Care Institutions Research Articles

Cost-reduction Analysis of Percutaneous Pinning of Hand Fractures in an Outpatient Clinic

Background: The University of Sherbrooke's Hospital Center operating room has been affected by the COVID-19 pandemic, prompting surgeons to seek alternative ways to treat acute injuries requiring surgery. In the spring of 2020, we began performing percutaneous pinning of hand fractures in our outpatient clinic. We aimed to estimate the savings in 2021 by transferring these procedures from the operating room to the outpatient clinic. Methods: We identified all patients with hand injuries who received percutaneous pinning in 2021 using billing codes. Only patients treated in the outpatient clinic were included. We estimated the cost of hand fracture fixation in the operating room by considering the anesthesiologist's fee, the hospital's hourly rate for a 1-hour surgery (including a respiratory therapist, 2 nurses, and equipment) and salary bonuses for unfavorable hours, subtracting the cost difference of outpatient equipment. Results: We identified 114 patients treated with percutaneous pinning, of whom 93 were included in our study. Our calculations showed a total cost reduction of CAD $55,789 in 2021. Conclusions: Percutaneous pinning of hand fractures in an outpatient setting resulted in a yearly cost reduction of more than CAD $55,000. Investing in ambulatory care for hand fracture management benefits both patients and institutions.

Attitudes of nurses and physicians working in hard-to-heal wound management towards person-centred care.

Person-centred care (PCC) is an important approach as it positively affects disease management. Guiding studies are needed on the use and development of PCC in hard-to-heal (chronic) wound management. This study aimed to determine attitudes and approaches of nurses and physicians working in hard-to-heal wound management towards PCC, and obtain their views and suggestions for its scope and improvement. Participants of this descriptive survey study consisted of nurses and physicians responsible for hard-to-heal wound care and treatment in healthcare institutions at all levels in Turkey. Data were collected through a structured online survey shared with members of professional associations via social media platforms between March-November 2020. Descriptive statistics and qualitative inductive content analysis were used to analyse data. Participants (n=418) included physicians (84.2%) and nurses (15.8%). Mean participant-graded their person-centred behaviour level was 8.18±1.80 (out of 10 points). The majority of participants reported that they informed patients about care, treatment processes and options (87.3%) as well as including them in the decision-making process (74.6%). Responses of the participants regarding the scope of PCC were classified into five main categories, the most prominent being: 'individual', 'care', 'professional development' and healthcare system'. Suggestions for the improvement of PCC were classified into seven main categories, with 'personalised care', 'disease-specific care', 'continued training of healthcare professionals should be ensured' and 'home care system should be developed for the continuity of care' among the prominent subcategories. The findings of this study suggests that education on PCC is an important approach. Institutional protocols and guidelines can support person-centred hard-to-heal wound management. In this study, the level of person-centred behaviour of the participants was determined to be good. Although the results of the study cannot be generalised to all health professionals-the majority of the participants were physicians-it is recommended to develop and disseminate the PCC model in hard-to-heal wound management using the findings.

Medical Tourism for Cancer Treatment: Trends, Trajectories, and Perspectives From African Countries.

Cancer continues to be a significant public health concern. Sub-Saharan Africa (SSA) struggles with a lack of proper infrastructure and adequate cancer care workforce. This has led to some countries relying on referrals of cancer care to countries with higher income levels. In some instances, patients refer themselves. Some countries have made it their goal to attract patients from other countries, a term that has been referred to as medical tourism. In this article, we explore the current status of oncology-related medical tourism in SSA. This was a cross-sectional study. The study participants included oncologists, surgeons, and any other physicians who take care of patients with cancer. A predesigned questionnaire was distributed through African Organization for Research and Training in Cancer member mailing list and through study team personal contacts and social media. A total of 52 participants from 17 African countries with a 1.6:2 male to female ratio responded to the survey. Most (55.8%) of the respondents were from Eastern African countries. The majority (92%) of study participants reported that they knew patients who referred themselves abroad, whereas 75% referred patients abroad, and the most common (94%) referral destination was India. The most common (93%) reason for referral was perception of a higher quality of care in foreign health institutions. The findings suggest the need to improve local health care systems including building trust of the system among general population. The study highlights potential financial toxicity, and it adds to the current emphasis on return of investment on homegrown workforce and cancer treatment infrastructure.

Impact of functional recovery on patients having heart surgery.

To describe the results of a program developed to manage institutional postacute care (IPAC) (postacute skilled nursing, inpatient rehabilitation facility, and long-term acute care) in a CMS Bundled Payments for Care Improvement (BPCI) project for coronary artery bypass graft (CABG) surgery. We compared pre- and postutilization patterns during a 3-year period by evaluating risk-adjusted national, state, and other BPCI participant comparisons using a difference-in-differences (DID) analysis in a large urban community tertiary center with a CABG surgery program. Included in the analysis were all Medicare patients receiving CABG surgery at the institution (n = 504), across the nation (n = 213,423), and at other BPCI institutions (n = 4939). The intervention included (1) use of a standardized tool for evaluation and prognostication of patient placement, (2) programmatic changes to manage patient functional recovery, and (3) patient and family engagement in postacute placement and functional recoveryplan. Physical therapist/occupational therapist time with patients who had undergone CABG surgery increased by more than 179% between the pre- and postintervention periods. This was associated with a 41.2% and 51.6% decline in IPAC use at the institution on an observed basis and adjusted basis, respectively. DID comparison demonstrated a 14.40% (95% CI, -19.30% to -9.60%) greater reduction at the target hospital than at other participating BPCI hospitals. A strong association exists between a focused patient functional recovery program and IPAC use reduction after CABG surgery. Using a structured approach to clinical analytics and hypothesis testing of redesign efforts when managing postacute care populations removes waste from care delivery.

“You need to step back when you're contract faculty”: Information Practices and Care in Casual Academic Work

ABSTRACTThis study uses the concepts of information practices and care as theoretical lenses to explore the information practices of casual academic staff, who experience complex information contexts. Semi‐structured online interviews followed by thematic qualitative data analysis revealed that, while these academics care deeply about their contributions to student learning, they experience a lack of institutional support and care. This experience leads to individualized information practices, and dependence on an uncertain and unreliable information landscape, characterized by information marginalization, information precarity, and information vulnerability. Exposing the informational challenges experienced by this large subpopulation of academic laborers can support efforts to improve their information environments and support their work. The study also contributes to contemporary theoretical understandings of information vulnerability within academic contexts.

Institutional pedagogy and the transformation of residential care for, and with, disabled citizens

In this article, we build upon a historical and critical analysis of de-institutionalisation strategies, representing a fundamental shift in disability policy and practice starting in the 1960’s. We state that de-institutionalisation has commonly been interpreted and translated as a vital ‘transition’ – referring to the dismantling of residential care and institutions – in rights discourse, policy, and (self-) advocacy. Whereas de-institutionalisation currently often interferes with neo-liberal welfare state reforms, we argue that the focus on ‘transition’ tends to ignore controlling and oppressive institutional care cultures that circulate in a variety of settings, whether ‘community based’ or not. In this article, we elaborate on Francois Tosquelles’ Institutional Pedagogy as a theoretical framework to radically ‘transform’ (residential) care in a wide variety of settings. Our analysis is based on qualitative interviews with residential care providers and (self-) advocacy groups, and offers a more in-depth insight in the complexities of de-institutionalisation as ‘transformation’.

The time toxicity efficacy-effectiveness gap: A population-based study of stage III/IV non-small cell lung cancer (NSCLC) in Ontario, Canada.

133 Background: While patients enrolled in clinical trials tend to have superior cancer-specific outcomes relative to those in routine practice (the ‘’efficacy-effectiveness gap’’), it is unknown if this gap extends to time toxicity. While trial protocols can impose additional contact days, trial participants also tend to be healthier, perhaps needing fewer contact days. We sought to evaluate the time toxicity efficacy-effectiveness gap among patients with stage III/IV NSCLC. Methods: We created a population-based, retrospective cohort with health administrative data covering the population of Ontario, Canada (15.5 million), of adults aged ≥20 years diagnosed with stage III/IV NSCLC in 2014-2017 and died in 2014-2019, receiving palliative systemic anti-cancer drug(s) as part of a trial. We matched patients 1:1 to those who received the same drug(s) in the real world (post-approval) in the same line of treatment, and received the same total lines of therapy. We calculated contact days (days with healthcare contact outside the home) from diagnosis to death and measured overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course. Results: We identified and matched 55 trial participants to 55 patients in routine practice. Trial participants were younger (median age, 62 vs 66 years), had fewer co-morbidities (hypertension, 35% vs 53%), and more often had de novo metastatic disease (82% vs 67%). Median lines of therapy were 2. Systemic therapy regimens most commonly included immunotherapy (n=41, 75%). Trial participants initiated systemic therapy sooner than in routine practice (median 2.0 vs 2.4 months). Trial participants had a longer overall survival (median 13.8 vs 11.6 months) and a similar number of contact days (median 79 vs 78 days). The percentage of contact days was lower in trial participants due to longer survival (median 19% vs 22%). Trial participants had similar acute/assisted institutional care contact days (median 19 vs 18 days), but more days with laboratory tests (median 23 vs 17 days), systemic therapy (median 9 vs 6 days), and radiotherapy visits (median 15 vs 11 days). Normalized trajectories for both cohorts followed a ‘’U-shape’’; the difference between the maximal peak and trough was smaller in trial participants. Conclusions: We describe a novel efficacy-effectiveness gap in time toxicity, in addition to the previously established efficacy-effectiveness gap in overall survival. Encouragingly, trial participants did not experience delays in treatment, and initiated treatments sooner than in routine practice. Among trial participants, the higher number of contact days for tests, and the shallower U-shaped curve (indicating frequent visits even when relatively well) indicate potential opportunities to decrease trial-related time toxicity.

Experiences of family caregivers and nursing home staff interactions during the adaptation process of elderly individuals moving to nursing home: a qualitative study

ObjectiveTo explore the interaction between family members and nursing home staff during the adjustment period of newly admitted elderly individuals in a nursing home.DesignA qualitative descriptive study based on semistructured...

Magyarországi helyzetkép az alternatív gondoskodás lehetőségeiről, különös tekintettel a gyermekotthoni, nevelőszülői elhelyezésre

In this study, we compare institutional and foster care. The method chosen is a secondary analysis of statistical data. In the study, we seek to answer the question of how the number of places, the number of children, the age composition of children, the duration of placement and the type of placement vary in Hungary and in the Northern Great Plain region. We analyse data for the years 2014, 2021 and 2023 in terms of deinstitutionalisation and present the current situation of child protection care alongside the trends in institutional restructuring in recent years. A further aim of our comparative analysis is to review the number of cases of runaways from care in recent years, assuming that they occur less frequently in foster care. For the analysis, we have primarily used data for the years 2014, 2021 and 2023. In some places, the year 2020 was analysed due to data availability. We have used publicly available data series from the KSH, as well as data recorded on the basis of individual data requests according to the KSH OSAP Form 1208, which contains data provided by child protection centres based in the respective counties.

Optimising Delirium Pathways in Geriatric Care: The Impact of Consultant Led Old Age Psychiatry Liaison Service

Abstract Background Delirium is a common and severe condition affecting up to 50% of older adults in hospitals. Delirium is compounded by the noisy and frightening environment of medical wards, often leading to prescription of antipsychotics. There is often no clear plan to monitor effects of these medications. Delirium is also associated with increased rates of institutionalised care on discharge, readmission rates and mortality. Methods This QIP examines the effectiveness of interventions for patients with delirium in COE wards, focusing on involvement of consultant led old-age psychiatry liaison service. This 2-cycle process included 106 patients in the 1st cycle (Feb 2020-Sep 202, nurse-led), and 64 patients in the 2nd cycle (Nov 2022-Aug 2023, consultant-led). Outcome measures the number of patients assessed, new antipsychotic prescription, new nursing home placement, follow-up plans, readmission rate, and 1year mortality. Results The QIP revealed an increase in the number of inpatients reviewed by the POA team (330%) and planned out-patient POA follow-up (320%). There was an increase in the number of antipsychotics prescribed on discharge (61.5%) and discharge to a new appropriate placement (27.6%). The overall readmissions rates had slightly decreased (2.5%), and readmissions with delirium had further reduced (4%) (not significant, p=0.66). The overall mortality rate increased by 4% since the introduction of these measures (not significant, p=0.63), however, this is small and at a level expected with this population group. Conclusion These results suggest that the new consultant led liaison team resulted in an increased use of their expert opinion on challenging patients with delirium. Significantly, more patients received psychiatric follow-up crucial for antipsychotic monitoring. There is a slight reduction in the readmission rates. Although, the increase in the mortality rate is insignificant, this warrants a closer look as antipsychotics are associated with cardiovascular diseases. A larger study over a longer period of time would provide more useful data.

Risk Factors Affecting the Psychological Resilience of Adolescents in Institutional Care: A Systematic Review.

Psychological resilience is defined as the resilience capacity and the power to recover in the face of stressful life events. Adolescents in institutional care have different individual, familial, and environmental risk factors that negatively affect their psychological resilience. This study aimed to comparatively examine studies that detect the risk factors affecting the resilience of adolescents living in institutional care and make recommendations regarding initiatives or specific outcomes related to this. This study systematically reviewed national and international literature databases such as PubMed, Web of Science, Science Direct, Medline, CINAHL, EBSCO host, Psychinfo, Cochrane Library, Turkish Ulakbim, Turkish Medical Directory, and Turkish Psychiatry Directory up to December 2021. Fourteen studies were included in this study. Many significant risk factors, such as adolescents' interpersonal relationships, self-confidence, self-esteem, self-efficacy levels, problem-solving skills, empathy skills, as well as parental abandonment, domestic violence, socioeconomic poverty, a history of abuse, peer rejection, lack of social support resources, and low academic performance, have been identified and discussed at individual, familial, and environmental levels. Adolescents in institutional care were more vulnerable and had more mental and behavioral problems than their peers. This systematic review found no studies evaluating preventive programs, interventions, or interventions designed to reduce the frequency and prevalence of future adverse events for children growing up in institutional care settings. Recommends the comprehensive inclusion and evaluation of preventive programs, practices, and assessments aimed at reducing the frequency and prevalence of risk factors affecting resilience.

What do we know now about evidence-based treatment for psychosis and aggressive behaviour or criminality that we did not know when community care was implemented?

Purpose Community care replaced institutional care for people with psychosis without guidance about what constituted effective treatment. In a Swedish birth cohort, many of those who developed schizophrenia or bipolar disorder as community care was being implemented were subsequently convicted of violent and non-violent crimes. Studies from other countries that were implementing community care at this time also reported elevated proportions of patients acquiring criminal convictions. Since community care was first implemented, much has been learned about factors that promote and treatments that limit aggressive/antisocial behaviour/criminality (AABC) among people with psychosis. Without the benefit of this knowledge, did mental health policy and practices that were in place as the asylums were closed inadvertently contribute to criminality? Material and methods This article provides a narrative review of current evidence of effective treatments and management strategies to reduce AABC among patients with psychosis. Results Reductions in AABC are associated with stable contact with psychiatric services, second-generation antipsychotic medication, clozapine for patients with schizophrenia and elevated levels of hostility and/or a history of childhood conduct disorder, abstinence from substances, avoidance of trauma, and constant monitoring of both illness symptoms and AABC. Conclusions Failure to adopt evidence-based practices allows the problem of AABC to persist, prevents patients from experiencing independent, safe, community tenure, and puts those around them at risk. Many challenges remain, including implementing effective assessment and interventions at first-episode and convincing patients with antisocial attitudes and behaviours to participate in treatment programs to reduce AABC and to learn prosocial behaviours.

Challenges experienced by caregivers working in institutions for children. A case of four children’s homes in Zimbabwe

ABSTRACT Institutional care is one of the child care strategies used to provide secure family environments to children at risk. In this vein, institutions provide care through caregivers who look after children round the clock. These caregivers are trained and expected to provide high-quality services. However, in so doing, the caregivers face several challenges. This paper is based on a qualitative study that collected data from 24 caregivers working at four childcare institutions in Harare, Zimbabwe. The study employed a multiple case study design that was embedded in a phenomenological design. Findings from the study revealed that challenges experienced by caregivers include high caseloads and lack of resources, regulations which do not promote proper child development, inadequate training for caregivers, and nonexistence of a representative body for caregivers and the existence of multiple reporting systems for children. Noteworthy, is the fact that these challenges result in the provision of inappropriate services to children in institutions culminating in dilution of quality-of-care services’ provision to children. To this end, the author suggests a redress of caregivers’ roles and revision of institutional care framework; to address the challenges faced by caregivers.

How Socially Sustainable Is the Institutional Care Environment in China: A Content Analysis of Media Reporting

The multiple changes in population, economy, and social structure have significantly impacted China’s traditional home-based elderly care and social welfare. The importance of institutional care is becoming increasingly prominent. One of the critical considerations for the development of institutional care is its social sustainability, which pursues the realization of human well-being and aims to bring about good quality of life. However, this issue has not received due attention. The purpose of this paper is to investigate the social sustainability of the institutional care environment. Based on stakeholder theory and content analysis, this research identified and discussed the problems of the institutional care environment mentioned in the news coverage on eight major Chinese portal websites. The results indicate that seven of the eight problems that employees, the elderly, and their relatives encounter in providing and receiving elderly care services in the institutional environment are related to social sustainability. Employees’ health and safety is a concern; they lack education and training opportunities and have been unequally treated in the employment process. The elderly’s psychological, physical, and safety needs should also be further satisfied. Unequal access to institutional care and the inaccessibility of elderly care institutions is another problem that needs to be solved urgently. These findings will help government departments and investors become aware of the issues and implement countermeasures to create a successful, socially sustainable institutional care environment. They can also provide valuable insights for the elderly and their relatives in choosing appropriate elderly care institutions.

Institutional care and education: circulation of knowledge about epilepsy in Sweden 1915-40.

This article focuses on the circulation of knowledge about epilepsy in Sweden between 1915 and 1940. During the period medical research on epilepsy increased, which simultaneously brought a new degree of specialisation and distinction between branches of medicine. The aim of this article is to study the impact of new medical knowledge about epilepsy on the treatment and education of children with epilepsy in Sweden. In order to concretise the aim, the study focuses on the asylum Margarethahemmet. The key source material consists of Margarethahemmet's annual reports and yearbooks. The minutes of the meetings of the Swedish General Association for the Care of the Feebleminded and Epileptic for the period 1915-1938 have been used as supplementary material. In order to trace the impact of medical discoveries on Margarethahemmet's operations, contemporary scientific articles, mostly from Germany, have also been used. The article demonstrates how new research and new knowledge was sought internationally and nationally, to provide doctors and special teachers at the asylum with a proper knowledge about education, care and treatment for children with epilepsy. The increased understanding of the disease directly impacted the ability of a stigmatized group - people with epileptic disorder - to actively participate in society on the same terms as others.

Using and Measuring Motivational Interviewing in a New Setting: Experiences From a Project Highlighting Relationship-Building Skills in the Process of Recruiting New Staff

Relationship-building skills, with empathy and empathic abilities as crucial ingredients, are described as central in human service professions. These professions usually require training on relationship-building skills. However, in many professional groups, with support or care functions, rather than functions specifically oriented towards treatment, the level of education and training required varies. Empathic skills are central in the concept of Motivational Interviewing (MI). It has been suggested that for the ethical reason that treatment staff should not harm clients, workplaces should assess staff members’ empathic skills and ability to refrain from harmful behaviours, and these capabilities should be investigated when recruiting new staff. In accordance with this suggestion, the residential homes at the Swedish National Board of Institutional Care (SiS), which provides compulsory care for young people, initiated a project to develop and trial a work test based on the concept of MI. The aim of the article is to, based on 59 interviews with stakeholders in the SiS-project, add to the discussion on the balancing act required in evidence-based practise of maintaining psychometric stringency versus making contextual and situational adjustments. Focus is on exploring the possibilities for using and interpreting measures of MI in a new setting as well as the possibilities for assessing relationship-building skills in the recruitment process. The results suggest that tinkering is often necessary when using standardised measures for complex skills like relationship building. The study proposes that a nuanced understanding of the method, measurement, and organisational context is essential even with well-established methods.

Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care.

Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period. We conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post-acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g-formula to standardize for age and sex. We identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI -264 to -69] fewer MMEs [-248 mg oxycodone]; no PAC: 167 [95% CI -274 to -62] fewer MMEs [-251 mg oxycodone]) and average MME per days' supply of medication (PAC: -3.0 [-4.6 to -1.4] fewer MMEs per day [-4.5 mg oxycodone]; no PAC: -4.7 [-4.6 to -1.4] fewer MMEs per day [-7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617-653 fewer cumulative mg oxycodone). Racial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short- and long-term health outcomes.

Resilience Building in Indian Adolescents

The study examined the resilience of Indian adolescents, specifically exploring the variations in resilience characteristics between genders. The study investigated a sample of 124 adolescents from the Khordha district. The descriptive statistics indicated that there were moderate levels of resilience observed in all categories, and there were no significant differences between males and female adolescents. The results also indicated that gender does not have a significant effect on resilience characteristics. This challenges the initial belief that boys would exhibit better levels of resilience in some areas. The results are consistent with previous research indicating that resilience is affected by a range of external and intervention- related factors, rather than being only determined by gender. Research studies emphasize the efficacy of focused interventions and support structures in bolstering resilience, as exemplified by inner-city programs and institutional care settings. In summary, the study suggests that resilience is a dynamic process influenced by several factors, not limited to gender.

Bullying, Discrimination, and Mental Health among South Korean Youth in Institutional Care: The role of peer and family support

Bullying, Discrimination, and Mental Health among South Korean Youth in Institutional Care: The role of peer and family support

Creating communities that care: social representation of mental health in two urban poor communities in Ghana

Building caring communities is fundamental to achieving a community-based approach to mental health. Understanding how communities perceive mental illness provides critical insight into fostering mental health awareness and care. We explored the perceptions of mental illness among members of two urban poor communities in Accra, Ghana. Qualitative data were collected from 77 participants through key informant interviews, focus group discussions, and situated conversations. Using theory-driven thematic analysis based on social representations theory, findings revealed cognitive-emotional representations of mental illness. The communities demonstrated high awareness of the multilevel factors contributing to mental illness risk and experiences, drawing on five sources of knowledge: embodied, common sense, medical, cultural, and religious. Mental illness representations informed the classification and legitimization of mental illness based on the severity of conditions and the identity of sufferers. These findings provide valuable insights for planning community mental health interventions that address both social and institutional care needs.