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1.
Silvia Gonella Ines Basso Valerio Dimonte Barbara Martin Paola Berchialla Sara Campagna Paola Di Giulio 《Journal of the American Medical Directors Association》2019,20(3):249-261
Objective
Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals–residents and health care professionals–family EOL conversations and EOL care outcomes.Design
Systematic review with meta-analysis.Setting and Participants
Seven databases were searched in December 2017 to find studies that focused on health care professionals–residents (without oncologic disease) and health care professionals–family EOL conversations and aimed to explore the impact of EOL conversations on resident's or family's EOL care outcomes.Measures
Random effects meta-analyses with subsequent quality sensitivity analysis and meta-regression were performed to assess the effects of EOL conversations on the decision to limit or withdraw life-sustaining treatments. A funnel plot and Eagger test were used to assess publication bias.Results
16 studies were included in the qualitative and 7 in the quantitative synthesis. Health care professionals–family EOL conversations were positively associated with the family's decision to limit or withdraw life-sustaining treatments (odds ratio = 2.23, 95% confidence interval: 1.58-3.14).The overall effect of health care professionals–family EOL conversations on the family's decision to limit or withdraw life-sustaining treatments remained stable in the quality sensitivity analysis. In the meta-regression, family members with a higher level of education were less influenced by EOL conversations with health care professionals when making decisions about limiting or withdrawing life-sustaining treatments. No publication bias was detected (P = .4483).Conclusions/Implications
This systematic review shows that EOL conversations promote palliative care. Structured conversations aimed at exploring NH resident preferences about EOL treatment should become routine. NH administrators should offer health care professionals regular training on EOL conversations, and resident-centered care that involves residents and their families in a shared decision-making process at EOL needs to be promoted. 相似文献2.
Tamara Sussman Sharon Kaasalainen Eunyoung Lee Noori Akhtar-Danesh Patricia H. Strachan Kevin Brazil Robin Bonifas Valérie Bourgeois-Guérin Patrick Durivage Alexandra Papaioannou Laurel Young 《Journal of the American Medical Directors Association》2019,20(3):262-267
Objectives
This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care.Design
A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use.Settings and Participants
Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use.Measures
Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution.Results
The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff.Conclusions/Implications
Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up. 相似文献3.
Paolo Dionigi Rossi Sarah Damanti Carolina Nani Mauro Pluderi Giulio Bertani Daniela Mari Matteo Cesari Dario Consonni Diego Spagnoli 《Journal of the American Medical Directors Association》2019,20(3):373-376.e3
Objectives
To evaluate the effects of repeated cerebrospinal fluid (CSF) tap procedures in idiopathic normal pressure hydrocephalus (iNPH) patients ineligible for surgical treatment.Design
Prospective, monocentric, pilot study.Setting
University hospital.Participants
Thirty-nine patients aged 75 years and older, ineligible for shunting surgical intervention.Intervention
Repeated CSF taps.Measurements
All patients underwent a comprehensive geriatric assessment before and after each CSF tap. Adverse events were recorded.Results
No major side effect was reported. Eleven patients showed no response to the first CSF tap test and were excluded. In the remaining 28 patients, all physical and cognitive functions improved after the drainage procedures, except for continence (which seemed poorly influenced). According to clinical judgment, the mean time frame of benefit between CSF taps was 7 months. Patients withdrawing from the protocol during the clinical follow-up showed a worsening of functional and cognitive performances after the interruption.Conclusions/Implications
Periodic CSF therapeutic taps are safe, allow a better control of iNPH symptoms, and prevent functional decline in geriatric patients. 相似文献4.
Anne C. Wheeler Amanda Wylie Adrienne Villagomez Ellen Bishop Melissa Raspa 《Disability and health journal》2019,12(2):269-277
Background
Previous research suggests that individuals with intellectual or developmental disabilities (IDD) may experience challenges accessing quality health care.Objective/Hypothesis
This study explored parent perceptions of access and quality of health care services for children with fragile X syndrome (FXS), the leading hereditary cause of intellectual/developmental disabilities.Methods
Nearly 600 primary caregivers of at least one child with FXS completed an online survey on access, barriers, and quality of health care for their family member with FXS (N?=?731).Results
In a convenience sample of well-educated and affluent caregivers, the majority did not report experiencing difficulties with access to services. Caregivers of younger children and those with lower family incomes reported greater challenges with health care access. Nearly 40% of caregivers indicated that their child's PCP was not as knowledgeable about FXS-related needs as they would prefer, indicating a possible knowledge gap on the part of providers.Conclusions
These factors represent potential barriers to quality health care for individuals with FXS, with potential lifelong effects ranging from delayed age of diagnosis to difficulty accessing a PCP in adulthood. 相似文献5.
Shubing Cai Susan C. Miller Ira B. Wilson 《Journal of the American Medical Directors Association》2019,20(4):497-502
Objective(s)
To examine the change in physical functional status among persons living with HIV (PLWH) in nursing homes (NHs) and how change varies with age and dementia.Design
Retrospective cohort study.Setting
NHs in 14 states in the United States.Participants
PLWH who were admitted to NHs between 2001 and 2010 and had stays of ≥90 days (N = 3550).Measurements
We linked Medicaid Analytic eXtract (MAX) and Minimum Data Set (MDS) data for NH residents in the sampled states and years and used them to determine HIV infection. The main outcome was improvement in physical functional status, defined as a decrease of at least 4 points in the activities of daily living (ADL) score within 90 days of NH admission. Independent variables of interest were age and dementia (Alzheimer's disease or other dementia). Multivariate logistic regression was used, adjusting for individual-level covariates.Results
The average age on NH admission of PLWH was 58. Dementia prevalence ranged from 14.5% in the youngest age group (age <40 years) to 38.9% in the oldest group (age ≥70 years). Overall, 44% of the PLWH experienced ADL improvement in NHs. Controlling for covariates, dementia was related to a significantly lower likelihood of ADL improvement among PLWH in the oldest age group only: the adjusted probability of improvement was 40.6% among those without dementia and 29.3% among those with dementia (P < .01).Conclusions/relevance
PLWH, especially younger persons, may be able to improve their ADL function after being admitted into NHs. However, with older age, PLWH with dementia are more physically dependent and vulnerable to deterioration of physical functioning in NHs. More and/or specialized care may be needed to maintain physical functioning among this population. Findings from this study provide NHs with information on care needs of PLWH and inform future research on developing interventions to improve care for PLWH in NHs. 相似文献6.
Stephanie A. Grilo Marina Catallozzi John S. Santelli Hanying Yan Xiaoyu Song Jennifer Heitel Kristen Kaseeska Julie Gorzkowski Alexandra E. Dereix Jonathan D. Klein 《The Journal of adolescent health》2019,64(3):311-318
Purpose
The objective of the study was to define factors associated with adolescent and young adult (AYA) experiences with private time and having discussed confidentiality and the impact of these experiences on improving delivery of clinical preventive services.Methods
In 2016, a nationally representative sample of 1,918 US AYAs (13- to 26-year-olds) was surveyed. Survey questionnaire domains were based on prior research and Fishers' information-motivation-behavior skills conceptual model. Data were weighted to represent US households with AYA and analyzed to identify factors independently associated with ever experiencing private time and discussions of confidentiality with a regular health-care provider (HCP). We examined the association of these experiences on AYA attitudes about health care.Results
Fifty-five percent of female and 49% of male AYA reported ever having had private time with an HCP and 55% of female and 44% of male AYA had spoken to an HCP about confidentiality. Independent predictors of having experienced private time and confidentiality included older age, race, higher household income, gender of the provider, amount of years with the provider, and involvement in risk behaviors. AYA who had experienced private time and confidentiality discussions had more positive attitudes about their providers, were more willing and comfortable discussing sensitive topics, and thought that these discussions should happen at younger ages.Conclusions
Although confidentiality and private time are important to AYA, many are not experiencing these components of care. Providing private time and discussions of confidentiality can improve the delivery of health care for young people by enhancing positive youth attitudes about preventive care. 相似文献7.
Teresa Botigué Olga Masot Jèssica Miranda Carmen Nuin Maria Viladrosa Ana Lavedán Sandra Zwakhalen 《Journal of the American Medical Directors Association》2019,20(3):317-322
Objective
The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors.Design
This was a cross-sectional study.Setting and Participants
The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years.Measures
Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected.Results
Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio.Conclusions/Implications
The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes. 相似文献8.
9.
John A. Bourke Joanne L. Nunnerley Martin Sullivan Sarah Derrett 《Disability and health journal》2019,12(2):257-262
Background
Spinal Cord Injury (SCI) can have substantial consequences for the injured person, and also their family/whānau (Māori word for extended family and social networks). Family members can adopt either formal or informal care roles when the person returns home, and people with high-level care requirements may also need non-family support workers.Objective
This study considers how SCI can impact relationships during the transition from spinal rehabilitation units to home.Method
Nineteen SCI participants from the New Zealand longitudinal study were interviewed six months post-discharge from either of New Zealand's two spinal units. Data were analysed using the framework method.Results
Three themes captured participants' relationship experiences during the time of transition: Role Disruption, examines how participants' pre-SCI family/whānau relationships underwent change as previously understood parameters of engagement were disrupted. A Balancing Act, explores the challenge of renegotiating previously-understood parameters between participants and whānau. The Stranger in My/Our Room focuses on how the relationship between participants and support workers was (necessarily) new to the participant and their family/whānau who now had an ‘outsider’ episodically or continuously in their home. The specifics of ‘their’ relationship was also new to the support worker; and negotiating the parameters of this relationship could only occur on transition home.Conclusion
SCI necessitates a renegotiation of relationships and, for some, also involves the negotiation of a new type of relationship with support workers. Understanding the ways a SCI may affect relationships can enable rehabilitation services to best support people with SCI and their family to prepare for their transition home. 相似文献10.
Julia Jackson Toni L. Williams Brittany M. McEachern Amy E. Latimer-Cheung Jennifer R. Tomasone 《Disability and health journal》2019,12(2):296-301
Background
Opportunities to be physically active within one's community need to be available and accessible to individuals with physical disabilities in order to increase participation; however, what constitutes quality participation within these opportunities and how exercise programs can foster quality experiences for this population have yet to be explored.Objectives
(1) To explore the participation experiences of adults with physical disabilities in a community-based exercise program from two perspectives; (2) To establish whether the participants' experiences could be understood through an existing quality participation framework.Methods
Participants were thirteen members and ten providers (i.e., coordinators, trainers, and supervisors) recruited from a community-based exercise program for adults with physical disabilities. Six focus groups (three with program members and three with each distinct group of program providers) were carried out, audio recorded and transcribed. Following an initial inductive thematic analysis, themes were deductively mapped to Martin Ginis and colleagues' (2017) conceptualization of the experiential aspects of participation.Results
Six themes (autonomy, belongingness, challenge, engagement, mastery and meaning) important for experiencing quality participation were identified and were in line with Martin Ginis and colleagues' (2017) framework.Conclusion
Findings support the use of Martin Ginis and colleagues' (2017) conceptualization of quality participation within the context of community-based exercise programs for adults with physical disabilities. Practitioners and researchers can use the findings as a starting point for designing, implementing and evaluating programs with the goal of optimizing quality participation. 相似文献11.
12.
Thierry Bautrant Michel Grino Corinne Peloso Frédéric Schiettecatte Magali Planelles Charles Oliver Caroline Franqui 《Journal of the American Medical Directors Association》2019,20(3):377-381
Objectives
To determine whether environmental rearrangements of the long-term care nursing home can affect disruptive behavioral and psychological symptoms of dementia (BPSD) in residents with dementia.Design
Prospective 6-month study.Setting
The study was conducted before (phase 1) and after (phase 2) environmental rearrangements [skylike ceiling tiles in part of the shared premises, progressive decrease of the illuminance at night together with soothing streaming music, reinforcement of the illuminance during the day, walls painted in light beige, oversized clocks in corridors, and night team clothes color (dark blue) different from that of the day team (sky blue)].Participants
All of the patients (n = 19) of the protected unit were included in the study. They were aged 65 years or older and had an estimated life expectancy above 3 months.Measures
Number and duration of disruptive BPSD were systematically collected and analyzed over 24 hours or during late hours (6:00-12:00 pm) during each 3-month period.Results
There was no significant change in the patients' dependency, risk of fall, cognitive or depression indexes, or treatment between phase 1 and 2. Agitation/aggression and screaming were observed mainly outside the late hours as opposed to wandering episodes that were noticed essentially within the late hours. The number of patients showing wandering was significantly lower over 24 hours during phase 2. The number of agitation/physical aggression, wandering, and screaming and the mean duration of wandering episodes were significantly (P = .039, .002, .025, and .026 respectively) decreased over 24 hours following environmental rearrangements. Similarly, a significant reduction in the number and mean duration of wandering was noticed during the late hours (P = .031 and .007, respectively).Conclusions
Our study demonstrates that BPSD prevalence can be reduced following plain environmental rearrangements aimed at improving spatial and temporal orientation. 相似文献13.
14.
15.
Claudia Schulz Gisela Büchele Martin Rehm Dietrich Rothenbacher Patrick Roigk Kilian Rapp Christian Günster Hans-Helmut König Katrin Reber 《Journal of the American Medical Directors Association》2019,20(4):451-455.e3
Objectives
Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture.Design
Retrospective cohort study.Setting and participants
Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011.Measures
The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome.Results
Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level.Conclusions/Implications
This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures. 相似文献16.
Anupam Chandra Parvez A. Rahman Amelia Sneve Rozalina G. McCoy Bjorg Thorsteinsdottir Rajeev Chaudhry Curtis B. Storlie Dennis H. Murphree Gregory J. Hanson Paul Y. Takahashi 《Journal of the American Medical Directors Association》2019,20(4):444-450.e2
Objectives
Patients discharged to a skilled nursing facility (SNF) for post-acute care have a high risk of hospital readmission. We aimed to develop and validate a risk-prediction model to prospectively quantify the risk of 30-day hospital readmission at the time of discharge to a SNF.Design
Retrospective cohort study.Setting
Ten independent SNFs affiliated with the post-acute care practice of an integrated health care delivery system.Participants
We evaluated 6032 patients who were discharged to SNFs for post-acute care after hospitalization.Measurements
The primary outcome was all-cause 30-day hospital readmission. Patient demographics, medical comorbidity, prior use of health care, and clinical parameters during the index hospitalization were analyzed by using gradient boosting machine multivariable analysis to build a predictive model for 30-day hospital readmission. Area under the receiver operating characteristic curve (AUC) was assessed on out-of-sample observations under 10-fold cross-validation.Results
Among 8616 discharges to SNFs from January 1, 2009, through June 30, 2014, a total of 1568 (18.2%) were readmitted to the hospital within 30 days. The 30-day hospital readmission prediction model had an AUC of 0.69, a 16% improvement over risk assessment using the Charlson Comorbidity Index alone. The final model included length of stay, abnormal laboratory parameters, and need for intensive care during the index hospitalization; comorbid status; and number of emergency department and hospital visits within the preceding 6 months.Conclusions and implications
We developed and validated a risk-prediction model for 30-day hospital readmission in patients discharged to a SNF for post-acute care. This prediction tool can be used to risk stratify the complex population of hospitalized patients who are discharged to SNFs to prioritize interventions and potentially improve the quality, safety, and cost-effectiveness of care. 相似文献17.
Background
This research deals with the way people create discourses around disability, which shape the community's concept of disability.Objective
The purpose of this article is to find out how the community configures "disability", in particular by understanding the ideas, needs and strategies that the community uses towards people with disabilities. Specifically, different roles have been involved, such as professionals, volunteers, family members and citizens. The final aim is intervening on the discourses that can contrast the full personal fulfilment of people with disabilities and social inclusion.Methods
This paper relates to discursive psychology's theoretical references and makes use of the Methodology of Textual Analysis. The tools we used include investigation protocols specially designed to detect text both through manual "pencil and paper" and computerized denominations.Results
The results show that those who are in direct contact with people with disabilities (volunteers and family members) are more exposed to treating them as disabled, making the deficit coincide with the person and also have a more judgemental approach.Conclusions
From the results obtained we can see which practices can be activated to facilitate the network between the various roles in order to implement inclusive interventions and help those more exposed to prejudices. 相似文献18.
Gretchen A. Benson Abbey Sidebottom Joy Hayes Michael D. Miedema Jackie Boucher Marc Vacquier Arthur Sillah Safa Gamam Jeff J. VanWormer 《Journal of the Academy of Nutrition and Dietetics》2019,119(4):585-598
Background
Clinical care for type 2 diabetes has improved but remains suboptimal. Collaborative, team-based models that maximize skills of different disciplines may improve care for individuals with diabetes, but few have been tested using rigorous research designs.Objective
To investigate the efficacy of a registered dietitian nutritionist–led telemedicine program compared with that of a control group in terms of diabetes optimal care goals.Design
A randomized controlled trial in which participants were assigned to a control or intervention group.Participants/setting
One hundred eighteen adults with type 2 diabetes (mean age, 60 years; 45% female) participated in the study between April 2016 and December 2017. Participants were recruited from separate primary care clinics in two rural Minnesota communities.Intervention
For those assigned to the intervention, registered dietitian nutritionists used a treatment protocol to initiate and titrate therapies for blood glucose, hypertension, and lipid levels in addition to providing medical nutrition therapy; telemedicine visits supplemented usual care.Main outcome measures
Primary outcomes included composite and individual diabetes optimal care goals: hemoglobin A1c, blood pressure, not using tobacco, and taking a statin and aspirin (as appropriate). Secondary measures included physical activity, breakfast, fruits and vegetables, whole grains, body mass index, low-density lipoprotein, and medication adherence.Statistical analysis
Mixed-model regression was used to examine outcomes between baseline and 1-year follow-up.Results
A modest but significantly greater improvement in the number of diabetes optimal care measures met at follow-up was found in the intervention group (3.7 vs 3.2 in the control group [P=0.017]). Among individual measures, the intervention group had significantly greater medication use, with 2.5 and 2.2 higher odds (compared with the control group) of taking a statin [95% CI, 1.0 to 6.24]) and aspirin [95% CI, 0.90 to 5.19] as appropriate, respectively.Conclusions
ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) findings suggest that registered dietitian nutritionists following medication treatment protocols can effectively improve care for adults with type 2 diabetes and can serve an instrumental role as part of the health care team in providing evidence-based, patient-centered care. 相似文献19.
20.
Julia Thornton Snider Jesse Sussell Mahlet Gizaw Tebeka Alicia Gonzalez Joshua T. Cohen Peter Neumann 《Value in health》2019,22(3):332-339