Hours Of Care Research Articles

SELF-DIRECTED CARE IN HOME-BASED LONG-TERM CARE DURING THE PANDEMIC: POLICY AND PRACTICE IMPLICATIONS

Abstract The COVID-19 pandemic highlighted strengths and challenges of the self-directed care model for home-based long-term care. We discuss policy and practice implications drawing on interviews with over 50 home-and-community-based-services consumers, caregivers, workers, and providers in Kansas. Low-pay, lack of benefits, rising wages in competing sectors, enhanced unemployment and COVID-19 concerns exacerbated workforce shortages that compromised consumer safety and well-being. The lack of budget authority for self-directed consumers in Kansas limited their ability to address these issues. Furthermore, the self-directed model was excluded from emergency funding sources that would have enhanced pay and benefits for workers, including sick pay for quarantine, pointing to the need for targeted funding. Emergency flexibility allowing paid family caregivers addressed care needs for some but is temporary and should be expanded. In the managed care model, MCOs still kept their capitated payment despite significant unfilled care hours, and thus pay-for-performance incentives need to be revisited.

THE INCREMENTAL EFFECTS OF DEMENTIA ON HEALTHCARE USE AND ECONOMIC STATUS IN THE US: A QUASI-EXPERIMENTAL APPROACH

Abstract This research is to assess the impact of dementia on healthcare use and economic status over the course of dementia. We used a nationally representative, longitudinal study of older adults, specifying two propensity-score matched samples: 1) 3,476 adults aged 55+ at baseline who would have dementia in two years (hereafter “dementia group”), and 2) 3,476 adults who had never transitioned to dementia but had similar baseline sociodemographic and health status (hereafter “control group”). In two-year follow-up, the total care hours from unpaid helpers (44 hours per month vs. 20) and other in-home medical care (24% vs. 15%) were substantially higher with vs. without dementia. In the dementia group, the percentage of using nursing homes increased from 4% at the baseline to 27% at 8-year follow-up, compared to the increase from 3% to 10% in the control group. There was little change in OOP costs in the control group but a substantial increase in the dementia group over time (from $4,443 at baseline to $11,806 in an 8-year follow-up). The percent having Medicaid increased from 17% at baseline to 33% in 8-year follow-up in the dementia group. By using a quasi-experimental approach with longitudinal data, the study clarifies the incremental effects of dementia on health care and economic status. The effects of dementia on both home-based and facility-based care are substantial, with major changes occurring at the onset. Dementia exacerbated financial resources with increasing OOP medical costs, which may have profound impacts on families and society.

UNDERSTANDING THE IMPACT OF CARE LITERACY ON PREVENTATIVE CARE: EVIDENCE FROM FAMILY CARERS IN JAPAN

Abstract To address the importance of family carers’ understanding of care, encompassing their own care as well as the broader care and health social systems, this paper leverages the notion of ‘care literacy’. The aim of this study is to understand the variation in care literacy and the impact of care literacy on preventative care. The empirical focus is on working family carers for older relatives in Japan, through a cross-sectional online survey that includes a novel operationalization of care literacy, established measure of health literacy, assessment of information used to understand care, and measures of preventative care. The participants’ (n = 292) mean age was 53, with 44% women, and an average of 8.3 hours per week caring for their parent(s). The measure of care literacy is shown to be correlated, as expected, but distinct to health literacy (correlation 0.60). Based on regression analysis of care literacy, significant explanatory variables are health literacy (p< 0.001), gender (p=0.044), number of sources of information on care (p=0.029), and care hours (p< 0.001). In contrast, proximity in living arrangements of carer and care receiver, and severity of care needs were not significant predictors. Turning to the impact of care literacy, care literacy is a significant explanatory variable for use of preventative measures (p=0.002), in particular related to nutrition (p< 0.001), frailty (p=0.028), dementia (p=0.090) and general home renovations (p=0.018). The pattern of results from this cross-sectional analysis indicates the importance of understanding the potential for improved care literacy as an enabler of better care.

THE ROLE OF FAMILIES IN FACILITATING USE OF HOME-BASED SERVICES

Abstract Homebound older adults rely on home-based clinical services (e.g., home based medical care) and long-term services and supports (e.g., caregiving support, environmental modifications) to remain living at home, however patterns of service use are unknown. Using data from the 2015 National Health and Aging Trends Study linked to Medicare Claims Data, we identified a population of homebound older adults enrolled in fee-for-service Medicare (n=1066). Latent class analysis identified 3 distinct patterns of home-based service use: low (36%), medium (51%), and high (13%) service use. High family caregiving support was particularly prevalent in the medium service group (35% with over 40 hours of family care per week), but receipt of home-based medical care was minimal in this group. Additional support to connect family caregivers with other home-based services may improve care and outcomes for older adults living at home.

THE EFFECT OF COMMUNITY HEALTHCHOICES ON USE OF HOME AND COMMUNITY-BASED SERVICES

Abstract Medicaid claims data for the years 2013 to 2020 were analyzed to examine use of common categories of home and community-based services (HCBS) as well as the proportion of people living in nursing homes as opposed to receiving long-term services and supports in the community. There was a long-term trend prior to Community HealthChoices of a shift the locus of LTSS away from nursing homes. The implementation of managed care to deliver LTSS continued, but did not appear to accelerate this trend. However, MLTSS did appear to control to growth in hours of personal care per person both in the aggregate and longitudinally within the same individuals over time. There were decreases in the use of adult day services and home delivered meals. However, the decline in home delivered meals was more than offset by an increase in uptake of the supplementary nutritional assistance program (SNAP).

REBALANCING LONG-TERM CARE: THE ROLE OF MEDICAID-MANAGED LONG-TERM SERVICES AND SUPPORTS

Abstract From 2018 to 2020, Pennsylvania conducted a phased implementation of a mandatory Medicaid managed long-term services and supports program called Community HealthChoices (CHC). The new program covers people receiving Medicaid financed long-term services and supports (LTSS) in nursing homes and home and community-based settings. The three participating MCOs are incentivized to serve people in the community. This study took advantage of the phased implementation to generate causal estimates of the effect of the new program on both the extensive margin (the proportion of people receiving HCBS vs. nursing homes), and the intensive margin (the type and amount of HCBS services). Medicaid claims data for the years 2013 to 2020 were analyzed to examine pre-program trends and program effects. There was a long-term pre-program trend away from nursing homes. The implementation of managed care did not appear to accelerate this trend, however, analysis of data from 2020 is complicated by the COVID-19 pandemic. However, MLTSS did appear to control to growth in hours of personal care per person both in the aggregate and longitudinally within the same individuals over time. There were decreases in the use of adult day services and home delivered meals. However, the decline in home delivered meals was more than offset by an increase in uptake of the supplementary nutritional assistance program (SNAP). This is the first causal analysis of the effects of managed care on use of long-term services and supports. The findings have implications for other states that are considering implementing similar policies.

INNOVATIVE CARE ENVIRONMENTS FOR PEOPLE WITH DEMENTIA

Abstract As part of the ongoing culture movement within long-term care several innovative care concepts for people with dementia are developing. These concepts radically change their physical, social and/or organizational environment in order to align care services with needs and demands of people with dementia, and providing meaningful activities. The current symposium will discuss the effects and possible working mechanisms of innovative caring environments for people with dementia across three European countries and the US. The symposium will start with a presentation describing the Homestead care model in the Netherlands, which is a care model that was developed following a co-creation study focused on translating scientific knowledge on nursing home care environments into practice. This is followed by three presentations about the effects of three types of innovative care environments for people with dementia: (1) farm based day care in Norway, (2) shared housing arrangements in Germany, (3) green care farms providing 24-hour nursing care in the Netherlands. The three studies on the effects of innovative care environments present a variety of designs (case study, cluster randomized controlled multi-center intervention study, and a qualitative study with semi-structured interviews) to study the effects on various outcomes (activities, physical effort, social interaction, mood, the number of hospital admissions for people with dementia, quality of life, challenging behavior, risk of falls, stabilization of cognitive abilities, daily life). The symposium will conclude with a reflection on these innovative care concepts from a US perspective.

NOWHERE ELSE TO GO: EFFECTIVENESS OF THE PASRR PROGRAM TO MEET THE NEEDS OF RESIDENTS WITH SMI ADMITTED TO NURSING HOMES

Abstract The number of adults with serious mental illness (SMI) who receive care in nursing homes (NHs) continues to rise. The Preadmission Screening and Resident Review (PASRR) program requires screening for SMI prior to NH placement, in order to avoid inappropriate admission and unnecessary institutional care. We interviewed staff responsible for the processing of PASRR documentation at four NHs in Minnesota (n=15), and obtained and analyzed all completed PASRR-II assessments in Minnesota from 2019 (N=532). PASRR assessments overwhelmingly recommended 24-hour NH care (94.7%) with 94% of assessments indicating a need for mental health services while at the NH. Most NH staff interviewed noted that PASRR is not used in the care planning process and described PASRR as a regulatory hoop. Staff shared that PASRR assessments could provide insight into an individual’s mental health history, current and future needs, and can be helpful in assessing NH capacity to provide such services. Although mental health services provided while at the NH are supposed to be facilitated in partnership with the county, there is a lack of follow-up and NH staff are largely left to deal with SMI in isolation. PASRR assessments are supposed to be a tool for care coordination, but leave the NH as the sole responsible point of contact for residents with SMI. A more integrated PASRR program that better focuses on incorporating PASRR into care planning and mental health service delivery in NHs and the broader community is necessary to improve the lives of individuals with SMI.

1998. Association of Infection Recurrence with Oral Step-Down vs Continued Intravenous Antimicrobial Therapy in Patients with Complicated Intra-Abdominal Infection

Abstract Background Complicated intra-abdominal infections (cIAIs) require a combined strategy of source control and antimicrobial therapy. Guidelines recommend initial intravenous (IV) therapy with oral step-down therapy following source control. Due to limited data supporting this strategy, we aimed to evaluate the safety and efficacy of oral step-down antimicrobial therapy in cIAIs after initial IV antimicrobial therapy. Methods This retrospective cohort study included hospitalized patients ≥ 18 years of age diagnosed with a cIAI who received > 7 days of IV therapy during index hospitalization at quaternary hospital from March 2017 to October 2021. Patients were excluded for primary or peritoneal dialysis-related peritonitis, necrotizing pancreatitis, fistulizing inflammatory bowel disease, or upper gastrointestinal tract infection; repeat hospitalization during study period; or transfer from another facility after > 24 hours of care. Patients were assigned into two treatment groups: IV-only or oral step-down therapy. The primary outcome was infection recurrence defined as re-initiation of antimicrobials after a treatment-free period of ≥ 3 days. Secondary outcomes included treatment escalation, repeat source control procedure, treatment-related complications, and all-cause mortality. Results The cohort consisted of 248 patients (199 IV-only and 49 oral step-down). Baseline, infection, and treatment characteristics were similar between groups, except for gender, length of stay, and overall treatment duration (Table 1). Patients receiving IV-only therapy had a shorter median antimicrobial duration than the oral step-down group (13 vs. 23 days; P < 0.001). Infection recurrence occurred in 26 (13.1%) and six (12.2%) patients in the IV-only and oral step-down groups, respectively (P = 0.88). Treatment escalation, repeat source control, and 28-day mortality were similar between groups (Table 1). Oral step-down therapy resulted in more adverse drug events (10.2% vs. 3.0%; P = 0.04). Table 1: Baseline and infection-related characteristics for IV only and oral step-down therapy groups aDefined as: solid organ transplant, hematopoietic stem cell transplant within the last 1 year, long-term high-dose steroids (prednisone >10 mg, or equivalent, for ≥2 weeks), concomitant immunosuppressive medication, or HIV (CD4 count <200 cells/µL) bOther antimicrobials included cephalexin, cefpodoxime, doxycycline, fluconazole, and sulfamethoxazole-trimethoprim cAdverse drug events included dermatologic reactions, gastrointestinal upset, nausea/vomiting, diarrhea, fatigue, thrombocytopenia, and acute kidney injury Conclusion Transition to oral step-down after initial IV antimicrobial therapy may be an alternative strategy for the management of cIAIs; however, larger non-inferiority studies are warranted to confirm the safety and efficacy of this approach. Disclosures James Sanders, PhD, PharmD, Merck & Co., Inc.: Grant/Research Support|Shionogi Inc.: Grant/Research Support Sara Hennessy, M.D., Boston Scientific: Advisor/Consultant Sara Hennessy, M.D., Boston Scientific: Advisor/Consultant.

1149: IMPACT OF AN INTENSIVIST TEAM IN AN URBAN EMERGENCY DEPARTMENT

Introduction: A seminal 2007 study found that critically-ill patients with a greater than six hour Emergency Department (ED) length of stay had a significant increase in intensive care unit (ICU) mortality (10.7% vs. 2.4%). Furthermore, U.S. ED’s have provide a 217% increase in critical care hours provided in U.S. ED’s. These two factors have likely been exacerbated by worsening ED boarding. To address the imminent need for critical care in the ED, we deployed an emergency medicine-intensivist team as a resource during the highest patient volume time at our tertiary care academic ED. Methods: We performed a retrospective analysis of patient management by the resource intensivist team (RIT) from September 2020 to October 2021. We compared patient characteristics managed by the RIT to those managed by the rest of the ED at that time as well as historical norms. The primary outcome was patients per hour seen by the emergency medicine physicians during the RIT deployment hours; secondary outcomes included length of stay (ED, ICU, and hospital), time to first antibiotic, time to first vasopressor, procedures per patient (PPP) and disposition level of care. Results: Over the study period, 88 patients were managed by the RIT and 2480 were managed by the emergency medicine physicians on-shift. While statistically significant, there was only a minimal difference in patients per hour (PPH) between the two groups (1.27 PPH vs 1.38 PPH). There was a significantly faster time to first antibiotic (2.41 hours vs 4.96 hours) with a trend towards faster time for first vasopressors (4.08hrs vs 5.79hrs, p=0.338). Additionally, 24.7% of patient initially triaged to critical care were transitioned to a lower level of care by the RIT without a change in their ED length of stay (10.60hrs vs 10.88hrs p = 0.703). Finally, significantly more procedures were performed on patients managed by the RIT (0.47 PPP vs 0.05 PPP). Conclusions: The addition of a resource intensivist model to our academic tertiary care ED significantly decreased the time to antimicrobial administration and allowed RIT residents to perform more procedures, and transitioned patients to lower levels of care without adversely affecting ED length of stay. Additional work is required to identify areas where a RIT can improve the care of patients in the ED.

822: COMPARISON OF CHEMOPROPHYLACTIC AGENT SELECTION ON VENOUS THROMBOEMBOLISM IN LARGE BURN PATIENTS

Introduction: Burn patient venous thromboembolism (VTE) rates can range from 0.2 to 43%, with chemical thromboprophylaxis shown to independently decrease mortality. There is a paucity of data on effectiveness, safety, and appropriateness of agent selection for patients with large burns. Methods: This retrospective cohort study included adult patients (age ≥18) with large burns (total body surface area, TBSA ≥15%) who were admitted to a Regional Burn Center. Patients were excluded if they had therapeutic anticoagulation resumed within 24 hours of admission, VTE chemoprophylaxis agent switched within the first 48 hours, VTE chemoprophylaxis delayed ≥48 hours of admission, death or comfort care within 48 hours of admission. The primary outcome compared VTE rates between patients receiving chemoprophylaxis with subcutaneous heparin versus enoxaparin. Patient groups were categorized by the first chemoprophylaxis agent administered for 48 hours. Secondary outcomes identified rate of switching chemoprophylactic agents and incidence of therapeutic anticoagulation orders. Safety outcomes compared heparin-induced thrombocytopenia, in-hospital mortality, and number of transfusions. Results: A total of 50 patients (enoxaparin, n=35; heparin, n=15) were included. There were no differences in baseline characteristics. VTE incidence was not statistically significantly different between enoxaparin and heparin (1 [2.9%] vs 2 [13.3%], p=0.21). Subgroup analysis of TBSA 15% to 30% and TBSA >30% found no difference in rates of VTE between enoxaparin and heparin. No difference was found between enoxaparin and heparin for rates of switching chemoprophylactic agent (10 [28.6%] vs 3 [20%], p=0.73), for full dose anticoagulation orders (3 [8.6%] vs 3 [20%], p=0.35), or HIT positive tests (1 [14.3%] vs 2 [22.2%], p=1.0). Compared to the enoxaparin group, patients receiving heparin had higher in-hospital mortality (6 [17.1%] vs 7 [46.7%], p< 0.05). There was no difference in transfusions between groups. Conclusions: VTE rates were similar in adult patients with large burns regardless of chemoprophylactic agent selection. Larger studies are necessary to confirm the impact of chemoprophylaxis choice and timing of initiation on VTE incidence.

End-of-life care for people with dementia on a green care farm during the COVID-19 pandemic: a qualitative study

ObjectiveGreen care farms combine agriculture production with health-related, social and educational services. In the Netherlands, they form an alternative to traditional nursing homes for people with dementia. Green care farms that offer 24-hour care, also offers end-of-life care. To date, little is known about end-of-life care for people with dementia on green care farms. This study aimed to explore the experiences of healthcare workers and family caregivers with end-of-life care for people with dementia who died on a green care farm.DesignAn explorative, descriptive qualitative design with a phenomenological approach.Setting and participantsA purposive sample of 15 participants – seven healthcare workers and eight family caregivers - from three green care farms in the Netherlands.MethodsSemi-structured, in-depth interviews were conducted to explore participants’ experiences with end-of-life care, including topics such as advance care planning, the influence of COVID-19, and bereavement support. Transcripts were thematically analysed using Braun and Clarke’s approach.ResultsFour main themes were extracted: 1) tailored care and attention for the individual resident, 2) reciprocal care relationships between healthcare workers and family caregivers, 3) compassionate care and support in the dying phase, and 4) the influence of COVID-19 on end-of-life care.Conclusion and implicationsThe overall experience of the healthcare workers and family caregivers was that end-of-life care offered on green care farms is person-centred and compassionate and is tailored to the person with dementia and their family caregivers. Despite the COVID-19 pandemic, healthcare workers and family caregivers were satisfied with end-of-life care on the green care farms. Green care farms may offer a valuable alternative care setting for people with dementia in their last phase of life. More research is needed to investigate green care farms’benefits compared to other, more traditional settings.

Sleep Disturbance, Psychological Distress and Perceived Burden in Female Family Caregivers of Dependent Patients with Dementia: A Case-Control Study.

This case-control study analyzed the sleep disturbance, psychological distress and perceived burden in female family caregivers of dependent people with dementia (n = 74) compared with female family caregivers of dependent people without dementia (n = 74) and with age-matched non-caregiver control females (n = 74). Participants completed the Pittsburgh Sleep Quality Index (PSQI), the 12-item General Health Questionnaire (GHQ-12), the Caregiver Burden Inventory (CBI) and an ad hoc questionnaire to collect sociodemographic data. There were significant differences between the groups in PSQI total (F = 24.93; p &lt; 0.001), psychological distress (F = 26.71; p &lt; 0.001) and in all sleep domains assessed: subjective sleep quality (F = 16.19; p &lt; 0.001), sleep latency (F = 9.5; p&lt; 0.001), sleep duration (F = 18.57; p &lt; 0.001), habitual sleep efficiency (F = 19.77; p &lt; 0.001), sleep disturbances (F = 9.22; p &lt; 0.001), use of sleep medications (F = 4.24; p&lt; 0.01) and daytime dysfunction (F = 5.57; p &lt; 0.01). In all measures, the female family caregivers of dependent people with dementia showed the significantly higher mean scores. Regarding the two groups of female caregivers, statistically significant differences were found in daily hours of care (t = -2.45; p &lt; 0.05) and perceived burden (t = -3.65; p &lt; 0.001), as well as in the following dimensions of caregiver burden: time-dependence burden (t = -5.09; p &lt; 0.001), developmental burden (t = -2.42; p &lt; 0.05) and physical burden (t = -2.89; p &lt; 0.01). These findings suggest that female family caregivers of dependent patients with dementia should be subject to psychopathological screening and preventive cognitive-behavioral interventions in clinical practice in primary health care.

Testing the validation and reliability of the Caregiver-Patient Activation Measure (CG-PAM).

The objective of this study was to test the reliability and validity of the Caregiver-Patient Activation Measure (CG-PAM). Based on the psychometric testing of the original Patient Activation Measure (PAM), three assessments of reliability and validity were completed on the CG-PAM. Test-retest reliability was assessed across two weeks (n = 23). Criterion validity was assessed by interviewing participants from the test-retest cohort (n = 10), with transcripts assessed by subject matter experts (n = 3) to classify activation levels of the interviewee. Construct validity was assessed through a survey (n = 179) consisting of demographic questions, the CG-PAM and concepts hypothesised to be related to caregiver activation. There was strong test-retest reliability (r = 0.893), but poor criterion validity. Assessment o;f construct validity demonstrated significant relationships found between caregiver activation and weekly hours of care provided (p < 0.001), relationship satisfaction (p < 0.001), and dyad typology (p < 0.001), but not with perceived levels of stress or social support. The CG-PAM was found to have strong reliability, but there were inconsistent results across the validation tests conducted. Future research must consider the dynamic nature of caring and the importance of the relationship between the caregiver/recipient when defining activation levels within the CG-PAM.

The impact of Alzheimer’s Disease on care partners

AbstractBackgroundThe burden of informal caregiving of people with Alzheimer’s Disease (AD) is often overlooked. We wanted to provide an overview of the burden of AD for care partners and to explore how the burden increases with disease progression through a systematic literature review.MethodA protocol was developed before searches in PubMed, Embase, PsycINFO, and Cochrane Library were run October 2021 via the Silvi.ai‐platform. Eligible studies were published in English and provided data from 2010 or later. Two reviewers screened titles and abstracts independently. A single reviewer conducted full‐text analysis and data extraction, and a PRISMA overview was generated. Studies were quality ranked in accordance with Oxford quality grading scale.Result911 hits were identified of which 61 studies were relevant for data extraction. Most care partners were women. The majority of studies reported moderate‐to‐severe levels of impact on care partners life (using the Zarit Burden Interview (ZBI) and the Maslach burnout inventory) and on care partners’ overall quality of life (using the WHO Quality of Life questionnaire);1,2 care partners exhibited higher levels of stress, depression, and anxiety compared to control groups.3,4,5,6 Females had significantly higher score on care partner burden than males (measured by the Caregiver Burden Inventory (CBI)).7 The higher the number, frequency and severity of symptoms affecting patients, the more intense care partner distress as measured by the Neuropsychiatric Inventory Distress Scale.8 The care partners of people with severe dementia due to AD reported the greatest care partner burden measured by the short version of the ZBI and the CBI.9,10 There was a clear correlation between hours of care giving and score of the ‘Activities of Daily Living’ questionnaire. The higher the score, the more hours of care giving.11,12,13,14 ConclusionBeing a care partner to a person with AD is often associated with emotional stress, depression, anxiety, low overall QoL as well as impact on physical health. Female care partners are disproportionally affected compared to males. The more severe the AD, the larger the burden. More research within the field is required to illuminate the true health consequences for care partners of people with AD.

Perioperative pain control represents the primary concern for patients considering outpatient shoulder arthroplasty: a survey-based study.

Outpatient (OP) total shoulder arthroplasty (TSA) with same-day discharge can now be performed safely in appropriately selected patients. Patient knowledge and perspectives regarding OP TSA are yet unknown and such information may inform surgeon decision-making and provide a framework for addressing patient concerns. The goal of this study was to understand and quantify patient knowledge of and concerns for OP TSA, with a working hypothesis that majority of patients are unaware of OP TSA as a realistic option and that their primary concern would be postoperative pain control. This was a retrospective cohort study at a tertiary care academic medical center including patients who underwent anatomic or reverse shoulder arthroplasty and completed an OP TSA expectations questionnaire/survey. This survey was provided preoperatively and included demographic factors, self-rated health evaluation, and perioperative expectations. Surveys evaluated whether patients undergoingTSA had any prior awareness of OP TSA and evaluated their primary concern with same-day discharge. Secondary questions included an assessment of patient expectations of outcomes of outpatient vs. inpatient surgery as well as their expected length of inpatient stay. A total of 122 patients who underwent anatomic and reverse shoulder arthroplasty completed the questionnaire and comprised the study cohort. Fifty-two (42.6%) of the patients were unaware that OP TSA was an option, and 26 (50%) of these were comfortable with the idea of OP TSA. Comfort with OP TSA was significantly associated with higher subjective patient-reported health status. Fifty-eight patients (47.5%) expected that following TSA they would require <24 hours of in-hospital postoperative care. The primary concern for patients considering OP TSA was postoperative pain control, endorsed by 44.3% of patients, compared with 13.1% of patients stating this would be their primary concern if admitted as an inpatient postoperatively. Pain control being a primary concern was significantly different between those considering outpatient vs. inpatient TSA. Most patients anticipated that OP shoulder arthroplasty would lead to a better (36%) or comparable (53%) outcome, whereas only 11% had concerns that it would lead to a worse outcome. Expanding OP TSA crucially depends on awareness and education. Perceived ability to control pain is an importantconcern. Patients may benefit from preoperative counseling, including emphasizing a comprehensive postoperative pain management strategy.

Leisure jobs: Recreating family and social life in Canadian electric utility marketing, 1920–1970

<h2>Abstract</h2> This paper contributes to debates of how technological and cultural change occurs in sociotechnical transitions. I this research I apply concepts from contemporary management theory to a historical case study to make two contributions. The first is to understand historical energy transitions in a new way. The second is to show how marketing and business model innovation theory can be used to examine utility marketing practices and understand how utilities help shape changes in family and social practices. The empirical case study is framed in the context of the seemingly contradictory views about technology and housework in the twentieth century. One view is that the transformation of homes with electric power created more work for mothers as they used their appliances to achieve new standards of cleanliness and devote more time to child care. The other is that it was beyond dispute that clothes dryers saved time and that over the twentieth century, women performed fewer hours of housework and family care. To investigate the issue and more generally technological and cultural change, I examined how electric power utilities in Canada conceptualized the use of domestic customer time during scale up of the grid. The research question asks what values and jobs to be done were marketed by electric utilities during the period, beyond giving homemakers more time to run the house and more money to shop? Utilities initially sought to grow by selling power as capital and labour rationality, mirroring industrial ideals of producing more with fewer resources. As those labour savings were realized, they increasingly sold power as a means to perform the new organizational and emotional jobs of creating a more intimate, happier and child-centred family life and a more entertaining social life. In doing so, they contributed to a redefinition of family and social life, from family-as-labour to family-as-leisure. Future research builds on this historical study in applying jobs to be done, business model innovation and social tableaux frameworks to understand contemporary marketing as it seeks to realize decarbonized power grids, expansion of electricity into mobility and heating markets and changed social practices to reduce greenhouse gas emissions.

Use of virtual meeting and survey technology to assess Covid-19-related mental well-being of healthcare workers

- Healthcare workers (HCW) throughout the world have been exposed to economic and existential stress during the Covid-19 pandemic. The American Medical Association (AMA) has documented that increased healthcare burden correlates with increased HCW stress, burnout, and psychological burden. However, limits on personnel, time, and in person interactions make it challenging to assess mental health outcomes during a pandemic. This pilot test case study used virtual technology to efficiently assess these outcomes. - Data were collected based on voluntary participation in the Coping with Covid-19 for Caregiver's survey created by AMA. The survey was sent out to approximately 300 participants who included local physicians, medical residents, medical students, and allied health professionals and students who attended a virtual Mental Health Summit. - The survey was developed by the AMA, and it included questions about demographics, overall stress, fear of infection and transmission of the virus, perceived anxiety or depression due to Covid, work overload, childcare issues, and sense of meaning and purpose. The AMA allows for up to five additional questions to be added to their survey, therefore five questions regarding support service utilization, perseverance, and resilience during Covid-19, and two items to further understand students' areas of medical interest. The survey was administered using an online platform through the AMA. The data were analyzed using descriptive statistics. - There were 81 survey respondents. Based on the results of the survey, "high stress" was found in 52 (64%) participants. 66 (81%) were afraid (moderately or to a great extent) of exposure or transmission, 61 (75%) described high levels of anxiety or depression, and 67 (84%) noted work overload. Despite this increase in stress, most respondents (77%) said they were not likely to reduce their devoted hours in clinical care or research in the next 12 months, and 81% answered that they would not leave their practice or research within two years. - Covid-19 has negatively affected the wellbeing of HCW. This is a similar trend seen during other times of healthcare strain. Mental health support, work modulation, and various provisions should be explored as means to reduce Covid-related negative impacts. The use of online an online summit and online data collection methods were appropriate for collecting data on the impact of Covid on mental health. This pilot study supports the larger scale implementation of this technology for health informatics research.

Situación y actividad de las unidades de geriatría de enlace con residencias de mayores en la Comunidad de Madrid

IntroductionIn June 2020, after the first wave of the COVID-19 pandemic, Hospital-Based Liaison Geriatrics units and Primary Care nursing care units were created in the Community of Madrid to improve health care for residents in a coordinated manner. ObjectiveTo analyze the situation and the activity of the Hospital-Based Liaison Geriatrics units. Material and methodsA cross-sectional study was conducted using an electronic survey prepared and sent to the liaison geriatricians in March 2022, including the following sections: available resources, areas of health care, reasons for consultation, care interventions, research and teaching activity, profiles of residents attended and coordination with other health professionals at that time. A descriptive analysis of the data was performed. Results100% of the existing Liaison Geriatrics units responded, describing essential differences in human resources, hours of care and volume of patients attended. Regarding the care activity of these units, they highlighted the telematic consultation, and the face-to-face assessment during hospitalization and in the emergency department. The main reasons for assessment were decision-making, acute pathology and geriatric syndromes; and the in-hospital drug management or orthoprosthetic aids among the interventions. ConclusionsDespite the heterogeneity in the resources of the different Liaison Geriatric units, there is a similarity in their care activity and the use of telemedicine. It is common to request an assessment for decision-making, acute pathology or geriatric syndromes and interventions for managing in-hospital drugs and tests, orthoprosthetic aids and coordination with other specialists. Liaison Geriatrics units must continue leading quality health care coordinated with nursing homes, as well as continuity of care for residents.

A national profile of sandwich generation caregivers providing care to both older adults and children.

Many U.S. caregivers provide care to the generation above and below simultaneously, described as "sandwich" generation caregivers. We seek to provide the first national estimates characterizing sandwich generation caregivers and the older adults for whom they care. We used the 2015 National Study of Caregiving (NSOC) and National Health and Aging Trends Study (NHATS) to compare individual (demographic, socio-economic, health, and caregiving characteristics) and caregiving-related experience (financial and emotional difficulties, caregiver role overload and gains, supportive services, employment and participation restrictions) between sandwich and non-sandwich generation caregivers. The analysis included adult child caregivers with or without any minor child under 18 years (n=194 and 912 NSOC respondents, respectively) providing care to n=436 and 1217 older adult NHATS respondents. Of all adult child caregivers, 24.3% also cared for a minor child (i.e., sandwich generation caregivers), representing 2.5 million individuals. Sandwich generation caregivers provided similar care hours to older care recipients as non-sandwich caregivers (77.4 vs. 71.6 h a month, p=0.60), though more of them worked for pay (69.4% vs. 53.9%, p=0.002). Both sandwich generation caregivers (21.0% vs. 11.1%, p=0.005) and their care recipients (30.1% vs. 20.9%, p=0.006) were more likely to be Medicaid enrollees than their non-sandwich caregiving counterparts. More sandwich generation caregivers reported substantial financial (23.5% vs. 12.2%, p < 0.001) and emotional difficulties (44.1% vs. 32.2%, p=0.02) than non-sandwich caregivers; they also reported higher caregiver role overload (score: 2.9 vs. 2.4, p=0.04). Their supportive services use was similarly low as non-sandwich caregivers except for seeking financial help (24.8% vs. 14.7%, p=0.008). Besides caring for minor child(ren), sandwich generation caregivers provided similarly intense care to care recipients as non-sandwich caregivers and had higher labor force participation; they experienced more caregiving-related financial and emotional difficulties and role overload. Policymakers may consider supportive services that address their unique needs and roles.