Home Care Visits Research Articles

Diabetes management in people living with dementia in Japan: a qualitative exploration.

Dementia and diabetes are highly prevalent among the older society in Japan. People living with dementia (PLWD) often face hurdles in managing diabetes. This study explored the perspectives of healthcare providers in Japan regarding diabetes management in PLWD. We conducted a qualitative study using in-depth interviews as a data collection method. A total of 15 physicians and nurses were interviewed. A qualitative content analysis of the codes was performed to generate the themes. The major themes focused on the management of medications/therapeutic regimen, difficulties of continuing health care, emotional aspects of PLWD for adherence to lifestyle modification, and varying direction and degree of family support for diabetes care. PLWD in Japan face challenges in medication management, food restriction, and lifestyle modification. Policies to engage home visit care workers in medication management, consideration of the emotional aspect of PLWD, and utilisation of social support might help in the proper management of diabetes in PLWD.

914-P: Are Longitudinal Success in Glycemic Control and Long-Term A1C Testing Different by Race Groups?

The purpose of this study is to test whether race is associated with longitudinal success in glycemic control or consecutive years of A1c testing. A retrospective cohort study of 531,995 adults with type 2 diabetes who received care between 20 and 2018 was conducted. The independent variable was race (white, black, Hispanics, and other) . Dependent variables were (1) success rate for glycemic control (A1c <7 [<65 y/o] or <8 [>=65 y/o]) , defined as (number of A1c tests meeting target) / (number of A1c tests) ; and (2) the number of three consecutive years of A1c testing. Confounder variables were age, gender, first year, last year, and health service utilization (yearly rate of outpatient, emergency department, hospitalization and home care visits) . We used generalized linear regression (GLM) to analyze the success rate of glycemic control, and GLM with negative binomial to analyze the number of years of A1c testing. Ten-year level observations (N=531,995) summarized from 3,044,247 year-level electronic medical-record observations showed mean observed years of 5.2, median years of A1c tested of 3.5, and mean fraction of years tested A1c over observed of 69%. Mean success rate of glycemic control was 67% in a 10-year period (IQR of 67%) . The success rate of glycemic control differed by race (P<0.001) : estimates were lower for black (-0.037) , other (-0.066) , and Hispanics (-0.089) compared to white. Controlled for confounders, black had 4% lower success rate of glycemic control than white. The number of three consecutive years of A1c testing differed by race (P<0.001) : estimates were lower for black (-0.100) and other (-0.146) , compared to white. Controlled for covariate plus the success rate for glycemic control, blacks had mean count ratio = 0.9 in the number of 3 consecutive years of A1c testing. Ten-year longitudinal glycemic control was worse among black adults with type 2 diabetes. Greater understanding of the disparities in glycemic control and long-term monitoring of A1c testing is needed. Disclosure H.N.Fu: None. T.Schleyer: None. J.Wolfson: None. T.S.Hannon: Advisory Panel; Eli Lilly and Company. P.Balius: None. M.Weiner: Stock/Shareholder; AbbVie Inc., Accuray, Inc., Allscripts Healthcare Solutions, Amgen Inc., Boston Scientific Corporation, Bristol-Myers Squibb Company, Crispr Therapeutics Ag Com, Express Scripts Hdlg Co, General Electric Co., Globus Med, Inc., IBM, Integer Hldgs Corp Com, Integra Lifesciences Holdings Corp, Johnson & Johnson, Mallinckrodt PLC, Mead Johnson & Company, LLC., Medtronic, Metlife Inc Com, Mylan N.V., Novo Nordisk A/S, Nuvasive, Inc., Orthofix Medical Inc., Perspecta Inc Com, Pfizer Inc., Resmed, Inc., Roche Pharmaceuticals, Seaspine Hldgs, Inc., Senseonics, Stryker Corp., Teva Pharmaceutical Industries Ltd., Varex Imaging Corp., Varian Med Sys, Inc., Walgreens Boots Alliance, Inc. Funding T15LM012502, UL1TR002529, the Lilly Endowment Physician Scientist Initiative

Perceived Value of Pediatric Palliative Care Home Visits by Caregivers and Patients (GP756)

Perceived Value of Pediatric Palliative Care Home Visits by Caregivers and Patients (GP756)

Conflict with Guardians Experienced by Home-visiting Care Helpers

본 연구는 재가급여 방문요양보호사가 경험한 보호자와의 갈등에 대해 심층적으로 살펴보고 이를 바탕으로 재가급여 방문요양보호사와 보호자 간 갈등을 예방 및 중재하기 위한 실천적, 제도적 방안 마련을 목적으로 하였다. 이를 위해 9명의 재가급여 방문요양보호사를 대상으로 심층면접을 진행하고 취합된 자료는 질적 내용분석 방법으로 분석하였다. 그 결과, 갈등의 원인, 갈등에 대한 대처, 갈등 대처의 결과로 3개 상위범주와 10개의 하위범주가 도출되었다. 갈등의 원인 및 양상에는 “상이한 인식”, “모호한 경계로 인한 갈등 양상”의 하위범주가, 갈등에 대한 대처에는 “보호자의 무리한 요구에 대해 거절”, “보호자의 무리한 요구에 대해 수용”, “외부의 도움을 요청” 하위범주가 구성되었다. 갈등 대처의 결과에는 “보호자 행동과 인식의 개선”, “서비스 중단”, “체념과 업무가중”으로 분류되었다. 상기한 결과를 바탕으로 재가급여 방문요양호보사와 보호자 간 갈등을 예방 및 중재하기 위한 실천적, 제도적 제언을 하였다.

PENGALAMAN PENDERITA LUKA DIABETES DENGAN POLA PERAWATAN HOME VISIT DI KLINIK IIN WOUND CARE CIBITUNG, BEKASI

Background : Diabetes Mellitus that is not controlled and handled can be a serious problem. The increase in the number of patients with diabetes mellitus will exacerbate the increased risk of developing diabetic wounds. One of the efforts of diabetic wound patients to optimize their recovery is by using health care services at home visits. Objective: The research was to explore in depth the experiences of diabetic wound patients who received Home Visit care patterns. Methods: This research design uses a qualitative method with a phenomenological study. Data collection was carried out by in-depth interviews on 6 diabetic wound patients who underwent wound care at home visits. Patients were selected by purposive sampling. Results: the study found five themes, namely the reasons for choosing to do treatment at a home visit, experiences while receiving care at a home visit, obstacles experienced during a home visit, efforts to overcome obstacles, and expectations for future home visit care. Suggestion: For further researchers, it is hoped that it can be used as basic data for further research and can take advantage of the categories generated in this research.

Analysis of Implementation Home Visit Home Care Program during the Covid-19 Pandemic in Sinjai District Health Center

Home Visit and Home Care are Jamkesda Plus service programs through health service visits with a health service approach to the community in an effort to improve community health status. The purpose of this study was to analyze the Implementation of the Home Visit Home Care Program during the Covid-19 Pandemic at the Sinjai District Health Center. This study uses descriptive analysis method with a qualitative approach by means of observation, in-depth interviews and literature study to all informants. Purposive sampling research informants. Research variables include communication, resources, attitude/disposition and bureaucratic structure. The results showed that at the Sinjai District Health Center during the Covid-19 pandemic the Home Visit Home Care program in terms of communication with the Sinjai District Health Office remained the same as before the Covid-19 pandemic went well, but communication with the community did not run optimally, especially the implementation of socialization in a comprehensive manner. Comprehensive during the pandemic is not done. Then the resources, officers during the Covid-19 pandemic remain the same as those on duty at the Puskesmas, there are special criteria for officers. Attitudes of officers and patients are committed to carrying out the Home Visit Home Care program. The bureaucratic structure of implementing Home Visit Home Care at the Sinjai District Health Center has been running according to the SOP of Perbup No. 39 of 2018. It was concluded from the aspect of resources, attitudes/dispositions and the bureaucratic structure had gone well, but from the aspect of communication such as the delivery of information as a whole it was not optimal. It is expected that the use of technology such as the existence of a special website and social media to facilitate the delivery of information.

Toe Grip Strength and Its Related Factors among Older Adults Receiving Services from Home-visiting Caregivers

Purpose: This study aimed to measure toe grip strength (TGS) and identify its related factors among older adults receiving services from home-visiting caregivers. It is necessary to investigate TGS to develop fall prevention programs because the chance of falling at home increases among older adults.Methods: Data were gathered from 91 older adults enrolled in six home-visiting care centers located in C city. Six trained social workers at each center visited older adults’ homes and gathered data between March 29 and April 15, 2021.Results: There were significant differences in TGS by gender (t=2.15, p=.035), age (r=-.28, p=.006), education level (F=6.69, p<.001), living arrangement (F=6.13, p=.003), and diabetes mellitus (DM) (t=-2.50, p=.014). Levels of TGS were significantly correlated with self-rated health status (r=.28, p=.08), satisfaction with daily life together (r=.28, p=.007), and number of falls (r=-.22, p=.035). TGS was influenced by being educated(high school and beyond) (β=.28, p=.004), living with a spouse only (β=.26, p=.009), having DM (β=.23, p=.015), and satisfaction with doing daily life together with caregivers (β=.21, p=.030). The regression model explained 25% of study participants’ TGS.Conclusion: TGS among Korean older adults receiving services from home-visiting caregivers was low. At-home fall prevention programs must develop for the older population. Home-visiting caregivers must take key roles to strengthen older adults’ TGS and prevent their falls.

Negotiating ‘the problem’ in GP home visits to people with dementia

People with dementia are often marginalised in health care due to the effects of the condition on short term memory and communication. The problem presentation is a key area of primary care consultations where patients ‘have the floor’, and hence are able to direct the trajectory of the consultation to achieve certain ends. An exploration of how patients with advanced dementia participate in this stage of the consultation can thus demonstrate their participation and subsequent engagement. We used conversation analysis to describe how healthcare professionals (HCPs), people with dementia, and their carers establish the presenting problem in 17 out-of-hours primary care home visit consultations. In all cases, the carer had called the out of hours service on behalf of the patient. Rather than traditional “what can I help you with?” problem solicits, HCPs instead stated their reason-for-visit using information provided by the carer. All the patients showed some misalignment with this presented reason-for-visit, by denying the existence of current symptoms and/or their involvement in the decision to call the doctor. Carers appeared to show respect for the patient's ownership of their experience, only providing input on invitation from doctors or patients. Patient acknowledgement and willingness to engage in examination were needed for progressivity, but agreement with the reason-for-visit was not. In two consultations, the reason-for-visit was not explained to patients, and in both cases this resulted in the person with dementia showing frustration and resistance to examination. People with dementia may resist doctor home visits for many reasons, such as embarrassment for not remembering symptoms, or stoicism in the face of medical ailments. These findings show how the balance of progressivity and intersubjectivity tips towards progressivity in consultations with people with dementia, but this is reversed when the patient is not engaged in the reason-for-visit.

Competency Achievement of Apothecary Students through Community Health Interprofessional Program

Objective: aims to measure the achievement of inter-professional competency of apothecary and medical students after taking IPE in a form of home care visit.
 Methods: Fifty-eight students of pharmacy and seventy-eight medical students are listed in the community health interprofessional program (COHIP) by simulation on prescription service and followed by home visit to patients of public health center. Evaluation is conducted by taking the design of pre-test and post-test quasi-experimental without group control. The research result is measured by using Interprofessional Collaborative Competency Attainment Scale (ICCAS) consists of communication, collaborative, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution, and team functioning. The compiled data are displayed descriptively in which statistical paired sample T-test was conducted.
 Result: 134 respondents involved in this program had finished the pre-test and post-test. The highest mean values of IPE activity of apothecary and medical student are collaborative and conflict management/resolution domain. The overall statistical analysis result of ICCAS domains and items shows significant improvement.
 Conclusion: Home visit program and simulation on prescription service in a frame of community health interprofessional program have effect towards the improvement of inter-professional competency of pharmacy and medical students, which consists of Communication, Collaborative, Roles and Responsibilities, Collaborative Patient/Family-Centered Approach, Conflict Management/Resolution, and Team Functioning.

Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic

Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services. To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada. COVID-19 pandemic as of March 1, 2020. Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels. Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts. In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.

"Because if I don't hold his hand then I might as well not be there": Experiences of Dutch and UK care home visiting during the COVID-19 pandemic.

To explore and compare the experiences of care home visits during the pandemic in the UK and the Netherlands. Qualitative semi-structured interview studies. Family carers of relatives residing in care homes in the UK and the Netherlands were interviewed remotely. Family carers were asked about their experiences of care home visits during the pandemic, and specifically in the Netherlands after care homes had reopened. Transcripts were analyzed in each country separately in the native language using thematic analysis, before discussing findings at multiple analysis meetings. Across 125 interviews, we developed four themes: (1) different types of contact during lockdown; (2) deterioration of resident health and well-being; (3) emotional distress of both visitors and residents; and (4) compliance to guidelines and regulations. Visiting in both the UK and the Netherlands was beneficial, if possible in the UK, yet was characterized by alternative forms of face-to-face visits which was emotionally distressing for many family carers and residents. In the Netherlands, government guidance did enable early care home visitation, while the UK was lacking any guidance leading to care homes implementing restrictions differently. Early and clear guidance, as well as communication, is required in future pandemics, and in this ongoing pandemic, to enable care home visits between residents and loved ones. It is important to take learnings from this global pandemic to reimagine long-term care, highlighting the value of socializing for care home residents.

Supporting going out through long-term home-visit care using the Management Tool for Daily Life Performance:

Supporting going out through long-term home-visit care using the Management Tool for Daily Life Performance:

The impact of the first wave of the COVID‐19 pandemic on health service use by persons with dementia in Ontario, Canada: A population‐based time series analysis

BackgroundLittle has been quantified, at a population‐level, about the magnitude of heath service disruption to persons living with dementia in community settings during the COVID‐19 pandemic. Sustained access to health care services is particularly important for persons with dementia and other neurodegenerative diseases as they are vulnerable to decline.MethodHealth administrative data from Ontario, Canada were used to examine patterns of health service use among all persons with Alzheimer disease and related dementias (dementia) who were alive and living in the community. This cohort was compared to persons with Parkinson’s disease (PD) as well as all older adults (age 65+ years) without neurodegenerative diseases. Rates of all‐cause hospital admissions, emergency department visits, primary care and specialist physician visits and home care visits were analyzed for all individuals alive and eligible for provincial health insurance at the start of each weekly period from March 1, 2020 to September 20, 2020 (pandemic period) and from March 3, 2019 to September 22, 2019 (pre‐pandemic period). Rates of health service use during specific weeks in the pandemic period (i.e., lowest week, last available week) were compared to corresponding weeks in the pre‐pandemic period within each cohort using percent changes.ResultsOn March 1, 2020, 128,696 persons with dementia, 30,099 with PD and 2,460,358 older adults were eligible for provincial health services. Across cohorts and services, dramatic declines in use of health services were observed at the lowest week: hospitalization (‐38.7% dementia, ‐72.3% PD, ‐44.2% older adults); emergency department (‐54.9% dementia, ‐57.7% PD, ‐53.6% older adults); home care (‐14.8% dementia, ‐19.4% PD, ‐7.4% older adults). Health services varied in how quickly they rebounded to pre‐pandemic levels within cohorts; notably, by the end of the study period, emergency department visits had increased to a level higher than corresponding 2019 weekly rates (24.2% dementia, 15.2% PD, 7.4% older adults).ConclusionsThe first wave of the COVID‐19 pandemic meaningfully and immediately disrupted use of health care services for persons living with dementia and PD and may have resulted in long‐term consequences that should be monitored.

Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces' Administrative Health Care Data Evaluating Changes over Time.

This retrospective cohort study of cancer decedents during 2004–2015 examined end-of-life cancer care quality indicators (QIs) in the provinces of British Columbia (BC), Ontario, and Nova Scotia (NS). These included: emergency department use, in-patient hospitalization, intensive care unit admissions, physician house calls, home care visits, and death experienced in hospital. Ontario saw the greatest 12-year decrease in in-hospital deaths from 52.8% to 41.1%. Hospitalization rates within 30 days of death decreased in Ontario, increased in NS, and remained the same in BC. Ontario’s usage of aggressive end-of-life measures changed very little, while BC increased their utilization rates. Supportive care use increased in both NS and Ontario. Those who were male or living in a lower income/smaller community (in Ontario) were associated with a decreased likelihood of receiving supportive care. Despite the shift in focus to providing hospice and home care services, approximately 50% of oncology patients are still dying in hospital and 11.7% of patients overall are subject to aggressive care measures that may be out of line with their desire for comfort care. Supportive care use is increasing, but providers must ensure that Canadians are connected to palliative services, as its utilization improves a wide variety of outcomes.

Access to post-acute care services reduces emergency department utilisation among individuals insured by Medicaid: An observational study.

We examined whether access to post-acute care services differed between individuals insured by Medicaid and commercial insurers and whether those differences explained emergency department utilisation 30days post-hospitalisation. Timely follow-up to community-based providers is a strategy to improve post-hospitalisation outcomes. However, little is known regarding the influence of post-acute care services on the likelihood of emergency department use post-hospitalisation for individuals insured by Medicaid. We conducted a retrospective observational study of electronic health record data from an academic medical centre in a large northeastern urban setting. The STROBE checklist was used in reporting this observational study. Our analysis included adults insured by Medicaid or commercial insurers who were discharged from medical services between 1 August-31 October 2017 (n=785). Logistic regression models were used to examine the effects of post-acute care services (primary care, home health, specialty care) on the odds of an emergency department visit. Post-hospitalisation, 12% (n=59) of individuals insured by Medicaid experienced an emergency department visit compared to 4.2% (n=13) of individuals commercially insured. Having Medicaid insurance was associated with higher odds of emergency department visits post-hospitalisation (OR=3.24). Having a home care visit or specialty care visit within 30days post-discharge were significant predictors of lower odds of emergency department visits. Specific to specialty care visits, Medicaid was no longer a significant predictor of emergency department visits with specialty care being more influential (OR=0.01). Improving connections to appropriate post-acute care services, specifically specialty care, may improve outcomes among individuals insured by Medicaid. Hospital-based nurses, including those in direct care, case management and discharge planning, play an important role in facilitating referrals and scheduling appointments prior to discharge. Individuals insured by Medicaid may require additional support in accessing these services and nurses are well-positioned to facilitate care continuity.

Negative Pressure Wound Therapy After Abdominal Body Contouring: A Comparative Matched Analysis of Outcomes and Cost.

Background: Studies that have previously validated the use of incisional negative pressure wound therapy (iNPWT) after body contouring procedures (BCP) have provided limited data regarding associated health care utilization and cost. We matched 2 cohorts of patients after BCP with and without iNPWT and compared utilization of health care resources and post-operative clinical outcomes. Methods: Adult patients who underwent abdominoplasty and/or panniculectomy between 2015 and 2020 by a single surgeon were identified. Patients were propensity score matched by body mass index (BMI), gender, smoking history, diabetes mellitus, hypertension, and incision type. Primary outcomes included time to final drain removal, outpatient visits, homecare visits, emergency department visits, and cost. Secondary outcomes included surgical site occurrences (SSO), surgical site infections, reoperations, and revisions. Results: One hundred sixty-six patients were eligible, and 40 were matched (20 with iNPWT and 20 without iNPWT) with a median age of 47 years and BMI of 32 kg/m2. There were no differences in demographics or intraoperative details (all P > .05). No significant differences were found between the cohorts in terms of health care utilization measures or clinical outcomes (all P > .05). Direct cost was significantly greater in the iNPWT cohort (P = .0498). Inpatient length of stay and procedure time were independently associated with increased cost on multivariate analysis (all P < .0001). Conclusion: Consensus guidelines recommend the use of iNPWT in high-risk patients, including abdominal BCP. Our results show that iNPWT is associated with equivalent health care utilization and clinical outcomes, with increased cost. Additional randomized controlled trials are needed to further elucidate the cost utility of this technique in this patient population.

Resource use and costs in patients with relapsed/refractory diffuse large C-cell lymphoma who initiated a third-line therapy in the post CAR-T era: A longitudinal outlook.

e19560 Background: The study described longitudinal costs and healthcare resource utilization (HRU) associated with third-line (3L) treatments in patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) post chimeric antigen receptor T-cell (CAR-T) approval. Methods: Adult patients newly diagnosed with DLBCL (ICD-10: C83.3) from 10/01/2015 to 03/31/2020 and receiving 3L after CAR-T approval (10/18/2017) were identified from IQVIA PharMetrics Plus. Monthly HRU and total costs were evaluated during month 1, months 2-6, and months 7-12 following 3L initiation for three treatment groups: CAR-T, stem cell transplantation (SCT), and non-cell therapy including chemoimmunotherapy and the targeted therapies that are recommended by the NCCN guidelines (including brentuximab vedotin, ibrutinib, venetoclax, lenalidomide, polatuzumab, obinutuzumab, nivolumab and pembrolizumab). Results: The study identified 145 R/R DLBCL patients initiating 3L with a mean age of 56.7 years and 66.2% male; 135 patients with ≥1 month of follow-up (median 6.7 months) were included: 24 CAR-T, 15 SCT, 96 non-cell therapy. At each time period, CAR-T had the highest median monthly costs, followed by SCT; both had higher median costs than non-cell therapy. The median monthly costs for CAR-T and SCT were $205,034 and $160,423 in month 1, and reduced to $14,333 and $11,840 in months 2-6, then increased to $27,090 and $17,695 in months 7-12, respectively. The monthly median cost for non-cell therapy was $36,015, $11,878, and $4,806 in month 1, months 2-6 and 7-12, respectively. Inpatient (IP) visits and IP days were higher in month 1 than later months for CAR-T and SCT. In addition, outpatient (OP) and emergency room (ER) visits were more frequent for CAR-T than SCT except for ER visits in month 1 (Table). Conclusions: In R/R DLBCL patients receiving 3L, CAR-T had the highest median monthly costs during month 1, months 2-6 and 7-12. In addition, CAR-T has more frequent OP and ER visits compared with SCT in general.[Table: see text] The maximum observed follow-up time for SCT was 8 months. Other visits were mainly home care visits.

Management of Comprehensive Care of multiple-birth infants from fetal to infancy period: challenges, training, strategies

BackgroundPrematurity escalates the crisis of the infants a susceptible group of the society. Multiple delivery further intensifies the susceptibility of both family and health system. A comprehensive care is, thus, necessary to ensure the optimal growth and development of such multiple-births. Accompanied by trainings, challenges, and strategies, the present study was conducted based on a two-year report of comprehensive care management experience on two sets of multiple infants.MethodsA qualitative case study approach was used to survey these two sets of premature infants (quadruplet and quintuplet) and their families. The data were collected through medical files, interviews, questionnaire, field presence, phone call and WhatsApp application, and continued follow-ups. Content analysis was performed based on survey and interventions during a period of two years in Isfahan, Iran (2018–2020).ResultsCase presentation and comprehensive care management are the main areas resulted from this study. The results of the study were categorized in eight challenging areas (categories) and strategies including sterility and infertility period, transition from the intrauterine to neonatal intensive care unit (NICU), discharge process, physical and developmental status, home visit and home care, development of care plan, socio-economic support, and coronavirus nightmare.ConclusionBased on challenges and strategies during these two years, the situation of the multiple-birth infants and their families’ needs should be identified as the first prerequisites in an inter-professional approach and in collaboration with the health providers. Isfahan University of Medical Sciences, Welfare Organization, and the charities were the parties involved with this process in our study. It was also found that developing a separate specific package of comprehensive care management plan for multiple-births is a necessity.

Swiss family physicians and home visits: a 10-year retrospective analysis and typology based on billing data

In the context of an aging population, homecare visits by family physicians may contribute to maintaining older patients at home; however, home visits by family physicians have decreased in number in the last decade with the emergence of homecare-oriented healthcare services. We aimed to describe the diversity of activities and evolution over time of home visits by Swiss family physicians. This was a retrospective observational descriptive study. We used billing data collected by the cantonal trust centre for home visits made by family physicians of the canton of Vaud, Switzerland from 2006 to 2015. We separated billed items into specific categories, including the Tarmed catalogue (Swiss pricing system for medical services), laboratory catalogue, medications, medical material and vaccines. We compared billing patterns between emergency and routine visits. We used discrete mixture models to identify cluster classes of visits, and compare their characteristics. From 2006 to 2015, Vaud family physicians made 451,634 home visits for which they billed a median of 5 items per visit (range 2&ndash;95). Most home visits (65%, 293,713) were routine visits consisting of consultation time without additional investigation. We identified four cluster classes of visits comprising routine visits, routine visits with laboratory tests, emergency visits during the day and emergency visits during the night. Routine visits were the main cluster class while emergency home visits were rare. Family physician home visits are mainly routine visits without additional investigation. Thus, we wonder if a part of this activity could be delegated to other healthcare professionals.

Mediastinitis Secondary to Peripherally Inserted Central Catheter Migration and Perforation after Minor Trauma: A Case Report.

IntroductionThe use of peripherally inserted central catheters (PICC) has been integral to the advancement of medical care in both in-patient and out-patient arenas.1 However, our knowledge of PICC line complications remains incomplete, particularly in regard to venous perforation and extraluminal migration. Utilization of displaced catheters harbors lethal complications and is an infrequently reported phenomenon, with traumatic etiologies only referenced as possible mechanisms; however, to date no formal cases have been reported.5,6Case ReportWe report a case of a fall associated with extraluminal PICC migration and perforation causing mediastinitis and severe sepsis after total parenteral nutrition (TPN) infusion in a 54-year-old woman. Our patient required a right-sided PICC for long-term home TPN due to severe malnutrition following gastric bypass surgery. During a routine home care visit our patient was found tachypneic, hypoxic, and short of breath. Computed topography imaging in the emergency department (ED) identified the injury, likely related to the recent fall. The patient experienced a complicated hospital course after removal of the PICC. Although rare, PICC line migrations and perforations cause serious complications that should be considered by emergency physicians evaluating patients with chronic indwelling vascular access.ConclusionGiven the efficacy and widespread use of PICC lines, we present this case as a rarely reported but life-threatening complication that requires particular attention. Emergency physicians should be aware of such PICC line complications when encountering patients with chronic indwelling vascular access.