Home Management Research Articles

Abstract 10591: Psychometric Testing of the Left Ventricular Assist Device Self-Care Behaviour Scale

Introduction: Adequate self-care behaviour is essential for patients with a left ventricular assist device (LVAD) to prevent complications, prolong life, and optimise quality of life. However, this field has lacked valid and reliable measures to assess self-care behaviour among patients with LVAD. To address this need, we recently developed the 33-item LVAD self-care behaviour scale based on a literature review and 2-round Delphi method. Objectives: To evaluate psychometric properties of the new 33-item LVAD self-care behaviour scale. Methods: A cross-sectional survey using a self-administered questionnaire was performed in Japan, Israel, and the United States. Measurement properties of the LVAD self-care behaviour scale were evaluated in reference to the COSMIN Study Design Checklist. In the present study, construct validity, convergent validity, internal consistency, and test-retest reliability were examined. Test-retest reliability was evaluated in a subsample of data (n = 18) from the first and second surveys. Results: Data on 127 patients with LVAD in Israel, Japan, and the USA were analysed (mean age 51±14.3, 81% male). Approximately half had a HeartMate II (47%), while 20% had a HeartMate 3. The median time patients lived with the LVAD was 9.7 months [IQR 3.9-21.8]. Exploratory factor analysis with promax rotation extracted three factors [Factor 1: Monitoring (8 items), Factor 2: Heart failure self-care (5 items), and Factor 3: LVAD self-care (7 items)], and during the analysis 13 items were excluded from the scale. Internal consistency assessed by Cronbach’s alpha was acceptable for the total scale (α=0.80) and the three subscales: Monitoring (α=0.81), Heart failure self-care (α=0.67), and LVAD self-care (α=0.63). The 20-item version of the LVAD self-care behaviour scale had sufficient convergent validity with the LVAD Patient Home Management Adherence Scale (r=0.47, p<0.001). The intraclass correlation coefficient of the total score was 0.58, suggesting adequate test-retest reliability. Conclusions: The 20-item version of the LVAD self-care behaviour scale showed adequate validity and reliability. The scale is ready for use in clinical practice and research. Additional testing might further optimise the scale.

Home management of pediatric sulfonylurea ingestions

Introduction Sulfonylureas are oral antidiabetic medications that act by stimulating insulin release from pancreatic beta cells. Unintentional pediatric ingestions may result in hypoglycemia. While guidelines often recommend up to a 24-hour hospital observation period for any ingestion, the Oregon Poison Center has historically managed select patients at home. This study aimed to describe outcomes of home-managed pediatric sulfonylurea exposures and characteristics of ingestions that are appropriate for home monitoring. Methods This is a retrospective chart review of pediatric (≤5 years) sulfonylurea ingestions in a single poison center over a 19-year period (2002–2020). We reviewed 491 individual cases for age, ingestion quantity, witnessed or unwitnessed ingestions, hypoglycemia (<60 mg/dL), disposition, and severe events (seizures or coma). We excluded cases in which missing pills were later found or another agent was identified. Results Of 474 patients meeting inclusion criteria, 135 (28%) were initially managed at home. Of these, 115 (85.3%) were ingestions of ≤1 tablet, where 68 (59%) were witnessed and 47 (41%) were unwitnessed. One hundred twenty five (92.6%) of these patients were successfully monitored at home, with 10 (7%) ultimately referred to a healthcare facility (HCF). Symptoms of hypoglycemia, measured glucose on home meter <60 mg/dL, fluctuations in monitored glucose, or parental concern were indications for HCF referral. Of those referred, 5 (4%) developed uncomplicated, asymptomatic hypoglycemia. Two of these received octreotide, at the discretion of the treating physician. No patients developed seizures or coma. Discussion We report 135 pediatric sulfonylurea ingestions managed with initial home monitoring, the majority of which were successfully monitored at home without any reported adverse events. Ten patients “failed home monitoring,” as defined by referral to a healthcare facility. Of these, five developed hypoglycemia, though no patients developed symptoms or serious adverse events. Conclusion Our findings support home observation for children ≤5 years with small ingestions of second-generation sulfonylureas.

Approach to urethral obstruction in cats. Part 3: addressing underlying concerns and preventing recurrence

Background: The management of cats with urethral obstruction does not end in the clinic. Unless the underlying cause of urethral obstruction is addressed, this problem is likely to recur and this requires a multimodal approach that includes a behavioural assessment and evaluation of the cat's home environment.Aim of the article: This is the final article in a three‐part series on urethral obstruction in cats. This article focuses on home management to prevent recurrent obstruction, and on addressing underlying feline idiopathic cystitis. The first article discussed presentation and stabilisation, while the second summarised urethral catheterisation and immediate postcatheterisation management.

Iot Smart Home Management System Based on Embedded Devices

This project is the use of Internet of Things technology how to better serve people's home life, which is a wide range of application prospects, social and economic benefits of the research direction. The system is mainly designed based on the planning of multiple detection points of the home environment, so as to provide personal intelligent housekeeping services from temperature, humidity, purification, cleaning, audio and visual for home life. Provide a set of solutions for smart homes, continuously optimize the comfort and services of the home environment, so as to improve people's home life.

Facilitating and Implementing a Process for the Delivery of Pediatric Oncology New Diagnosis Education Among Nursing Staff Through the Electronic Medical Record.

Background: An estimated 11,060 children between the ages of 1 and 14 years and 4,900 adolescents between the ages of 15 and 19 years are diagnosed with cancer in the United States. Parents with children newly diagnosed with cancer must acquire new knowledge related to the diagnosis, treatment plan, psychosocial care, and home management therapies to safely provide care following discharge. Expert consensus and review of current evidence demonstrate that utilizing a new diagnosis education checklist allows the delivery of essential information to patients and caregivers. The checklist divides educational topics into three sections: primary, secondary, and tertiary topics. This project followed the completion of an evidence-based fellowship through Children's Oncology Group focusing upon the feasibility and efficacy of implementing a standardized new diagnosis education checklist. The fellowship identified secondary topic documentation and an electronic medical record (EMR) checklist as areas of future work. Methods: This quality improvement project focused upon nursing staffs' documentation of secondary topics and the development/utilization of an EMR checklist. A pre-post survey design evaluated the outcomes of secondary topic documentation and EMR checklist implementation. Results: This nurse-led initiative created templates for primary and secondary topic checklists using Epic's SmartPhrase feature ".PHOPTED1" and ".PHOPTED2." Secondary topic completion and documentation increased 26% following implementation, and over 40% of the nursing staff indicated that they were very likely to continue to use the new templates. Discussion: Project templates are readily applicable to institutions that utilize Epic. Template examples and strategies to facilitate inpatient/outpatient checklist completion are discussed.

Design and Implementation of a Real-Time Smart Home Management System Considering Energy Saving

One of the most challenging problems related to the operation of smart microgrids is the optimal home energy management scheme with multiple and conflicting objectives. Moreover, there is a noticeable increase in homes equipped with renewable energy sources (RESs), where the coordination of loads and generation can achieve extra savings and minimize peak loads. In this paper, a solar-powered smart home with optimal energy management is designed in an affordable and secure manner, allowing the owner to control the home from remote and local sites using their smartphones and PCs. The Raspberry Pi 4 B is used as the brain of the proposed smart home automation management system (HAMS). It is used to collect the data from the existing sensors and store them, and then take the decision. The home is monitored using a graphical interface that monitors room temperature, humidity, smoke, and lighting through a set of sensors, as well as PIR sensors to monitor the people movement. This action enables remote control of all home appliances in a safe and emission-free manner. This target is reached using Cayenne, which is an IoT platform, in addition to building some codes related to some appliances and sensors not supported in Cayenne from scratch. Convenience for people with disabilities is considered by using the Amazon Echo Dot (Alexa) to control home appliances and the charging point by voice, implementing the associated code for connecting the Raspberry pi with Alexa from scratch, and simulating the system on LabVIEW. To reach the optimal operation and reduce the operating costs, an optimization framework for the home energy management system (HEMS) is proposed. The operating costs for the day amounted to approximately 16.039 €. There is a decrease in the operating costs by about 23.13%. The consumption decreased after using the smart HAMS by 18.161 kWh. The results of the optimization also show that the least area that can be used to install solar panels to produce the desired energy with the lowest cost is about 118.1039 m2, which is about 23.62% of the total surface area of the home in which the study was conducted. The obtained results prove the effectiveness of the proposed system in terms of automation, security, safety, and low operating costs.

Expert consensus on the whole-course management of home medical care for patients with pancreatic cancer in China

Pancreatic cancer is known as the " king of cancer" . The incidence and mortality of pancreatic cancer are increasing year by year worldwide. The prognosis of pancreatic cancer is very poor, and the effect of existing diagnosis and treatment methods is limited. The Oncologist Branch of the Chinese Medical Doctor Association, the Pancreatic Disease Special Committee of the China International Exchange and Promotive Association for Medical and Health Care, and the Abdominal Tumor Special Committee of the China Medical Education Association convened relevant experts to put forward useful suggestions for clinical reference on nine aspects of home management of patients with pancreatic cancer, including condition communication, follow-up, nutritional support, cancer pain management, psychological adjustment, ascites management, jaundice management, and daily food management. The aim is to improve the quality of life and prolong the survival time of patients with pancreatic cancer.

The design of a user-centred m-health application for caregivers of children undergoing ORL surgery

Abstract Background In the context of common surgical procedures in pediatric otorhinolaryngology (ORL) patients, providing for education to families for hospitalization, surgery, and postoperative home management has been shown to improve peri-operative outcomes. In this regard, the use of Mobile Health Applications (MHA) is increasing. However, for these tools to be needs-appropriate and effective, their development requires a user-centred approach. Methods Our study aimed to explore the informational needs and preferences - in terms of features and functionalities - of health care providers and ORL patients’ caregivers (end-users) to inform the development of an MHA supporting ORL peri-operative process effectively. The study was conducted at a 136-bed maternal and child health hospital in Trieste. A user-centred participatory study design was employed, and the methodology steps were informed by the 3 cycles of the Information System Research Framework (Schnall et al., 2016). Results The Relevance cycle was performed to better understand the environment as well as end users’ (64 participants) informational needs and desired features for the MHA. Five critical information/education moments of the ORL perioperative period were identified. In the Rigour cycle a literature review was performed to identify further key topics relevant to understanding ORL end-users’ needs and relevant features for the MHA. In the Design cycle the final contents were defined to be displayed on the MHA spread across the 5 identified moments. A randomized controlled trial will then be conducted to evaluate the effectiveness of the MHA compared to standard care. Conclusions Triangulation of data sources collected by experts, ORL patients’ caregivers, and healthcare professionals ensured the rigour of the methodology adopted in the study. Moreover, such a MHA user-centred developed MHA favours end-users positive health outcomes and organizational benefits of health services. Key messages

Evaluating machine learning models to classify occupants’ perceptions of their indoor environment and sleep quality from indoor air quality

ABSTRACT A variety of factors can affect a person’s perception of their environment and health, but one factor that is often overlooked in indoor settings is the air quality. To address this gap, we develop and evaluate four Machine Learning (ML) models on two disparate datasets using Indoor Air Quality (IAQ) parameters as primary features and components of self-reported IAQ satisfaction and sleep quality as target variables. In each case, we compare models to each other as well as to a simple model that always predicts the majority outcome. In the first analysis, we use open-source data collected from 93 California residences to predict occupant’s satisfaction with their indoor environment. Results indicate building ventilation rate, Relative Humidity (RH), and formaldehyde are most influential when predicting IAQ perception and do so with an accuracy greater than the simplified model. The second analysis uses IAQ data gathered from a field study we conducted with 20 participants over 11 weeks to train similar models. We obtain accuracy and F1 scores similar to the simplified model where PM2.5 and TVOCs represent the most important predictors. Our results underscore the ability of IAQ to affect a person’s perception of their built environment and health and highlight the utility of ML models to explore the strength of these relationships. Implications: The results from this study show that two outcome variables – occupant’s indoor air quality (IAQ) satisfaction and perceived sleep quality – are related to the measured IAQ parameters but not heavily influenced by typical values measured in apartments and homes. This study highlights the ability of machine learning models as exploratory analysis tools to determine underlying relationships within and across datasets in addition to understanding the importance of certain features on the outcome variable. We compare four different models and find that the random forest classifier has the best performance in both analysis on IAQ satisfaction and perceived sleep quality. It is a suitable model for predicting IAQ-related subjective metrics and also provides value insight into the feature importance of the IAQ parameters. The accuracy of any of these machine learning models in predicting occupants’ comfort or sleep quality is limited by the dataset size, how data is collected, and range of data. This study identifies the factors that are important to IAQ perception: ventilation rate, relative humidity, and concentrations of formaldehyde, NO2, and particulate matter. It indicates that sensors that can measure these variables are necessary for future, related studies that model occupants’ IAQ satisfaction. However, this study does not find strong relationships between any of the IAQ parameters measured in this study and perceived sleep quality despite the logical pathway between these many pollutants and respiratory issues. A prediction model of IAQ perception or sleep quality can be integrated into home management systems to automatically adjust building operations such as ventilation rates in smart buildings. Once buildings are equipped with a network of low-cost sensors that measure concentrations of pollutants and operating conditions of the ventilation system, the prediction model can be used to predict the occupants’ comfort and facilitate the control of the ventilation system.

Hoarding symptoms are associated with higher rates of disability than other medical and psychiatric disorders across multiple domains of functioning

BackgroundHoarding symptoms are associated with functional impairment, though investigation of disability among individuals with hoarding disorder has largely focused on clutter-related impairment to home management activities and difficulties using space because of clutter. This analysis assesses disability among individuals with hoarding symptoms in multiple domains of everyday functioning, including cognition, mobility, self-care, interpersonal and community-level interactions, and home management. The magnitude of the association between hoarding and disability was compared to that of medical and psychiatric disorders with documented high disability burden, including major depressive disorder (MDD), diabetes, and chronic pain.MethodsData were cross-sectionally collected from 16,312 adult participants enrolled in an internet-based research registry, the Brain Health Registry. Pearson’s chi-square tests and multivariable logistic regression models were used to quantify the relationship between hoarding and functional ability relative to MDD, diabetes, and chronic pain.ResultsMore than one in ten participants endorsed clinical (5.7%) or subclinical (5.7%) hoarding symptoms (CHS and SCHS, respectively). After adjusting for participant demographic characteristics and psychiatric and medical comorbidity, CHS and SCHS were associated with increased odds of impairment in all domains of functioning. Moderate to extreme impairment was endorsed more frequently by those with CHS or SCHS compared to those with self-reported MDD, diabetes, and/or chronic pain in nearly all domains (e.g., difficulty with day-to-day work or school: CHS: 18.7% vs. MDD: 11.8%, p < 0.0001) except mobility and self-care. While those with current depressive symptoms endorsed higher rates of impairment than those with hoarding symptoms, disability was most prevalent among those endorsing both hoarding and comorbid depressive symptoms.ConclusionsHoarding symptoms are associated with profound disability in all domains of functioning. The burden of hoarding is comparable to that of other medical and psychiatric illnesses with known high rates of functional impairment. Future studies should examine the directionality and underlying causality of the observed associations, and possibly identify target interventions to minimize impairment associated with hoarding symptomatology.

Individual and organizational features of a favorable work environment in nursing homes: a cross-sectional study

BackgroundThe organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments.MethodsThis study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment.Results45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment.ConclusionThe work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.

Increased Relapse Rate During COVID-19 Lockdown in an Italian Cohort of Children With Juvenile Idiopathic Arthritis.

ObjectiveChanges of routine disease management associated with COVID‐19 lockdown might have potentially affected the clinical course of juvenile idiopathic arthritis (JIA). The aim of our study was to assess the rate of disease flare before and during COVID‐19 lockdown to investigate its impact on disease course in children with JIA.MethodsA single‐center retrospective study was conducted, including patients presenting with inactive JIA between September 1, 2018 and March 9, 2019 (group A) and between September 1, 2019 and March 9, 2020 (group B). For each patient, demographic and clinical data were collected. The rate of JIA flare from March 10, 2019 to June 30, 2019 for group A and from March 10, 2020 to June 30, 2020 for group B was compared.ResultsGroup A included 126 patients, and group B 124 patients. Statistical analysis did not show significant differences among the 2 cohorts with respect to age, sex, age at JIA onset, JIA subtype, co‐occurrence of uveitis, antinuclear antibody positivity, and past or ongoing medications. The rate of disease flare during lockdown at the time of the first COVID‐19 pandemic wave was significantly higher in comparison to the previous year (16.9% versus 6.3%; P = 0.009).ConclusionOur study showed that COVID‐19 lockdown was associated with a higher rate of joint inflammation in children with JIA. This finding has a considerable clinical implication, as restrictive measures may be necessary in order to contain pandemics. Our data highlight the need for rearrangement in the home and health care management of children with JIA during lockdowns.

Virtual coaching system for continuity of care and rehabilitation in patients with stroke. Results of the pilot study in the home scenario

With the purpose of supporting self-care at home and health management as secondary prevention, the lack of continuity of care for patients with stroke requires innovative approaches that embed the home-rehabilitation into the clinical-care-chain. vCare, a European multicenter project (EU’s Horizon2020 - https://vcare-project.eu), proposes a new ICT-based concept offering personalized home rehabilitation solutions and care pathways through a Virtual Coach (VC) that integrates machine learning technologies with coaching and clinical pathway services. Coaching at home can help these patients to proceed with a personalized form of rehabilitation and the VC can be a key technology to ensure continuity of care, reinforce self-management, enhance adherence to the care plan and risk prevention and ultimately empower patients. From the technical point of view, vCare integrates a set of technologies in a single platform. The VC provides the patient with a number of services clustered into: 1) coaching services such as physical training based on motion tracking and cognitive training; 2) supporting services such as reminders; 3) clinical pathways services allowing the seamless configuration of the VC [1,2]. The aim of this study was to evaluate the health status (EQ-5D), the reduction of risk factors and the adherence to the prescribed care plan in patients with stroke, who experienced home rehabilitation, either mediated by the virtual coach (experimental group – EG) or conventional (control group – CG). Patients with stroke were enrolled among those who were hospitalized at the Casa di Cura del Policlinico (Milan, Italy). For a period of 30-60 days in their own home, patients experienced rehabilitation treatments and activities based on the neurologist, physiotherapist and neuropsychologist’s clinical indications, provided at the discharge after the hospital care. All participants signed an informed consent. All research procedures were approved by the Local Ethics Committee. The patients in the CG performed motor and cognitive exercises suggested by therapists during the first visit. For the EG, personalized treatments and activities were suggested by the VC through a tablet, following the therapists’ predefined schedule. The rehabilitation plan consisted mainly in motor and cognitive serious games executed in a virtual reality environment realized in the patient’s home through a 3D depth camera and a monitor for the motor games, and the tablet for the cognitive ones. Additional risk factor–related activities (e.g.: e-learning session) were also foreseen and suggested. Every day the VC proposed videos with different contents; the patient could evaluate them, allowing the VC to refine the choice of videos and increase the patient’s satisfaction. Moreover, based on the monitoring of patient’s physical activity by means of an activity tracker wristband, the VC counseled additional exercise or leisure activities. The EQ-5D descriptive system and the EQ-5D visual analogue scale (EQ- VAS) were used as measure of health status for both patients belonging to the EG and CG. All the enrolled participants (N=20; 71.9±10.2 years old; 13 males; 16 ischemic) completed the experimental protocol and no adverse events were encountered during the treatment period. Subjects showed mild impairment as documented by median NIHSS of 2.5 (IQR 2.0–4.8), and median FIM score of 115 (IQR 101.3–121.8). Preliminary results on the experimental group showed, for each week of treatment, an average of: 3.07±1.76 accesses to the VC’s platform, 3.60±2.07 e-learning videos viewed, 12.69±10.75 active interactions of patients with the VC (i.e., feedback, reminders, questionnaires). In addition, results showed that patients worn the activity tracker 28.6 ± 7.7% of days of monitoring. Data-analysis and interpretations on potential benefits (quality of life, reduction of risk factors, adherence to the care plan) related to both groups (i.e., experimental and control) will be presented during SIAMOC 2022. Considering: the preliminary results related to the activities performed by the experimental group, the state of the art regarding the adherence to conventional cares and the data already obtained in a clinical home-like scenario during the previous testing phase [3], we expect to demonstrate that the vCare solution is promising in educating and empowering patients to adhere and to pursue personalized physical and cognitive rehabilitation programmes, with the final aim of regaining independence and a better quality of life through a consistent healthier lifestyle.

Approach to urethral obstruction in cats. Part 2: catheterising and postobstruction management

Background: Catheterisation is the key definitive emergency procedure in relieving urethral obstruction. However, ensuring that the patient is stable to tolerate the procedure and having a plan in place if placement is challenging is also essential. Aim of the article: This is the second article in a three-part series. The aim of this article is to summarise urethral catheterisation, and immediate postcatheterisation management. The first article discussed presentation and stabilisation (Breheny and others 2022), while the third will focus on home management to prevent recurrent obstruction and on addressing underlying feline idiopathic cystitis.

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.

Evaluation of CirrhoCare® – a digital health solution for home management of individuals with cirrhosis

Individuals with cirrhosis discharged from hospital following acute decompensation are at high risk of new complications. This study aimed to assess the feasibility and potential clinical benefits of remote management of individuals with acutely decompensated cirrhosis using CirrhoCare®. Individuals with cirrhosis with acute decompensation were followed up with CirrhoCare® and compared with contemporaneous matched controls, managed with standard follow-up. Commercially available monitoring devices were linked to the smartphone CirrhoCare® app, for daily recording of heart rate, blood pressure, weight, % body water, cognitive function (CyberLiver Animal Recognition Test [CL-ART] app), self-reported well-being, and intake of food, fluid, and alcohol. The app had 2-way patient-physician communication. Independent external adjudicators assessed the appropriateness of CirrhoCare®-based decisions. Twenty individuals with cirrhosis were recruited to CirrhoCare® (mean age 59 ± 10 years, 14 male, alcohol-related cirrhosis [80%], mean model for end-stage liver disease-sodium [MELD-Na] score 16.1 ± 4.2) and were not statistically different to 20 contemporaneous controls. Follow-up was 10.1 ± 2.4 weeks. Fifteen individuals showed good engagement (≥4 readings/week), 2 moderate (2-3/week), and 3 poor (<2/week). In a usability questionnaire, the median score was ≥9 for all questions. Five CirrhoCare®-managed individuals had 8 readmissions over a median of 5 (IQR 3.5-11) days, and none required hospitalisation for >14 days. Sixteen other CirrhoCare®-guided patient contacts were made, leading to clinical interventions that prevented further progression. Appropriateness was confirmed by adjudicators. Controls had 13 readmissions in 8 individuals, lasting a median of 7 (IQR 3-15) days with 4 admissions of >14 days. They had 6 unplanned paracenteses compared with 1 in the CirrhoCare® group. This study demonstrates that CirrhoCare® is feasible for community management of individuals with decompensated cirrhosis with good engagement and clinically relevant alerts to new decompensating events. CirrhoCare®-managed individuals have fewer and shorter readmissions justifying larger controlled clinical trials. As the burden of cirrhosis grows worldwide, increasing demands are being placed on limited healthcare resources, necessitating the adoption of more sustainable care models that allow for at-home patient management. The CirrhoCare® management system was developed to fill this care gap, deploying a novel combination of hardware, apps, and algorithms, to monitor and intervene in individuals at risk of new decompensation. This study highlights the possibility of reducing hospital readmissions for cirrhosis by optimising specialist community care, reducing the need for interventions such as paracentesis, while providing a more sustainable care pathway that is acceptable to patients. However, given the pilot and non-randomised nature of this study, the outcomes require further validation in a larger randomised controlled trial, to assess both clinical effectiveness and cost-effectiveness. Moreover, the data generated will also facilitate data modelling and further research to refine the CirrhoCare® algorithms to increase their detection sensitivity and utility.

Parents'/caregivers' fears and concerns about their child's epilepsy: A scoping review.

BackgroundChildhood epilepsy is a serious and common neurological condition and can have life-long consequences and its impact can pervade all aspects of family life. Whilst the medical management of seizures is important, much of the day-to-day home management of epilepsy is invisible to people external to the family, including health care professionals, and parents’/caregivers’ fears and concerns can go unacknowledged and unaddressed by health care professionals.ObjectiveThis objective of this review was to examine parents’/caregivers’ fears and concerns regarding their child’s epilepsy, the impact of these fears and concerns on family life, the social and emotional well-being of parents/caregivers and any factors which mitigate these fears and concerns.DesignScoping review using a modified version of Arksey and O’Malley’s framework.Data sourcesRelevant studies were identified using key search terms in Scopus, Medline, CINAHL and PsychInfo databases in March 2021 with hand checking of reference lists. Search terms were developed using population (parents/caregivers of children aged ≤ 18 years with epilepsy, families); concept (parents’/caregivers’ fears, concerns, anxiety about their child’s epilepsy); and context (any setting). A further search was run in April 2022. Other inclusion criteria: English language empirical studies, 2010–2021.Study appraisal methodsA minimum of two reviewers independently screened articles and undertook data extraction and decisions were consensually made.Methodological quality appraisal was undertaken using the Mixed Methods Appraisal Tool v2018. A data extraction table was created to chart all studies. The conduct and reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (S1 Table). There is no published copy of the review protocol.Main findingsThe search identified a total of 4077 papers (after duplicates were removed) of which 110 were assessed for eligibility. Twenty-four papers published between 2010–2021 were included in the review and each paper was treated as a separate study. The review findings indicate that parents’/caregivers’ fears and concerns stem from more than their child’s seizures and relate to many wider aspects of family life. These fears and concerns had far-reaching influences on their parenting/caregiving, and on the lifestyle and activities of their child and their family. What was less evident was what parents/caregivers wanted in terms of support or how they thought health professionals could acknowledge and/or allay their fears and concerns. The discussion is framed within the compassion-focused therapy model as a basis for generating new thinking about the impact of these fears and concerns and the need for a new agenda for clinical consultations in childhood epilepsy.ConclusionsThe review concludes with a proposal that a more compassionate agenda underpins the dialogue between parents/caregivers and clinicians to encompass and mitigate the wider emotional, psychosocial, and societal threats that impact on the parent/caregivers of children with epilepsy.

Is Home Oxygen Therapy an Alternative to Hospitalization for Bronchiolitis?

Bronchiolitis is the leading cause of hospitalization in infants and children younger than age 2 years.1 Although recent data demonstrate that admissions for bronchiolitis are decreasing, the burden on the pediatric health care system remains substantial.2 The most common reasons for admission include hypoxia, increased work of breathing, and dehydration. Treatment remains largely supportive. Home treatment options targeting these areas have the potential to alleviate burden on both the health care system and individual family unit.In this issue of Pediatrics, Lawrence et al present a systematic review of literature relating to home oxygen and home nasogastric feeding for infants and toddlers with bronchiolitis.3 The review identified only 10 studies meeting inclusion criteria, all pertaining to home oxygen therapy (HOT). These studies demonstrated feasibility, acceptability, and safety among the high-altitude population but there are notably fewer data on HOT use at lower elevations. Although there is certainly a need for further research into HOT for bronchiolitis at sea level, it is also worth noting that 6 of these studies report data from growing or sustained HOT programs, with 2 reporting high levels of caregiver comfort and satisfaction, adding support to the acceptability, sustainability, and positive impact of HOT for bronchiolitis.The authors also note a paucity of data on health care cost-savings. A recent study from Rodríguez-Martínez et al used a cost-analysis modeling technique and found a potential significant cost savings in home therapy.4 Even without patient-level data, with the high cost of inpatient care, home care is likely to be less expensive than hospitalization in nearly all instances. It is also important to recognize that there are significant costs associated with hospitalization that are difficult to quantify, including the nonmedical costs to the family such as caregiver workdays missed, the cost of childcare for siblings, and disruption to parenting plans that may be associated with hospitalization of a child.Barriers to implementation and feasibility concerns clearly remain. Interestingly, the pandemic may provide some answers with recent literature describing the use of HOT for hypoxic adults with COVID-19, a process begun during the unprecedented volume of emergency department (ED) and hospitalized patients who accompanied the pandemic.5 This suggests that HOT programs may be implemented safely and quickly, even at sea level. Although some of the HOT literature describes ED-initiated HOT, thereby circumventing hospitalization entirely, short-stay, observation, and inpatient units may be the most feasible starting point for new HOT programs, allowing for more time to coordinate discharge planning and working with primary care providers for follow-up.The authors also suggest a potential role for home management of infants traditionally admitted for observation only, with neither supplemental oxygen nor hydration support. Although this is a cohort that could benefit from recent advances in telehealth capabilities, we would caution against the addition of home pulse oximetry monitoring, which is already overrelied on in decision-making in patients with bronchiolitis, difficult for providers to ignore, and linked to increase in hospitalization and length of stay.6 The use of home pulse oximetry could result in an increase in ED visits and hospitalizations in a system not prepared to provide other home care services such as HOT.Moving forward, the current health care climate of understaffed and overcrowded hospitals will likely necessitate changes in the way that we care for patients. The establishment of home care programs such as HOT may be a worthwhile investment for systems that are experiencing hospital bed shortages and boarding patients in EDs. The current data do demonstrate that HOT can decrease length of stay, and improve family-centered care. In regions where dehydration, more than hypoxia, drives bronchiolitis admissions, trials of home nasogastric hydration may be useful. Sharing of data on the implementation logistics used by successful HOT programs for bronchiolitis could be useful for other interested institutions to move forward with implementation of HOT programs and the research that may reaffirm their benefits.

Personality and Attitudes towards Machismo as Predictors of Sexual Harassment in University Students in Northern Peru

The objective of the study was to determine to what extent personality and attitudes towards machismo predict sexual harassment in a sample of 470 university students in Chiclayo. The research is a predictive, cross-sectional, non-experimental research. The instruments applied were the Big Five Personality Inventory (BFI), the Attitudes towards Machismo Scale and the Sexual Harassment and Social Interaction with Sexual Content in the University Environment Scale (EASIS-U), which were virtualized through "google forms". The results indicate that all significance indices, statistical power and effect size are adequate. Therefore, in women, neuroticism and macho attitudes towards male chauvinism explain 12.5% of sextortion. And for men, extraversion, macho attitudes towards home management and sex role socialization explain 13.5% of verbal sexual harassment.&#x0D; &#x0D; Received: 26 May 2022 / Accepted: 21 August 2022 / Published: 2 September 2022

Home management of COVID-19 symptomatic patients: a safety study on COVID committed home medical teams.

To reduce the overburden in the hospital, during the COVID-19 pandemic, some "COVID Committed Home Medical Teams" (CCHTs) were created in Italy. These units consist of a small pool of general practitioners who aim to evaluate all patients with COVID-19 who require a medical examination directly at home. After the first visit (which can end with patient hospitalisation or home management), CCHTs periodically monitor the patients' clinical conditions and vital signs (usually a revaluation every 24-48 hours, except for a sudden worsening). However, this strategy - which reduces the pressure on hospitals - has never been evaluated for patient safety. Our study aims to determine whether a home-based monitoring and treatment strategy for non-severe COVID-19 patients was safe as direct hospital admission by the emergency department. We conducted a retrospective observational study about 1,182 patients admitted to the hospital for COVID-19 between September 2020 and April 2021, confronting in-hospital and 30-day mortality in both CCHT-referred (n=275) and directly admitted by emergency department (n=907). Patients assessed by the CCHT had lower in-hospital and 30-day mortality (18% vs 28%, p=0.001; and 20% vs 30%, p=0.002); but, in the propensity score matching comparison, there was no characteristic between the two groups turned out significantly different. CCHT did not correlate with in-hospital or 30-day mortality. CCHT is a safe strategy to reduce hospital overburden for COVID-19 during pandemic surges.