible for study. Assessment of unnecessary drug use was determined by clinical pharmacists applying the criteria of the Medication Appropriateness Index to each regularly scheduled medication. Those drugs that received an inappropriate rating for indication, effectiveness, or therapeutic duplication were defined as unnecessary. Health beliefs regarding medication use were assessed with decisional balance, self-efficacy, and health locus of control scales. RESULTS: A total of 128 veterans (mean [SD] age, 72.0 [8.9] years; 93.0% white; 93.0% male) were enrolled. Analysis showed that 58.6% of patients had > or =1 unnecessary prescribed drug; the most common reason for a medication being considered inappropriate was lack of effectiveness (41.4%). The most commonly prescribed unnecessary drug classes were central nervous system (19.5%), gastrointestinal (18.0%), and vitamins (16.4%). Factors with tendency for association (P < 0.20) with any unnecessary drug use included race (white), income (<$30,000/year), number of prescription medications (mean [SD], 6.8 [2.8]), and lack of belief in a "powerful other" for their health locus of control. CONCLUSIONS: We found a very high prevalence of unnecessary drug use in this older veteran outpatient population. Race, income, and polypharmacy, as well as health-related beliefs, were central factors associated with unnecessary drug use.

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The positive financial contribution of home-based primary care programs: the case of the Mount Sinai Visiting Doctors. Desai, N. R., K. L. Smith and J. Boal. 2008

Not relevant (Reference to caregiver/informal not evident)

The coming decade will see a rise in the number of homebound seniors. These vulnerable patients have great difficulty accessing primary care. Home-based primary care (HBPC) can fill this healthcare need. Presently, such programs have been slow to develop, in part because of the perception that they are fiscal liabilities. Using the Mount Sinai Visiting Doctors (MSVD) program, the total financial effect of an HBPC program on an Academic Health Center (AHC) was assessed. A retrospective cohort analysis (n=692, 565 patient years) of Medicare-eligible individuals who were enrolled in the MSVD HBPC program was conducted. Revenues and associated costs for direct physician home care services, inpatient admissions, and outpatient clinic and emergency department visits for 1 calendar year were captured. Sensitivity analyses varying efficiency and cost variables were performed. Total direct cost for HBPC for the patient cohort was $976,350. Direct billing from home visits generated revenues that covered 24% of total direct care costs. Over a 12-month period, the cohort had 398 inpatient admissions and 1,100 non-HBPC outpatient visits, generating an overall contribution to margin of nearly $2.6 million. It is likely that this analysis underestimates the true contribution to margin, because it does not capture patient encounters at specialty clinics not in the Department of Medicine, unaffiliated medical centers, or private community-based practices. Although direct billing for HBPC programs does not generate enough revenue to meet operating costs, they can be significant revenue generators for the wider healthcare system and thus are fiscally worthy of subsidization.

EBSCOhost; rzh

Possible medication errors in home healthcare patients. Meredith, S., P. H. Feldman, D. Frey, K. Hall, K. Arnold, N. J. Brown and W. A. Ray. 2001

Not relevant (Pre '2004)

OBJECTIVE: To determine the frequency of possible medication errors in a population of older home healthcare patients according to expert panel objective criteria. DESIGN: A cross-sectional survey. SETTING: Two of the largest urban home healthcare agencies in the United States. PARTICIPANTS: Home healthcare patients age 65 and older admitted to selected offices of these agencies between October 1996 and September 1998. MEASUREMENTS: We used two sets of consensus-based expert panel criteria to define possible medication errors. The Home Health Criteria identify patients with patterns of medication use and signs and symptoms that indicate sufficient likelihood of a medication-related problem to warrant reevaluating the patient. The Beers criteria identify medications that experts have deemed generally inappropriate for older patients. RESULTS: The 6,718 study subjects took a median of five drugs; 19% were taking nine or more medications. A possible medication error was identified for 19% of patients according to Home Health Criteria, 17% according to the Beers criteria, and 30% according to either. Possible errors increased linearly with number of medications taken. When patients taking one to three medications were compared with those taking nine or more drugs, the percentages with possible errors were, respectively, 10% and 32% for the Home Health Criteria, 8% and 32% for the Beers criteria, and 16% and 50% for both. CONCLUSION: Nearly one-third of the home healthcare patients surveyed had evidence of a potential medication problem or were taking a drug considered inappropriate for older people. More-effective methods are needed to improve medication use in this vulnerable population.

EBSCOhost; rzh

Postacute care services use for dysvascular amputees: A population-based study of Massachusetts. Dillingham, T. R. and L. E. Pezzin. 2005

Not relevant (Reference to caregiver/informal not evident)

Objective: Rehabilitation and other postacute care services utilization for persons with a lower limb amputations due to dysvascular disease is important information for physiatrists, therapists, patients, and health-policy planners. The purpose of this study was to examine rates of inpatient rehabilitation services use in a statewide population. Design: Massachusetts Hospital Case Mix and Charge Data for 1997 were used to select persons with dysvascular limb amputations. Disposition locations after amputation were analyzed. Results: There were 2487 persons who incurred a lower limb amputation, with the majority being white (94%), male (58%), and elderly (69 yrs). Most had diabetes (62%) or peripheral vascular disease (51%). The most common disposition was home (33%), with 16% receiving inpatient rehabilitation after amputation. Persons with transtibial and transfemoral amputations were the most likely to receive inpatient rehabilitation, 28% and 19% respectively. Conclusions: Sixteen percent of dysvascular amputees received inpatient rehabilitation services. This was higher than the 1997 rate for Maryland (12%) and suggests geographic differences in services utilization. Prospective studies are necessary to examine outcomes for persons receiving rehabilitation services in different care settings to define the optimal rehabilitation venue for functional restoration. Development of more specific International Classification of Diseases, Ninth Revision-Clinical Modification codes for dysvascular amputations would further research and public policy efforts.

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Post-acute home care and hospital readmission of elderly patients with congestive heart failure. Li, H., N. Morrow-Howell and E. K. Proctor. 2004

Not relevant (duplicate)

After inpatient hospitalization, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce hospital readmission during the post-acute period. Using proportional Cox regression analysis, the authors examined the independent and joint effects of post-acute informal and formal services on hospital readmission. No evidence of service impact was found. Rather, hospital readmission was associated with a longer length of CHF history and noncompliance with medication regimes. Research, policy, and practice implications are discussed.

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Potential and readiness for video-visits in rural palliative homecare: Results of a multi-method study in Canada. Hebert, M. A., R. Brant, D. Hailey and M. Van Der Pol. 2006

Not relevant (Reference to caregiver/informal not evident)

We compared conventional palliative homecare visits and a combination of conventional and home telehealth 'video-visits' with respect to symptom management and quality of life. Participants were recruited from 11 rural communities in Alberta and randomized to the treatment or control groups, remaining in the study for 8 weeks. Although we planned to recruit 200 clients over two years, only 44 clients participated. Factors contributing to low recruitment included the introduction of new service delivery models and changes in the home care environment. No significant differences were found between the groups in measures of symptom management and quality of life. Compared to the home care nurses, clients generally indicated a higher level of readiness to use the technology. The study suggested that videophone technology would probably not be adopted for palliative home care in the population that was studied although it might be considered for other applications in the management of chronic illnesses. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Predicting and comparing patient satisfaction in four different modes of health care across a nation. Bikker, A. P. and A. G. Thompson. 2006

Not relevant (Reference to caregiver not evident)

This study aims to inform strategic policy makers and managers about the value of general population surveys by determining and comparing dimensions of satisfaction in four different health services in Scotland: general practice, domiciliary care, outpatients and inpatients (including day cases). The research design involved secondary data analysis of a national telephone survey conducted to inform the development of a national health plan. The database was created using a stratified quota sample of 3052 people of 16 years and above resident in Scotland in 2000. The main outcome measures investigated were overall measures of patient satisfaction with each type of service. Principal components analysis was used to determine the dimensions. Interest was in the extent to which patients, many of whom were the same (having used more than one service), evaluated different services in similar ways, as well as those factors specific to each service. Using logistic regression, the results demonstrate that interpersonal care and information, and desired improvements in service were universal and key explanatory dimensions in all services, followed by a combination of access, physical facilities, time and quality of food, depending on relevance to the service. These factors, particularly interpersonal care and information, distinguished well the highly satisfied from the others, with age providing further discrimination between non-hospital patients, while gender added to discrimination between inpatients. In conclusion, despite the limitations of telephone interviews, it is feasible to ask about several services at the same time and for the answers to reflect common underlying dimensions of evaluation found in more exhaustive research within each service. These factors offer a set of summary measures by which services can be easily evaluated at a strategic level and point to where efforts to increase patient satisfaction can be maximised.

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Prediction of attrition among first year United States Army recruits by pre-military trauma, sense of attachment to caregiver, pre-military depression, risk-taking behaviors and sense of social support. Cabrera, D. The Catholic University of America, 2006

Not relevant

The U.S. Army is currently losing approximately one third of its new recruits prior to the completion of their service contract which results in a significant loss of both human potential and financial resources. Approximately 80% of the attrition rate in the first three years of service is attributed to behavioral dysfunctions including issues such as risk-taking behaviors, depression, and alcohol use which have shown to correlate with a history of pre-military trauma. Studies suggest that an adolescent's sense of social support may act as a mitigating factor to the negative consequences of these variables. The study utilized attachment theory that posits that impaired attachment remains highly stable across one's lifetime. The purpose of this study was to test a causal model that predicts attrition among Army recruits. It was hypothesized that controlling for gender and race, higher levels of pre-military trauma and depression and lower levels of a sense of attachment to caregiver(s) and social support would lead to higher levels of risk-taking behaviors and alcohol use, which would lead to greater attrition among Army recruits. This study was a secondary analysis of existing data from the Recruit Assessment Program (RAP) gathered on soldiers being trained at Ft. Jackson, South Carolina at the time of recruitment and one calendar year later. Path analysis was used to test the hypothesis. Utilizing the full path, the strongest overall predictor of attrition was gender. Of the independent variables, impulsive risk and depression were the strongest predictors of attrition followed by pre-military trauma. The pathways from alcohol use and social support to attrition were not significant. The findings were consistent with the study hypothesis, suggesting that a history of trauma increased the likelihood of a decrement on sense of attachment, an increase in impulsive behaviors, depression, alcohol use, and eventual attrition rates. The path model explained only seven percent of the variance in attrition though the study's findings offered preliminary insight into another direction of inquiry. Future research with original data is needed to better define the questions and scales of these variables in order to strengthen the path model.

Predictors of clinical outcome in advanced heart failure patients on continuous intravenous milrinone therapy. Bhat, G. 2006

Not relevant (Reference to caregiver/informal not evident)

Home-based milrinone therapy (HMT) is used as a bridge to cardiac transplant (CT). The safety, efficacy, and predictors of success of HMT were assessed. Forty-five patients with heart failure, referred for CT, were prospectively studied. After initial assessment, low-dose milrinone was titrated based on clinical response. Hemodynamic status was then reevaluated. Thirty-nine patients were discharged on HMT. Patients needing a left ventricular assist device (LVAD) despite milrinone (group I) and those not requiring LVAD (group II) were compared. Six of the 45 patients were ineligible for CT; 16 of 39 required LVAD as a bridge to CT despite milrinone (group I); 23 were stable on milrinone and did not require LVAD (group II). Group I was younger than group II (mean age 38.4 +/- 14.5 years vs. 57.3 +/- 5.9 years, p < 0.001). Initial acute response to intravenous milrinone [e.g., fall in the PCWP (-10.7 +/- 9.5 vs. -2.7 +/- 10.4, p = 0.02), rise in pulmonary artery oxygen saturations (16.5 +/- 8.7 vs. 7.3 +/- 10.9, p = 0.05)] was significantly better in group II than in group I. Acute hemodynamic response to milrinone predicts success of HMT as a bridge to CT.

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Predictors of new onset depression in medically ill, disabled older adults at 1 year follow-up. Weinberger, M. I., P. J. Raue, B. S. Meyers and M. L. Bruce. 2009

Not relevant (Reference to caregiver/informal not evident)

OBJECTIVE: Although medical illness and physical disability are strongly associated with depression, the majority of older adults who experience medical illness or disability at any given time are not depressed. The aim of these analyses was to identify risk factors for new onset depression in a sample of medically ill, disabled older adults. METHODS: The authors used data from a representative sample of homebound older adults who recently started receiving Medicare home healthcare services for medical or surgical problems (N = 539). The authors report on the rate and baseline predictors of new onset major or minor depression, using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders, at 1-year follow-up. Our analyses were conducted with a subsample of older adults (N = 268) who did not meet criteria for major or minor depression and were not on an antidepressant medication at our baseline interview. RESULTS: At 1-year follow-up, 10% (28/268) of patients met criteria for either major (3%; 9/268) or minor depression (7%; 19/268). In multivariate analyses, the authors found that worse self-rated health (odds ratio [OR] = 0.53, p = 0.042), more somatic depressive symptoms (OR = 1.19, p = 0.015), greater number of activities of daily living (ADL) limitations at baseline (OR = 1.63, p = 0.014), and greater decline in ADL functioning from baseline to 1 year (OR = 1.59, p = 0.022) were all independently associated with onset depression. CONCLUSION: These findings underscore the significant fluctuations in both depression and disability in high-risk older adults and suggest that both persistent and new onset disability increase the risk of depression. They may also help in designing preventive strategies to promote the ongoing good mental health of these high-risk patients over time. Copyright copyright 2009 American Association for Geriatric Psychiatry.

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Predictors of noncompliance to exercise training in heart failure. Corvera-Tindel, T., L. V. Doering, T. Gomez and K. Dracup. 2004

Not relevant (Reference to caregiver/informal not evident)

BACKGROUND/OBJECTIVES: Exercise training is an emerging therapy in heart failure (HF). However, factors influencing noncompliance to exercise have not been evaluated. We assessed clinical factors, functional status, and emotional predictors of noncompliance to a 12-week home walking exercise program. METHODS: Using a correlational design, we evaluated noncompliance of 39 HF patients (aged 63.2 +/- 10.1 years, left ventricular ejection fraction 29.5% +/- 8.0%, peak oxygen consumption 14.1 +/- 3.7 mL/kg/min, HF duration 37.5 +/- 32.9 months, 74% New York Heart Association class II) to home walking exercise. Noncompliance was defined as (1) completion of the 12-week program with 60% or less of prescribed weekly walking duration (noncompliant completers); or (2) failure to complete the 12-week program (dropouts). Univariate analyses (chi-square or t test) and multivariate backward logistic regression were performed to identify clinical factors (body mass index, comorbidities, and HF duration), functional status (peak VO2), and emotional dysphoria (anxiety, hostility, depression) predictive of noncompliance to training. RESULTS: Mean compliance was 35% +/- 30% (945/2700 minutes) for noncompliant patients (n = 13) and 99% +/- 13% (2673/2700 minutes) for compliant patients (n = 26). In the multivariate analysis, higher comorbidity (odds ratio [OR]: 2.7, confidence interval [CI]: 1.11-6.71), longer HF duration (OR: 1.1, CI: 1.01-1.13), lower hostility (OR: 0.47, CI: 0.24-0.91), and lower body mass index (OR: 0.76, CI: 0.58-0.98) were predictive of noncompliance to exercise training in patients with HF. CONCLUSIONS: Noncompliance should be monitored carefully in HF patients with multiple comorbidities, longer HF duration, lower body mass index, and lower hostility scores. In this subgroup of HF patients, tailored exercise prescriptions may enhance compliance to an exercise program.

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Predictors of place of death for seniors in Ontario: A population-based cohort analysis. Motiwala, S. S., R. Croxford, D. N. Guerriere and P. C. Coyte. 2006

Not relevant (Reference to caregiver/informal not evident)

Place of death was determined for all 58,689 seniors (age >= 66 years) in Ontario who died during; fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2%) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p < 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes. Schwien, T., J. Gilbert and C. Lang. 2005

Not relevant (Reference to caregiver/informal not evident)

Home health agencies, challenged to demonstrate quality while containing costs, are motivated to find best practices for managing patient and wound care. The effects of different wound therapies on frequency of hospitalization and emergent care, two prominent quality measures, have not been studied. A retrospective study was conducted to determine the prevalence of Stage III and Stage IV pressure ulcers in the home health population and to quantify the impact of negative pressure wound therapy in reducing acute care hospitalizations and emergent care in general, and wound infection or deteriorating wound status in particular. Data from 1.94 million OASIS start-of-care assessments in 2003 and 2004 were evaluated to estimate pressure ulcer prevalence and a retrospective matched group analysis compared patients using (n = 60) and not using (n = 2,288) negative pressure wound therapy. In 2003, 6.9% and in 2004, 7% of patients had pressure ulcers at start of care. Of these, 23% were Stage III or Stage IV and 31% were 'not healing.' In the matched analysis group, it was found that compared to comparison group patients, those receiving negative pressure wound therapy experienced lower rates of hospitalization (35% versus 48%, P <.05), hospitalization due to wound problems (5% versus 14%, P < .01), and emergent care for wound problems (0% versus 8%, P = .01). To offset potential limitations in generalizability and increase practical application of these results, further research is needed with a larger, nationally representative sample to compare other quality outcomes as well as the cost of providing negative pressure wound therapy to other specific wound care modalities.

EBSCOhost; rzh

The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector. Gershon, R. R., J. M. Pearson, M. F. Sherman, S. M. Samar, A. N. Canton and P. W. Stone. 2009

Not relevant (Reference to caregiver/informal not evident)

BACKGROUND: Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted. METHODS: A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure. RESULTS: Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others. CONCLUSION: The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.

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Prevalence of mental illness and its impact on the use of home care and nursing homes: a population-based study of older adults in Manitoba. Martens, P. J., R. Fransoo, E. Burland, C. Burchill, H. J. Prior, O. Ekuma and T. Need to Know. 2007

Not relevant (duplicate)

OBJECTIVES: To determine the prevalence of mental illness in older adults and its effect on home care and personal care home (PCH) use. METHODS: Using nonidentifying administrative records (fiscal years 1997-1998 to 2001-2002) from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, we determined the 5-year period prevalence for individuals aged 55 years and over (119 539 men and 145 752 women) for 3 mental illness categories: cumulative mental disorders (those having a diagnosis of depression, anxiety disorder, personality disorder, schizophrenia, and [or] substance abuse), any mental illness, and dementia. We calculated age-specific and age-adjusted rates of home care and PCH use and the prevalence of mental illness in PCH residents. RESULTS: From the group aged 55 to 59 years to the group aged 90 years or older, the prevalence of mental illness increased with the population's age. The prevalence of any mental illness rose from 32.4% to 45.0% in men and from 42.6% to 51.9% in women, and dementia prevalence rose from 2.0% to 33.6% in men and from 1.3% to 40.3% in women. The age-adjusted annual rates of open home care cases per 1000 population aged 55 and older varied by mental illness grouping (no mental disorder, 57 for men and 91 for women; cumulative mental disorders, 162 for men and 191 for women; dementia, 300 for men and 338 for women). The age-adjusted rates of PCH use per 1000 population aged 75 years and older also varied by mental illness grouping (no mental disorder, 53 for men and 78 for women; cumulative mental disorders, 305 for men and 373 for women; dementia, 542 for men and 669 for women). Among patients admitted to (or resident in) a PCH in 2002-2003, 74.6% (87.1%) had a mental illness, and 46.0% (69.0%) had dementia. CONCLUSIONS: Mental illness affects the use of home care and nursing homes profoundly. Individuals with dementia used home care at 3 times the rate of those having no mental illness diagnosis, and they used PCHs at 8 times the rate.

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Process evaluation of a nurse home visiting intervention that postpones disability worsening in older adults. Liebel, D. V. 2008

Not relevant (Reference to caregiver/informal not evident)

Context. Since the vast majority of older adults experiencing and recovering from disability prefer to live in the community, nurse home visiting offers an effective method to deliver targeted geriatric strategies to maintain or improve disability status. The nurse intervention of the recently concluded Medicare Primary and Consumer-Directed Care Demonstration is one of only six nurse home visiting studies that have reported positive disability outcomes for community dwelling elders with disability. Purpose. The study purpose was to describe and evaluate the components of a nurse intervention responsible for disability maintenance/improvement among community dwelling older adults. Design setting and participants. The study was a process evaluation of the nurse intervention tested in a randomized controlled trial. The conceptual model of Mowbry based on the classic Donabedian model was employed to structure the evaluation. Outcomes were assessed using data from nurse notes, case studies, and Demonstration databases. Results. Results showed high levels of participation, dose, and fidelity for the intervention components. Nurse home visits were effective in maintaining/improving ADL dependence among 60% of the patients. These individuals were more limited in ADLs, younger, and had less cognitive impairment, higher SF-36 scores, and perceived their health as being unchanged. After adjusting for baseline characteristics, the number of intervention materials patients used and medication self-management were significantly associated with less disability and disability maintenance/improvement. Additionally, patients with more disability received significantly more nurse home visits, family conference visits, and nursing home visits, set more goals, and worked on more disease selfmanagement activities. Furthermore, sub-analyses revealed that patients receiving the prescribed dose of the intervention components (e.g., 20-30 nurse visits, set four goals, and engaged in three family conference visits) were more likely to maintain/improve disability. Conclusions. This evaluation identified a specific group of community living older adults for whom this type of expert community health nursing in the home was effective in reversing or at least maintaining disability. There is also considerable evidence to support the creation of a new home care model that integrates the significant intervention components found in this nurse intervention to maintain/improve disability into new and existing home care models. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Professional boundaries violations: case studies from a regulatory perspective. Fischer, H. R., B. J. Houchen and L. Ferguson-Ramos. 2008

Not relevant (Reference to caregiver/informal not evident)

This article provides case studies in professional boundaries violations from a state regulatory perspective. All cases discussed are actual cases that occurred in the state of Ohio, based on complaints investigated by the Ohio Board of Nursing. The studies set forth basic factual information related to the boundary violation, relevant law and administrative regulations, and disciplinary outcomes. One can conclude that boundaries violations that result in licensure board disciplinary sanctions typically involve gross or egregious conduct rather than subtle or transitional zone conduct. These cases tend to involve recurring patterns that may be categorized as involving 2 factors: (1) high patient vulnerability and (2) prolonged patient contact. Often, the 2 patterns coalesce. Administrators, directors of nursing, and supervisors in these patient populations and in the settings discussed should be particularly mindful of potential boundary violation behavioral indicators.

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Professional carers' knowledge and response to depression among their aged-care clients: the care recipients' perspective. Mellor, D., T. Davison, M. McCabe and K. George. 2008

Not relevant (Reference to caregiver/informal not evident)

Depression is an under-diagnosed disorder among the elderly, even in those who are in receipt of aged-care services. One factor associated with this under diagnosis has been identified as a reluctance amongst the elderly to discuss their mood and emotions with their medical practitioners. The current study focused on why depression is not recognised and acted on by those providing residential or home-based care to older people. We interviewed 15 elderly people residing in high-level or low-level aged-care facilities, and three elderly people who were receiving personal care in their homes. All participants had been identified by their care agencies as depressed. Participants reported their perceptions of their personal carers' knowledge and practices in managing the residents' depression. Although the participants described their carers in positive terms, they were critical of their knowledge and skills in recognising depression, and indicated that the communication between personal carers and care recipients about depressive symptomatology was seriously flawed. Training for personal carers in these areas, and efforts to change organisational culture are recommended.

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Profile and risk of mental illness in caregivers for home care patients. [Spanish]. Moral Serrano Ma, S., J. J. Ortega, M. J. Lopez Matoses and P. Pellicer Magraner. 2003

Not relevant (Pre '2004, and Spain)

Objectives. To determine the profile of caregivers for patients in home hospitalization, and to investigate morbidity and strain in caregivers. Design. Descriptive, cross-sectional study based on personal interviews. Setting. Health area in the community (autonomous region) of Valencia (Eastern Spain). Participants. Systematic sampling was used to select 215 caregivers who took care of home-hospitalized patients during the year 2001. Measures. Personal interview at home with a questionnaire that contained items on descriptive variables, psychological well-being (Goldberg Anxiety and Depression scale), social support (Duke-UNC Functional Social Support Questionnaire), caregiver strain index and profile of the care receiver. Results. The typical caregiver was a 55-year-old woman who was a first-degree relative of the patient, with primary level education, who formed part of a normally functional family and who received good social support. Anxiety was found in 32%, depression in 22% and a high strain index in 11%. The patient was typically a 70-year-old man with chronic disease, a high degree of dependence and good mental status. Correlation analysis showed that the risk of anxiety, depression and strain in caretakers increased with the patient's degree of physical dependence and mental deterioration, and with lower degrees of social support and longer periods devoted to caregiving. The risk of anxiety and depression increased as the strain index and familial dysfunction increased. Strain index was the factor that explained most of the variability in anxiety and depression. Conclusions. Feelings of psychological distress (anxiety and depression) and strain were common among caregivers. Care for caregivers should form part of the measures to provide care to patients.

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Provider and Care Workforce Influences on Quality of Home-Care Services in England. Netten, A., K. Jones and S. Sandhu. 2007

Not relevant (Reference to caregiver/informal not evident)

A key trend in home care in recent years in England has been movement away from 'in-house' service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users' views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality. Adapted from the source document. COPIES ARE AVAILABLE FROM: HAWORTH DOCUMENT DELIVERY CENTER, The Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580

CSA Sociological Abstracts

Providing pediatric palliative care through a pediatric supportive care team.[see comment]. [Review] [10 refs]. Jennings, P. D. 2005

Not relevant (duplicate)

We expect children to live to adulthood; however, children do die. Some die from diseases they are born with, others from accidents or illnesses. The devastating effects associated with the death of a child can be lessened by providing palliative, hospice, and bereavement care. At St. John Hospital (SJH) in Detroit, MI, the services that provide care for children chartered the Pediatric Palliative Care Committee. The committee brought together staff from the inpatient pediatric unit, cancer center, home care, and hospice care services within the St. John Health System. Utilizing established staff and services, this group began to provide care for children with potentially life limiting illnesses in a coordinated, multidisciplinary team approach. The positive outcomes of this approach include an overall increase in patient and family satisfaction with care, a decrease in the number of emergency room visits and inpatient hospital stays, and an increase in patient and family informed decision making and goal setting. Positive outcomes for the staff include support in caring for children with life limiting illnesses and an increase in satisfaction with the care they provide. [References: 10]

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Provision for children with developmental co-ordination disorder (DCD): audit of the service provider. Peters, J. M., S. E. Henderson and D. Dookun. 2004

Not relevant

BACKGROUND: The aim of this study was to conduct an audit of parent/carer satisfaction with the service provided for children presenting with movement difficulties [developmental co-ordination disorder (DCD)/dyspraxia] at the out-patient physiotherapy clinic of a specialist tertiary referral paediatric hospital. METHOD: A postal questionnaire was used to obtain objective and subjective data on the service offered. Factual information on aspects such as waiting time for first appointment, type of intervention offered, etc. was checked against clinical records. Satisfaction with the service was assessed using ratings and open-ended comment. RESULTS: Forty-five families completed the questionnaire. The results showed that the service was generally rated highly. The opportunity to discuss the child's problems and its implications was considered valuable. Among families offered 1 : 1 intervention, a statistically significant correlation emerged between the number of sessions attended and perceived effectiveness. Among families offered a home programme, perceived effectiveness was related to the number of times per week the child practised the programme. CONCLUSIONS: This study showed that many children from mainstream schools with co-ordination problems continued to find it difficult to obtain a clear diagnosis. Once a referral and assessment had been achieved, however, parents/carers were shown to be satisfied with the package offered by this service provider.

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Proxy perspectives regarding end-of-life care for persons with cancer. Bakitas, M., T. A. Ahles, K. Skalla, F. C. Brokaw, I. Byock, B. Hanscom, K. D. Lyons, M. T. Hegel and E. p. team. 2008

Not relevant (Reference to caregiver not evident)

BACKGROUND: Each year, greater than a half million people die of cancer in the U.S. Despite progress in increasing access to palliative oncology services, end-of-life care still needs improvement. Measuring the quality of the end-of-life experience is difficult because of patient debility and reduced consciousness as death approaches. Family proxies have been proposed as valuable informants regarding the quality of end-of-life care. This article describes family proxy perspectives concerning care at the end of life in patients who died of advanced cancer. METHODS: In the context of a novel outpatient palliative care demonstration project, 125 family proxy respondents completed a structured survey by telephone 3 months to 6 months after the patient's death from breast, lung, or gastrointestinal cancer. Four key quality of care indicators were measured: decision-making and physician communication, location of death, hospice involvement, and end-of-life symptoms. RESULTS: Proxies reported that 78% to 81% of patients completed at least 1 form of advance directive and approximately half of them were helpful in guiding care. Communication with physicians regarding end-of-life treatment wishes occurred in 67% of cases, but only 57% of the patients actually made a plan with their physician to ensure that their wishes were followed. The majority of patients died in their location of choice, most often at home, and greater than half had hospice involvement for an average of 41.8 days before death. During the last week of life, the majority of patients experienced troublesome physical and emotional symptoms. CONCLUSIONS: Measurement of proxy perspectives is feasible as an indicator of the quality of end-of-life care, and the results of the current study provide actionable data for areas of improvement in palliative oncology care.

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Psychiatric patients and their experience of need for help in their own home. Birkeland, A. and K. Kristoffersen. 2004

Not relevant (Reference to caregiver/informal not evident)

During the last years there has been a wide reduction in institution places in psychiatric health care. The purpose of this study was to present how psychiatric patients experience their situation at home, and in what situations they need help from the psychiatric community nurses. Data were gathered from eleven qualitative interviews with eight patients. A hermeneutical approach and method was used in the study. The main focus was on the quality of life of the patients. The patients expressed a need of having an informal contact with the nurses and that the nurses focused on motivation and practical action. Three main factors showed out to be the causes related to the need of help. The first factor was the experience of psychological pain. The second factor was the experience of loneliness, and the third factor was related to the tendency of passivity. The patients need for help and guidance was therefore often related to emotional support, social contact and activities. This abstract was translated into English by the publisher or author.

EBSCOhost; rzh

Psychiatry and history. Contribution of the family association. Van Amerongen, A. 2005

Not relevant (Study may be France-based)

In France, the concept of family association in the area of psychiatry and mental health began in 1963, with the creation of UNAFAM (association of friends and parents with a mentally ill relative). Support to professionals was seen as a complement to the association's statutory goals (mutual help, training and advocacy for patients and families). Since then, patients, families, health and social care professionals, decision makers and elected representatives have been working together. This partnership has led to define the concept of "psychological" handicap as well as to rediscover and rebuild the "club house" scheme for patients. Despite theoretical and socio-economic problems, UNAFAM aims to promote patients' autonomy, help for families, and it also intends to participate in the quality of care. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Psycho-social necessities for an informal caretaker [Spanish]. Leyva-Moral, J. M. and N. Mogeda-Marina. 2008

Not relevant (Spain)

Of the many activities which nurses in primary attention care teams carry out, health promotion and prevention of diseases have a prominent place. These activities are not carried out only in Primary Attention Care Centers. For some time now, there has been a tendency to keep dependent patients in their homes as much as possible. For this reason, At Home Care has an important place in nurses' daily practices. This article reviews the concept of an informal caretaker and the main reasons which can cause an overload. At the same time, the authors show the tool which nurses use to know the emotional state of informal caretakers, as well as the environment and the circumstances where they are found. The authors propose to use nursing diagnoses as a planning tool for objectives and action strategies to overcome the shortages detected.

EBSCOhost; rzh

Public Health Agency of Canada - Population Health Approach - Statistical Report. Canada, P. H. A. o. 2007

Not relevant (pre '2004 link; more info needed)

Public health care: Essays on wait times, home care, and the public-private mix. Mou, H. Carleton University (Canada), 2009

Not relevant

This thesis investigates various health care policies in a framework that combines heath care financing, health expenditure, and public choice procedure. The health care policies studied include wait times for public health care, subsidy for home care for the elderly, and the public-private mix of health expenditure. Chapter 1 investigates the determinants of wait times for public health care in a political economy framework. A public-private health system is modeled, where the longer wait for public care is the major difference between the public and private systems. Voters' preferences for health care vary according to their expected morbidity and by income. In the political equilibrium, wait times in the public system depend on demographics and morbidity. But they are independent of the distributions of income and of political influence, which affect only individual tax-transfer rates. Chapter 2 studies analytically and with simulation the measurement of the net fiscal incidence of a program that subsidizes home care of the elderly, when both individual welfare and family structure matter. The definition of welfare incidence, the comparison of welfare-based incidence with budgetary incidence for non-cooperative and cooperative families, and the calculation of the shifting of program benefits between family members, some of whom may be altruistic, are key issues in the analysis. Chapter 3 investigates the determinants of the public-private mix in health care expenditure in OECD countries over the 1981-2005 period. Estimating equations are based on an extension of Usher (1977)'s model of the collective decision to socialize private goods. The estimation results verify Usher's theory concerning the roles of incentives to redistribute and the losses from socialization of health care when preferences are diverse. In addition, we find that the general right-left ideological views of citizens play an important role in defining the boundary between public care and private care. Finally, the results indicate that population aging is likely to lead to increased spending on the public health care system rather than to greater relative reliance on private care.

Quality child care supports the achievement of low-income children: Direct and indirect pathways through caregiving and the home environment. McCartney, K., E. Dearing, B. A. Taylor and K. L. Bub. 2007

Not relevant

Existing studies of child care have not been able to determine whether higher quality child care protects children from the effects of poverty, whether poverty and lower quality child care operate as dual risk factors, or whether both are true. The objective of the current study was to test two pathways through which child care may serve as a naturally occurring intervention for low-income children: a direct pathway through child care quality to child outcomes, and an indirect pathway through improvements in the home environment. Children were observed in their homes and child care settings at 6, 15, 24, and 36 months. An interaction between family income-to-needs ratio and child care quality predicted School Readiness, Receptive Language, and Expressive Language, as well as improvements in the home environment. Children from low-income families profited frorn observed learning supports in the form of sensitive care and stimulation of cognitive development, and their parents profited from unobserved informal and formal parent supports. Policy implications are discussed. (c) 2007 Elsevier Inc. All rights reserved.

Quality of care for Medicare beneficiaries with disabilities under the age of 65 years. Iezzoni, L. I. 2006

Not relevant

Social Security Disability Insurance provides cash benefits to disabled workers and certain others under the age of 65 years. These individuals become eligible for Medicare 24 months after Social Security Disability Insurance cash benefits start. In 2001, 13.9% of Medicare's approximately 40 million beneficiaries were adults under the age of 65 years with disabilities, and they generated 15% of total program costs. Medicare beneficiaries with disabilities under the age of 65 years are much more likely than elderly beneficiaries to be minority race and ethnicity, impoverished, and to report fair or poor health. They are clinically diverse, with 53.4% reporting mental health conditions. Although Medicare provides essential coverage of acute medical services and selected rehabilitative and long-term care services, by law, Medicare does not reimburse important items and services essential to daily living for many people with disabilities, including mobility aids for use outside the home, physical and occupational therapy to maintain functioning or prevent declines, as well as personal assistance services. This gap represents a fundamental, structural quality problem for persons with disabilities. Surveys suggest that most Medicare beneficiaries with disabilities are generally satisfied with their standard medical services, but they report problems at much higher rates than elderly beneficiaries. Reforming Medicare to meet pressing needs of beneficiaries with disabilities will likely require statutory changes. copyright 2006 Future Drugs Ltd.

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Quality of life in dementia: A 2-year follow-up study. Missotten, P., M. Ylieff, D. Di Notte, L. Paquay, J. De Lepeleire, F. Buntinx and O. Fontaine. 2007

Not relevant (Reference to caregiver not evident, study may also be Belgium based)

Objectives: To examine the evolution of quantity of life (QOL) in demented subjects at base-line, one and 2 years later and to determine clinical variables associated with QOL. Method: Longitudinal study of a cohort of 127 subjects living at home or in a long-term care institution. A QOL measure (Alzheimer Disease Related Quality of Life; ADRQL) was administered three times. In addition, several clinical instruments (MMSE, IADL, ADL and CDR/M) were also administered. Results: ADRQL data analysis did not reveal significant modifications of QOL over the 2-year period, whereas results from clinical instruments showed a significant deterioration. On the group, the variations of ADRQL scores were limited, with some improvement after the first year followed by some deterioration after the second year. On the other hand, ADRQL scores fluctuated every year by at least 10 points for more than 50% of subjects. With dementia evolution, it was observed that the clinical variables were more strongly correlated with ADRQL scores and were more significant predictors. This varied from 5.9% (MMSE) in 2002 to 40.01% in 2004 (MMSE and CDR/M). Conclusions: QOL did not develop in a strictly linear manner following the deterioration of clinical state. This suggests that the evolution of QOL is also determined by other variables relating to the physical and social environment of the patients. Their role seems particularly important for the mild to moderate stages of dementia. Copyright copyright 2007 John Wiley & Sons, Ltd.

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Quality of life in dementia: A 2-year follow-up study. Missotten, P., M. Ylieff, D. Di Notte, L. Paquay, J. De Lepeleire, F. Buntinx and O. Fontaine. 2007

Not relevant (duplicate)

Objectives: To examine the evolution of quality of life (QOL) in demented subjects at base-line, one and 2 years later and to determine clinical variables associated with QOL. Method: Longitudinal study of a cohort of 127 subjects living at home or in a long-term care institution. A QOL measure (Alzheimer Disease Related Quality of Life; ADRQL) was administered three times. In addition, several clinical instruments (MMSE, IADL, ADL and CDR/M) were also administered. Results: ADRQL data analysis did not reveal significant modifications of QOL over the 2-year period, whereas results from clinical instruments showed a significant deterioration. On the group, the variations of ADRQL scores were limited, with some improvement after the first year followed by some deterioration after the second year. On the other hand, ADRQL scores fluctuated every year by at least 10 points for more than 50% of subjects. With dementia evolution, it was observed that the clinical variables were more strongly correlated with ADRQL scores and were more significant predictors. This varied from 5.9% (MMSE) in 2002 to 40.01% in 2004 (MMSE and CDR/M). Conclusions: QOL did not develop in a strictly linear manner following the deterioration of clinical state. This suggests that the evolution of QOL is also determined by other variables relating to the physical and social environment of the patients. Their role seems particularly important for the mild to moderate stages of dementia. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Quality of Life of Patients With Terminal Cancer Receiving Palliative Home Care. Yan, S. and C. Kin-Fong. 2006

Not relevant (Reference to caregiver/informal not evident)

The purpose of this study was to determine the levels of quality of life of patients with terminal cancer who received palliative care in home settings. Data were collected from 85 cancer patients with a life expectancy of less than 12 months using the McGill Quality of Life Questionnaire-Hong Kong version (MQOL-HK). The mean total quality of life score was 6.36 +or- 1.37 out of 10. Among the various domains, the physical and existential domains scored relatively low with mean scores of 4.9 +or- 1.28 and 6.12 +or- 1.6 out of 10, respectively. Conversely, the subscales of sexual functioning and support yielded the highest scores with mean values of 7.45 +or- 4 and 6.8 +or- 1.9, respectively. There was a significant moderate correlation between age and the mean total quality of life scores (r = 0.53, p < 0.01). In addition, a moderate negative correlation was found between pain intensity and physical subscale (r = -0.57, p < 0.01). In conclusion, patients with terminal cancer receiving palliative home care experienced a moderately high level of quality of life, especially in the sphere of support. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic. Hastings, S. N., R. J. Sloane, K. C. Goldberg, E. Z. Oddone and K. E. Schmader. 2007

Not relevant (Reference to caregiver/informal not evident)

OBJECTIVES: To determine the prevalence and type of suboptimal pharmacotherapy that older veterans discharged from the emergency department (ED) or urgent care clinic (UCC) receive and to examine factors associated with suboptimal pharmacotherapy in this population. DESIGN: Retrospective, cohort study. SETTING: An academically affiliated Department of Veterans' Affairs (VA) Medical Center. PARTICIPANTS: Four hundred twenty-one veterans aged 65 and older who were prescribed a new medication at the time of discharge from the ED or UCC. MEASUREMENTS: The primary dependent variable, suboptimal pharmacotherapy, was a composite measure defined as one or more drug-related problems, based on drugs-to-avoid criteria, drug-drug interactions, drug-disease interactions, and failure to satisfy an explicit quality indicator for prescribing or medication monitoring. RESULTS: A total of 757 drugs were prescribed to the 421 patients at the time of discharge from the ED or UCC (mean number+/-standard deviation per patient 1.65+/-1.1). The most frequently prescribed medications were nonsteroidal antiinflammatory drugs (n=59), opioid analgesics (n=47), and fluoroquinolone antibiotics (n=46). Overall, 134 (31.8%) subjects were found to have suboptimal pharmacotherapy with regard to their discharge medications; 49 (11.6%) were prescribed a drug to avoid, 53 (12.6%) received a drug that introduced a new drug-drug interaction, 24 (5.7%) were given a drug that introduced a drug-disease interaction, and 74 (17.6%) did not have a quality indicator satisfied (61% of these evaluated prescribing and 39% evaluated medication monitoring). No consistent associations between patient or visit characteristics and suboptimal pharmacotherapy were identified in multivariable models. CONCLUSION: A substantial number of older adults discharged from the ED or UCC may be at risk for adverse events due to suboptimal prescribing and inadequate medication monitoring. Further study is needed to examine the relationship between suboptimal pharmacotherapy and adverse clinical outcomes.

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Racial and ethnic disparities in the outcomes of elderly home care recipients. Brega, A. G., G. K. Goodrich, M. C. Powell and J. Grigsby. 2005

Not relevant (Reference to caregiver/informal not evident)

The purpose of this study was to examine racial/ethnic disparities in functional outcomes of elderly home health care recipients. Analyses were conducted using Outcome and Assessment Information Set (OASIS) data for a nationally representative sample of home health care episodes for patients aged 65 and older. Risk-adjusted regression analyses examined the association between race/ethnicity and functional outcomes. Fourteen outcome measures reflected improvement in specific functional areas (e.g., ambulation) and two reflected overall functional change. Non-Hispanic Whites ("Whites") experienced substantially better functional outcomes than did home health care recipients of other racial/ethnic backgrounds. The disparity in outcomes was most pronounced between Whites and African Americans.

EBSCOhost; rzh

A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress. Tibaldi, V., N. Aimonino, M. Ponzetto, M. F. Stasi, D. Amati, S. Raspo, D. Roglia, M. Molaschi and F. Fabris. 2004

Not relevant (Italy)

EBSCOhost; rzh

A randomized intervention to improve heart failure outcomes in community-based home health care. Feldman, P. H., T. R. Peng, C. M. Murtaugh, C. Kelleher, S. M. Donelson, M. E. McCann and M. E. Putnam. 2004

Not relevant (Reference to caregiver/informal not evident)

This study examines the effects of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. Participants were 371 Medicare CHF patients served by 205 nurses randomized to intervention and control groups in a large urban home healthcare agency (HHA). The intervention consisted of an evidence-based nursing protocol, patient self-care guide, and training to improve nurses'teaching and support skills. Outcome measures included home care,physician and emergency department (ED) use, hospital admission, condition-specific quality of life (QoL), satisfaction with home care services and survival at 90 days. The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits (p = .074), and a reduction variation in the typical number of visits provided (p < .05), without a significant increase in physician or ED use or patient mortality. Hypothesized improvement in other outcomes did not occur.

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A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. Dar, O., J. Riley, C. Chapman, S. W. Dubrey, S. Morris, S. D. Rosen, M. Roughton and M. R. Cowie. 2009

Not relevant (Reference to caregiver/informal not evident)

AIMS: Heart failure chiefly affects the elderly, with frequent emergency admissions. Telemonitoring can identify worsening heart failure but previous randomized trials have enrolled selected patient populations. The Home-HF study examined the impact of home telemonitoring on typical heart failure patients discharged from three acute hospitals in North West London, UK. METHODS AND RESULTS: Patients hospitalized with heart failure were randomized to telemonitoring or usual specialist care. Primary outcome measures were days alive and out of hospital. Secondary outcome measures were number and duration of heart failure hospitalizations, clinic visits, and quality of life. We recruited 182 patients. There was no difference in the primary outcome measure in the two groups, but there were significantly fewer unplanned hospitalizations for heart failure decompensation, and a reduction in clinic and emergency room visits in the telemonitoring group. There was no statistically significant difference in the mean direct health service costs. CONCLUSION: Home telemonitoring in a typical elderly population of heart failure patients produces a similar outcome to 'usual' specialist care, but reduces clinic and emergency room visits and unplanned heart failure rehospitalizations at little additional cost. This method of disease monitoring may allow specialist services to increase the number of patients under their care.

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A randomized trial of two types of nurse-assisted home care for patients with COPD. Coultas, D., J. Frederick, B. Barnett, G. Singh and P. Wludyka. 2005

Not relevant (Reference to informal caregiver not evident)

STUDY OBJECTIVES: Whereas pulmonary rehabilitation reduces symptoms and improves the quality of life of patients with COPD and is recommended in management guidelines, few patients have access to rehabilitation services. The purpose of this study was to investigate the effectiveness of increasing access to selected components of pulmonary rehabilitation by providing nurse-assisted home care that was composed of patient education, efforts to improve patient self-management skills, and enhanced follow-up. DESIGN: We conducted a 6-month, randomized, controlled trial. SETTING: Primary care clinics associated with an urban academic health system. PATIENTS: Patients were > or = 45 years of age with a physician diagnosis of COPD, and had a > or = 20-pack-year smoking history, had experienced at least one respiratory symptom during the past 12 months, and had airflow obstruction (ie, FEV1/FVC ratio, < 70%; FEV1, < 80%). INTERVENTIONS: Four nurses were trained in the use of the Global Initiative for Chronic Obstructive Lung Disease guidelines, and two of the four nurses received additional training in collaborative management. Patients were randomly assigned to usual care (UC), nurse-assisted medical management (MM), or nurse-assisted collaborative management (CM). MEASUREMENTS: The main outcome measures were of generic (Medical Outcome Study 36-item short form [SF-36], illness intrusiveness) and disease-specific (St. George's respiratory questionnaire [SGRQ]) quality of life and self-reported health-care utilization. RESULTS: Overall, 151 patients (UC group, 51 patients; MM group, 49 patients; and CM group, 51 patients) completed the study, their average age was 69 years, and 56.9% were women. The average change in the SF-36 general health domain for the MM group vs the UC group was 1.1 (95% confidence interval [CI], -7.9 to 11.2), and for the CM group vs the UC group the average change was 2.5 (95% CI, -7.0 to 12.3). The corresponding changes in SGRQ total domain were -2.9 (95% CI, -9.8 to 4.1) and -2.6 (95% CI, -9.5 to 4.3). There was no change in the number of self-reported emergency department visits or hospitalizations, but the utilization of these services was infrequent. CONCLUSION: The findings of our investigation and those from the published literature suggest that interventions to enhance patient education, self-management skills, and follow-up among patients with COPD do not result in clinically meaningful improvements in health status or self-reported health-care utilization. Moreover, future studies of disease management programs for patients with COPD need to evaluate interventions that address associated comorbidities, exercise, and social support.

EBSCOhost; rzh

ReACH National Demonstration Collaborative: early results of implementation. Boyce, P. S. and P. H. Feldman. 2007

Not relevant (Reference to caregiver/informal not evident)

The Reducing Acute Care Hospitalization (ReACH) National Demonstration Collaborative is a two-year multi-wave initiative using a "virtual" Collaborative Learning Model to reduce acute care hospitalization rates among home care patients. ReACH aims to reduce hospitalization to 23%, as recommended by the Centers for Medicare and Medicaid Services in its 8th Scope of Work for Quality Improvement Organizations. This article reports on the early implementation experience of a sample of 17 of 65 home health agencies participating in Wave I of ReACH. It examines agency challenges in implementing a structured practice improvement initiative, improving hospital to home transitions and focusing appropriate resources on high risk patients. Lessons learned will inform future home health care quality improvement initiatives.

EBSCOhost; rzh

Reach out to ENhancE Wellness in older cancer survivors (RENEW): Design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer. Snyder, D. C., M. C. Morey, R. Sloane, V. Stull, H. J. Cohen, B. Peterson, C. Pieper, T. J. Hartman, P. E. Miller, D. C. Mitchell and W. Demark-Wahnefried. 2009

Not relevant (Reference to caregiver/informal not evident)

Objective: Cure rates for cancer are increasing, especially for breast, prostate, and colorectal cancer. Despite positive trends in survivorship, a cancer diagnosis can trigger accelerated functional decline that can threaten independence, reduce quality-of-life and increase healthcare costs, especially among the elderly who comprise the majority of survivors. Lifestyle interventions may hold promise in reorienting functional decline in older cancer survivors, but few studies have been conducted. Methods: We describe the design and methods of a randomized controlled trial, RENEW (Reach out to ENhancE Wellness), that tests whether a home-based multi-behavior intervention focused on exercise, and including a low saturated fat, plant-based diet, would improve physical functioning among 641 older, long-term (>=5 years post-diagnosis) survivors of breast, prostate, or colorectal cancer. Challenges to recruitment are examined. Results: Twenty thousand and fifteen cases were approached, and screened using a two-step screening process to assure eligibility. This population of long-term, elderly cancer survivors had lower rates of response (similar to 11%) and higher rates of ineligibility (similar to 70%) than our previous intervention studies conducted on adults with newly diagnosed cancer. Significantly higher response rates were noted among survivors who were White, younger, and more proximal to diagnosis and breast cancer survivors (p-values < 0.001). Conclusion: Older cancer survivors represent a vulnerable population for whom lifestyle interventions may hold promise. RENEW may provide guidance in allocating limited resources in order to maximize recruitment efforts aimed at this needy, but hard-to-reach population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Reaching the homebound elderly: the Prescription Intervention and Lifelong Learning (PILL) program. Williams, B. R. and S. Lopez. 2005

Not relevant (Reference to caregiver/informal not clearly evident)

This article describes the Prescription Intervention and Lifelong Learning (PILL) program, a three-year pilot project to develop in-home pharmacy care services to clients of a community-based social service agency. Clients who were homebound, at least 62 years of age, and taking at least five medications were eligible for inclusion. Potential participants were referred by care managers to the pharmacist, who conducted an in-home evaluation of the medication regimen and assessed the risk for medication-related problems. The pharmacist provided instruction for hypertension and diabetes mellitus self-monitoring, extensive medication counseling for clients with complex medications regimens, and conducted other activities to promote positive medicationrelated outcomes. The clients served were primarily female, between 70 and 90 years of age, and almost one-half lived alone. They were taking an average of more than nine medications daily, and had at least one chronic disease. The clients of the social service agency were highly vulnerable to medication-related problems and were in need of in-home pharmacy care services.

EBSCOhost; rzh

Receiving care at home at end of life: Characteristics of patients receiving Hospice at Home care. Tyrera, F. and C. Exley. 2005

Not relevant (Reference to caregiver/informal not evident)

Background: Specialist Hospice at Home (HAH) services play an important role in the provision of care for people who choose to die at home. Methods: A pilot evaluation of a new HAH scheme in East Midlands, UK was carried out between January and December 2003, in which routine data were collected and analysed. Results: In 2003,155 people received the HAH service. Most patients (83%) were over the age of 60 and had a cancer diagnosis (92%). Almost one-third of patients waited for 2 days or longer to receive care from the HAH scheme. These patients were around three times as likely to be in an inpatient hospice (RR = 3.27; 95% CI = 1.19-8.95) or an acute hospital (RR = 2.85; 95% CI = 1.33- 6.09) when they were referred. The median length of service use was 4 days. Conclusions: The HAH service enabled people to die at home in the last days of life. Given the aging population, we would expect the demand for such services to further increase. Shortcomings identified included delay in receiving care for people moving to home from hospices and acute hospitals. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Recruitment of African American women to a walking program: eligibility, ineligibility, and attrition during screening. Wilbur, J., J. McDevitt, E. Wang, B. Dancy, J. Briller, D. Ingram, T. Nicola, H. Lee and S. N. Zenk. 2006

Not relevant

The purposes of this study were to identify strategies successful in the recruitment of African American (AA) women to a home-based walking program and to examine factors that contribute to attrition, eligibility, and ineligibility during the recruitment screening protocol. Of the 696 women who contacted the researchers, 281 (40.4%) women enrolled in the study, 227 (32.6%) were lost to attrition, and 188 (27%) were ineligible. Those not enrolled due to attrition during screening or ineligibility reported more family risk for cardiovascular disease (CVD) and lived in neighborhoods with higher poverty. Although our recruitment strategies may have been successful in attracting low-income AA women, we were not as successful in preventing their attrition during the screening protocol, particularly for those living in poorer neighborhoods.

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Reduced mortality: The unexpected impact of a telephone-based care management intervention for older adults in managed care. Alkema, G. E., K. H. Wilber, G. R. Shannon and D. Allen. 2007

Not relevant

Objective: This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program(CA Program) designed to link those with high health care utilization to home- and community-based services. Data Source: Secondary data from the CA Program, part of the California Health-Care Foundation's Elders in Managed Care Initiative. Study Design: Randomized-control trial in which participants (N = 781) were randomly assigned to intent-to-treat (ITT) and control groups. ITT group received telephonic social care management and 12 months of follow-up. Various multivariate analyses were used to evaluate mortality risk throughout multiple study periods controlling for sociodemographic characteristics, health status, and health care utilization. Population Studied: Older adults (65+) enrolled in a Medicare managed care plan who had high health care utilization in the previous year. Principal Findings: ITT group had a significantly lower odds of mortality throughout the study (OR = 0.55; p = .005) and during the care management intervention (OR = 0.45; p = .006), whereas differential risk in the post-intervention period was not statistically significant. Other significant predictors of mortality were age, gender, three chronic conditions (cancer, heart disease, and kidney disease), and emergency room utilization. Conclusions: Findings suggest that the care advocate model of social care management affected mortality while the program was in progress, but not after completion of the intervention phase. Key model elements accounted for the findings, which include individualized targeting, assessment, and monitoring; consumer choice, control, and participant self-management; and bridging medical and social service delivery systems through direct linkages and communication. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Registered nurses' experiences with an evidence-based home care pathway for myocardial infarction clients. Young, W., J. McShane, T. O'Connor, G. Rewa, S. Goodman, S. B. Jaglal, L. Cash and P. Coyte. 2004

Not relevant

Objectives: To obtain home health nurses' comments on an evidence-based care pathway for post myocardial infarction.

Design: A qualitative design was used.

Setting: Culturally diverse, lower income area of a large city.

Participants: All home health nurses from one nursing agency who participated in a comparative study on the impact of the evidence-based care pathway.

Results: The largest number of comments made by the nurses were related to the beneficial impact of the pathway on the provision of quality nursing care and on increased job satisfaction. The home health nurses reported that the pathway increased clients' knowledge of medications and diet. In addition, they commented that they were able to use the pathway effectively because of the training they received from the inpatient cardiac nurses.

Conclusions: This qualitative study demonstrates the benefits of investing in the implementation of best practice guidelines by home health nurses. However, nursing associations, such as the Canadian Community Health Nurses Initiatives Group, will need to continue to champion for additional funds to support the additional expenses incurred.

EBSCOhost; rzh

Rehabilitation Setting and Associated Mortality and Medical Stability Among Persons With Amputations. Dillingham, T. R. and L. E. Pezzin. 2008

Not relevant (Reference to caregiver not evident)

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations. Objective: To estimate the differences in outcomes across postacute care settings-inpatient rehabilitation, skilled nursing facility (SNF), or home-for dysvascular lower-limb amputees. Design: Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997. Setting: Postacute care after amputation. Participants: Dysvascular lower-limb elderly amputees (N=2468). Interventions: Not applicable. Main Outcome Measures: Mortality, medical stability, reamputations, and prosthetic device acquisition. Results: The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%). Conclusions: Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers. copyright 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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The relationship between agency characteristics and quality of home care. Dalby, D. M. and J. P. Hirdes. 2008

Not relevant (Reference to caregiver/informal not evident)

BACKGROUND: This project assessed the relationship between home care quality indicators (HCQIs) and agency characteristics. METHODS: Twelve agencies completed a mailed survey on a variety of characteristics, including size of their caseload and for-profit (FP) status of contracted service providers. The HCQIs were derived from standardized assessments completed voluntarily for home care clients in Ontario and in Manitoba, Canada. RESULTS: The average caseload was 121.3 clients per case manager, and over 40% of nursing, personal support and therapy providers were considered FP. For individual HCQIs, few correlations were statistically significant. An overall summary measure of quality was correlated with the size of the population served (r = -0.80; p < 0.05) and the number of clients per case manager (r = -0.56; p < 0.1). CONCLUSION: These data represent unique information on home care quality and organizational characteristics in Canada. The question remains as to how best to use HCQI data to inform practice in an era of limited resources and increasing caseloads.

Ovid Technologies; Ovid MEDLINE(R)

The relationship between depressive symptoms and symptom distress in patients with cancer newly admitted to hospice home care. McMillan, S. C. and H. R. Rivera, Jr. 2009

Not relevant (hospice setting)

The purpose of this project was to evaluate the relationship between depressive symptoms and symptom distress experienced by hospice patients with cancer. A total of 275 hospice patients with cancer were evaluated using the Memorial Symptom Assessment Scale (MSAS), the Center for Epidemiological Study-Depression (CES-D) Scale and a Demographic Data Form. Patients in the sample were mostly white and Christian with a variety of types of cancer with lung cancer being most common. Patients reported an average of 10 symptoms with fatigue, pain, dry mouth, drowsiness, loss of appetite and shortness of breath being reported most frequently. Among the most common symptoms, those with the highest intensity scores were pain and fatigue and with the highest distress scores were fatigue, pain, and shortness of breath. Depressive symptoms reached the cut-off score of 4 for 38% of patients indicating a likelihood of clinical depression. A moderate significant correlation (r = 0.45; P = .000) was found between CES-D scores and total number of symptoms reported and with total symptom distress (r = 0.49; P = .000). Results underscore the continued need for a focus on symptoms in cancer patients, and further delineates the need to ameliorate depressive symptoms in order to enhance quality of life near the end of life.

EBSCOhost; rzh

The relationship between managed competition in home care nursing services and nurse outcomes. Doran, D., J. Pickard, J. Harris, P. C. Coyte, A. R. MacRae, H. S. Laschinger, G. Darlington and J. Carryer. 2007

Not relevant

The objective of this study was to investigate the relationship between the characteristics of home-care contracts, as indicators of employment relationships, and nurses'job satisfaction and perceived job security. A cross-sectional design was used to collect data on the study variables.The setting was 11 Community Care Access Centres and 11 nursing provider agencies in the Canadian province of Ontario. The sample included 700 nurses. A mailed survey was used to collect data from CCACs on length of contract awarded to provider agencies, potential for renewal, volume of service awarded, and profit status of the agency. Data were collected, via a mailed survey, on nurses' age, gender, work status, and years of employment in the community and at the current agency. The Nursing Job Satisfaction Scale was used to collect data on nurses'job satisfaction. Perceived job security was assessed using a single item measured on a 5-point Likert scale. Significant differences were found among provider agencies in nurses' perception of the quality of care, work enjoyment, satisfaction with time for care, and job security. Older nurses rated work enjoyment higher than younger nurses. Nurses paid on an hourly basis were more satisfied with their time for care than those paid on a per-visit basis. Nurses employed on a casual basis were less satisfied with job security than those employed on a full-time basis. Differences in nurse outcomes were observed among nursing provider agencies, but these were not related to the profit status of the agency. Further research is needed on the best practices within agencies that result in more satisfied staff.

Ovid Technologies; Ovid MEDLINE(R)

Relative Permanence: An Evaluation of KinGAP, California's Subsidized Guardianship Program for Kinship Caregivers. Shlonsky, A. R. 2740

Not relevant

The 1980 Adoption Assistance and Child Welfare Act requires that public child welfare agencies pursue legal permanence for children remaining in out-of-home care. While children placed in relative or kinship foster care tend to have greater placement stability than children in nonrelated foster care, their lower rate of exit from care has contributed to the census of children residing in long-term foster care, a type of placement that is not legally permanent and requires continuous and costly child welfare supervision. Effective January 1, 2000, the Kinship Guardianship Assistance Payment (KinGAP) program was enacted by the California legislature. This act permits stable, long-term relative caregivers to establish legal permanence for their relative children by becoming the legal guardians of their kin, and then exiting the foster care system while maintaining a foster care equivalent subsidy. This study investigates the utilization of this program, the rates of substantiated maltreatment and reentry to foster care, and the stability of these homes. Between January 1, 2000 and February 8, 2002, more than 8000 children (n = 8,231) exited foster care to KinGAP. Exits to KinGAP in Los Angeles County were more likely to occur during year one, and exits in other counties occurred at fairly low levels when considering the number of eligible children. The low rate of uptake is likely a result of funding concerns. Subsequent maltreatment (n = 173) and reentry to foster care (n = 85) were exceedingly rare, indicating high levels of safety and permanence. Further analysis of reentries revealed that only 30 percent of children returned to care due to maltreatment, the rest largely returning as a result of child behavior problems, caregiver death or medical problems, the initiation of formal reunification procedures, or specialized service needs that are unavailable to KinGAP recipients. Event history analyses of time to subsequent maltreatment and reentry to care found a strong, positive association with a prior history of group care. A comparison of a sub-sample of children who exited to KinGAP (n = 5,095) and children who did not exit but were otherwise eligible (n = 19,177) found that children exiting to KinGAP were far less likely to experience a change of caregiver. Implications for social work practice, policy, and future research are discussed.

CSA Sociological Abstracts

Relatives' opinions of IT support, perceptions of irritations and life satisfaction in dementia care. Engstrom, M., R. Lindqvist, B. Ljunggren and M. Carlsson. 2006

Not relevant (residential facility)

We studied relatives' opinions of IT support at a residential home for persons with dementia. We also investigated the relatives' perceptions of irritations and life satisfaction before and after increased IT support. This was accomplished using an experimental group (n = 14) and a control group (n = 8) of subjects in dementia care. The design was quasi-experimental with baseline assessments and three follow-ups. Data were collected using two questionnaires measuring opinions of the IT support: irritations in care (the Nursing Home Hassles Scale) and life satisfaction (the Life Satisfaction Questionnaire). Results showed that relatives' opinions of IT support were generally positive. In the experimental group, relatives' perceptions of practical/logistical irritations decreased between baseline and 12-month follow-up. In the control group, there was an increase in the total Nursing Home Hassles score between baseline and three-month follow-up. This difference did not persist at seven- and 12-month follow-ups. No significant differences were found for life satisfaction. We conclude that relatives had positive opinions of IT support, and their perceptions of practical/logistical irritations decreased after implementation of the IT support package.

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The renaissance of home hemodialysis: Where we are, why we got here, what is happening in the United States and elsewhere. Blagg, C. R. 2008

Not relevant (Reference to caregiver/informal not evident)

Abstract: Home hemodialysis has been around since 1964, but its use has declined over the years in most countries, this despite its advantages, particularly improved patient survival and quality of life and significant cost savings. Experience has shown that home hemodialysis can be performed successfully by many more patients than at present. Recently, with the demonstration of even better results with more frequent hemodialysis that is obviously best performed at home and with the development of new, more patient-friendly machines, the use of home hemodialysis is beginning to increase again. copyright Journal compilation copyright 2008 International Society for Hemodialysis.

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Research briefs. Teaching with the Nightingale Tracker technology in community-based nursing education: a pilot study. Ndiwane, A. 2005

Not relevant (Reference to caregiver/informal not evident)

Changes in health care delivery are becoming increasingly focused on technology. Nursing students are often expected to travel long distances to suitable community sites for clinical experiences, which challenges nurse educators to design and implement instructional strategies to provide students with optimal clinical practice opportunities, while maintaining preceptor-student supervision and vital communication links. This article reports a pilot evaluation of the Nightingale Tracker system, which included both a server and an innovative, hand-held device designed to accommodate multiple forms of data input and allow timely communication between clinical faculty and students in community-based clinical settings. A sample of 5 nursing students reported that the Nightingale Tracker enhanced learning, particularly in performing and documenting physical assessments, data input and transmissions, and autonomous clinical practice.

EBSCOhost; rzh

Research challenges and lessons learned from a heart failure telehomecare study. Duffy, J. R. and L. M. Hoskins. 2008

Not relevant (Reference to caregiver/informal not evident)

Examining the benefits of nursing interventions through research significantly contributes to both professional nursing and quality healthcare, yet few benefits of home healthcare have been rigorously studied. Research challenges and lessons learned during a clinical trial of heart failure patients receiving home health nursing services are presented with recommendations.

Ovid Technologies; Ovid MEDLINE(R)

Research on Alzheimer's caregiving in Canada: Current status and future directions - Canada, P. H. A. o. 2005

Not relevant (duplicate)

Research on Alzheimer's caregiving in Canada: Current status and future directions - Chronic Diseases in Canada (CDIC) - Vol. 25, no. 3/4, 2004 - Public Health Agency of Canada Canada, P. H. A. o. 2005

Not relevant (duplicate)

Resilience and transitions from dementia caregiving. Je Gaugler, R. L. K. R. N. Google Scholar, 2007

Not relevant (duplicate)... in sight&quot; to at-home care may have ... require assistance that supplements informal care provision but ... and longitudinal change in caregiver depression: Impact of a ...

Response to "Flying under the radar: Engagement and retention of depressed low-income mothers in a mental health intervention". Downing, D. A. 2008

Not relevant (Reference to caregiver/informal not evident)

Comment on an article by Beeber et al. (see record 2007-12951-003), who conducted a randomized trial of in-home psychotherapy for depressive symptoms that targeted low-income mothers of infants and toddlers and used innovative design features to reduce stigma and enhance acceptability. The current author, noting the ineffectiveness of the in-home intervention used by Beeber et al., recommends the success of the Program of Assertive Community Treatment (PACT), a service-delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illnesses. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Retrospective evaluation of an intensive method of treatment for children with pervasive developmental disorder. Vorgraft, Y., I. Farbstein, R. Spiegel and A. Apter. 2007

Not relevant

The objective of this preliminary study was to evaluate a novel intensive therapy program in young children with pervasive developmental disorder (PDD). Twenty-three children treated at the Mifne Institute in Israel between 1997 and 1999 were assessed. Videos taken before coming to Mifne and after intensive treatment at the institute and before and after another 6 months of continued treatment at children's homes were coded and blind rated by trained personnel using the Childhood Autism Rating Scale (CARS) and the Social Behavior Rating Scale (SBRS). Total scores on both scales improved significantly after 3 weeks and after 6 months. There were some significant improvements at item level although the magnitude of the changes was modest. Despite the small number of participants, the modest increase in test scores, and the retrospective study design, these preliminary results are promising. There is a case for performing a full prospective, comparative investigation of this treatment approach.

Nlm;

Review of Caring for the Dying at Home: Companions on the Journey. Linden, D. 2006

Not relevant (book review)

Reviews the book, Caring for the Dying at Home: Companions on the Journey by Keri Thomas (2003). The book contains useful advice on pain and symptom management in an easily read format based on tumor type as well as individual generic symptoms. The third section of the book compliments the paperwork available for the Gold Standards Framework (GSF) programme for community palliative care in the UK, and is essential reading for those practitioners who have not been able to gain instruction from others. The reader will find a well-researched methodical, yet practically based guide, to community palliative care and GSF in this book. The content is exhaustive but not immersed in unnecessary detail, ensuring that it is easy to read. Relevant sections are not difficult to find and for those who wish a quick refresher or who do wish information on where to obtain further detail, this is an ideal book for the shelf in the medical, nursing and allied health professional library. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Review of Home treatment for acute mental disorders: An alternative to hospitalization. Clegg, K. A. 2006

Not relevant (book review)

Reviews the book, Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization by David S. Heath (see record 2005-06148-000). This text will appeal to readers from a variety of disciplines in mental health care, as well as to clients and their family members interested in increasing their fund of knowledge about available treatment options. In a particularly useful review, the author discusses the use of mobile crisis home treatment for several common psychiatric diagnoses--including depression, schizophrenia, borderline personality disorder, mania, first-episode psychosis, and severe postpartum depression--and illuminates this discussion with numerous detailed case examples. The author utilizes sidebars to discuss areas of related interest, thereby highlighting these areas for interested readers as well as for those who do not wish for a diversion from the content at hand. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Review of Talking about care. Lawton, S. 2005

Not relevant (book review)

Reviews the book "Talking about care," by Liz Forbat (2005). This book introduces new ideas for the analysis of informal care relationships, with particular focus on how difficulties within such relationships may be constructed. It is aimed at researchers, trainees and professionals within a health and social care field. A review of earlier literature and research into care relationships is shown to falsely polarise the two identities of carer and caree (the term used in this book for the person receiving care). Further literature, it is discussed, has focused on abuse, with some of the literature focusing on the vulnerability of the caree and others focusing on the difficulties facing a carer. This book suggests that literature about care relationships rarely suggests that both partners may in fact be acting inappropriately. The focus of this book is the importance of listening to both sides of the story in relationships and how professionals need to be trained in the use of discourse analysis to gain a deeper understanding of how difficulties in care relationships are constructed. This book also shows how history in a relationship - particularly a lifetime relationship - can play an important role in how people explain or waive responsibility for behaviour. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Review: review of nurse home visiting interventions for community-dwelling older persons with existing disability. Liebel, D. V., B. Friedman, N. M. Watson and B. A. Powers. 2009

Not relevant (Reference to caregiver/informal not evident)

Despite there being a considerable number of meta-analyses and reviews synthesizing the nurse in-home visiting literature, there have been no reviews examining nurse in-home visiting for patients who are already disabled. This article presents a literature review and synthesis of 10 trials targeted on older adults with disability. The review is organized into structure and process components related to the outcome variable disability based on the classic Donabedian model. The review suggests that the components of in-home visiting associated with favorable disability outcomes include multiple home visits, geriatric training and experience, health provider collaboration, multidimensional assessment, and theory use. In contrast, lack of process measures, physician collaboration, training, and specific intervention components targeting disability are associated with ineffective interventions. This review helps provide insight into variables that influence disability outcomes as well as the development of best-practice models of in-home visiting to older adults with existing disability.

EBSCOhost; rzh

Revisiting children 'home on trial' in the context of current concerns about the costs and effectiveness of the looked-after children system: findings from an exploratory study. Broadhurst, K. and T. Pendleton. 2007

Not relevant

Statute and practice relating to s.31 part IV of The Children Act 1989 allow children subject to care orders to be placed at home with their parent(s). It is not uncommon for the courts to accept a plan for children to return home at the final hearing of care proceedings at which full care orders are granted. In such instances, children retain looked-after status but, in terms of their day-to-day care, are looked after by parent(s). Whilst there are a small number of studies conducted in the 1990s relating to children 'home on trial', there is a much more limited recent literature. It is important to revisit this population of children, given current concerns about the burgeoning costs of child care proceedings and the looked-after children system (LAC). This paper reports on a small-scale exploratory study in one north-west local authority area. Consisting of a file study and interviews with parents and professionals, the study examines the factors that contributed to initial removal of children to public care, the impact of the LAC system for children 'home on trial', stability of placements at home, as well as issues to do with the discharge of care orders. Particular attention is drawn to lone father headed households, a social group over-represented in our sample. The study aims to inform further multi-location studies.

EBSCOhost; rzh

The role of individual and community characteristics in child welfare placement decisions. Brown, E. L. 2006

Not relevant

This research examines both individual and community characteristics that may influence decisions of a local child welfare agency, following a substantiated report of maltreatment, to place children in out-of-home care or leave them in their own home. There is little research to date that integrates characteristics of the child and mother, with characteristics of the local agency and surrounding county, and methodological concerns have precluded analysis of possible cross-level interactions. The study presented here makes use of recent advances in event history analysis, and uses data routinely collected such as vital statistics, child welfare administrative records, and US Census Bureau reports. Support for this research was provided by the CAPTA fellowship grant (2003-2005) from the Children's Bureau, US DHSS, Administration for Children and Families. Findings suggest three areas where individual and community characteristics seem to play a role in decisions to place a child. First, it would appear that placement decisions are associated with characteristics that describe very vulnerable children---low birth weight, newborn abnormalities, multiple reports of maltreatment, victim of abuse rather than neglect, or age 0-30 days at substantiation. Second, results suggest that for many children without these vulnerabilities, placement decisions are based on maternal characteristics evaluated differently from one agency to another. The education levels of agency staff, participation in reform, and use of foster home initial placements, seem to moderate the influence of maternal characteristics such as prenatal care, marital status, and prior births. Finally, levels of staff turnover, use of foster care versus in-home services, and social services reform appear to influence placement decisions for African-American children differently than for other children. However, results address associations not causality, and are exploratory not conclusive. As child welfare research has only begun to include multi-level analyses, and few studies address any of the community contextual variables included here, further research would help determine whether results can be confirmed in other settings. More information about agency and maternal characteristics, and a more focused analysis of race and ethnicity, would also be helpful in exploring the issues illuminated by this analysis. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Role of peritoneal dialysis in the era of the resurgence of home hemodialysis. Burkart, J. 2008

Not relevant (Reference to caregiver/informal not evident)

In recent years, there has been a resurgence of home hemodialysis (HHD) therapies. Given the small percentage of prevalent patients in the United States currently on home dialysis, an appropriate question is: What is the role of peritoneal dialysis (PD) in this era? Data suggest that in centers that are promoting the growth of HHD, their PD programs also tend to be very active. Furthermore, our experience and other data suggest that one should not worry about cannibalizing PD in order to grow HHD. Most HHD patients come from in-center hemodialysis or those patients transitioning from PD to another therapy. In fact, data suggest that in order to promote the growth of HHD, a certain minimal infrastructure is needed in terms of staff. An active PD program not only supports a robust infrastructure that allows for HHD growth but also fosters profitability of a home program. copyright Journal compilation copyright 2008 International Society for Hemodialysis.

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Safety factors predictive of job satisfaction and job retention among home healthcare aides. Sherman, M. F., R. R. Gershon, S. M. Samar, J. M. Pearson, A. N. Canton and M. R. Damsky. 2008

Not relevant

Objectives: Although many of the well known work characteristics associated with job satisfaction in home health care have been documented, a unique aspect of the home health care aides' (HHA) work environment that might also affect job satisfaction is the fact that their workplace is a household. To obtain a better understanding of the potential impact of the risks/exposures/hazards within the household environment on job satisfaction and job retention in home care, we recently conducted a risk assessment study. Methods: Survey data from a convenience sample of 823 New York City HHAs were obtained and analyzed. Results: Household/job-related risks, environmental exposures, transportation issues, threats/verbal and physical abuse, and potential for violence were significantly correlated with HHA job satisfaction and job retention. Conclusions: Addressing the modifiable risk factors in the home health care household may improve job satisfaction and reduce job turnover in this work population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Screening for undiagnosed cognitive impairment in homebound older adults. Setter, S. M., J. J. Neumiller, D. L. Weeks, S. Borson, J. M. Scanlan and T. E. Sonnett. 2009

Not relevant (Reference to caregiver/informal not evident)

Objective: To screen for undetected cognitive impairment in homebound elders receiving home health care services. Design: A cross-sectional study of adults 60 years of age and older receiving visiting nurse services. A pharmacist administered the Mini-Cog, a rapid screening test for cognitive impairment, during the enrollment home visit. Setting: Participants' homes. Participants: A consecutive sample of 100 homebound adults, 60 years of age or older with no previous diagnosis of dementia, Alzheimer's disease, or other cognitive impairment. Main outcome measure: Percentage of participants scoring in the likely impaired range (screen failure) on the Mini-Cog. Results: Seventeen percent of persons with no prior diagnosis of dementia or cognitive decline failed the Mini-Coc Conclusion: Rates of undetected cognitive impairment are substantial in homebound elders receiving care from a visiting nurse service. The home health setting represents an important point in the continuum of geriatric care for detection of cognitive impairment. Future work should define the types and trajectories of cognitive impairment detected in home care patients by simple screens such as the Mini-Cog and test ways to integrate this knowledge into longitudinal treatment plans across settings of care. copyright 2009 American Society of Consultant Pharmacists, Inc.

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Secure attachment to family and community: a proposal for cost containment within higher user populations of multiple problem families. Sacco, F. C., S. W. Twemlow and P. Fonagy. 2007

Not relevant (Reference to caregiver/informal not evident)

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services.Aplacement prevention model, outlined as an alternative "mentalising social system" approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.

EBSCOhost; rzh

Self-management of medication for mental health problems by homeless young people. Muir-Cochrane, E., J. Fereday, J. Jureidini, A. Drummond and P. Darbyshire. 2006

Not relevant

Youth homelessness is a growing Australian and international concern associated with considerable health disadvantage, including serious mental health problems. This paper reports findings of a qualitative study that explored young homeless people's experiences of mental health and well-being through in-depth interviews. Thematic analysis identified medication use and management as a central issue for the young people. Reasons identified for medication non-adherence included unwanted side-effects, issues of access and storage, and lack of support from health and social agencies. These problems were compounded by everyday stresses of homelessness. Medication adherence was facilitated by social support, consistent contact with supportive health services, and regular medication supply, often resulting in improved mental health and well-being. For these young people, prioritizing management of medication helped stabilize one aspect of their lives. Health professionals can play an important role in helping them achieving this goal.

EBSCOhost; rzh

Seniors at risk: The association between the six-month use of publicly funded home support services and quality of life and use of health services for older people. Markle-Reid, M., G. Browne, R. Weir, A. Gafni, J. Roberts and S. Henderson. 2008

Not relevant (Reference to caregiver/informal not evident)

This study examines the baseline characteristics and changes in health status and cost of use of health services associated with use of publicly funded home support services. The analysis includes 122 people 75 years of age or more who were eligible for home support services. Over a 6-month period, one third of the sample used home support services for more than 1 hr/week; these seniors had higher rates of depression and cognitive impairment, lower levels of physical and emotional functioning, and less effective coping styles than those who used fewer services. Cognitive impairment explained 17 per cent of the variation in use of home support services. At 6 months, use of home support services for more than 1 hr/week by seniors with higher levels of need was associated with lower cost of use of health services and lower levels of improvement in health status. These findings suggest the need for further research to identify efficacious ways of providing home support services to this population to enhance their health status using available resources. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Sensor acceptance model - Measuring patient acceptance of wearable sensors. Fensli, R., P. E. Pedersen, T. Gundersen and O. Hejlesen. 2008

Not relevant (Reference to caregiver/informal not evident)

Objectives: This project focuses on how patients respond to wearable biomedical sensors, since patient acceptance of this type of monitoring technology is essential for enhancing the quality of the data being measured. There is a lack of validated questionnaires measuring patient acceptance of telemedical solutions, and little information is known of how patients evaluate the use of wearable sensors. Methods: In information systems research, surveys are commonly used to evaluate the user satisfaction of software programs. Based on this tradition and adding measures of patient satisfaction and health-related quality of life (HRQoL), a Sensor Acceptance Model is developed. The model is made operational using two questionnaires developed for measuring the patients' perceived acceptance of wearable sensors. Results: The model is tested with 11 patients using a newly developed wearable ECG sensor, and with 25 patients in a reference group using a traditional "Holter Recorder". Construct validity is evaluated by confirmatory factor analysis, and internal consistency is calculated using the Cronbach's alpha coefficient. Sensor Acceptance Index (SAI) is calculated for each patient, showing reasonable dependencies and variance in scores. Conclusions: This study attempts to identify patients' acceptance of wearable sensors, describing a user acceptance model. Understanding the patients' behavior and motivation represents a step forward in designing suitable technical solutions, and calculations of SAI can, hopefully, be used to compare different wearable sensor solutions. However, this instrument needs more extensive testing with a broader sample size, with different types of sensors and by explorative follow-up interviews. copyright 2008 Schattauer GmbH.

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Sexuality in palliative care: Patient perspectives. Lemieux, L., S. Kaiser, J. Pereira and L. M. Meadows. 2004

Not relevant (Reference to caregiver/informal not evident)

This qualitative study investigated the meaning of sexuality to palliative patients. Face-to-face interviews were conducted with ten patients receiving care in a tertiary palliative care unit, a hospice or by palliative home care services in their homes. Several themes emerged. Emotional connection to others was an integral component of sexuality, taking precedence over physical expressions. Sexuality continues to be important at the end of life. Lack of privacy, shared rooms, staff intrusion and single beds were considered barriers to expressing sexuality in the hospital and hospice settings. Only one subject had previously been asked about sexuality as part of their clinical care, yet all felt that it should have been brought up, especially after the initial cancer treatments were completed. Home care nurses and physicians were seen as the appropriate caregivers to address this issue. Subjects unanimously mentioned that a holistic approach to palliative care would include opportunities to discuss the impact of their illness on their sexuality. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Shifts in Attachment Relationships: A Quantitative Study of Adolescents in Brief Residential Treatment. Bettmann, J. 3458

Not relevant

This study examined the shifts in adolescents' perceptions of attachment relationships with parents and peers over the course of a seven-week residential program. The convenience study sample was created from voluntary participants, drawn from adolescents entering a seven-week wilderness therapy program during a given five-month period. The 93 adolescents, ranging in age from fourteen to seventeen, filled out three quantitative measurements which evaluated their perceptions of attachment relationships with mother, father and peers at the beginning and again at the end of treatment. Based on attachment theory, study hypotheses predicted that adolescents would develop healthier attachments to mother and father figures, as measured by a decrease in attachment scores from pre to post administrations. Results from this study generally supported hypotheses regarding adolescents' improved attachment relationships in terms of decreased anger and increased emotional connection towards parents. The hypotheses were not supported in regards to other elements of those relationships, including trust or communication with parents where more problems were reported by the end of treatment. These findings indicate the complexity of parent-adolescent relationships, particularly when considered in the context of out-of-home care, and point to the importance of continued exploration in this area. The effect of family treatment interventions on these reported attachment shifts was unclear, and should be probed in further study.

CSA Social Services Abstracts

Silent witnesses: Child health and well-being in England and Australia and the health transition 1870-1940. McCalman, J. 2009

Not relevant

This study explores the 'black box' of changes in both the macro and micro - the societal and domestic - environment that transformed the health and well-being of children in England and Australia between 1870 and 1940. It argues that in addition to the control of environmental hazards and improved medical care, changes in family life made possible by the decline in the informal economy of casual work, provided the domestic security that enabled the major improvements in child health measures before immunisation and antibiotics. The golden age of childhood came after World War II, with the relief of peace and unparalleled stability in marriages and home making. Since the 1970s, however, capitalist societies have succumbed to a pursuit of affluence and individualism that has had profound psychic and physical effects and aggravated inequality and discontent: the obesity epidemic is the embodiment of that transformation.

Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care. Meyers, F. J., J. Linder, L. Beckett, S. Christensen, J. Blais and D. R. Gandara. 2004

Not relevant (Pertains to 'care transition' and as such is not within the purview of this Project)

Clinical trials of investigational therapy in patients with advanced cancer may not pay sufficient attention to quality of life (QOL) and supportive care issues, resulting in an adverse impact on the quality of care (QOC). We hypothesized that the simultaneous delivery of investigational therapy and a structured program of supportive care would result in measurable improvements in predefined outcomes without adverse events for patients, caregivers, or the physician/patient interaction. This report describes the findings of a trial designed to test the feasibility and initial results of such an approach. Forty-four patients accrued to Phase I or Phase II investigational therapy trials were simultaneously enrolled into a defined home care program focused on supportive care needs of the patient and family, as well as assessment of the toxicities of investigational therapy. These 44 patients constitute the Simultaneous Care (SC) cohort. Twenty patients receiving investigational therapy and the standard supportive care measures available through the Cancer Center served as a control group, designated the Usual Care (UC) cohort. We measured QOL using baseline and monthly assessments of the Functional Assessment of Cancer Therapy (FACT-G) instrument. This instrument measures four domains of well-being: physical, emotional, functional, and social/family. We prospectively defined QOC as: the percentage of hospice referrals; hospice length of stay; and number of cycles of chemotherapy administered. A summary score for the four FACT domains at each time point for each patient was calculated (FACT 4). The FACT 4 scores of the SC group improved compared to the UC group but did not reach a significant difference. Individual scores reflected a wide range of psychometric variability. A statistically significant difference in referral to hospice was seen in the SC group (35/44) compared to the UC group (8/15) (P=0.034). The median length of stay in hospice was the same for both cohorts but the mean stay was greater in the SC cohort (54 days) compared to the UC cohort (37 days). The mean number of chemotherapy cycles was not different between SC and UC (P=0.25). The self-reported acceptance by patients, caregivers, physicians and Cancer Center support staff was qualitatively excellent. Patients with advanced cancer at the time of enrollment onto investigational therapy should have made an explicit transition to palliative care goals but often have not. In the current health care environment, patients with advanced cancer without curative potential may be forced by their health provider or health insurer to choose between disease-directed therapy (including investigational therapy) or structured best supportive care programs. In this emerging era of targeted therapies, SC provides an approach designed to optimize palliative care goals while supporting the clinical research mission of offering patients with advanced cancer new and potentially better therapeutic interventions. SC is a system of care that enhances patient choice by allowing patients and families to have concurrent access to two beneficial options. SC may enhance coordination of care and facilitate patients' explicit transition from curative intent to palliative intent. In order to validate this approach, a randomized comparative trial evaluating SC has been initiated.

Ovid Technologies; Ovid MEDLINE(R)

A Six-Month Profile of Community Case Coordinated Older Adults. Bierlein, C., H. Hadjistavropoulos, M. Bourgault-Fagnou and M. Sagan. 2006

Not relevant (Reference to caregiver/informal not evident)

The purpose of this study was to assess the needs of older case coordinated clients receiving community health services, by examining changes in cognitive status, physical and mental health status, social support, risk for institutionalization, and service use over a 6-month period from initial intake into home care. Significant predictors of professional and supportive home care, as well as emergency room use and hospital days, were also examined. Standardized interviews were conducted with 234 clients at the time of referral; follow-up interviews were conducted with 179 of these clients after 6 months of case coordination. Results reveal that physical and mental health improved, while cognitive status remained stable. Although social interaction and instrumental support decreased, subjective support remained stable. Risk of institutionalization decreased. Occupational therapy, nursing, and homemaking were the most frequently used services. The best predictor of professional and supportive home care was a risk of institutionalization score. The needs of this older adult population changed even within the relatively short span of 6 months. Frequent review of needs in some form may. be warranted in order to maintain effective service plans. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Skills-based learning for caring for a loved one with an eating disorder : the new Maudsley method. Smith, G., 1945-, J. Treasure and A. Crane. 2007

Not relevant (Pertains to eating disorder)

CAMH;

Social Capital as a Public Policy Tool: Project Report. Initiative, P. R. 2005

Not relevant

Social Care and Social Networks of Elderly Patients in Need of Homecare. Zimmermann, M. and C. Schaepe. 2006

Not relevant (Germany)

Patients in need of outpatient nursing care were asked about the quality of care & their patients' satisfaction. The aim of the study was to show their social situation & their assistance by relatives like spouse, offspring & neighbours in relation to their age & gender & the kind of care they received. Results of other studies like the Berlin study on aging showed that with increasing age the social network decreased. These results could be confirmed. There were daily contacts in a group of 42 percent, but all of the included people had weekly contact to different members of their family or their friends. There was a strong correlation between daily contacts & the grade of physical or cognitive independence measured by the EBI. As it was expected we could find a linear relationship between assisting people & the degree of need for care. It was surprising that one third of the assisting persons were male & most of them were persons who carried the main burden of care. This could be influenced by changing gender roles & the high unemployment rate in eastern Germany. As we could show that a high correlation is existing between number of contacts & the number of people in the social network we have to assume that social contacts among people in need of care are mostly related to care & assistance.

CSA Sociological Abstracts

Social networks, informal child care, and inadequate supervision by mothers. Coohey, C. 2007

Not relevant

The purpose of this study is to determine whether less informal child care support from family and friends is related to supervisory neglect and, if there is a relationship, to test several explanations for why some mothers receive less child care. Thirty-two low-income mothers who did not adequately supervise their children were matched to 32 mothers who provided adequate supervision. The results showed the mothers who provided inadequate supervision received less child care support from their partners and relatives, but not their friends. These differences appear to be linked to several properties of the mothers' social networks. For example, the majority of the mothers who provided inadequate supervision either did not have a partner or knew them for less than one year. They had fewer family members living nearby and more negative relationships with them than the mothers who provided adequate supervision. To reduce chronic supervisory neglect, mothers may need assistance with both informal and formal child care support.

Social participation in home-living patients with mild Alzheimer's disease. Sorensen, L. V., F. B. Waldorff and G. Waldemar. 2008

Not relevant

The purpose of this study was to investigate social participation in home-living patients with mild Alzheimer's disease (AD) and to identify predictors for low social participation. The study was based on baseline data from 330 home-living patients with mild AD who participated in The Danish Alzheimer Intervention Study (DAISY). Proxy-obtained information from primary caregiver assessed patients' social participation. The result showed that low social participation was present in mild AD. Significant independent predictors of low social participation were impairment in activities of daily living (ADL) and neuropsychiatric symptoms. The findings from this study add to the literature that social impairment is present even in the mild stage of AD. The findings underscore the importance of assessing social participation in mild AD as soon as few ADL skills are lost.

Nlm;

Social Security Spouse and Survivor Benefits for the Modern Family. Favreault, M. and C. E. Steuerle. SSRN, 2007

Not relevant

Our project uses DYNASIM3, the Urban Institute's dynamic microsimulation model of the U.S. population, to simulate several alternative systems of Social Security auxiliary benefits. We specifically consider earnings sharing, a system in which a husband's and a wife's earnings records are combined and averaged over the duration of their marriage when computing Social Security benefits. We also consider whether other changes to Social Security's benefit computations - like caregiver credits, minimum benefits, and more modest changes to spouse/survivor benefits - could improve program adequacy and horizontal equity with less complexity and fewer transition difficulties relative to earnings sharing. Each proposal we examine substitutes existing spouse (and, sometimes, all or parts of survivor) benefits with mechanisms that explicitly acknowledge marital partnerships, are more neutral with respect to marriage, and/or better target economically vulnerable people. All proposals are roughly cost-equivalent in 2050. We find that all three packages - earnings sharing, replacement of most of the spouse benefit with a minimum, and full spouse replacement with caregiver credits - reduced poverty modestly and made lifetime benefits more similar for couples paying the same amount in taxes relative to current law scheduled. The earnings-sharing proposal, however, only achieved the poverty reduction with significant adjustments to the treatment of surviving spouses through a self-financed survivor benefit. The packages reveal important tradeoffs among beneficiary groups, with particular tensions between workers and non-workers, and married, never married, divorced, and widowed persons.

Social work in home care and adult day settings: a comparative study. Novick, J. G. 2008

Not relevant

This article explores the job characteristics of social work practice in the home health care field versus the adult day care arena. In many ways, the two positions are very similar; the types of clients or patients serviced, the multidisciplinary nature of the work, and the issues faced when working with this population are examples of similarities. This comparison helps readers understand how the transition from fieldwork to the center setting can be achieved. This exploration represents the personal experiences of the author, who, after almost 25 years in the home health care field, now works in adult day care.

EBSCOhost; rzh

Social work licensing and the evolving home care setting. Dyeson, T. B. 2004

Not relevant

The home health care industry has recently undergone dramatic changes in Medicare reimbursement and the delivery of patient care services to the chronically ill elderly. One of the primary differences in the funding structure is that medical social services are no longer directly billable within the Medicare home health system. Many authors support the contention that social work field-educational experiences in health care are crucial in order to have a more prepared work force. Unfortunately, field practicum opportunities for social work students have been rare in the home health care industry because of the converging problems of licensing regulations and Medicare reimbursement. Although students must be supervised and monitored by a licensed social worker, there are many functions that they can perform in the home health care setting.

EBSCOhost; rzh

Social work update. Home health and wound care: an interdisciplinary research opportunity. Dyeson, T. B. 2005

Not relevant

This article reviews the role of the social worker in home care, briefly describes the literature concerning the psychosocial impact on wound care patients, and suggests opportunities for expanding this area of inquiry. The literature suggests that patients who have leg, foot, or pressure ulcers experience quite a number of psychosocial problems related to the presence and treatment of the wounds. The author is of the opinion that wound care research should include more disciplines, specifically social workers.

EBSCOhost; rzh

Social workers' perspectives on care arrangements between vulnerable elders and foreign home care workers: lessons from Israeli/Filipino caregiving arrangements. Ayalon, L., M. Kaniel and L. Rosenberg. 2008

Not relevant (Reference 'paid caregivers')

OBJECTIVES: This pilot study addresses a universal social phenomenon of foreign workers of lower socioeconomic status who provide care to more affluent, but frail older adults. In Israel, foreign workers from the Philippines provide the majority of paid 24-hour home care services to older adults. To date, the views of social workers, who are highly involved in this arrangement of care, have never been evaluated. Hence, this study evaluates the advantages and challenges associated with such an arrangement of care from the perspective of social workers. METHODS: We conducted four focus groups with 31 social workers who work closely with Filipino home care workers, older adults, and their family members. RESULTS: Using grounded theory methodology, we identified motivating factors that contribute to the popularity of this caregiving arrangement among both Filipinos and Israelis. We also identified four major areas of challenge; these include the intimate nature of this caregiving arrangement as well as cultural, legal, and financial disparities. Social workers also discussed strategies they use to assure the safety and satisfaction of the involved parties. DISCUSSION: Despite the high need for this caregiving arrangement, many difficulties and challenges exist; these are partially due to very prominent cultural differences between the host culture, Israel, and the culture of the Filipino home care worker, and they are also due to legal, social, and economic differences ingrained in such a care arrangement.

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The socioeconomic impact of Alzheimer's disease. Bosanquet, N. 2001

Not relevant (pre '2004)

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Space, Choice and Control, and Quality of Life in Care Settings for Older People. Barnes, S. 2006

Not relevant (institutional settings)

This cross-sectional study aims to establish whether gradation of space and daytime location are associated with quality of life in care home residents, irrespective of dependency. Thirty-eight homes and 452 residents are recruited. Quality of life measures used are as follows: observation of the time residents spent in active behavior and observation of well-being, both derived from Dementia Care Mapping, and a measure of environmental control. Residents in homes providing more gradation of space have higher observed well-being and environmental control, and those spending the day located in their own rooms have higher observed active behavior and environmental control. Higher dependency residents are more likely to be located in lounges. Gradation of space is associated with resident quality of life, highlighting the necessity for design guidance to emphasize a variety of spaces. However, well-designed buildings with a variety of spaces can offer little choice to residents if access to different daytime locations is restricted. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Spiritual needs of persons with advanced cancer. Hampton, D. M., D. E. Hollis, D. A. Lloyd, J. Taylor and S. C. McMillan. 2007

Not relevant (hospice)

Spiritual needs, spiritual distress, and spiritual well-being of patients with terminal illnesses can affect their quality of life. The spiritual needs of patients with advanced cancer have not been widely studied. This study assessed the spiritual needs of 90 patients with advanced cancer who were newly admitted to hospice home care. They completed a demographic data form and the Spiritual Needs Inventory shortly after hospice admission. Scores could range from a low of 17 to a high of 85; study scores were 23 to 83. Results showed great variability in spiritual needs. Being with family was the most frequently cited need (80%), and 50% cited prayer as frequently or always a need. The most frequently cited unmet need was attending religious services. Results suggest the importance of a focus on the spiritual more than the religious in providing care to patients at the end of life. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Standards of care in home care services: A comparison of generic and specialist services for older people with dementia. Venables, D., S. Reilly, D. Challis, J. Hughes and M. Abendstern. 2006

Not relevant (Reference to caregiver/informal not evident)

Current policy in England emphasises both the importance of caring for highly dependent older people for as long as possible in their own homes, and the development of specialist care services for people with dementia. However, the differences between specialist and generic home care services for people with dementia are poorly understood. This cross-sectional postal survey describes the standards of home care services for people with dementia in the North West of England, and investigates the differences in quality standards between specialist and generic home care services. Forty-six percent of identified services provided information on a range of quality indicators. Most services provided only a few of the indicators utilized by the study, and there was little evidence of services adopting national minimum standards. Few differences were found between the two service types, although generic services appeared to offer a greater degree of flexibility than specialist services. These results help to inform the understanding of home care service mix and provision, and the uptake of national minimum standards. They provide key material for shaping the future provision of home care for older people with dementia. copyright 2006 Taylor & Francis.

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State commitment to home and community-based services: effects on independent living for older unmarried women. Burr, J. A., J. E. Mutchler and J. P. Warren. 2005

Not relevant (Reference to caregiver/informal not evident)

This study examines the impact of state variation in commitment to the provision of home and community-based services on the living arrangement outcomes of older unmarried females with functionallimitations. We combine data from the 1990 U.S. Census of Population (PUMS) with state-level information on long-term care home and community- based service expenditures, nursing home bed availability, and Medicaid nursing home costs from a special report that compares state variation in long-term care systems. Using multilevel logistic regression modeling techniques, we find that the risk of institutionalization compared to community living arrangements is reduced as spending for home and community-based services at the state level increases. We discuss these findings in light of policy changes during the 1990s.

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State of the science: posthospitalization nursing interventions in congestive heart failure. [Review] [46 refs]. Hamner, J. B. 2005

Not relevant (Reference to caregiver/informal not evident)

Nursing's role as key healthcare providers who give emotional support and teach self-care to patients with congestive heart failure has evolved substantially in recent years. The purpose of this article is to provide a systematic evaluation of the impact of posthospital nursing interventions in the management of heart failure. Four models of nursing interventions emerged: home-based nursing interventions, multidisciplinary interventions, heart failure clinics, and telephone- or technology-based nursing interventions. On the basis of currently available data, posthospital nursing interventions in congestive heart failure can improve clinical outcomes and decrease healthcare costs and resource use. [References: 46]

Ovid Technologies; Ovid MEDLINE(R)

Stay Well and Healthy! Pilot Study Findings from an Inhome Preventive Healthcare Programme for Persons Ageing with Intellectual and/or Developmental Disabilities. Aronow, H. U. and J. E. Hahn. 2005

Not relevant (Reference to caregiver/informal not evident)

Background: While disparities in the health status for persons ageing with intellectual and developmental disabilities have been well documented, interventions that address individual risks in physical, emotional, social and environmental health among this population are lacking. This pilot study evaluated the feasibility of two inhome interventions designed to reduce health risks and improve health outcomes among persons ageing with intellectual and developmental disabilities. Method: Interventions and assessment tools were developed. Adults with intellectual and developmental disabilities, aged 32 and over (n = 201) living in non-institutional settings were recruited and assigned to either an advance practice nurse (APN) intervention of inhome multidimensional assessment, targeted recommendations and follow-up visits (n = 101) or an inhome health risk appraisal (HRA) with printed feedback only (n = 100). Results: The development and pilot testing of the interventions, assessment tools and methods demonstrated feasibility in the population from mild to moderate intellectual and developmental disabilities. In addition, high levels of health risks were identified (mean = 5.0; range 0-16) in the sample suggesting the need for effective interventions. Both pilot groups showed significant reduction in health risks between baseline and followup. Further rigorous randomized field trials are required to test the effectiveness of each intervention. Conclusions: Community-based preventive interventions are feasible for randomized trials in this population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

The struggle for dignity by people with severe functional disabilities. Wadensten, B. and G. Ahlstrom. 2009

Not relevant (Reference to caregiver/informal not evident)

The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Subjective quality of life of care-dependent older people in five European Union countries. Saks, K. and E.-M. Tiit. 2008

Not relevant (Reference to caregiver/informal not evident)

(from the chapter) The main aim of the present study was to compare quality of life (QoL) of older people receiving long-term care--clients of home-based or institutional care--in different regions of the European Union (EU): Estonia, United Kingdom, Sweden, Finland and Germany. Estonia is a "new" EU member and other four countries are "old" members. During the study Estonia had been a member of EU less than 2 years while others more than 10 years. Estonia differed from other project countries in several socio-economic areas. The mean life expectancy in Estonia was significantly lower (Estonia 71.8, UK 84.1, Sweden 86.3, Finland 81.4, Germany 82.3 years) (List of countries by life expectancy, 2005), general life satisfaction and happiness were poorer, security and state of repair of houses were more problematic and people were less satisfied with their homes, social life and health services (InfobaseEUROPE Database Record No. 7530, 2004). An additional aim of the study was to search, pilot and validate suitable tools for evaluating subjective QoL of older care-dependent persons. Although the need for comprehensive approach to QoL in long-term care is generally recognized there are no standardized measures available. Some QoL questionnaires, such as the World Health Organization Quality of Life Bref questionnaire (WHOQOL-Bref) (WHOQOL group, 1998) and the Philadelphia Geriatric Morale Scale (PGCMS) (Lawton, 1991) are well validated in the general older population (Skevington, Lofty, Oconnell, & The WHOQOL Group, 2004; von Heideken Wagert et al., 2005; Wong, Woo, Hui, & Ho, 2004) but in less extent with long-term care clients. Persons in long-term care probably have different needs and expectations compared with healthy older people or with patients in hospitals, rehabilitation and primary care settings. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial. Aimonino Ricauda, N., V. Tibaldi, B. Leff, C. Scarafiotti, R. Marinello, M. Zanocchi and M. Molaschi. 2008

Not relevant (Reference to caregiver/informal not evident)

OBJECTIVES: To evaluate hospital readmission rates and mortality at 6-month follow-up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN: Prospective randomized, controlled, single-blind trial with 6-month follow-up. SETTING: San Giovanni Battista Hospital of Torino. PARTICIPANTS: One hundred four elderly patients admitted to the hospital for acute exacerbation of COPD were randomly assigned to a general medical ward (GMW, n=52) or to a geriatric home hospitalization service (GHHS, n=52). MEASUREMENTS: Measurements of baseline sociodemographic information; clinical data; functional, cognitive, and nutritional status; depression; and quality of life were obtained. RESULTS: There was a lower incidence of hospital readmissions for GHHS patients than for GMW patients at 6-month follow-up (42% vs 87%, P<.001). Cumulative mortality at 6 months was 20.2% in the total sample, without significant differences between the two study groups. Patients managed in the GHHS had a longer mean length of stay than those cared for in the GMW (15.5+/-9.5 vs 11.0+/-7.9 days, P=.010). Only GHHS patients experienced improvements in depression and quality-of-life scores. On a cost per patient per day basis, GHHS costs were lower than costs in GMW ($101.4+/-61.3 vs $151.7+/-96.4, P=.002). CONCLUSION: Physician-led substitutive hospital-at-home care as an alternative to inpatient care for elderly patients with acute exacerbations of COPD is associated with a substantial reduction in the risk of hospital readmission at 6 months, lower healthcare costs, and better quality of life.

EBSCOhost; rzh

Supporting Arguments for Including the Teaching of Team Competency Principles in Higher Education. Jewels, T. and R. Albon. 2007

Not relevant

The article emphasizes the need for teachers to apply team competency principles to address and accommodate the dynamic, fast-paced world in which knowledge management is a feature. A new team-centered pedagogy to team learning has been presented and supported by examples of successful teaching practices. A taxonomy for assessing team competencies at different levels of team maturity is proposed. Information technology educators have a responsibility to their graduates to prepare them to be managers of knowledge in an information-knowledge era.

EBSCOhost; lxh

Survival of intimate partner violence as experienced by women. Flinck, A., E. Paavilainen and P. Åstedt-Kurki. 2005

Not relevant

AIMS AND OBJECTIVES: The study set out to describe women's experiences of intimate partner violence, the consequences of such violence, the help they received and women's experiences of their survival. BACKGROUND: Social and health professionals do not have sufficient ability to identify and help families who suffer from intimate partner violence. Methods for identifying and treating partner violence not have been developed adequately. METHOD: The study was conducted in Finland by loosely formulated open-ended interviews with seven battered women. The data were analysed by inductive qualitative content analysis. FINDINGS: Women had past experience of maltreatment and a distressing climate at their parental home. Women experienced both themselves and their spouse as having weak identities; their ideals, patterns of marriage and sexuality were different. Violence occurred in situations of disagreement. Women tried to strike a balance between independence and dependence in the relationship. The different forms of couple violence were interlinked. The women sought help when their health and social relationships got worse. An awareness of the problem, taking action, counselling and social relationships helped them survive. Religiousness was a factor that involved commitment to the couple relationship, made religious demands on women and promoted the recovery of integrity. CONCLUSIONS: Intimate partner violence was associated with the family model, childhood experience of maltreatment, the partners' weak identity and conflicts between individualism and familism. Social and healthcare professionals need competence in early intervention and skills to discuss moral principles, sexuality, and violence in a way that is free of prejudice and condemning attitudes. Spiritual approaches in the context of interventions should be taken into consideration. RELEVANCE TO CLINICAL PRACTICE: In a clinical context, nurses should be aware of the symptoms of violence, and they should have skills in dealing with intimate moral and spiritual issues.

EBSCOhost; rzh

Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home. Gustafson, T., K. A. Franklin, B. Midgren, K. Pehrsson, J. Ranstam and K. Ström. 2006

Not relevant

BACKGROUND: Home mechanical ventilation (HMV) and long-term oxygen therapy (LTOT) are the two treatment alternatives when treating respiratory insufficiency in patients with kyphoscoliosis. We aimed to study the effect on survival with regard to HMV or LTOT alone in patients with respiratory insufficiency due to kyphoscoliosis. METHODS: Swedish patients with nonparalytic kyphoscoliosis (ie, scoliosis not related to neuromuscular disorders) who started LTOT or HMV between 1996 and 2004 were followed up prospectively until February 14, 2006, with death as the primary outcome. Treatment modality, arterial blood gas levels, the presence of concomitant respiratory diseases, and age were recorded at the onset of treatment. No patient was lost to follow-up. RESULTS: One hundred patients received HMV, and 144 patients received oxygen therapy alone. Patients treated with HMV experienced better survival, even when adjusting for age, gender, concomitant respiratory diseases, and blood gas levels, with a hazard ratio of 0.30 (95% confidence interval, 0.18 to 0.51). CONCLUSION: The survival of patients with kyphoscoliosis receiving HMV was better than that of patients treated with LTOT alone. We suggest HMV and not oxygen therapy alone as the primary therapy for patients with respiratory failure due to kyphoscoliosis, regardless of gender, age, and the occurrence of concomitant respiratory diseases.

EBSCOhost; rzh

Symptoms in patients receiving palliative care: a study on patient-physician encounters in general practice. Borgsteede, S. D., L. Deliens, B. Beentjes, F. Schellevis, W. A. Stalman, J. T. Van Eijk and G. Van der Wal. 2007

Not relevant (Netherlands)

Most people with an incurable disease prefer to stay and die at home, cared for by their general practitioner (GP). This paper aims at describing the prevalence of symptoms in patients receiving palliative care at home. Within the framework of a nation wide survey of general practice in the Netherlands, GPs received a questionnaire for all patients who died within the 1-year survey period to determine whether patients received palliative care (n = 2,194). The response rate was 73% (n = 1,608), and 38% of these patients received palliative care until death. Information regarding encounters during the last 3 months of life was derived from the records kept by the GPs. Digestive symptoms (59%) and pain (56%) were the most prevalent. The total number of symptoms per patient was higher in cancer patients (11.99) than in non-cancer patients (7.62). Not reported in previous studies were musculoskeletal symptoms (20%) and chronic ulcer (18%). Concluding, this showed that Dutch GPs encounter a diversity and wide range of symptoms in palliative care. To face these complex challenges in patients receiving palliative care at home, GPs have to be trained as well as supported by specialized palliative care consultants.

Ovid Technologies; Ovid MEDLINE(R)

A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Stevenson, M., M. L. Jones, E. De Nigris, N. Brewer, S. Davis and J. Oakley. 2005

Not relevant

Objectives: To establish the clinical effectiveness and cost-effectiveness of selective oestrogen receptor modulators, bisphosphonates and parathyroid hormone (subject to licensing) for the prevention and treatment of osteoporosis and the prevention of osteoporotic fractures in postmenopausal women. Data sources: Electronic databases. Review methods: Studies that met the review's entry criteria were eligible for inclusion in the meta-analyses provided that they reported fracture incidence in terms of the number of patients suffering fractures. Meta-analysis was carried out using the random-effects model. A model was constructed to estimate the cost-effectiveness of osteoporosis interventions. The model calculated the number of fractures that occurred and provided the costs associated with osteoporotic fractures, and the quality-adjusted life-years (QALYs). In addition, the conditions of breast cancer and coronary heart disease (CHD) were modelled, as some interventions have been shown to affect the risk of these conditions. Results: Ninety randomised controlled trials (RCTs) met the inclusion criteria. They related to the five interventions (alendronate, etidronate, risedronate, raloxifene and teriparatide) and to five comparators (calcium, calcium plus vitamin D, calcitriol, hormone replacement therapy and exercise), as well as placebo or no treatment. All five interventions have been shown to reduce the risk of vertebral fracture in women with severe osteoporosis with adequate calcium intakes. However, none of these drugs has been demonstrated, by direct comparison, to be significantly more effective than either each other or the other active interventions reviewed in this report. The intervention costs of treating all osteoporotic women, for a period of 5 years, were in the region of [pounds]900-1500 million for alendronate, etidronate, risedronate and raloxifene. The cost per QALY ratios fell dramatically with age. Assuming the risks of a woman with severe osteoporosis at the threshold of osteoporosis, no treatment had a cost per QALY below [pounds]35,000 at 50 years of age. At 60 years of age, the cost per QALY of raloxifene was [pounds]26,000 assuming no impact on hip fractures, and [pounds]31,000 assuming an adverse effect. However, these results are driven by the effect on breast cancer and the assumptions made regarding this disease state. No other intervention had a cost per QALY below [pounds]35,000. When analyses were conducted assuming that the fracture risk is doubled at each site, alendronate and risedronate had cost per QALY ratios below [pounds]30,000 at all ages. For women at the threshold of osteoporosis, without a prior fracture and aged 70 years, the cost per QALY of the three bisphosphonates ranged from [pounds]34,000 to [pounds]41,000. Raloxifene had a cost per QALY of [pounds]23,000, assuming no effect on hip fracture, given assumptions regarding breast cancer. At 80 years of age, the cost per QALY of alendronate and risedronate was below [pounds]20,000. This was true for etidronate when incorporating observational data, but the value rose to [pounds]69,000 when only RCT data were used. No other intervention had a cost per QALY below [pounds]35,000. It was assumed that doubling the risk of fracture for women without a prior fracture would give results similar to patients at the threshold of osteoporosis with a prior fracture. Conclusions: Of the five interventions, only raloxifene appeared to reduce the risk of vertebral fracture in postmenopausal women unselected for low bone mineral density (BMD). However, as the full data have not been made public, there is some uncertainty regarding this result. None of the five interventions has been shown to reduce the risk of non-vertebral fracture in women unselected for low BMD. All of the proposed interventions provided gains in QALYs compared with no treatment in women with sufficient calcium and vitamin D intakes. The size of the QALY gain for each intervention was strongly related to the age of the patient. The estimated costs varied widely for

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Systematic review of respite care in the frail elderly. Shaw, C., McNamara, R., Abrams, K., Cannings-John, R., Hood, K., Longo, M., Myles, S., O’Mahony, S., Roe, B, Williams, K. 2009

Not relevant (duplicate)

Taking the community into the home. Notter, J., T. Spijker and K. Stomp. 2004

Not relevant (Netherlands)

The changing demographics of the population are such that there is an increasing need for care for frail older people with both physical and mental health problems. At the same time, the increased migration of workers and their families means that care provision now has to embrace a range of cultures. The present paper explores how the concept of cultural safety has importance for those planning and providing care for older adults. The recognition that removing individuals with mental health problems from their own environment causes increased disorientation and confusion has led to some organisations trying to maintain the community aspects of life when independent living is no longer possible. The present paper focuses on two such organisations in the Netherlands, demonstrating how they have changed their practice to improve and enhance the quality of life of their clientele through 'taking the community into the home'. Whilst sharing the same goals and aspirations, each organisation, serves a different population, and therefore, has developed a unique approach.

Ovid Technologies; Ovid MEDLINE(R)

Technology-dependent children and their families: a review. Wang, K. W. and A. Barnard. 2004

Not relevant (duplicate)

BACKGROUND: Advances in medical technology and nursing care have enabled children who rely on long-term medical and technical support to reunite with their families and community. The impact of discharging these children into the community involves a number of unprecedented social implications that warrant policy consideration. To begin with, an effort must be made to understand the phenomenon of caring for technology-dependent children living at home. AIM: The aim of this paper is to provide a comprehensive literature review on caring for technology-dependent children living at home. METHODS: The review was conducted via keyword searches using various electronic databases. These included CINAHL, MEDLINE, Social Science Index, Sociological Abstracts, Australian Family and Society Abstracts, and the Australian Bureau of Statistics. The articles and books found were examined for commonality and difference, significant themes were extracted, and the strength of the research methods and subsequent evidence were critiqued. FINDINGS: In this paper, themes relating to home care for technology-dependent children and their families are elucidated and summarized. These are: chronic illness and children; the impact of paediatric home care on children; the uniqueness of technology-dependent children and their families; and parents' experience of paediatric home care. DISCUSSION: Contentious issues, relevant to the social life of these children and their families, are raised and are discussed with the intention of extending awareness and provoking further debate among key stakeholders. These issues include: the changed meaning of home; family dynamics; social isolation; saving costs for whom?; shifts in responsibility; and parent-professional relationships. CONCLUSION: More research is needed in the arena of paediatric home care, to facilitate relevant policy formation and implementation.

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Telehealth. Developing a pilot telehealth program: one agency's experience. Walsh, M. and J. R. Coleman. 2005

Not relevant (Caregiver/informal not evident)

This article explores one home care agency's experience launching a pilot telehealth program. Patient selection, costs, projected savings, and patient satisfaction with the telehealth program are discussed.

EBSCOhost; rzh

Ten years' activity of the first Italian public hospice for terminally ill patients. Monti, M., E. Cunietti, L. Castellani, M. Merli and F. Cruciatti. 2004

Not relevant (Italy)

We present a review of the first 10 years of the hospice at the Geriatric Institute Pio Albergo Trivulzio of Milan, Italy's first public hospice for the admission of terminally ill patients. Over 1200 patients were admitted to the nine-bed hospice between October 1991 and December 2001, most of whom (63%) were referred by the Home Palliative Care Units operating in Milan. The hospice patients are elderly (nearly 60% are 70 or more years of age, median 72 years). Admission to the hospice was until the patient's death (74% of patients) after a brief time (4 weeks on average). From the very outset, we have striven to focus our attention on the daily application of the programmes of care inspired by the philosophy and practice of palliative medicine, i.e. the holistic approach and attention devoted to quality of life, multidimensional assessment, and the services of a multiprofessional team to provide, alongside medical and nursing assistance, psychosocial and spiritual support, bereavement support, etc. The continuing education of health workers and the systematic use of a clinical audit tool specifically designed for palliative care, are the two key elements which, in our judgement, have proved to be the most fruitful in reaching the objectives described above. These 10 years of the Pio Albergo Trivulzio Hospice have made a significant contribution towards defining a concrete Italian model which can be applied to the care of the terminally ill inpatient.

Ovid Technologies; Ovid MEDLINE(R)

There's no place like home: a qualitative study of the working conditions of home health care providers. Markkanen, P., M. Quinn, C. Galligan, S. Chalupka, L. Davis and A. Laramie. 2007

Not relevant (Reference to caregiver/informal not evident)

OBJECTIVE: Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. METHODS: The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. RESULTS: HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. CONCLUSIONS: The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.

EBSCOhost; rzh

Time to treatment in prolonged seizure episodes. Pellock, J. M., A. Marmarou and R. DeLorenzo. 2004

Not relevant (Reference to caregiver/informal not evident)

Prompt intervention in seizure emergencies is critical to reducing morbidity and mortality risks associated with status epilepticus. To determine the need for wider education about the benefits of at-home treatment, we examined the time from seizure onset to initial treatment in a cohort of patients with epileptic seizures. The seizure database of patients admitted in the greater Richmond, Virginia, area during a 5-year period (1989-1994) was queried to extract time to seizure treatment. Records were available for 889 patients. Patients were divided into two subgroups: children (age < 16 years, 29.7% of the cohort) and adults. Time to seizure treatment varied broadly; only 41.5% of all patients received their first antiepilepsy drug within 30 minutes. Time to treatment did not significantly differ between age groups. This baseline study supports the need for patient education regarding seizure emergencies and wider availability of at-home treatment options to shorten time to seizure treatment.

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Towards a new understanding of provider continuity.(Reflections). Buetow, S. A. 2004

Not relevant (Provider)

Transitions in living arrangements of Canadian seniors: findings from the NPHS longitudinal data. Sarma, S., G. Hawley and K. Basu. 2009

Not relevant (Reference to caregiver/informal not evident; pertains to care transitions)

This paper examines transitions in living arrangement decisions of the seniors using the first six cycles of the Canadian longitudinal National Population Health Survey microdata. Transitions from independent to intergenerational and institutional living arrangements are uniquely analyzed using a discrete-time hazard rate multinomial logit modelling framework and accounted for unobserved individual heterogeneity in the data. Our results show: a) provision of publicly-provided homecare reduces the likelihood of institutionalization, but it has no effect on intergenerational living arrangements; b) access to social support services reduces the probability of both institutional and intergenerational living arrangements; c) higher levels of functional health status, measured by Health Utility Index, reduce the probability of transitions from independent to intergenerational and institutional living arrangements; d) a decline in self-reported health status increases the probability of institutionalization, but its effect on intergenerational living arrangements is statistically insignificant; e) higher levels of household income tend to decrease the probability of institutionalization; and f) the likelihood of transitioning to both intergenerational and institutional living arrangements increases with the duration of survival. Our findings suggest that access to and availability of publicly-provided homecare, social support services and other programs designed to foster better functional health status would contribute positively towards independent or intergenerational living arrangements and reduce the probability of institutionalization.

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Under surveillance, yet looked after: telehomecare as viewed by patients and their spouse/partners. Dinesen, B., C. Nøhr, S. K. Andersen, H. Sejersen and E. Toft. 2008

Not relevant (duplicate)

INTRODUCTION: In this research project, a group of heart patients were transferred from traditional hospital settings to home hospitalisation across sectors. The project involved patients with heart failure and arrhythmia. AIM: The aim was to understand the experiences and attitudes of patients and their spouses/partners with regard to the application of telehomecare technology as an option within home hospitalisation. METHODS: A phenomenological hermeneutic approach was used to collect and interpret the findings and data. A triangulation of data collection techniques was applied using participation observation and qualitative interviews with patients and spouse/partner. Data were analysed from the perspective of the sociology of everyday life. FINDINGS: The impact of home hospitalisation on patients is described according to several themes: security, freedom, increased awareness of own symptoms, being 'looked after' but annoyed with their spouse/partner. The patients experience a seamless cross-sector patient care process. The impact on the spouse/partner includes elements of increased responsibility, nervous tension, and invasion of privacy. CONCLUSION: Patients believe that home hospitalisation speeds up the process of returning to everyday life, both physically and mentally. It is important to be aware of certain anxieties experienced by the patient's spouse/partner about home hospitalisation, and these anxieties may also affect the patient.

EBSCOhost; rzh

Under-Served or Under-Surveyed: The Information Needs of Studio Art Faculty in the Southwestern United States. Gregory, T. R. 2007

Not relevant

The article discusses the information needs of studio art faculty in the southwestern U.S. According to it, libraries are being used by art faculty to find images for the purpose of teaching. Meanwhile, half of the respondents to the survey that was conducted said that they have computers in their classroom and studios that are connected to the Internet.

Understanding aging and disability perspectives on home care: Uncovering facts and values in public-policy narratives and discourse. Clark, P. G. 2007

Not relevant (Reference to caregiver/informal not evident)

Every public-policy problem can be defined in terms of its empirical ("facts") and normative ("values") dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the application of an analytical framework based on the concept of "narrative frame" analysis. The literature on home care policy reports and recommendations is examined within this conceptual structure--including especially publications and reports from the federal government, national organizations, and the aging and disability communities. Finally, observations and conclusions about the significance of home care policy discourse, and of the differences between the aging and disability constituencies in this debate, are offered as a guide for deconstructing the public-policy process. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Unexplained clinical variance: are health plans (partly) responsible?(surveys of health plans). Patmas, M. A. 2006

Not relevant

IN THIS ARTICLE ... More research is needed to determine if health plan decision making is contributing to clinical variance in health care. But an informal survey shows it is.

Use of home care services effectively reduces feelings of burden among family caregivers of disabled elderly in Japan: Preliminary results. Kumamoto, K., Y. Arai and S. H. Zarit. 2006

Not relevant (Japan)

Background: Relatively few observational studies have been conducted on the impact of home care services on burden or other aspects of the caregiver's experience. Objectives: To examine whether the use of care services reduces the feelings of burden among family caregivers in Japan. Specifically, the study was aimed at testing the following three hypotheses: (1) The severity of impairment and the dementia among the disabled elderly increases the feelings of burden among family caregivers and the support from family members decreases burden: (2) the amount of services used by older people and their caregivers is affected by the severity of dementia and ADL deficiencies among the disabled elderly and the amount of support from family members: and (3) controlling for severity, the use of care services under the LTC insurance program serves to reduce the feelings of burden among family caregivers. Methods: A structural equation model using the data obtained from 82 pairs of community-dwelling disabled elderly and their principal family caregivers. The model included the following variables: age of the disabled elderly; the severity of ADL deficiency and behavioral disturbances; use of formal (public) care services; support from family members; and feelings of burden among family caregivers. Results: The structural equation model revealed that, after controlling for the effects of severity on service use, home care services effectively reduce feelings of burden among family caregivers. Conclusions: The findings suggest that care services provided under the LTC insurance have been successfully reducing burden among family caregivers in the study area. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Use of multiple psychotropic medications among adolescents aging out of foster care. Raghavan, R. and J. C. McMillen. 2008

Not relevant

OBJECTIVES: This study described the prevalence of and risk factors for using multiple concurrent psychotropics among adolescents leaving foster care. METHODS: In-person interviews were conducted with 406 adolescents who were aged 17 years and were leaving foster care in a Midwestern state. RESULTS: Of the 403 who had complete records, most (N=257, or 64%) did not report taking any psychotropic medications, while 46 (10%) were on three or more concurrent psychotropics. A history of physical or sexual abuse and a diagnosis of major depressive disorder or manic episode were significantly associated with the use of three or more concurrent medications. Between 19% and 41% of adolescents with diagnoses for which psychotropics are indicated were not taking any medications. CONCLUSIONS: This local cohort of adolescents aging out of foster care seemed to display both overuse and underuse of psychotropics. Research on larger and more representative cohorts of youths leaving foster care is necessary in order to understand the appropriateness of psychotropic prescribing among these adolescents.

EBSCOhost; rzh

The use of supportive-educative and mutual goal-setting strategies to improve self-management for patients with heart failure. Kline, K. S., L. D. Scott and A. S. Britton. 2007

Not relevant (Reference to caregiver/informal not evident)

This study examined the effects of 2 home healthcare nursing approaches--supportive-educative and mutual goal setting--on self-management for patients with heart failure. Both approaches are specifically related to participants' understanding of heart failure and self-efficacy in managing the condition. An experimental, longitudinal, repeated-measures design was used with a sample of 88 participants. Although no significant difference was demonstrated in participants' understanding of heart failure, the supportive-educative group showed a significantly increased self-efficacy in managing heart failure symptoms.

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Using the linkage model for integrating evidence into home care nursing practice. [Review] [22 refs]. Ervin, N. E., K. Scrivener and T. Simons. 2004

Not relevant (agency based)

A home care agency's patient population with heart failure demonstrated improved outcomes after the agency implemented an evidence-based protocol. The model holds promise for use in other agencies working to improve patient outcomes as well as have an impact on decreasing costs. [References: 22]

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Utilization of adult car services by elderly with functional incapacities. Savard, J., N. Leduc, P. Lebel, F. Beland and H. Bergman. 2007

Not relevant

This study consists of a secondary analysis of data collected during the SIPA demonstration project. Its purpose is to identify the proportion of Adult Day Care (ADC) users as well as the determinants of use in this group of persons 65 years old and over receiving home care services in Montreal. Results show that 18.8% of the sample have at least one ADC presence during a 6 months study period. The following factors increase the probability of ADC use: being younger; not having a university degree; being born outside of Canada or for persons born in Canada, living with a caregiver; receiving help from the CLSC for daily life activities more than once a week; being in the catchment population of an ADC which fees are lower; and for men only, having had a stroke or presenting more functional incapacities. Adapted from the source document.

CSA Sociological Abstracts

The values and qualities of being a good helper: a qualitative study of adult foster home caregivers for persons with serious mental illness. Piat, M., N. Ricard, J. Sabetti and L. Beauvais. 2007

Not relevant (foster homes)

BACKGROUND: Canadian foster homes for adults with serious mental illness are operated by non-professional caregivers, usually women, whose mandate is to support residents and reintegrate them into the community. While mental health professionals recognize that adult foster homes are an important service for this population, there is little understanding of how caregivers impact on the lives of their residents. AIMS AND OBJECTIVES: This article draws on the findings of a larger study which examined both caregiver and resident perspectives on the helping relationship in adult foster homes. Caregiver perspectives on the values and qualities required to help people living in foster homes are reported. DESIGN AND METHODS: With no pre-set theoretical framework, this qualitative study employed an inductive approach within a naturalistic paradigm. Semi-structured interviews were conducted with 20 caregivers. Data analysis was an ongoing, 2-year process, involving the identification of categories and themes through several distinct stages. SETTING: The study included Montreal adult foster homes (n=242) for persons with serious mental illness, supervised by two university-affiliated psychiatric hospitals. PARTICIPANTS: Twenty caregivers, selected according to years of experience and number of residents in the home, were diverse in terms of age, cultural background, family composition, education and occupational background. RESULTS: Caregivers possess a clearly articulated value system, and 21 specific qualities which reflect the attributes of both professional and informal helpers. These values and qualities provide caregivers with a "professional" or "vocational" orientation. CONCLUSIONS: A deeply held system of values and qualities is critically important to caregiver effectiveness and job satisfaction. Findings suggest that caregivers are highly motivated, and should be recognized as full participants in the mental health system at both policy and practice levels.

EBSCOhost; rzh

Variation in types of service use and expenditures for individuals with developmental disabilities. Kang, T. and C. Harrington. 2008

Not relevant (Reference to caregiver/informal not evident)

Background: This study examined the types of services and expenditures for 8 service categories provided by regional centers to 138,336 individuals with developmental disabilities living at home and in the community in California in 2004-2005. Methods: Logistic regressions of secondary data were used to predict the types of services received, and ordinary least squares regressions were used to predict types of service expenditures. Results: Higher client needs generally were associated with higher odds of receiving services and with expenditures, although the types of services varied by client need. Controlling for client needs and other factors, males were more likely to receive out-of-home services. Individuals aged 3-21 years were generally less likely to receive many services but were more likely to receive in-home and out-of-home respite services than were those over age 62. All racial and ethnic minority groups were less likely to receive support and out-of-home services than were whites and had lower expenditures, although these varied by the types of services. The supply of nursing homes, community care facilities, area population characteristics, and regional centers also predicted variations in service use and expenditure patterns. Conclusion: Studies of the underlying reasons for the variations are needed to ensure equity in access to all types of services and expenditures. copyright 2008 Elsevier Inc. All rights reserved.

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Vascular disorders. Multiprofessional follow up of patients after subarachnoid haemorrhage. Jarvis, A. and L. Talbot. 2004

Not relevant (Reference to caregiver/informal not evident)

Subarachnoid haemorrhage (SAH) is a life-threatening illness that affects people suddenly and without warning. Previous research has estimated that only 7% of SAH survivors suffer physical deficits (Stegan and Freckmann, 1991), whereas two-thirds of those classed as having made a good recovery actually experience a range of debilitating cognitive or emotional difficulties (Bindschaedler et al, 1997; Buchanan et al, 2000). At Hope Hospital, a structured system was set up to help support the survivors of SAH through follow-up via the neurovascular team providing patients with information, guidance and early intervention including screening for potential cognitive and emotional difficulties and fast-track referral to neuropsychology services. Behavioural indices demonstrated that patients experienced a range of difficulties in everyday functioning such as problems that prevent a return to work and excessive fatigue, among others. Although this innovative system does address follow-up need, improvements could be made to ensure that all patients receive an equitable service.

EBSCOhost; rzh

"We Only Own the Hours": Discontinuity of Care in the British Columbia Home Support System. Sharman, Z., A. T. McLaren, M. Cohen and A. Ostry. 2008

Not relevant

This article uses the concept of continuity of care to examine the implications of health-system restructuring for workers & staff in the BC home support system. Home support primarily serves frail seniors living in poverty & has the potential to provide assistance with tasks like bathing, dressing, & toileting, as well as offer social support & relational care to isolated clients. Through presentation of qualitative data from focus groups & interviews with home support workers & clients in the Greater Vancouver area, we demonstrate how the casualization & intensification of work in a context of increasing client acuity levels has diminished both continuity & quality of care. This article discusses how restructuring in the home support sector in BC has reduced the overall number of persons under care in the system, disrupted continuity of care, & compromised quality. Tables, Figures, References. Adapted from the source document.

CSA Sociological Abstracts

What were the outcomes of home follow-up visits after postpartum hospital discharge? Jirojwong, S., D. Rossi, S. Walker and B. Ritchie. 2005

Not relevant

OBJECTIVES: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. DESIGN: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. MAIN OUTCOME MEASURES: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. RESULTS: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. CONCLUSION: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes.

Nlm;

Whose service is it? A pressing need for change. Pointon, B. and M. Pointon. 2001

Not relevant (Pre '2004)

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Why do we have different urinary catheter use in European home care? Pfisterer, M. and P. Oster. 2005

Not relevant (more info needed)

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Women's priorities for lay health home visitors: implications for eliminating health disparities among underserved women. Sheppard, V. B., K. P. Williams and J. T. Richardson. 2004

Not relevant

While racial, ethnic, and socioeconomic health disparities in maternal and child health persist among women, few studies describe experiences of low-income women during pregnancy. We undertook a qualitative study of women's self-reported experiences with home visitors to gain understanding of priorities for participation and service delivery. Lay health home visitors provided satisfactory services and maintained close relationships with their clients. The mother-to-mother relationship is critical in facilitating continued participation in and ensuring positive health and social outcomes from lay health home visitation services. Many women lacked sufficient social support during their pregnancy and received this from the health visitor. Appropriate integration of lay health visitors with traditional prenatal care may alleviate many of the deleterious stressors that low-income women experience and may ultimately impact racial, ethnic, and socioeconomic disparities in maternal and child health.

Nlm;

Working in partnership: user perceptions of intensive home visiting. Kirkpatrick, S., J. Barlow, S. Stewart-Brown and H. Davis. 2007

Not relevant

The aim of this study was to explore the perceptions of vulnerable women about the value of intensive home visiting in pregnancy and the first year of life delivered by health visitors trained to work in partnership with families. Twenty in-depth interviews were conducted with women who had completed the home visiting programme and agreed to be interviewed. The data were fully transcribed and analysed thematically. Despite initial concerns and negative preconceptions about health and social service professionals, participating women greatly valued the relationships that were established with their home visitors and identified a number of ways in which they had benefited. These included increased confidence, improved mental health, better parenting, improved relationships and changes in their attitudes toward professionals. These findings demonstrate the potential of intensive home visiting delivered in partnership with mothers in reaching and helping vulnerable and 'hard-to-reach' families. They highlight the importance of establishing a trusting relationship between helper and provider, and the need for home visitors to have the necessary skills and qualities to establish such relationships. Copyright © 2007 John Wiley & Sons, Ltd.

EBSCOhost; rzh

Working the past narrative and institutional memory. Linde, C. and P. Oxford University. Oxford University Press, 2009

Not relevant

Working with adolescents at risk of out of home care: The effectiveness of specialist teams. Biehal, N. 2005

Not relevant

This paper reports findings from a quasi-experimental study of services for young people who appeared to be at risk of placement. It compares outcomes for young people in England referred to specialist support teams, which offered an intensive service with those for a group referred to the mainstream 'service as usual' delivered by local area social work teams. The services offered by the specialist teams bear some similarities to intensive family preservation services (IFPS) in the USA, insofar as they offer an intensive, short-term preventive service whose principal aim is the prevention of placement. Many of the young people had serious emotional and behavioural difficulties, and many had lengthy histories of abuse, neglect, or past placement. At follow-up, many young people and families receiving both types of service showed considerable improvement on a variety of measures of child and family functioning, but results were not significantly better for the group served by the intensive service. However, the intensive services group were found to be significantly less likely to enter placement. The paper discusses the merits of considering both individual and service outcomes, and considers the impact of a variety of child and service system factors. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).

Work-life differences and outcomes for agency and consumer-directed home-care workers. Benjamin, A. E. and R. E. Mattias. 2004

Not relevant

Research on home-care outcomes has highlighted the promise of consumer-directed models that rely on recipients rather than agencies to arrange and direct services. However, there has been little research on workers employed directly by recipients. This study examined differences in work-life and worker outcomes between workers in consumer-directed versus agency care as well as between family and nonfamily workers. A random sample of 618 workers in the In-Home Supportive Services program in California was selected and interviewed by telephone between September 1996 and March 1997. Interviews were conducted in English, Spanish, and three Asian languages, with a focus on worker stress and satisfaction. Findings indicated a mixed portrait of worker experience and outcomes. Most model differences disappear when other variables are controlled, but some worker-stress differences persist between models and types of worker. On most dimensions of stress and satisfaction, consumer-directed workers report outcomes equal to or more positive than agency workers. Efforts to improve the work life of home-care workers should acknowledge the strengths of consumer-directed approaches and target all workers across models. (Journal abstract).

EBSCOhost; swh

Workplace variables and their relationship to quality client outcomes in home health. Kroposki, M. and J. W. Alexander. 2004

Not relevant

The purpose of the study was to investigate the relationship of workplace variables and client outcomes, and to propose a model of the fit between the workplace variable dimensions of nursing technology (NT) and organizational structure (OS) to predict client outcomes in home health. The researchers used a correlational, predictive, descriptive design to measure NT, OS, nurses' role clarity, client outcomes, and client satisfaction. A convenience sample consisted of 43 home health sites with 205 nurses and 325 clients completing surveys. Nurses perceived that clients had better outcomes when the three dimensions of NT fit the three dimensions of OS: (1) when clients' conditions were unstable, nurses interacted with peers; (2) when care was complex, nurses consulted with supervisors; and (3) when clients' needs varied, nurses used rules to guide clinical decisions. Findings suggested that nurses' understanding of their roles correlated to OS. Nurse managers in home health care settings can use the model constructed as a result of the research to adjust the dimensions of OS to improve client outcomes.

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Zoledronic acid treatment at home: Safety data from an observational prospective trial. Tassinari, D., B. Poggi, S. Nicoletti, M. Fantini, E. Tamburini, C. Possenti and S. Sartori. 2007

Not relevant

Background. To prospectively assess feasibility, side effects, and safety of a home treatment with zoledronic acid in patients with bone metastases confined to home. Patients and methods: Forty-two patients with bone metastases (15 males and 27 females; mean age, 72 years; range, 48-86), confined to home because of functional impairment or low performance status, were enrolled into the trial. They were included in a comprehensive program of home care, and were treated with zoledronic acid, 4 mg. Primary end point of this observational trial was the safety assessment of the treatment at home; secondary end points were the clinical assessment of the time to treatment discontinuation and the definition of a pattern of patients who could benefit by a home treatment with intravenous bisphosphonates. Results: Nineteen patients had breast cancer; 7, multiple myeloma; 5, non-small-cell lung cancer; 4, renal cancer; 4, prostate cancer; 1, thyroid cancer; 1 non-Hodgkin's lymphoma; and 1 soft tissue sarcoma. On the whole, 220 home treatments were administered in 3 years, with a median of 4 administrations per patient (range, 1-28). Median time to treatment discontinuation was 130 days. The treatment was interrupted for worsening of the performance status in 30 patients (71.4%), length of the treatment greater than 24 months in 2 patients (4.8%), hypocalcemia in 1 patient (2.4%), renal failure in 1 patient (2.4%). No difference in median time to treatment discontinuation was observed among patients with breast cancer, multiple myeloma, or other tumors in univariate analysis. Multivariate analysis showed no prognostic significance for kind of tumor, age at the time of entering the trial, gender, and number of extraosseous sites of disease. No acute major side effects were observed during the treatment, and the treatment had to be interrupted for side effects in 2 patients (4.8%). One patient had jaw osteonecrosis some months after the treatment was stopped. Conclusions: The home treatment with zoledronic acid seems safe. The appropriate use of biphosphonates in such a new setting needs a criterion to identify the subset of patients with bone metastases confined to home who can really benefit by this treatment. copyright Mary Ann Liebert, Inc.

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