Home-based Settings Research Articles

PSYCHOTROPIC MEDICATION USE PATTERNS IN HOME-BASED PRIMARY CARE: A SYSTEMATIC REVIEW

Introduction Up to a third of patients seen by home-based primary care providers suffer from mental health problems, predominantly major depressive disorder. These conditions tend to be under-recognized and under-treated for patients receiving home-based care. This may be due to providers feeling inadequately trained on how to screen for various mental health disorders, and/or how to provide comprehensive mental health treatment. Given the high prevalence of patients suffering from mental health problems in this setting, the goal of this systematic review was to evaluate current psychotropic use patterns for patients receiving home-based primary care (HBPC). Methods Using controlled vocabulary terms (e.g. MeSH, Emtree) and keywords, a medical librarian conducted systematic literature searches in the following seven databases: Ovid/MEDLINE, Wiley/Cochrane Library, Elsevier/Embase, Elsevier/Scopus, Clarivate/Web of Science, EBSCO/CINAHL, and EBSCO/PsycInfo, limiting articles to those published between January 1, 2007 and January 5, 2018. Two independent reviewers screened all titles and abstracts and resolved differences by consensus. Two independent reviewers screened the full text of all publications selected in the screening phase. Differences were resolved by consensus with a third reviewer. Studies were selected if a) they were conducted in home-based primary care settings and b) identified psychotropic use/prescription patterns. We specifically did not include studies that were limited to patients in hospice care or nursing or rehabilitation facilities. Studies were excluded if they were: not in English; drug trials; limited to pediatric patients; or opinion pieces, case studies, case series, meeting abstracts, reviews, systematic reviews, or meta-analyses. Results Of the 2,675 publications identified through the seven database searches, 1,388 remained after duplicates were removed (Figure 1). Of these, 1,329 were eliminated because of irrelevance to the topic and 59 were selected for full text screening. Of these, four met full selection criteria and were included in the data extraction and analysis. Citation checking of these four, as well as of relevant review articles, resulted in the selection of an additional 15 articles for full text screening. None of these additional articles met the full selection criteria. Conclusions Pending ongoing investigation. This research was funded by This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.

Caregiver exposure to critical events and distress in home-based palliative care in Germany a cross-sectional study using the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) scale

BackgroundLay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient’s care. Yet, to our knowledge, no study to date has examined the family caregivers’ exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient’s critical health events and relate that to the caregiver’s own psychological distress to examine associations with general health within a home-based palliative care situation in Germany.MethodsA cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data.ResultsThe frequency of the caregiver’s exposure, or witness of, critical health events of the patient ranged from 95.2% “pain/discomfort” to 20.8% “family caregiver thought patient was dead”. The highest distress scores assessing fear and helpfulness were associated with “family caregiver felt patient had enough’” and “family caregiver thought patient was dead”. Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers.ConclusionsFamily caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver’s degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.

Identifying profiles of listed home-based child care providers based on their beliefs and self-reported practices

This study seeks to broaden the knowledge base of the diverse home-based child care provider workforce in the United States. Home-based child care is a crucial part of the child care landscape with approximately seven million children from birth to five receiving care in home-based settings. Through secondary analysis of the National Survey of Early Care and Education data on listed home-based providers (n = 3493), latent profile analysis was used to explore how providers grouped into profiles based on key characteristics related to their caregiving beliefs and their self-reported instructional practices, professional engagement, and family supportive practices. Findings reveal providers aligned into three profiles: Educationally Focused (72.4%), Educationally Aware (15.7%), and Caregiver (11.8%). Frequency of implementing planned educational activities emerged as a particularly salient distinction among the three groups. Results suggest that although listed home-based providers appear somewhat homogeneous in their demographic characteristics, they vary in their instructional practices with children and their own professional engagement. Therefore, they may benefit from a tailored approach to quality improvement that attends to these differences.

Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia.

Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context. To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another. The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections. Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together. There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role.

Inclusion of Sleep Promotion in Family-Based Interventions To Prevent Childhood Obesity.

Sleep promotion in childhood may reduce the risk of obesity, but little is known of its inclusion in family-based interventions. This study examines the proportion and context of family-based interventions to prevent childhood obesity that promote child sleep. We drew on data from a recent systematic review and content analysis of family-based interventions for childhood obesity prevention published between 2008 and 2015, coupled with new data on sleep promotion strategies, designs, and measures. Out of 119 eligible family-based interventions to prevent childhood obesity, 24 (20%) promoted child sleep. In contrast, 106 (89%) interventions targeted diet, 97 (82%) targeted physical activity, and 63 (53%) targeted media use in children. Most interventions that promoted sleep were implemented in clinics (50%) and home-based settings (38%), conducted in the United States (57%), and included children 2-5 years of age (75%). While most interventions utilized a randomized controlled design (70%), only two examined the promotion of sleep independent of other energy-balance behaviors in a separate study arm. Sleep was predominately promoted by educating parents on sleep hygiene (e.g., age-appropriate sleep duration), followed by instructing parents on responsive feeding practices and limiting media use. One intervention promoted sleep by way of physical activity. A large number promoted sleep by way of bedtime routines. Most interventions measured children's sleep by parent report. Results demonstrate that sleep promotion is underrepresented and variable in family-based childhood obesity interventions. While opportunities exist for increasing its integration, researchers should consider harmonizing and being more explicit about their approach to sleep promotion.

A model predicting the health status of patients with heart failure

Objective: To test the causal relationships among the components of sociodemographics,illnesscharacteristics, and selfmanagement ability, and health status in the model of health status of patients with heart failure (HSHF). Design: Descriptive cross-sectional study Materials and methods: Four hundred heart failure patients, either hospitalized or attending out-patient clinics at six hospitals in southern Thailand, were interviewed. Questionnaires covered sociodemographics, the duration of illness, severity of illness, comorbid diseases, measured by the New York Heart Association Functional Classification (NYHA-FC) using the Charlson Comorbidity Index, self-management ability, using the Self-Care of Heart Failure Index (SCHFI), and health status using the Short Form-36 Health Survey (SF-36). The relationships among the study variables were tested and modified under the structural equation modeling (SEM) technique by using LISREL. Results: The collected data were found not to fit with the initial hypothesized model but after modification the new derived model gave an adequate fit with the data and accounted for 64% of the variance in health status. Age had a direct negative effect on health status ( β =-0.20, p β =-0.13, p β =0.12, p β =-0.05; -0.05, p β =0.09, p β =-0.31; -0.16, p β =-0.06; -0.05, p β =0.38, p Conclusions: The final model provides a guideline for explaining and predicting the health status of patients with heart failure. To improve health status continuity care programs promoting self management ability should be developed and imple-mented both in hospital-based and home-based settings.

Methodology for Establishing a Community-Wide Life Laboratory for Capturing Unobtrusive and Continuous Remote Activity and Health Data.

An end-to-end suite of technologies has been established for the unobtrusive and continuous monitoring of health and activity changes occurring in the daily life of older adults over extended periods of time. The technology is aggregated into a system that incorporates the principles of being minimally obtrusive, while generating secure, privacy protected, continuous objective data in real-world (home-based) settings for months to years. The system includes passive infrared presence sensors placed throughout the home, door contact sensors installed on exterior doors, connected physiological monitoring devices (such as scales), medication boxes, and wearable actigraphs. Driving sensors are also installed in participants' cars and computer (PC, tablet or smartphone) use is tracked. Data is annotated via frequent online self-report options that provide vital information with regard to the data that is difficult to infer via sensors such as internal states (e.g., pain, mood, loneliness), as well as data referent to activity pattern interpretation (e.g., visitors, rearranged furniture). Algorithms have been developed using the data obtained to identify functional domains key to health or disease activity monitoring, including mobility (e.g., room transitions, steps, gait speed), physiologic function (e.g., weight, body mass index, pulse), sleep behaviors (e.g., sleep time, trips to the bathroom at night), medication adherence (e.g., missed doses), social engagement (e.g., time spent out of home, time couples spend together), and cognitive function (e.g., time on computer, mouse movements, characteristics of online form completion, driving ability). Change detection of these functions provides a sensitive marker for the application in health surveillance of acute illnesses (e.g., viral epidemic) to the early detection of prodromal dementia syndromes. The system is particularly suitable for monitoring the efficacy of clinical interventions in natural history studies of geriatric syndromes and in clinical trials.

Implementation of Intravenous Drip Infusion Therapy with Peripheral Venous Catheters and the Incidence of Related Complications in Home-Based Medical Care Settings in Japan

Background/Aims: Home-based medical care is rapidly expanding in Japanese health care settings. We aimed to clarify the implementation status of drip injection with peripheral venous catheters (PVCs) and the incidence of related complications. Methods: We investigated the number of patients who required intravenous drip infusion therapy at home. We also examined the incidence rate of PVC-related complications and their statistical correlation with patients’ characteristics. Results: Of 139 patients, 30 (21.6%) received intravenous drip infusion therapy through PVCs at home. Patients’ activities of daily living (bed-ridden) and the presence of underlying disease (terminal cancer) were significantly correlated with the requirement for drip infusion therapy (p < 0.0001 and p < 0.0001, respectively). A high incidence of PVC-related complications (75%: 15 out of 20 patients) was observed. More than 50% of patients experienced multiple needling due to difficulty in securing venous access. Conclusions: This is the first report to reveal the relatively high incidence of PVC-related complications in home-based medical care settings. Safer vascular devises should be incorporated for more stable intervention.

Assist-as-Needed Controller to a Task-based Knee Rehabilitation Exoskeleton.

This research aims to design and implement an assist-as-needed controller and patient recovery tracking system into a novel task based knee rehabilitation exoskeleton device. The level of support from the exoskeleton is measured through the force sensing resistors (FSR) placed in the interface of lower- leg and the exoskeleton. The signal from the FSR is used as a feedback to control the actuator torque. The intent of the user to start, stop, move left, and right are associated with muscle activities, surface electromyography (sEMG) signals in the upper-leg. The preliminary results have shown that the system has provided the user a visual display of the amount of recovery and history while providing full autonomy to control the exoskeleton device. The successful implementation of these features can eliminate the need of constant supervision, and hence saves time and reduces cost of the rehabilitation process; which can also be used in a home-based or telerehabilitation settings.

Moving beyond the ‘language problem’: developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters

ABSTRACTHealth systems internationally are dealing with greater diversity in patient populations. However the focus on ‘the language problem’ has meant little attention is paid to diversity within and between migrant populations; and how interpreted consultations are influenced by intersecting migratory, ethnicity and sociodemographic variables. Our analysis of the experiences of patients, health care providers and interpreters in Scotland evidences the need to move beyond language, addressing multiple hidden inequalities in health care access and provision that operate in both clinic and, especially, home-based settings. We call for a practice-evidenced research agenda promoting cultural communication across health care and home settings, acknowledging immigration status as a social determinant of health.

Conceptualising Home-Based Child Care: A Study of Home-Based Settings and Practices in Japan and England

Home-based child care or childminding as it is commonly known in the United Kingdom (UK) is a service often used by parents and families in many countries. However, despite its prevalence, there is a paucity of research on the subject. Addressing this gap, this study presents new empirical data to better understand this type of provision in supporting children’s learning and development. The paper presents the findings of a qualitative study of home-based child care undertaken in five settings in Japan and England. The study examined caregivers’ activities and their interactions with the children aged 4 months to 4 years. The methods included practitioner interviews, narrative observations, document analysis of activity records, and documentations of the structural and process features of the settings. The study is significant for advancing the international knowledge base of home-based child care in highlighting the service as a form of distinct, specialised care and pedagogy, as well as family support.

Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis.

This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000-February 2017 inclusive) using the keywords 'osteoporosis', 'fractures', 'liaison', and 'service' to identify randomised controlled trials and observational studies of patients aged ≥50years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18-0.29), 20 percentage points for treatment rates (95% CI 0.16-0.25), and 22 percentage points for adherence (95% CI 0.13-0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI -0.08 to -0.03) and mortality reduced by three percentage points (95% CI -0.05 to -0.01). FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.

Workforce well-being: Personal and workplace contributions to early educators' depression across settings

Building on research demonstrating the importance of teachers' well-being, this study examined personal and contextual factors related to early childhood educators' (n=1640) depressive symptoms across licensed child care homes, centers, and schools. Aspects of teachers' beliefs, economic status, and work-related stress were explored, and components of each emerged as significant in an OLS regression. After controlling for demographics and setting, teachers with more adult-centered beliefs, lower wages, multiple jobs, no health insurance, more workplace demands, and fewer work-related resources, had more depressive symptoms. Adult-centered beliefs were more closely associated with depression for teachers working in home-based settings compared to center-based settings. These findings provide preliminary evidence about what relates to depression in the early childhood workforce, which has implications for supporting well-being across settings.

Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis

Abstract Objectives This systematic review and meta-analysis evaluated the outcomes of patients with osteoporosis-related fractures managed through fracture liaison services (FLS) programs. Methods Medline, PubMed, EMBASE, and the Cochrane Library were searched (January 2000–February 2017 inclusive) using the keywords ‘osteoporosis’, ‘fractures’, ‘liaison’, and ‘service’ to identify randomised controlled trials and observational studies of patients aged ≥50 years with osteoporosis-related fractures in hospital, clinic, community, or home-based settings who were managed using FLS. Risk of bias was assessed at outcome level. Meta-analysis followed a random-effects and fixed-effects model. Outcomes of interest were incidence of bone mineral density (BMD) testing, treatment initiation, adherence, re-fractures, and mortality due to osteoporosis treatment. Results A total of 159 publications were identified for the systematic literature review; 74 controlled studies (16 RCTs; 58 observational studies) were included in the meta-analysis. Overall, 41 of 58 observational studies and 12 of 16 RCTs were considered of high quality. Compared with patients receiving usual care (or those in the control arm), patients receiving care from an FLS program had higher rates of BMD testing (48.0% vs 23.5%) and treatment initiation (38.0% vs 17.2%) and greater adherence (57.0% vs 34.1%). Unweighted average rates of re-fracture were 13.4% among patients in the control arm and 6.4% in the FLS arm. Unweighted average rates of mortality were 15.8% in the control arm and 10.4% in the FLS arm. Meta-analysis revealed significant FLS-associated improvements in all outcomes versus non-FLS controls, with BMD testing increased by 24 percentage points (95% confidence interval [CI] 0.18–0.29), 20 percentage points for treatment rates (95% CI 0.16–0.25), and 22 percentage points for adherence (95% CI 0.13–0.31) and absolute risk of re-fracture reduced by five percentage points (95% CI –0.08 to −0.03) and mortality reduced by three percentage points (95% CI –0.05 to −0.01). Conclusion FLS programs improved outcomes of osteoporosis-related fractures, with significant increases in BMD testing, treatment initiation, and adherence to treatment and reductions in re-fracture incidence and mortality.

Placement Instability Among Young People Removed from Their Original Family and the Likely Mental Health Implications.

BackgroundYoung people in out-of-home care are more likely to experience poorer mental and physical health outcomes related to their peers. Stable care environments are essential for ameliorating impacts of disruptive early childhood experiences, including exposure to psychological trauma, abuse and neglect. At present there are very few high quality data regarding the placement stability history of young people in out-of-home care in Australia or other countries.ObjectivesTo undertake the first systematic census of background, care type and placement stability characteristics of young people living in the out-of-home care sector in Australia.MethodsData was collected from four non-government child and adolescent community service organisations located across metropolitan Melbourne in 2014. The sample comprised 322 young people (females 52.8%), aged between 12 – 17 years (mean age=14.86 [SD=1.63] years).ResultsMost young people (64.3%) were in home-based care settings (i.e., foster care, therapeutic foster care, adolescent care program, kinship care, and lead tenant care), relative to residential care (35.7%). However, the proportion in residential care is very high in this age group when compared with all children in out-of-home care (5%). Mean age of first removal was 9 years (SD=4.54). No gender differences were observed for care type characteristics. Three quarters of the sample (76.9%) had a lifetime history of more than one placement in the out-of-home care system, with more than a third (36.5%) having experienced ≥5 lifetime placements. Relative to home-based care, young people in residential care experienced significantly greater placement instability (χ2=63.018, p<0.001).ConclusionsPlacement instability is common in the out-of-home care sector. Given stable care environments are required to ameliorate psychological trauma and health impacts associated with childhood maltreatment, well-designed intervention-based research is required to enable greater placement stability, including strengthening the therapeutic capacities of out-of-home carers of young people.

Palliative Care in Romania

HOSPICE Casa Sperantei has been pioneering palliative care development in Romania since 1992. The have developed specialist palliative care services in home-based settings, inpatient units, day care centers, and as hospital support teams. They have provided national and international education programs for professionals in the palliative care field, as well as promoting palliative care integration in the health care system. Legislative improvements were adopted, including funding mechanisms for the reimbursement of palliative care services through the health insurance funds, review of opioid policy, and quality standards of care. By the end of 2015, Romania had 115 specialist palliative care services (78 palliative care inpatient units, 24 home-based palliative care services, five outpatient palliative care clinics, four day care centers, and four hospital support teams). A palliative care subspecialty for doctors was recognized as early as 2000, and a multidisciplinary master's degree program has been available at Transilvania University since 2010, when the first palliative care academic position was established. Nursing education includes mandatory palliative care modules in nursing schools. For coordinated development of palliative care at the national level, a national strategy was proposed defining three levels of palliative care provision, local, district, and national. The implementation of the palliative care strategy is partially funded through a World Bank loan.

Electronic Visibility Management of Lesbian, Gay, and Bisexual Identities and Relationships in Young Adulthood

ABSTRACTVisibility management is a process the lesbian, gay, and bisexual-identifying (LGB) people use to manage the extent to which they will identify (“out”) themselves in various contexts such as school, work, family, and home-based settings. The purpose of this study then was to explore LGB persons' experiences of electronic visibility in online environments such as social networking sites and the manner in which LGB persons most commonly monitor their electronic visibility as individuals and in couple relationships. Analysis of the survey responses of 61 young adult participants indicated that this sample felt more positive about their identities overall compared with a national sample and that they frequently reported their sexual orientation online, most often on Facebook. In addition, participants reported online disclosure did not have an effect on their relationship satisfaction. Discussion and implications for research and clinical practice are presented.

Possibilistic activity recognition with uncertain observations to support medication adherence in an assisted ambient living setting

A recent trend in healthcare is to motivate patients to self-manage their health conditions in home-based settings. Self-management programs guide and motivate patients to achieve self-efficacy in the self-management of their disease through a regime of educational and behavioural modification strategies. To improve self-management programs effectiveness and efficacy, we must consider Ambient Assisted Living (AAL) technologies (smart environments, activity recognition, aid acts planning), since they alleviate issues related to unreliable self-reported data by monitoring self-management activities. To improve self-management programs in smart environments, it is necessary to recognize the occupant behaviour from observed data. Observed data/attributes generated from various sources (sensors, questionnaires, low-level activity recognition) are certain to uncertain (imprecise, incomplete, missing), where several values are plausible instead of only one. Thus, activity recognition must consider heterogeneous observations (sources’ types) and uncertainty in the activity recognition inputs (observations). To address this challenge, we propose an activity recognition approach based on possibilistic network classifiers with uncertain observations. We believe that this is the first work to consider possibilistic network classifiers for the recognition of activities in smart environments using uncertain observations. We have validated the approach on 780 synthetic scenarios illustrating behaviours related to medication adherence. The activity classifiers, based on knowledge and beliefs about the activities related to medication adherence, can correctly recognize 79% of an activity current state, which is comparable with approaches based on data-driven naïve Bayesian classifiers. Furthermore, the classification performance only decreases when we have highly partial to complete ignorance about the observations values. Hence, the validations results show the interest of activity recognition based on possibilistic network classifiers for handling uncertain observations.

Does a comprehensive family-centred early intervention service affect stress reactivity and emotion regulation in very low birthweight preterm infants at toddler age?

Commentary on: Wu Y-C, Hsieh W-S, Hsu C-H, Chang J-H, Chou H-C, Hsu H-C, Chiu N-C, Lee W-T, Chen W-J, Ho Y-W, Jeng S-F. Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial. Res Dev Disabil 2016; 48: 1–12. Preterm infants have higher risk of adverse developmental outcomes compared with term-born infants, including attentional 1, cognitive and behavioural impairments at school age 2, and motor impairment throughout childhood 3. Early intervention programmes positively affect cognitive and motor outcomes in infancy, with persisting cognitive benefits at preschool age 4. However, Wu and colleagues highlight that studies investigating the efficacy of early intervention programmes for emotion regulation in preterm infants at toddler age are lacking, and Taiwanese services for VLBW infants are largely limited to in-hospital, child-centred design 5. This multicentre RCT suggests that a comprehensive clinic or home-based child, parent and dyad-focused early intervention programme improved emotion regulation for Taiwanese VLBW infants. However, the authors found no stress reactivity benefits, or enhanced regulatory strategies for either intervention group, only partly supporting this conclusion. Cognitive and language performance at 12 months CA did not differ between groups, although statistical significance is not presented. The authors identify several pertinent study limitations. Of particular interest is the demographic characteristics of VLBW families, with 73% having high maternal education level and moderate to high socio-economic status. Socio-environmental factors play an important role in the developmental outcome of preterm infants 6, 7; therefore, this factor may affect the representativeness of participants. The laboratory setting for outcome assessment and follow-up length should be considered in future study design. Participant follow-up is another important consideration, with low follow-up rates introducing potential bias and possibly affecting the statistical power of this study. The lack of details regarding sample size calculation for stress reactivity and emotion regulation in this article is similarly important to highlight. Furthermore, at each time point, a proportion of infants were not assessed due to seating difficulty. For VLBW infants, this was reported 42 times, and eight term-born toddlers at 24 months were unable to be seated. The birth and demographic characteristics of these infants were comparable with assessed infants; however, it is possible that nonparticipants may have had underlying behavioural or motor difficulties. Exclusion of these infants from assessment limits the representativeness of the VLBW population in this study. This RCT contributes to the field by exploring the important area of emotion regulation and behaviour after a comprehensive child, parent and dyad-focused early intervention programme in Taiwan. In RCTs of early intervention, all participants receive the same intensity of in-hospital and post-discharge treatment; however, in clinical practice, it is important to target service provision to each family's individual needs and resources. Future research should include high-risk preterm populations to identify the efficacy of intervention programmes for those infants who are likely to benefit most 4. The financial feasibility of the home-based and clinic-based interventions detailed by Wu and colleagues would be a valuable area of further study to guide future design of early intervention programmes. As both clinic-based and home-based settings were found to be beneficial for reducing stress-evoked primitive behaviour when compared with usual care, the parental mental health, well-being and engagement in each programme could also be a valuable method of evaluating each setting. https://ebneo.org/2017/06/26524725 None to declare. Ms. FitzGerald's PhD candidature is supported by The University of Melbourne via The Australian Government Research Training Program Scholarship and the Centre of Research Excellence in Newborn Medicine.

Pain management in home hospice patients: A retrospective descriptive study.

The development and evaluation of evidence-based, safe, and effective home-based pain management models for caregivers implementation is receiving greater attention in the literature because of international initiatives intended to increase the number of people who receive end-of-life care in home-based settings. The purpose of this "retrospective descriptive design" study was to describe pharmacological pain management and outcomes for 40 cancer and non-cancer patients receiving hospice care at home. While the median pain score was higher at admission in the cancer group than in the hospice care at home group, the difference was not significant at or within 48hour of admission. Overall, there was a significant decrease in pain from the first measurement to the second. Within the last seven days of life, the majority of participants were not able to provide a pain severity score when asked to evaluate the effectiveness of pain management, thus their caregiver provided a proxy evaluation. Pain management was effective in the home setting. More research is needed on the best methods to teach lay caregivers to assess pain and evaluate the effectiveness of pharmacological modalities to manage pain.