Home Health Care Research Articles

Multi‐neighborhood simulated annealing for the home healthcare routing and scheduling problem

Multi‐neighborhood simulated annealing for the home healthcare routing and scheduling problem

Occupational therapists’ experiences of intra-professional collaboration during the discharge process from inpatient care to home healthcare

Introduction Swedish healthcare has undergone significant changes since the transferral of home healthcare from a regional to municipal responsibility, and since the new 2018 law regulating discharge from hospital. This meant changes to ways of working for Occupational Therapists (OTs), as OTs play a key role in planning for discharging patients, a crucial process before patients return home, and in the transition between care givers. Aim The aim of this study is to illuminate how OTs experience the intra-professional collaboration during the discharge process between inpatient care and home healthcare. Methods Interviews were conducted with OTs (N = 12), with even distribution between inpatient care and home healthcare, in three geographical locations in Sweden. Data analysis was performed according to qualitative content analysis. Results A central theme ran through all categories; the multi faces of intra-professional communication are challenging, intertwined and emotional. The categories illuminate experiences in terms of important but neglected patient participation and safety, different forms of mind-set depending on setting, complex rapid communication, unpredictable paths of discharge, unclear responsibility and organisational guidelines and, impact on work health and OT emotions. Conclusion Intra-professional communication is complex with many aspects and perspectives of importance for collaboration to run smoothly, but also the many individuals involved in the collaboration process of discharging a patient. This situates high demands on the professionals involved to distinguish and identify necessary information to make the discharge sound and safe for patient, as well as for relatives, involved services, and manageable for OTs.

Dynamically dealing with requests in a stochastic multi-period home healthcare problem with consistency constraints

This paper analyzes a Multi-Period Stochastic Vehicle Routing Problem in the healthcare sector. Patients with unknown locations and demands ask for domiciliary care services with unknown temporal distributions. Requests from patients arrive over time to a nurse agency that has to plan the activities of a fleet of nurses over several days. Based on daily information, the agency decides if a new patient can be accepted, earning the corresponding revenue, or assigned to an external provider. To guarantee high service satisfaction, the agency schedules the nurses' routing by guaranteeing consistency in nurse-patient assignments. The problem aims to plan nurses' routing to satisfy all requests of accepted patients while maximising the total profit measured as the difference between collected revenue and travelling costs. We propose different solution methodologies that either sequentially make short-sighted decisions or use a scenario-based strategy, leveraging historical data to predict future requests. All algorithms make use of an Adaptive Large Neighborhood Search and are validated on medium-sized instances. Managerial insights on the impact of consistency on the profit and its relation to date flexibility in patients' requests are provided. Interesting rules of thumb are derived from a case study conducted in the city of Brescia, Italy.

Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol of a prospective non-randomized complex intervention study with a pragmatic approach, Stay@Home – Treat@Home

BackgroundDemographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care.MethodsIn this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology.DiscussionDemographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies.Trial registrationGerman Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set.

Nurses' Experiences of Communicating With Families in Municipal Home Health Care.

To illuminate nurses' experiences of communicating with families in home health care. A qualitative inductive approach. An increasing number of ageing and sick people are being granted home health care. Nurses' duties involve caring for both patients and their families, which includes the important task of meeting and talking with them. Fourteen registered nurses working in home health care in Sweden participated in individual narrative semistructured interviews. The interviews were analysed with content analysis. To make sure all components of the study were clear, the Standards for Reporting Qualitative Research checklist was used as a guide. Communication with families was viewed as a crucial action for building rapport to facilitate the involvement and support of families in difficult situations. The nurses highlighted the struggles they sometimes faced in communication when they found it difficult to reach the family. When the communication was supportive for the family, the nurses felt that they were empowering the family members to empower themselves. This study highlights the vital role of communication in home health care nursing. Effective communication fosters trust and enables nurses to meet family needs. Effective communication between nurses and families in home health care is crucial from a health care perspective. Building reciprocal relationships fosters trust, enabling nurses to efficiently identify and address family needs and enhancing the quality of care. No patient or public contribution.

The Importance of Quality of Home Health Agencies for Patients in Socioeconomically Disadvantaged Neighborhoods

ObjectivesThis study investigated the role of patients' neighborhood socioeconomic status (SES) on the relationship between home health agency (HHA) care quality and health outcomes among home health care patients. DesignRetrospective cohort study. Setting and ParticipantsWe mainly used 2019 Outcome and Assessment Information Set data, Area Deprivation Index, and Quality of Patient Care Star Rating. We included Medicare beneficiaries (≥ 65 years of age) who received home health care. MethodsWe used linear probability regression models to examine whether patients' neighborhood SES moderates the association between care quality of HHAs and health outcomes for 1,657,133 home health care patients. ResultsOur findings show that patients in neighborhoods with lower SES were more likely to use low-quality HHAs (lease disadvantaged neighborhoods: 11%, most disadvantaged neighborhoods: 15.2%). Our main model, adjusted by patient- and HHA-level characteristics, reveals patients living in socioeconomically disadvantaged neighborhoods (less disadvantaged: coefficient: −0.017, P < .001; more disadvantaged: coefficient: −0.035, P < .001; most disadvantaged: coefficient: −0.06, P < .001) and receiving care from low-quality HHAs (average-quality HHAs: coefficient: 0.037, P < .001; high-quality HHAs: coefficient: 0.062, P < .001) were less likely to remain in the community during their home health care. Furthermore, our study highlights that patients in the most disadvantaged neighborhoods encounter additional challenges in remaining at their homes and communities when they use low-quality HHAs. Conclusions and ImplicationsThese findings highlight the need for targeted interventions and policy initiatives aimed at addressing disparities in care quality based on neighborhood SES. Efforts directed at enhancing the quality of care provided by HHAs and access to high-quality HHAs in socioeconomically disadvantaged neighborhoods could substantially impact health equity and outcomes for individuals in these settings.

Exploring the experiences of female undergraduate nursing students in providing home healthcare to older adults

ABSTRACTBackgroundIn light of the growing ageing population in Saudi Arabia and Saudi nurses’ hesitation to work with the older population, it is important to understand the experiences of nursing students on their clinical placement in home healthcare.MethodsThis study is a descriptive qualitative study based on five focus groups of 3–5 students each. Data were collected from female senior baccalaureate nursing students at a female governmental university in Saudi Arabia, and during their placement in home healthcare. Data were analysed using thematic analysis.ResultsFive main themes emerged : struggling with their own family; struggling with cultural and social beliefs; struggling during clinical training; struggling with domestic caregivers; and reflections for the future were considered important impressions in clinical experience.ConclusionThe culture of Saudi Arabian society is an important factor in shaping the training experience of female nursing students either positively or negatively, specifically in the context of home healthcare nursing for older patients. The results of this study show how important it is for students to be prepared for the clinical environment, the nature of the work, and the role of the home healthcare nurse in order to improve their clinical learning.

Frailty is Associated with Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Shoulder Arthroplasty

Frailty is an age-related state of multi-system decline that has been associated with negative outcomes after surgery. Numerous methods have been utilized to quantify frailty and predict postoperative outcomes with variable results. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is an independent predictor of postoperative complications and increased healthcare costs following elective primary total shoulder arthroplasty (TSA). The Nationwide Readmissions Database was queried to select patients undergoing elective primary TSA from 2016-2020. HFRS was calculated for each patient and patients with scores of five or greater were considered frail. Demographic characteristics, preoperative comorbidities, postoperative complications, and healthcare resource utilization metrics were compared between frail and non-frail patients using bivariate analysis. Binary logistic regression was used to determine if HFRS was independently predictive of adverse postoperative outcomes. There were 44,118 frail patients and 210,032 control patients undergoing TSA included in this study. After logistic regression analysis, HFRS was shown to be independently predictive of any complication (p<0.001), readmission (p<0.001), and mortality (p<0.001) within 180 days of elective primary TSA. HFRS was predictive of periprosthetic fracture (p<0.001), acute respiratory distress syndrome (p<0.001), acute renal failure (p<0.001), cellulitis (p<0.001), pneumonia (p<0.001), sepsis (p<0.001), transfusion (p<0.001), and urinary tract infection (p<0.001). Frail patients had higher resource utilization than control patients, including a higher mean total cost of hospitalization ($20,991 vs. $18,869; p<0.001) and a longer mean hospital LOS (3.1 vs. 1.4 days; p<0.001). Frail patients were more likely to be discharged to a facility (p<0.001) or with home healthcare (p<0.001). Frailty is independently associated with increased postoperative complications and healthcare utilization after elective primary TSA, and this study demonstrates the utility of HFRS as an adjunct for preoperative risk stratification and patient optimization prior to elective primary TSA. Frail patients had higher postoperative complications and healthcare costs after primary elective TSA compared to non-frail patients. The HFRS is easily calculated from routinely collected patient data and thus can help orthopedic surgeons and healthcare systems identify high-risk patients without significant burden to current provider workflows.

How aged care home staff and health care professionals understand the Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence (PRACTICE tool)? A cognitive interview study

IntroductionHigh use of psychotropic medications continues to be common in residential aged care homes despite the risk of harm and limited efficacy in people living with dementia. Research has shown that the organizational culture of aged care homes influences psychotropic medication use in residents with dementia. The PRACTICE (Psychotropic medicines use in Residents And Culture: Influencing Clinical Excellence) tool was developed to evaluate the organizational culture of aged care homes specific to the use of psychotropic medications. ObjectivesTo evaluate the comprehensibility, relevance, and comprehensiveness of the PRACTICE tool among end-users. MethodCognitive interviews were conducted with participants representing a broad range of health disciplines across Australia. Interviews were performed using a combination of the think-aloud technique and verbal probing. Interviews were transcribed and content coded for participants’ perceptions of the PRACTICE tool. Items were modified based on findings from the cognitive interviews, participants’ suggestions for rewording of items and discussions with the research team. ResultsA total of 20 cognitive interviews were conducted. Based on the cognitive interviews, 48 out of 63 items were modified. Reasons for modification were categorized into three themes: 1) Items changed to align with the aged care home staff’s scope of practice; 2) Items adjusted to prevent unintended blame from reading the items; and 3) Items modified to prevent potential misinterpretation of their intended meaning. Three items were added to improve the comprehensiveness of the tool. Most participants reported that they understood the items and considered them as relevant and acceptable for the evaluation of organizational culture and use of psychotropic medication in aged care homes. ConclusionThis study confirms that the PRACTICE tool is a comprehensive tool appropriate for the assessment of organizational culture specific to psychotropic medication use and is important for aged care settings.

Utilizing minimum spanning trees for effective mobile sink routing in wireless sensor networks

With many practical applications, wireless sensor networks (WSNs) represent an important field of study. Real-world applications of WSNs include smart home automation, healthcare, agriculture, industrial automation, and environmental monitoring. WSNs present countless chances for creative solutions across various industries as they develop and become more sophisticated. But because they are unattended, we must devise ways to make them work better without using the sensor nodes’ most important resource—battery power. A unique sink mobility model from a deployed WSN is proposed in this paper, based on constructing a minimal Spanning tree. The proposed approach derives a controlled movement model for the mobile sink based on minimal spanning tree (MST) features. Consequently, fixed nodes will be scheduled and visited to save routing overhead and improve network efficiency. Using the properties of the minimal spanning tree, the moving sink node can visit immobile sensor nodes, which is the most effective approach to gather data and send it to the base station. The effectiveness of WSNs was examined when implementing this mobility model, and we used the NS-2 simulator to run simulations to assess how efficiently the suggested strategy performed. Our findings demonstrate that WSN performance can be significantly enhanced by implementing the proposed method.

Exploring communication challenges in dementia care: Insights from home healthcare nurses

ObjectivesCare for people living with dementia predominantly takes place at home and is often characterized by multiple hospitalizations throughout the lengthy disease trajectory. Care transitions from the hospital often involve home health care. The purpose of this study was to explore communication challenges experienced by home health nurses to inform communication training needs for home-based dementia care. MethodsSeven audio-recorded focus group discussions were held with home health nurses (n = 31) from a large home care agency serving rural and urban counties. Focus group transcripts were thematically analyzed. ResultsWe identified the following themes highlighting communication challenges for home health nurses: addressing potential risk for harm or injury, patient vulnerability, care partner needs, shifting decision-making to surrogate, and discrepancy in home health goals and family needs. These themes identified specific care transition conversation topics and communication content imperative for dementia-specific staff training. ConclusionsTopics for communication skills training to improve person-centered dementia care were identified. These findings inform the future development of a home health staff communication curriculum for dementia care. Advanced communication skills are necessary to ensure these conversations take place and are engaged with sensitivity. Practice implicationsOur study informs the development of communication training on key communication topics in nurse-delivered and home healthcare interventions aimed at improving dementia care.

Impact of cognitive impairment on end-of-life care in patients with respiratory cancers

BackgroundsWith the aging population of Japan, an increase in patients with respiratory cancers coexisting with dementia is anticipated; however, the characteristics and terminal courses of these patients remain unclear. MethodsWe retrospectively assessed 142 patients with respiratory cancers receiving home health care, grouping them based on the presence of cognitive impairment and comparing their backgrounds. ResultsCognitive impairment was confirmed in 38 patients (26.8%), and these individuals were older and had a higher incidence of brain metastases than those without cognitive impairment. There was no statistically significant difference in 3-month survival rates. Patients with cognitive impairment exhibited significantly lower opioid use (23.5 vs. 76.4 mg/day, p < 0.001) and lower utilization of patient-controlled analgesia (43.3% vs. 67.4%, p = 0.029). DiscussionOur data reflect either milder symptoms or difficulty in accurately expressing pain or discomfort among patients with cognitive impairment, underscoring the importance of careful observation and management.

Applying natural language processing to understand symptoms among older adults home healthcare patients with urinary incontinence.

Little is known about the range and frequency of symptoms among older adult home healthcare patients with urinary incontinence, as this information is predominantly contained in clinical notes. Natural language processing can uncover symptom information among older adults with urinary incontinence to promote holistic, equitable care. We conducted a secondary analysis of cross-sectional data collected between January 1, 2015, and December 31, 2017, from the largest HHC agency in the Northeastern United States. We aimed to develop and test a natural language processing algorithm to extract symptom information from clinical notes for older adults with urinary incontinence and analyze differences in symptom documentation by race or ethnicity. Symptoms were identified through expert clinician-driven Delphi survey rounds. We developed a natural language processing algorithm for symptom identification in clinical notes, examined symptom documentation frequencies, and analyzed differences in symptom documentation by race or ethnicity using chi-squared tests and logistic regression models. In total, 39,179 home healthcare episodes containing 1,098,419 clinical notes for 29,981 distinct patients were included. Nearly 40% of the sample represented racially or ethnically minoritized groups (i.e., 18% Black, 14% Hispanic, 7% Asian/Pacific Islander, 0.3% multi-racial, and 0.2% Native American). Based on expert clinician-driven Delphi survey rounds, the following symptoms were identified: anxiety, dizziness, constipation, syncope, tachycardia, urinary frequency/urgency, urinary hesitancy/retention, and vision impairment/blurred vision. The natural language processing algorithm achieved excellent performance (average precision of 0.92). Approximately 29% of home healthcare episodes had symptom information documented. Compared to home healthcare episodes for White patients, home healthcare episodes for Asian/Pacific Islander (odds ratio = 0.74, 95% confidence interval [0.67-0.80], p < 0.001), Black (odds ratio = 0.69, 95% confidence interval [0.64-0.73], p < 0.001), and Hispanic (odds ratio = 0.91, 95% confidence interval [0.85-0.97], p < 0.01) patients were less likely to have any symptoms documented in clinical notes. We found multidimensional symptoms and differences in symptom documentation among a diverse cohort of older adults with urinary incontinence, underscoring the need for comprehensive assessments by clinicians. Future research should apply natural language processing to other data sources and investigate symptom clusters to inform holistic care strategies for diverse populations. Knowledge of symptoms of older adult home healthcare patients with urinary incontinence can facilitate comprehensive assessments, health equity, and improved outcomes.

Serious Game for the Nursing Assessment of Home-Dwelling Older Adults: Development and Validation Study.

The use of serious games (SGs) in nursing education is increasing, with the COVID-19 pandemic significantly accelerating their development. A key feature of SGs is their flexibility, allowing students to train at any place and time as needed. Recently, there has been a shift from developing disease-specific SGs to games focused on broader health issues. However, there has been a lack of proposals to enhance nursing interventions in home and frail care settings. The REACtion project developed a SG to improve students' understanding and clinical reasoning in caring for home-dwelling older adults. This study aims to describe the development of "REACtion Game" (RG) and explore its validity as an educational tool. A multidisciplinary team created a SG that simulates the assessment process of older adults in home settings by nurses. It features web-based scenarios, clickable objects, and a menu with tools, and medical records to enhance nursing students' knowledge and clinical reasoning skills. A prospective, observational study was conducted using the Dutch Society for Simulation in Healthcare's framework to validate the game. Further, 5 experts in home health care nursing evaluated content validity, while 30 students assessed construct validity, face validity, concurrent validity (by comparing game scores with those from the Nursing Clinical Reasoning Scale), game quality, and usability. Data were collected through self-administered web-based questionnaires and the debriefings of each match played. The students were enrolled in 2 postgraduate nursing programs: a master of science in nursing degree and a first-level continuing education in family and community nursing. Experts rated the content validity highly after revisions (universal agreement calculation method of scale-level content validity index=0.97). The sample consisted of 30 students, predominantly women (n=20, 67%) and aged younger than 45 years (n=23, 77%) with no prior experience in SG. Almost all students had a positive impression of RG as an attractive and useful method for learning new knowledge. Participants found the cases, scenarios, and dialogues realistic (face validity) and of high quality, though usability aspects such as instructions clarity and intelligibility of game progression were less favored. Construct validity showed general agreement on the game's educational value, with family and community nursing students reporting more consistent alignment with educational goals. Overall, RG scores correlated positively with time spent playing but showed limited correlation with Nursing Clinical Reasoning Scale scores. This study developed and validated a nursing education game, especially valuable as simulation is underused in some curricula. Created during the pandemic, it offered a digital learning environment. Although the game shows potential, further testing is needed for usability, concurrent validity, and functional improvements. Future research should involve larger samples to fully validate the game and assess its impact on academic achievement.

Incremental healthcare costs of the simple SOF measure of phenotypic frailty in community-dwelling older adults.

Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators. Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment. Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors. As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.

Using Virtual Reality Recreation Therapy to Enhance Social Interaction and Well-Being in Homebound Seniors

In view of Singapore’s rapidly ageing population, this study is an exploratory pilot designed to assess the feasibility and potential impact of virtual reality recreation therapy (VRRT) on homebound seniors. A tri-party research partnership was formed between the Singapore University of Social Sciences (SUSS), NTUC Health Home Care, and Vue Reality Labs. The aim was to explore the benefits of VR recreation therapy for homebound seniors, contributing to the goal of ‘aging in place’. Over two years, a 52-week VR curriculum was developed, featuring social, travel, and cultural topics tailored to the seniors. Five care associates from NTUC Health Home Care received facilitator training by Vue Reality Labs. A total of 71 homebound senior participants aged 50 to 102 engaged in over 1600 session hours during the 52-week trial; 62% had varying levels of dementia. A mixed-methods approach was adopted to explore the general impact and feasibility of VR recreation therapy, incorporating quantitative data on participants’ emotional, social, and cognitive conditions and qualitative data from facilitator interviews. The findings revealed that most senior participants enjoyed the VR sessions, perceiving them to positively impact their overall health and well-being. Caregivers reported improvements in cognitive, social, and emotional functioning of the participants. The positive effects extended to caregivers and facilitators, with renewed relationships and enhanced skills, respectively. The insights and observations gathered from this pilot study will serve as a foundation for designing a more robust study for deploying the VR recreation therapy programme in senior care.

Palliative Nursing in Home Health Care Across the Lifespan

Palliative Nursing in Home Health Care Across the Lifespan

Homeostatic Microfiber-Composed Synthetic Leathers with Chemical Robustness and Undercooling Self-Regulation.

Homeostatic microfiber leathers with temperature self-regulation promise broad applications, ranging from the apparel and automotive interior industries to the home furnishing and healthcare industries. Temperature self-regulation is achieved by phase-change materials containing microcapsules introduced within the leathers. The introduction of phase change microcapsules (PCMs) into microfiber leather faces two formidable challenges: (1) the shell of microcapsules must remain chemically stable against alkalis and organic solvents; (2) PCMs possess the ability to reduce supercooling during which latent heat is released, allowing for the precise and controllable release of latent heat. Here we present a high-performance homeostatic microfiber-composed synthetic leather containing PCMs that can address these two challenges, which not only demonstrate exceptional chemical robustness under alkaline conditions but also offer efficient and precise control over temperature fluctuation and latent heat release by reducing supercooling. Titanium carbide (TiC) known for its high thermal conductivity and alkali resistance has been selected as the shell material for the microcapsules, which can effectively resolve chemical stability issues. Meanwhile, the high thermal conductivity of TiC can be leveraged to enhance heterogeneous nucleation, thus narrowing the temperature range for latent heat release. The resultant microfiber leather shows outstanding capabilities for adjustable thermal energy storage. Our studies offer an effective approach to create homeostatic microfiber-composed synthetic leathers with chemical robustness and undercooling self-regulation, which would be useful in the fields of the textile, biomedical, and healthcare industries.

Validating the DIVERT scales, CARS, and EARLI for predicting emergency department visits in home health care in Japan: A retrospective cohort study

Validating the <scp>DIVERT</scp> scales, <scp>CARS</scp>, and <scp>EARLI</scp> for predicting emergency department visits in home health care in Japan: A retrospective cohort study

Assessment of the Ergonomic Exposures for Home Healthcare Workers in the United Kingdom

Home healthcare has been identified amongst the most hazardous industries in healthcare. Many of the tasks being conducted by home healthcare workers are associated with significant demands including physical demands such as mobility and repositioning activities as well as psychological demands which is attributed by dealing with a complex environment whilst administering medical and life saving care to patients, and social demands that encompasses dealing with dying and grieving patients. With the homes in United Kingdom having potentially unique exposures due to the healthcare system and design of the homes such as multi-floors, smaller condensed rooms, and limited ventilation, the purpose of this study was to investigate the exposures for home healthcare workers in the United Kingdom. Ergonomic hazards were observed through various tasks such as repositioning in bed (34.8%), transfer from bed to chair (30.4%), transfer from bed to chair (26.1%), and transfer from chair to chair (26.1%) and particularly for nursing aides. Lifting hoists were only used 13 times (19%) and predominantly by nursing aides (12 of 13, 92%). A slip sheet or slide board was used 7 times (10.1%), all being nursing aides using them.