Burden Of Care For Patients Research Articles

A cross-sectional study to correlate oral hygiene habit among orthodontic patients with their clinical findings and periodontal treatment need

BackgroundOrthodontic treatment requires good oral hygiene for successful completion of treatment. As protocol, patients are usually given instructions for oral hygiene and diet at the start of treatment, however, they are not fully followed. Different methods are employed in order to increase patient compliance including digital means, however, these are not possible in teaching hospitals with high burden of patient care and limited resources. The present study aims to correlate the patient reported behavior with their clinical findings and treatment need. This will enable us to identify potential sources of motivation which will be incorporated in daily practice and enable us to improve methods to enhance patient’s behavior.MethodA cross-sectional study was conducted in the orthodontic department of a semi-government teaching hospital from August to October 2023 using a modified questionnaire. The clinical examination was done using a Community Periodontal Index for Treatment Need-C (CPITN-C) probe. The diagnosis of presenting clinical conditions and treatment need was done using Community Periodontal Index for Treatment Need (CPITN) and Gingival Bleeding Index (BI). Data collected was analyzed for frequencies and correlation was done using Spearman Correlation Coefficient. P- value ≤ 0.05 was taken as statistically significant.ResultThe sample size consisted of 110 patients of which 60% were entitled to receive treatment. The predominant age group was 15–20 years (39.1%). Approximately 70% patients were in code 1 for CPITN and GI and in need of oral hygiene instructions. Overall patients’ showed good level of awareness, however, they were not compliant in behavior.ConclusionAlthough patients showed a good level of awareness towards oral hygiene practices, there was a lack of compliance in following them. Patients were more concerned for being affected by dental caries due to poor oral hygiene than its effect on overall treatment outcome.

Healthcare Costs Across Diabetic Kidney Disease Stages: A Veterans Affairs Study

In the United States, diabetic kidney disease (DKD) affects about one-third of individuals with type 2 diabetes, causing significant economic burdens on the health care system and affecting patients' quality of life. The aim of the study was to quantify the burden of care in patients at different stages of DKD and to monitor shifts in healthcare costs throughout these stages. This study used data from the Veterans Affairs National database, focusing on US veterans diagnosed with DKD between January 2016 and March 2022. Aggregated all-cause health care costs per month were summarized using descriptive statistics. We used a generalized linear model to calculate the cost of DKD patent care based on the stages, dialysis phase, and kidney replacement therapy. The cohort of 685,288 patients with DKD was predominantly male (96.51%), White (74.42%), and non-Hispanic (93.54%). The mean (SD) per-patient per-month costs were $1,597 ($3,178), $1,772 ($4,269), $2,857 ($13,072), $3,722 ($12,134), $5,505 ($14,639), and $6,999 ($16,901) for stages 1, 2, 3a, 3b, 4 and 5 respectively. The average monthly expenditure for patients receiving long-term dialysis was $12,299. Costs peaked sharply during the first month of kidney replacement therapy at $38,359 but subsequently decreased to $6,636 after 1 year. The economic implications of DKD are profound, emphasizing the need for efficient early detection and disease management strategies. Preventing patients from progressing to advanced DKD stage will minimize the economic repercussions of DKD and will assist health care systems in optimizing resource allocation.

Plastic Surgery Outreach Clinics Expand Access to Cleft and Craniofacial Care in Mississippi

Abstract Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)–approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis. The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P < 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P < 0.001) and post-pandemic prices ($36.52 vs $23.43, P < 0.001). The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.

Burning Bright or Burning Out: A Cross-sectional Study on Burnout among Postgraduate Residents in an Eastern Indian Teaching Hospital

Introduction: Burnout is a concerning clinical syndrome comprising excessive stress, lack of satisfaction, and a feeling of being overworked. In India, postgraduate residents who shoulder the entire burden of patient care, are prone to suffer from burnout. Only a few Indian studies have been carried out to estimate the prevalence of burnout among postgraduate resident doctors. Our study, the first of its kind from eastern India, aims to address this lacuna. Materials and Methods: This was a single-institution cross-sectional observational study carried out using an online semi-structured form comprising demographic data and the Maslach Burnout Inventory. Appropriate statistical tests were carried out to analyze the data obtained. Results: The study received a response rate of 79.2%. Of the participants, 44.1% were females, 54.9% were males, and 1% identified as other gender. The mean age (standard deviation) of the participants was 28.02 (3.67) years. Overall, 75% of the participants experienced burnout. Younger participants, females, clinical residents, those in a relationship, and 2nd year of residency reported higher emotional exhaustion. Depersonalization was associated with lower age, being in a relationship, metropolitan upbringing, and 2nd year of residency. The lower personal accomplishment was seen in those coming from metropolitan and rural backgrounds. Conclusion: Burnout has serious implications on psychological and physical health of the residents. Interventions for effective management will greatly improve the overall mental health and work performance of the junior doctors.

A quantitative cross-sectional study of the burden of caring for patients with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex-associated epilepsy in Japan

IntroductionLennox-Gastaut syndrome (LGS), Dravet syndrome (DS), and tuberous sclerosis complex (TSC)-associated epilepsy are rare conditions associated with severe childhood-onset epilepsy. Caregivers play a critical role in the patients’ care and may experience significant psychosocial and socioeconomic burden. This cross-sectional study determined the burden of caring for patients with these rare epilepsy conditions in Japan. MethodsA quantitative online survey was used to assess patients’ and caregivers’ characteristics and the caregivers’ emotional state, among others. Several validated questionnaires were used: the Hospital Anxiety and Depression Scale (HADS; 0–21 score) assessed the caregivers’ emotional wellbeing, the Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM; 0–100 score) assessed the health-related quality of life (HRQoL) of the caregivers and their families, and the Work Productivity and Activity Impairment General Health (WPAI:GH; 0–100 % score) questionnaire assessed work productivity. ResultsA total of 36 caregivers responded (median [interquartile range (IQR)] age 43.5 [39.5, 48.3] years; 33/36 [92 %] female; 13/36 [36 %] working part-time and 13/36 [36 %] not working). Participants cared for 7/36 (19 %), 19/36 (53 %), and 10/36 (28 %) patients with LGS, DS, and TSC, respectively (median [IQR] age, 11.0 [6.8, 16.3] years; age at first seizure, 0 [0, 0] years). Patients received a median (IQR) of 4 (3, 5) treatment drug types. Patients experienced median (IQR) 3.0 (0, 21.0) epileptic seizures in the previous week; 28/36 (78 %) had severe intellectual disabilities, and 34/36 (94 %) had developmental delays. Caregivers reported stress (17/36 [47 %]), sleep problems (13/36 [36 %]), and anxiety (12/36 [33 %]). They spent a median (IQR) of 50.0 (17.5, 70.0) hours caregiving in the previous week, with 3.0 (1.0, 11.0) hours of seizure-specific care. Caregivers reported that their lives would be easier with a median (IQR) of 1.5 (0, 5.0) hours fewer per week caring for patients during/following seizures. Median HADS scores were 9.5 (‘suspected anxiety diagnosis’) and 7.5 (‘no depression’) for caregivers, and PedsQL FIM Total median score was 60.1, indicating HRQoL impairment for the caregiver and their family. WPAI:GH scores for paid workers indicated important work impairment. Higher caregiving hours (≥ 21 h vs. < 21 h in the previous week) resulted in higher caregiver burden as indicated by the HADS Total score (p = 0.0062) and PedsQL FIM Total score (p = 0.0007). ConclusionsCaregivers of patients with LGS, DS, or TSC in Japan experience a significant time burden, reduced HRQoL, and high level of work/activity impairment. Caregivers provide round-the-clock care to patients and rely on family and specialized caring services to help manage the increased caregiving time, which tends to be associated with greater emotional burden and HRQoL impact.

Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses.

This study compared nurses' self-competency assessments and their managers' nurse competence assessments. Nurse competence is important for nursing care quality and patient safety. Executive (charge) nurses play a main role in the nurse competency assessment. In this study conducted at a university hospital between January and December 2020, the self-efficacy evaluations of nurses (n=162) working in services other than the emergency department, operating room, and outpatient clinics of the university hospital were compared with the evaluations of nurse executives (charges) on these nurses (n=21). Data were collected using the personal information form and the Nurse Competence Scale. A cross-sectional study design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guideline was used for reporting. Service nurses' self-assessments and nurses treating charge's assessment of clinical nurses evaluated the competence levels as excellent in both groups. The self-competency assessments of the nurses were higher than the charge nurses' competency assessments. In this study, the lower competence assessment of nurses by the charge nurses was may be due to their ability to observe nurses in their teams in general and that they have more experience in evaluation. It is suggested that professional development and competence programs be created to further develop the competencies of nurses. Nurse competency assessments support planning to ensure patient safety. Patient care burden and planning of risky patients according to the nurse competency level will provide safe patient care.

A Retrospective Cohort Study of At-Home Catheter Removal After Urogynecologic Surgery.

In-office postoperative voiding trials (VTs) increase health care burden for patients and physicians. Adoption of an at-home VT option may decrease burden without increasing adverse events postoperatively. The purpose of this study was to compare 30-day postoperative outcomes between participants who performed an at-home autofill VT after catheter self-discontinuation during the Assessing Healthcare Utilization and Feasibility of Transurethral Catheter Self-discontinuation (FLOTUS) study and a "historic" control cohort of patients who presented to the office for backfill-assisted VT on postoperative day (POD) 1. This was a retrospective cohort study of women with postoperative urinary retention after urogynecologic surgery between June 2020 and March 2022. Outcomes from the FLOTUS study were compared with a "historic" control cohort of patients that were identified on chart review from the year before FLOTUS initiation. Demographic, medical history, and procedure-related data were collected. Thirty-day outcome data included office calls/messages, office visits, emergency department visits, complications, and catheterization outcomes. Forty-six participants were included in the FLOTUS cohort and 65 participants in the historic cohort. There was no difference in the POD1 VT pass rate, number of office calls/messages, emergency department visits, or postoperative complications between the 2 cohorts. The FLOTUS patients attended 1 less office visit (1 vs 2 office visits, P <0.001), and this difference persisted on regression analysis (-0.87 office visits; 95% CI, -1.18 to -0.56, P <0.001). Patients who had backfill-assisted VTs on POD1 attended 1 additional office visit compared with those who removed their catheters at home.

Perceptions of burnout among public sector physicians in Sierra Leone: A qualitative study.

In Sierra Leone, physicians face a high risk of burnout due to systemic challenges, with studies suggesting a gap in recognizing and addressing this condition. We explored public-sector physicians' experiences and perceptions of the organizational structures and characteristics needed to help them thrive in a resource-limited practice setting. We conducted in-depth, semi-structured interviews with 24 public sector physicians across Western Area Urban (Freetown), Bo, Kono, and Kambia districts in Sierra Leone. Thematic content analysis was carried out using both deductive and inductive techniques to generate codes and identify key themes. Physicians in Sierra Leone face multifaceted challenges that significantly impact both healthcare delivery and personal well-being. Our findings reveal that overwhelming workload and stringent schedules contribute to burnout, directly compromising patient care quality. The emotional burden of caring for patients with economic constraints in accessing treatment further exacerbates physician stress. Limited resources, such as insufficient medical supplies and personnel, foster a sense of helplessness among clinicians, leading to detachment and cynicism towards their ability to effect change. In the absence of formal institutional support, physicians often rely on peer support to manage burnout. These challenges collectively undermine physicians' ability to provide optimal care, as the emotional and physical toll affects their decision-making and engagement with patients. Within Sierra Leone's resource-constrained healthcare context, systemic reforms are necessary to address the root causes of physician burnout, and to improve patient care. Our findings suggest that implementing formal support structures, including counselling services and mentorship programs, is crucial. Improving working conditions through better resource allocation and infrastructure development is essential. Developing strategies to address the emotional burden of care, including robust training programs, could enhance physician well-being, reduce burnout, and consequently improve the overall quality of patient care in Sierra Leone's public health sector.

UNDERSTANDING AND ADDRESSING BURNOUT AND COMPASSION FATIGUE IN HEALTHCARE PROFESSIONALS

Burnout and compassion fatigue are critical issues affecting healthcare professionals, leading to decreased job satisfaction, reduced quality of care, and signif- icant personal consequences. This presentation delves into the complex dynamics of burnout and compassion fatigue, exploring their causes, symptoms, and impact on healthcare providers across various settings. Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, is a response to prolonged stress and high demands in the workplace. Compassion fatigue, often described as the cost of caring, occurs when healthcare providers experience secondary traumatic stress due to the emotional burden of caring for patients in distress. Together, these conditions can lead to a decline in mental and physical health, increased absenteeism, and higher turnover rates among healthcare professionals. The presentation will provide an overview of the factors contributing to burnout and compassion fatigue, including excessive workloads, lack of support, emotional strain, and the ethical dilemmas often faced in clinical practice. It will also highlight the signs and symptoms of these conditions, emphasizing the importance of early recognition and intervention. Strategies for prevention and management will be a central focus, with a discussion on evidence-based approaches such as mindfulness, resilience training, peer support programs, and organizational changes aimed at creating a more supportive work environment. The role of self-care, work-life balance, and institutional responsibility in mitigating burnout and compassion fatigue will also be examined. By understanding the underlying causes and implementing effective strategies, healthcare organizations can foster a culture of well-being and resilience, ensuring that providers maintain their passion for patient care while safeguarding their own health and well-being. This presentation aims to equip healthcare professionals and administrators with the knowledge and tools needed to address burnout and compassion fatigue, ultimately leading to improved outcomes for both providers and patients.

Medical and social consequences of confusion syndrome that developed in the acute period of ischemic stroke

AIM: To assess the dynamics of cognitive functions in patients in whom the acute period of ischemic stroke was accompanied by the confusion syndrome, in comparison with patients in whom the acute period of stroke was not accompanied by the development of confusion. To assess the impact of clinical features of confusion syndrome on the development of post-stroke cognitive impairment, mortality, and patient care burden.&#x0D; MATERIALS AND METHODS: The study involved 99 patients, 55 of whom developed severe confusion during the acute period of stroke, and 44 patients whose ischemic stroke was not complicated by the development of confusion syndrome. The groups were homogeneous in terms of the main etiological factors: age, degree of pre-stroke cognitive impairment. The study assessed the impact of the development of confusional syndrome on the outcome.&#x0D; RESULTS: Confusion syndrome that develops in the acute period of ischemic stroke significantly increases the risk of developing or worsening existing cognitive impairment, mortality, dependence on care, and the burden on caregivers.&#x0D; CONCLUSION: Being a serious complication, confusion syndrome requires monitoring of qualitative and quantitative indicators of consciousness in the acute period of ischemic stroke, prevention and, if detected, immediate correction of confusion syndrome.

Predictors of Quality of Life Among Omani Family Caregivers of Patients With Traumatic Brain Injury.

This study aimed to explore the quality of life (QoL) of Omani family caregivers (FCs) of patients with traumatic brain injury (TBI). After acute care, the burden of caring for patients with TBI is mainly shouldered by FCs. This cross-sectional study was conducted at Khoula Hospital, Muscat, Oman. Patient data were collected at the time of discharge and 8 weeks post-discharge between April 2019 and December 2021. The SF-12 General Health Survey and Preparedness for Caregiving scale were used to measure the caregivers' QoL and preparedness, respectively. The Disability Rating and TBI Symptom scales were used to measure the patients' disability and symptoms, respectively. A total of 36 FCs and patients with TBI were recruited. Most caregivers were the parent (41.7%) or child (27.8%) of the patient with TBI. Overall, the caregivers had good physical QoL (PQoL) and mental health QoL (MHQoL) but low caregiving preparedness at the time of discharge. At 8 weeks post-discharge, there were significant improvements in caregiving preparedness (P <0.01) and patient disability (P <0.05) but a depreciation in caregivers' MHQoL (P <0.05), with no change in their PQoL. The caregiver's employment status and the severity of the patient's sleep and mood problems were modifiable predictors of the caregivers' PQoL. Caregiver's preparedness, the patient's inability to live independently, and the severity of the patient's mood and behavioural problems were predictors of caregivers' MHQoL. Caring for patients with TBI negatively impacts the QoL of Omani FCs; this correlates with the physical, emotional, and mental health symptoms of the patient.

Prediction models for physical function in COVID-19 survivors

BackgroundThe burden of caring for patients who have survived COVID-19 will be enormous in the coming years, especially with respect to physical function. Physical function has been routinely assessed using the Post-COVID-19 Functional Status (PCFS) scale. AimThis study built prediction models for the PCFS scale using sociodemographic data, clinical findings, lung function, and muscle strength. MethodTwo hundred and one patients with post-COVID-19 syndrome (PCS) completed the PCFS scale to assess physical function. Their levels of general fatigue were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and spirometry. ResultsThe number of participants who scored 0 (none), 1 (negligible), 2 (slight), 3 (moderate), and 4 (severe) on the PCFS scale was 25 (12%), 40 (20%), 39 (19%), 49 (24%), and 48 (24%), respectively. The PCFS scale was significantly correlated with the following variables: FACIT-F score (r = −0.424, P < 0.001), HGS (r = −0.339, P < 0.001), previous hospitalization (r = 0.226, P = 0.001), body mass index (r = 0.163, P = 0.021), and sex (r = −0.153, P = 0.030). The regression model with the highest coefficient of regression (R = 0.559) included the following variables: age, sex, body mass index, FACIT-F, HGS, and previous hospitalization. ConclusionsWorse general fatigue and HGS are associated with more severe physical function impairments in PCS patients. Furthermore, a history of prior hospitalization results in worse physical function. Thus, prediction models for the PCFS scale that incorporate objective measures enable a better assessment of the physical function of these patients, thus helping in the selection of candidates for a program of physical reconditioning.

Out-of-Pocket Expenditures of Myocardial Infarction Patients in Pondicherry, South India

Background: Myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. In India, incidence of MI is rapidly increasing due to lifestyle changes, ageing and rising healthcare costs. The out-of-pocket expenditure (OOPE) for MI care in India can be substantial, as majority of healthcare costs are paid by patients or their families. However, little is known about the actual OOPE incurred by MI patients in tertiary care centres in Pondicherry, South India. This study aims at estimating the OPPE by MI patients attending the tertiary care centre in Pondicherry. The findings can inform policymakers and healthcare providers in developing interventions to reduce the financial burden of MI care in patients and their families.&#x0D; Methods: This was a hospital-based, cross–sectional study conducted on patients attending Cardiology's outpatient department OPD, who had myocardial infarction in the past for about 3 months to 3 years at the time of enrolment in the study. A pre-designed and validated questionnaire was used to collect information regarding socio-demographic details and cost of health expenditures (direct medical and non-medical costs and indirect cost for both the participants and caregivers). Data analysis was done using SPSS24 Software. The median and inter-quartile range was used for assessing the cost of health expenditures.&#x0D; Results: Study participants underwent invasive and non-invasive procedure as part of their management. More than 93% underwent invasive, and the cost ranges from 1,694.03 USD to 2470.00 USD (1,20,000 INR to 1,75,000 INR). They spent 10.58 USD to 21.17 USD (750 INR to 1,500 INR) for their monthly medication. The travel expenses for each follow-up visit were between 5.64 USD to 70.57 USD (400 INR and 5000 INR). The majority of participants received health insurance or reimbursement of 1834 USD (1,30,000 INR) from their firm, 12.7% of the participants lost a payment of 162 USD to 776.28 USD (11,500 INR – 55,000 INR).&#x0D; Conclusion: The cost of the invasive procedure for myocardial infarction patients was 1694.03 USD to 2470.00 USD, which was the major share from the out-of-pocket expenditure compared with the other direct and indirect costs.

Open label single arm study to assess the implementation of home based daratumumab administration in patients being treated for multiple myeloma.

TPS1609 Background: Multiple myeloma (MM) is an incurable hematologic malignancy that has a high burden of care for patients and their caregivers. Over the last two decades, the treatment landscape for MM has changed dramatically. However, treatment burden with frequent visits to offices and the hospital is high. We need innovative care delivery models to alleviate these burdens. Chemotherapy at home remains uncommon in the US, though models for its use exist globally. In these models, home-based chemotherapy is safe, preferred by patients, and can be administered at lower cost. Herein, we propose a home-based subcutaneous daratumumab and hyaluronidase-fihj (dara) program for patients with MM. We hypothesize that this program will be feasible, reduce patient treatment and financial burden, and improve quality of life. Methods: We designed an open label single arm study to assess the implementation of home administration of dara. The primary objective is to evaluate (n=20) treatment satisfaction of patients, using the Cancer Therapy Satisfaction Questionnaire (CTSQ), when they receive care at home as compared to the standard of care (SOC). Secondary outcomes include evaluating adherence to home delivery, quality of life (EORTC QLQ-30), financial burden (COST survey), safety of home administration, and barriers to home administration. At the end of the study, we will conduct semi-structured interviews to assess patient experience with home administration of chemotherapy. Patients will be eligible for study participation if they have a diagnosis of multiple myeloma, are in the monthly phase of dara treatment and are treated with either monotherapy or in combination with oral agents. All participants who are interested and eligible will be on study for 8 cycles of dara (2 cycles of dara in the infusion center (IC) followed by 4 cycles at home and then 2 cycles in the IC). During the home administration phase, 1-3 days prior, patients will go to a local lab or have at home labs. On day of at home dara, the drug will be mixed and packaged by our pharmacy, and then delivered at room temperature to the patient’s home by our home infusion courier. The patient will take pre-medications 1-3 hours prior to nurse arrival. The nurse arrives, confirm pre-medications were taken. Pre-treatment vitals and post treatment vitals will be obtained. Drug will be administered as per label instructions. At the beginning of each cycle, patient reported outcome surveys and quality of life surveys will be collected. During the home administration phase, details on barriers to maintaining adherence (i.e. issues with storage, delivery, disposal of medication) will be collected. The study opened for enrollment on November 8th, 2022. As of February 1stth 2023, 9 patients have consented and 5 patients are on-treatment. Clinical trial information: NCT05511428 .

Current Status of the Pediatric Palliative Care Pilot Project in South Korea Based on the Experience of a Single Center.

We evaluated the status of patients enrolled in South Korea's pediatric palliative care pilot project based on the experience of a single center. This study examined factors related to end-of-life services and differences in medical costs. The medical records of 120 patients referred by a pediatric palliative care team were analyzed retrospectively. Data from July 1 to February 28, 2022 were collected and analyzed using the chi-square test and the Mann-Whitney U test. Volunteer programs and psychological support (100%), family support and education (99.2%), and financial support through institutional linkage (62.5%) were provided to the participants. In the deceased group, there were no significant differences in general characteristics, which included age, gender, primary disease, religion, duration of hospitalization in an intensive care unit (ICU) and non-intensive care unit (non-ICU). However, the ICU group had fewer opportunities to access individual pain and physical symptom management than the non-ICU group and there were limitations in linking with external resources. Medical expenses were significantly different for the ICU group, with a 3-times higher average cost than the non-ICU group. Although an individualized approach is needed for each patient in pediatric palliative care, psychosocial care is essential. In addition, if early intervention for end-of-life pediatric patients is available from a palliative care team, the cost burden of medical care for patients and their families should be minimal.

Skin self-management of community-dwelling patients with spinal cord injury: A cross-sectional study

Backgroundcommunity-acquired pressure injury is one of the most common and troublesome complications of discharged patients with spinal cord injury. Previous studies have shown that pressure injury can not only increase the financial burden and care burden of patients, but also seriously affect their quality of life. AimTo evaluate the skin self-management of community-dwelling patients with spinal cord injury and to explore the related independent influencing factors. MethodsThis was a cross-sectional survey study. A convenience sample of 110 community-dwelling patients with spinal cord injury recruited from three rehabilitation centers in Guangzhou and Chengdu in China completed the survey from September 2020 to June 2021. They were asked about their demographic data, skin self-management, knowledge about skin self-management, attitude to skin self-management, self-efficacy, and functional independence. Univariate analysis and multiple linear regression were performed to isolate the most important relationships. ResultsThe skin self-management of community-dwelling patients with spinal cord injury was relatively low, and they also performed poorly in the three categories of: skin check, preventing pressure ulcer, and preventing wounds. Skin self-management was found to be most often associated with level of knowledge about skin self-management, higher reimbursement and self-efficacy. ConclusionCommunity-dwelling patients with spinal cord injury with lower level of knowledge about skin self-management, with lower self-efficacy, and those with higher reimbursement have worse skin self-management.

Effectiveness of a Supportive Program on Caregiver Burden of Families Caring for Patients on Invasive Mechanical Ventilation at Home: An Experimental Study.

The prevalence of patients on mechanical ventilation who are being supported at home is increasing. Due to these patients' complex and chronic conditions, the subjective burden on their family caregivers increases after discharge. The aim of this study was to evaluate the effectiveness of a supportive home care program on the caregiver burden of families caring for patients on invasive mechanical ventilation at home. Sixty patients hospitalized in three university-affiliated hospitals in Tehran, Iran between 7/2020 and 8/2021 were randomly assigned to one of two groups: A supportive home care program, and routine hospital education. The supportive home care program included six educational sessions delivered in the hospital before discharge, and home visits and continued education after discharge. Caregiver burden was measured using the Zarit Burden Interview. Results showed that caregiver burden increased significantly (p ≥ .001) after discharge without the supportive home care program intervention. Follow-up by nurses after discharge is essential to reduce the psychological burden of caring for patients on invasive mechanical ventilation at home.

Comparison of Caregivers' Burden among Family Members of Patients with Severe Mental Disorders and Patients with Substance Use Disorder.

Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder. Method : First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers. Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers' burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013). Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.

Institutional-specific smartphone application as a supplemental tool for an antimicrobial stewardship program in 2 large community-based hospitals: Acceptance of physicians and pharmacists

PurposeAntimicrobial stewardship programs (ASPs) have been a challenge in less resourceful health care settings. Medical smartphone applications (apps) can be accessible tools to support ASPs under such circumstances. A hospital-specific ASP app was prepared and the acceptance and usability of the study ASP app were evaluated by physicians and pharmacists in 2 community-based academic hospitals. MethodsThe exploratory survey was conducted 5 months following the implementation of the study ASP app. A questionnaire was developed, and the validity and reliability were analyzed using S-CVI/Ave (scale content validity index/Average) and Cronbach’s alpha, respectively. The questionnaire consisted of demographics (3 items), acceptance (9 items), usability (10 items), and barriers (2 items). Descriptive analysis was conducted using a 5-point Likert scale, multiple selections, and free-text responses. ResultsApproximately 38.7% of 75 respondents (response rate, 23.5%) used the app. Most scored 4 or higher, indicating that the study ASP app was easy to install (89.7%), use (79.3%), and apply to clinical settings (69.0%). Frequently used contents were dosing (39.6%), the spectrum of activity (7.1%), and intravenous-to-oral conversion (7.1%). Barriers included limited time (38.2%) and insufficient content (20.6%). Users indicated that the study ASP app helped improve their knowledge on treatment guidelines (72.4%), antibiotic use (62.1%), and adverse reactions (69.0%). ConclusionThe study ASP app was well accepted by physicians and pharmacists and it can be useful to supplement ASPs activities in less resourceful hospitals with a large burden of patient care.

Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea.

The purpose of this study is to identify the factors associated with the burden on primary family caregivers of stroke patients at home without care services. For this study, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data were used. Of the total 8010 caregivers, 1133 family caregiver burden was assessed with the shortened Caregiver Burden Inventory (CBI) 3 months after stroke. Patient and caregiver-related factors affecting the heavier burden of caregivers were identified by comparing the heavier caregiver burden group and the lighter caregiver burden group, which divided according to the CBI scores. The 719 (63.5%) family caregiver cared for patients at home without care services. Logistic regression analysis showed that four or more comorbidities (p = 0.002), neurological impairment at early onset (p < 0.001), dependence on daily life (p < 0.001), aphasia (p = 0.024), and depression(p < 0.001) were associated with a heavier burden of care. According to the shortened CBI, caregivers tended to be concerned more about psychological stress than physical strain. The findings suggest the importance of proactively guiding the emotional support services to caregivers who are at high risk of the heavier burden of patient care.