医护人员预立医疗照护计划培训需求评估工具的编制

目的 以培训需求分析(training needs analysis,TNA)理论中绩效分析模式为指导框架,编制医护人员预立医疗照护计划(advance care planning,ACP)培训需求评估工具条目池,为下一步培训需求调查工作提供研究基础。方法 先是以文献分析法及资料查阅初步构建ACP培训需求评估工具条目池,再依据Brislin翻译模型对初步构建的英文条目进行翻译及汉化调试,通过德尔菲专家咨询法及预调查对条目进行修订。结果 经文献分析及资料查阅,评估工具内容确定为23个条目,涉及三个主题,分别是基础知识、专科知识及沟通技能。翻译及回译后的量表整体语义评价较高,条目语义等价程度是78.6%~100.0%,量表语义等价程度是82.6%~100.0%。两轮咨询后专家积极性为100%,专家权威程度为0.87,专家咨询协调系数分别是0.271和0.353,各条目重要性均值4.29~5.00,变异系数0.05~0.11。40位进行量表表面效度评价的医护人员对量表各条目问法的认可度为87.5%~100.0%。结论 本研究培训需求评估工具编制过程科学严谨,编制结果良好,为进一步开展培训需求调查工作提供了参考。     

Integrating advance care planning as part of comprehensive geriatric assessment for hospitalised frail elderly patients: findings of a cross-sectional study

INTRODUCTION:The integration of advance care planning (ACP) as part of the comprehensive geriatric assessment (CGA) of hospitalised frail elderly patients, together with the clinical and demographic factors that determine successful ACP discussion, has not been previously explored.METHODS:A cross-sectional study on patients and family caregivers admitted under the geriatric medicine department of a tertiary hospital was conducted from October 2015 to December 2016.RESULTS:Among 311 eligible patients, 116 (37.3%) patients completed ACP discussion while 166 (53.4%) patients declined, with 62 (37.3%) of the decliners providing reasons for refusal. Univariate logistic regression analysis showed that older age, higher Charlson Comorbidity Index, poorer functional status and cognitive impairment had statistically significant associations with agreeing to ACP discussion (p < 0.05). On multivariate logistic regression analysis, only poorer functional status was significantly associated (odds ratio 2.22 [95% confidence interval 1.27–3.87]; p = 0.005). Among those who completed ACP discussion, a majority declined cardiopulmonary resuscitation (79.3%), preferred limited medical intervention or comfort care (82.8%), and opted for blood transfusion (62.9%), antibiotics (73.3%) and intravenous fluid (74.1%) but declined haemodialysis (50.9%). Decision-making was divided for enteral feeding. Among decliners, the main reasons for refusal were ‘not keen’ (33.9%), ‘deferring to doctors’ decision’ (11.3%) and ‘lack of ACP awareness’ (11.3%).CONCLUSION:The feasibility and utility of integrating ACP as part of CGA has been demonstrated. Poorer functional status is significantly associated with successful ACP discussion. Greater public education on end-of-life care choices (besides cardiopulmonary resuscitation) and follow-up with decliners are recommended.     

Development of a nursing care problems coping scale for male caregivers for people with dementia living at home

Objective: The number of male caregivers has increased, but male caregiversface several problems that reduce their quality of life and psychological condition. Thisstudy focused on the coping problems of men who care for people with dementia at home. Itaimed to develop a coping scale for male caregivers so that they can continue caring forpeople with dementia at home and improve their own quality of life. The study also aimedto verify the reliability and validity of the scale.Patients/Material and Methods: The subjects were 759 men who care for peoplewith dementia at home. The Care Problems Coping Scale consists of 21 questions based onelements of questions extracted from a pilot study. Additionally, subjects completed threeself-administered questionnaires: the Japanese version of the Zarit Caregiver BurdenScale, the Depressive Symptoms and the Self-esteem Emotional Scale, and RosenbergSelf-Esteem Scale.Results: There were 274 valid responses (36.1% response rate). Regarding theanswer distribution, each average value of the 21 items ranged from 1.56 to 2.68. Themedian answer distribution of the 21 items was 39 (SD = 6.6). Five items had a ceilingeffect, and two items had a floor effect. The scale stability was about 50%, andCronbach’s α was 0.49. There were significant correlations between the Care ProblemsCoping Scale and total scores of the Japanese version of the Zarit Caregiver Burden Scale,the Depressive Symptoms and Self-esteem Emotional Scale, and the Rosenberg Self-EsteemScale.Conclusion: The answers provided on the Care Problems Coping Scalequestionnaire indicated that male caregivers experience care problems. In terms ofvalidity, there were significant correlations between the external questionnaires and 19of the 21 items in this scale. This scale can therefore be used to measure problems withcoping for male caregivers who care for people with dementia at home.     

Effectiveness of a community-based integrated care ward (CICW) on 90-day readmission among the elderly people: a retrospective cohort study of a rural area in Japan

Objective: Community-based integrated care wards (CICW) play a role in supporting the return of patients to their homes. However, studies investigating the readmission risk associated with CICW are lacking. To investigate the influence of CICW on readmission, we conducted a retrospective cohort study among Japanese elderly people.Materials and Methods: This study used data from the Diagnosis Procedure Combination (DPC) and medical records of the Hamada Medical Center, Shimane Prefecture in 2014–2019. The number of subjects and readmission in each hospitalization case (general ward only [GW] and CICW) were 1,521 and 416 subjects and 152 and 49 cases, respectively. We selected the hospitalization cases for heart failure (I30–I52), ischemic heart disease (I20–I25), pneumonia (J09–J18), chronic lower respiratory tract diseases (J40–J47), intestinal diseases (K55–K64), cerebrovascular disease (I60–I69), gallbladder, bile duct, and pancreatic diseases (K80–K87) from the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The hazard ratios (HRs) and 95% confidence intervals (CIs) for readmission via a CICW were estimated using a multivariate Cox proportional hazards model.Results: The HRs for readmission associated with CICW were not different between the shorter and longer durations, considering the percentage of CICW stay. Compared with GW cases, the HR of CICW cases was 0.40 (95% CI, 0.17–0.92) in coordination with outside agencies of hospital discharge support. While the HR of GW cases was 2.35 (95% CI 1.01–5.47), a significantly increased risk was observed in people living alone. A similar risk was not observed in CICW cases with the HR of 0.56 (95% CI 0.15–2.07).Conclusion: The present study observed decreased risk of readmission among the patients discharged from CICW, compared to GW. Further research is required to clarify the causal factors for this decreased risk.     

Effect of COVID-19 lockdown on the pathway of care and treatment outcome among patients with tuberculosis in a rural part of northern India: a community-based study

Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected routine healthcare services across all spectra, and tuberculosis (TB) care under the National Tuberculosis Elimination Program have been affected the most. However, evidence available at the community level is minimal. The clinical features, care cascade pathway, and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a rural community health block in northern India were assessed and compared.Materials and Methods: This was a retrospective cohort study that included all patients diagnosed with TB and initiated treatment under programmatic settings between January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and during/post-lockdown, respectively.Results: A total of 103 patients were diagnosed and treated for TB during the study period. A significantly higher proportion of pulmonary TB cases were reported during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis, patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95% confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI, 0.60–0.995) had significantly lower favorable treatment outcomes.Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have changed during/post-lockdown. The care cascade delays are still high among TB patients, irrespective of the lockdown status. Lockdown had a significant adverse impact on the outcomes of TB treatment.     

Vulnerable groups and protective habits associated with the number of symptoms caused by pesticide application in Kratie,Cambodia: a cross-sectional questionnaire study

Objective: The present study aimed to identify pesticide poisoning symptoms and related protective habits to effectively prevent pesticide poisoning among farmworkers in Kratie, Cambodia, where pesticide poisoning is an urgent public health problem.Materials and Methods: This cross-sectional study based on a questionnaire survey analyzing social demographics, number of symptoms, and protective behavior regarding pesticide application was conducted in Kratie Province from January 25 to 31, 2021. In total, 210 farmworkers completed the survey. The effects of social demographics and pesticide-protective behavioral scores on the number of symptoms were investigated using multivariable regression analysis.Results: The observed number of symptoms was 1.16 times higher among women (P=0.004), increased with the duration of work, and decreased with age. In addition, we identified five significant pesticide-protective behaviors: 1) preparing using gloves, 2) using protective equipment, 3) avoiding wiping sweat, 4) avoiding leaking, and 5) resting when feeling ill. Pesticide-protective behaviors tended to decrease with the duration of working years in the low-education group (B=−0.04, SE=0.01), whereas no association was observed in the high-education group (B=0.01, SE=0.01).Conclusion: Pesticide-protective behaviors significantly correlated with fewer symptoms. The female and aging groups required continuous special education or instructions for implementing pesticide-protective actions, especially the aforementioned five protective actions.