Relevant Caregivers Research Articles

Long-term effectiveness and generality of practical functional assessment and skill-based treatment.

There are several considerations to address when conducting functional communication training for challenging behavior in a school setting, such as the need for schedule thinning and maintenance across staff and the need to establish a variety of appropriate classroom skills. There are several strategies for conducting schedule thinning following functional communication training and for transferring effects across people or settings. However, there are few examples of these processes in natural settings with relevant caregivers and with long-term maintenance of effects. We implemented a functional assessment and skill-based treatment process with six children with autism in a specialized school setting and extended treatment until challenging behavior was reduced to near-zero levels across multiple staff and settings. Follow-up data indicate that effects were still observed 1 year posttreatment and the use of crisis procedures (e.g., physical restraint) was eliminated for all participants.

Policy Development on Upskilling/Reskilling Older Population Care Staff in China.

Mainland China has been concerned about the national growth rate of older adults aged 60 or above. The rapid growth of the cohort of older adults will significantly burden the Chinese healthcare system as they are at higher risk of suffering from chronic illnesses and functional disabilities. In geriatrics, aged populations often endure a wide range of diseases, dysfunctions, and cognitive impairment, so the corresponding healthcare services needed for them are substantial. The rise in the older adults’ life expectancy has compounded the burden of the healthcare system in mainland China in the long term. In this narrative essay, it is important to discuss how the state should assume a higher share of relevant responsibilities, by assessing how Chinese policymaking has been transformed to better satisfy the older population’s care and healthcare needs in mainland China. It is also pivotal to focus on analysing relevant Chinese policy development within the most recent dozen years to address how China’s state and local governments have been progressing in promptly providing health and older population care services to older Chinese adults. Because of the supply shortage and low quality of older population caregivers and alternative professionals, it is necessary to discuss and highlight the need to reskill or upskill relevant caregivers. As the trend of rural-to-urban labour migration continues, working adults of rural origins increasingly cannot provide domestic older population care, and human investment in training caregivers is an urgent task of Chinese policymaking. Therefore, how Chinese policymaking encourages upskilling or reskilling relevant caregivers is examined in this narrative essay.

Transition in cardiology 2: Maternal and fetal congenital heart disease.

The number of women with congenital heart disease (CHD) reaching reproductive age has been increasing. Many women with CHDs are desirous of pregnancy, but they face issues regarding preconception, antepartum, and postpartum management. On the other hand, the fetal diagnosis of CHD has improved with advances in the technique and equipment for fetal echocardiography. Recently, experiences with fetal intervention have been reported in patients with severe CHD, such as critical aortic stenosis. Nevertheless, some types of CHD are challenge to diagnose prenatally, resulting in adverse outcomes. Medical care is part of the transitional care for women and fetuses with CHD during the perinatal period. Pre-conceptional and prenatal counseling play an important role in transitional care. Sex and reproductive education need to be performed as early as possible. We herein review the current status, important issues to be resolved, and the future of maternal and fetal CHD to relevant caregivers.

Characteristics of Caregiving and Work-Related Burdens for Adult Children Caring for Older Parents

This study helps expand our knowledge on the link between caregiving and work by examining how characteristics of caregiving—intensity and regularity of care—relate to work. It is among the first studies to recognize that regularity of care might be linked with work independently of intensity of care. Moreover, unlike previous studies that imply the impact of caregiving on work based on the difference in the likelihood of working and total hours worked between caregivers and non-caregivers, our study uses the explicit reports from caregivers of the impact of caregiving on their ability to do paid work and, conditional on working, hours of work lost due to caregiving. We pool data from the first three waves of the National Study on Caregiving (NSOC) that has detailed information on family and other unpaid caregivers of Medicare beneficiaries ages 65 and older. We use a structural equation modeling approach to accommodate the complex nature of the relationships between work-related outcomes, intensity and regularity of care as the key predictors of interest, and other relevant caregivers’ and care recipients’ personal characteristics that are related with both the outcomes of interest and key predictors. Results provide tentative evidence that caregivers are more likely to miss work and, if working, work fewer hours if they provide more care and if they need to provide it more frequently. At any given level of caregiving intensity, more frequent care provision is related with more adverse work-related outcomes.

Wireless Wearable Ultrasound Sensor on a Paper Substrate to Characterize Respiratory Behavior.

Respiratory behavior contains crucial parameters to feature lung functionality, including respiratory rate, profile, and volume. The current well-adopted method to characterize respiratory behavior is spirometry using a spirometer, which is bulky, heavy, expensive, requires a trained provider to operate, and is incapable of continuous monitoring of respiratory behavior, which is often critical to assess chronic respiratory diseases. This work presents a wireless wearable sensor on a paper substrate that is capable of continuous monitoring of respiratory behavior and delivering the clinically relevant respiratory information to a smartphone. The wireless wearable sensor was attached on the midway of the xiphoid process and the costal margin, corresponding to the abdomen-apposed rib cage, based on the anatomical and experimental analysis. The sensor, with a footprint of 40 × 35 × 6 mm3 and weighing 6.5 g, including a 2.7 g battery, consists of three subsystems, (i) ultrasound emitter, (ii) ultrasound receiver, and (iii) data acquisition and wireless transmitter. The sensor converts the linear strain at the wearing site to the lung volume change by measuring the change in ultrasound pressure as a function of the distance between the emitter and the receiver. The temporal lung volume change data, directly converted from the ultrasound pressure, is wirelessly transmitted to a smartphone where a custom-designed app computes to show volume-time and flow rate-volume loop graphs, standard respiratory analysis plots. The app analyzes the plots to show the clinically relevant respiratory behavioral parameters, such as forced vital capacity (FVC) and forced expiratory volume delivered in the first second (FEV1). Potential user-induced error on sensor placement and temperature sensitivity were studied to demonstrate the sensor maintains its performance within a reasonable range of those variables. Eight volunteers were recruited to evaluate the sensor, which showed the mean deviation of the FEV1/FVC ratio in the range of 0.00-4.25% when benchmarked by the spirometer. The continuous measurement of respiratory behavioral parameters helps track the progression of the respiratory diseases, including asthma progression to provide alerts to relevant caregivers to seek needed timely treatment.

User-centered design of integrated eHealth to improve patients’ activation in transitional care

Introduction: The burden of chronic diseases is expected to escalate worldwide. Despite extensive use of emergency rooms and specialized care of persons with multiple or chronic diseases, the majority of the time care is managed in the patient’s home. For patients, living with chronic illnesses can be highly demanding, requiring them to manage their symptoms, disabilities and complex medical regimens at home. Effectively functioning in the role of self-manager requires a high level of knowledge, skill, and confidence. In order to handle these challenges, new models for care are required.eHealth solutions, successfully implemented in everyday clinical practice have shown significant effects on symptom management and self-efficacy, improving quality of care. Despite the wide proliferation and everyday use of consumer technology as well as eHealth solutions, the contribution of eHealth solutions in enhancing patients’ activation in self-management of their care is an underdeveloped field. Therefore, we undertake a long-term project of developing an eHealth solution where patients and care-givers are active stakeholders, and in parallel, paving the way for clinical ownership of the eHealth solution, in order to evaluate it in a randomized controlled study. The aim of this abstract is to describe the user-centered design in the development of an eHealth service.Theory and Method: We report process data from an ongoing study; aiming to improve transitional care by focusing on patient activation and participation during the critical post-hospitalization phase. We draw upon principals of the evidence-based Care Transition Intervention, which will be integrated into an eHealth solution, as a ‘digital coach’ to support patients’ self- management. We have identified four pillars that will form the foundation of the eHealth solution: care plan, medication self-management, symptom management, and contact information to relevant care-givers.In the first phase of the project, we have utilized a user-centered design process by engaging patients and care-givers in interviews, workshops and design activities. Results from these activities are documented in user-centered material such as patient journeys, effect maps, and prototypes of the eHealth solution. This material has been directly fed into the development of the technical solution, making us confident that the proposed solution will solve concrete user needs. At the same time, we make long-term collaborations with the care-givers and departments, from where the eHealth solution will be distributed to patients in the study.Progress report: A number of observational and design activities have been conducted with both patients and care-givers, at two different hospitals. User context has been documented in patient journeys, which describe a typical patient’s journey from first symptom through medical evaluation and treatment, up to living with the disease or complications of the treatment. The patient journey describes, in different stages, how the patient´s feels, their contact with health care, what information they receives and requires, and what examinations and treatments they undergoes. Visualizing health care from the patient’s perspective in this manner helps identifying gaps in e.g. information needs and to position the eHealth solution in situations where it can solve concrete needs. Furthermore, user needs have been captured in effect maps, which connect hands-on needs or functionality with high-level goals (e.g. ultimately enhanced patient activation and reduced re-hospitalization). As of now, in the second phase of the project, development of technical solution has commenced, and we are planning for pilot testing in the next couple of months.Discussion and conclusions: eHealth solutions play an important part in improving activation and awareness. However, it is not simply solved by the sheer introduction of eHealth solutions we have learned that it requires:- Successful implementation in the health care processes, as personnel should feel an ownership of the eHealth solution in order to perceive it as an effective tool in their communication with patients and collaboration with other care givers.- Presentation of relevant feedback to patients, in order for them to learn about their own disease and symptoms, and to be actively engaged in self-management at home Using motivational gamification in eHealth solutions will help to capture patients’ interest to take active role in their own care, and to motivate patients to learn and maintain self-management knowledge and skills.- Fitting it into the existing eco system of technical solutions for health care as well as patient- and lifestyle-centered applications.

English

In this work, a real time blood pressure, temperature measurement and reporting system for inpatients was developed. The function of this system is to constantly measure the blood pressure and temperature of a patient and send the measured values to the medical doctor or other relevant care givers through wireless link. The system is built around the STM32F103C8 Microcontroller programmed in C language which performs the overall control action and interfaces with other peripherals like MPX5050GP and the DS18B20 which acts as primary sensors for blood pressure and temperature respectively. The health monitoring system was designed, constructed and tested. The results of blood pressure and body temperature measurements were compared with those of an OMRON blood pressure monitor and a clinical thermometer respectively. The deviations in measurements are on average ±4 mmHg and ±0.17°C for blood pressure and temperature respectively. This is considered satisfactory as the measurement error is found to be within tolerable limits. Key words: Microcontroller, blood pressure sensor, temperature sensor, wireless link.

An Intelligent Information Forwarder for Healthcare Big Data Systems With Distributed Wearable Sensors

An increasing number of the elderly population wish to live an independent lifestyle, rather than rely on intrusive care programmes. A big data solution is presented using wearable sensors capable of carrying out continuous monitoring of the elderly, alerting the relevant caregivers when necessary and forwarding pertinent information to a big data system for analysis. A challenge for such a solution is the development of context-awareness through the multidimensional, dynamic and nonlinear sensor readings that have a weak correlation with observable human behaviours and health conditions. To address this challenge, a wearable sensor system with an intelligent data forwarder is discussed in this paper. The forwarder adopts a Hidden Markov Model for human behaviour recognition. Locality sensitive hashing is proposed as an efficient mechanism to learn sensor patterns. A prototype solution is implemented to monitor health conditions of dispersed users. It is shown that the intelligent forwarders can provide the remote sensors with context-awareness. They transmit only important information to the big data server for analytics when certain behaviours happen and avoid overwhelming communication and data storage. The system functions unobtrusively, whilst giving the users peace of mind in the knowledge that their safety is being monitored and analysed.

Severe food allergy and anaphylaxis: Treatment, risk assessment and risk reduction

An anaphylactic reaction may be fatal if not recognised and managed appropriately with rapid treatment. Key steps in the management of anaphylaxis include eliminating additional exposure to the allergen, basic life-support measures and prompt intramuscular administration of adrenaline 0.01 mg/kg (maximum 0.5 mL). Adjunctive measures include nebulised bronchodilators for lower-airway obstruction, nebulised adrenaline for stridor, antihistamines and corticosteroids. Patients with an anaphylactic reaction should be admitted to a medical facility so that possible biphasic reactions may be observed and risk-reduction strategies initiated or reviewed after recovery from the acute episode. Factors associated with increased risk of severe reactions include co-existing asthma (and poor asthma control), previous severe reactions, delayed administration of adrenaline, adolescents and young adults, reaction to trace amounts of foods, use of non-selective β-blockers and patients who live far from medical care. Risk-reduction measures include providing education with regard to food allergy and a written emergency treatment plan on allergen avoidance, early symptom recognition and appropriate emergency treatment. Risk assessment allows stratification with provision of injectable adrenaline (preferably via an auto-injector) if necessary. Patients with ambulatory adrenaline should be provided with written instructions regarding the indications for and method of administration of this drug and trained in its administration. Patients and their caregivers should be instructed about how to avoid foods to which the former are allergic and provided with alternatives. Permission must be given to inform all relevant caregivers of the diagnosis of food allergy. The patient must always wear a MedicAlert necklace or bracelet and be encouraged to join an appropriate patient support organisation.

The administration of rescue medication to children with prolonged acute convulsive seizures in a non-hospital setting: an exploratory survey of healthcare professionals’ perspectives

Timely administration of rescue medication for prolonged convulsive seizures lasting more than 5 min is necessary to prevent progression to status epilepticus in children. The Practices in Emergency and Rescue Medication for Epilepsy Managed with Community Administered Therapy (PERFECT™) initiative was set up to gain a better understanding of how prolonged convulsive seizures in children are managed when they occur outside of the hospital. We present the findings from an exploratory telephone survey of 128 healthcare professionals (HCPs) (85 pediatric neurologists and neurologists, 28 community pediatricians, and 15 epilepsy nurses) from six EU countries, conducted as part of the PERFECT™ initiative. Among HCPs, there was greater awareness of local protocols and lesser awareness of national or international guidelines. HCPs were not very aware of how prolonged convulsive seizures were managed outside of the hospital and had few professional links to schools or other settings where these seizures were most likely to occur. Approximately one third believed that lack of confidence and fear of liability were barriers to caregivers administering treatment in schools, as was insufficient training of caregivers in the wider community on the management of prolonged convulsive seizures. Results of this HCP survey have identified several clear gaps that need to be addressed: clearer guidance that spans all settings of care, greater dissemination of such guidelines across the chain of care, more open communication and better links between HCPs and schools, and systematic training of all relevant caregivers on the appropriate management of prolonged convulsive seizures.

A global travelers' electronic health record template standard for personal health records: Figure 1

Tourism as well as international business travel creates health risks for individuals and populations both in host societies and home countries. One strategy to reduce health-related risks to travelers is to provide travelers and relevant caregivers timely, ongoing access to their own health information. Many websites offer health advice for travelers. For example, the WHO and US Department of State offer up-to-date health information about countries relevant to travel. However, little has been done to assure travelers that their medical information is available at the right place and time when the need might arise. Applications of Information and Communication Technology (ICT) utilizing mobile phones for health management are promising tools both for the delivery of healthcare services and the promotion of personal health. This paper describes the project developed by international informaticians under the umbrella of the International Medical Informatics Association. A template capable of becoming an international standard is proposed. This application is available free to anyone who is interested. Furthermore, its source code is made open.

The effectiveness of the Screening Inventory of Psychosocial Problems (SIPP) in cancer patients treated with radiotherapy: design of a cluster randomised controlled trial

BackgroundThe Screening Inventory of Psychosocial Problems (SIPP) is a short, validated self-reported questionnaire to identify psychosocial problems in Dutch cancer patients. The one-page 24-item questionnaire assesses physical complaints, psychological complaints and social and sexual problems. Very little is known about the effects of using the SIPP in consultation settings. Our study aims are to test the hypotheses that using the SIPP (a) may contribute to adequate referral to relevant psychosocial caregivers, (b) should facilitate communication between radiotherapists and cancer patients about psychosocial distress and (c) may prevent underdiagnosis of early symptoms reflecting psychosocial problems. This paper presents the design of a cluster randomised controlled trial (CRCT) evaluating the effectiveness of using the SIPP in cancer patients treated with radiotherapy.Methods/DesignA CRCT is developed using a Solomon four-group design (two intervention and two control groups) to evaluate the effects of using the SIPP. Radiotherapists, instead of cancer patients, are randomly allocated to the experimental or control groups. Within these groups, all included cancer patients are randomised into two subgroups: with and without pre-measurement. Self-reported assessments are conducted at four times: a pre-test at baseline before the first consultation and a post-test directly following the first consultation, and three and 12 months after baseline measurement. The primary outcome measures are the number and types of referrals of cancer patients with psychosocial problems to relevant (psychosocial) caregivers. The secondary outcome measures are patients' satisfaction with the radiotherapist-patient communication, psychosocial distress and quality of life. Furthermore, a process evaluation will be carried out. Data of the effect-evaluation will be analysed according to the intention-to-treat principle and data regarding the types of referrals to health care providers and patient satisfaction about the with radiotherapists will be analysed by means of descriptive techniques. The process evaluation data will also be analysed by means of descriptive techniques.DiscussionUsing the SIPP may prevent underdiagnosis of early symptoms reflecting psychosocial problems, should facilitate communication between physicians and patients about psychosocial distress and may contribute to adequate referral to relevant (psychosocial) caregivers.Trial RegistrationNCT00859768

Hospital Discharge

Hospital Discharge

Health Policy Implications for Patient Education in Physical Therapy

ABSTRACT This paper explores the concept of health policy in light of the complexities of today's physical therapy practice, identifies many sources of health policy, and concludes with a discussion of our personnel responsibility for patient education. The paper explores three sources of health policy; personal standards of care, which we use in treating each patient or client; professional standards of care, which both influence and are influenced by individual standards; and external standards. which are a reflection of societal belief, personal standards, and professional norms. The paper continues with a discussion on the role of patient education as viewed by expert clinicians. The paper concludes with a reminder that, as long as research supports the efficacy of patent education, we must work with our professional organizations to effect the changes necessary in health policy to ensure that patient education is and continues to be a valued physical therapy intervention. INTRODUCTION What is health policy? Sometimes health policy feels like some very abstract concepts, and we might ask: How can these abstract, distant ideas affect how we make specific decisions about our individual patients? How can health policy tell us when to choose education as an intervention for our patients and clients? This paper explores the concept of health policy in light of the complexities of today's physical therapy practice, identifies many sources of health policy, and concludes with a discussion of our personnel responsibility for patient education. The working definition of patient education used in this paper is adapted from Burkhardt.1 Patient education is planned, organized learning experiences designed to facilitate voluntary adoption of behaviors, skills, or beliefs conducive to health. These educational activities can be part of either clinical patient care or community education. These activities can be provided directly to patients and clients or to their families and relevant caregivers. Extending patient/client education to caregivers is clearly necessary in the case of infants and children and people with cognitive impairments. People with chronic problems and other patients may also benefit from involving caregivers in their educational programs. Most of us made the decision to enter physical therapy because we wanted to provide care for individual patients. We were inspired in our career choice because we take pleasure in the one-on-one interactions we have with patients as we help them to recovery. Yet, each of us has responsibilities in our patient care to more than the individual patient. Each health care practitioner also has obligations to groups of patients. We build a database of similarities and differences seen in individual patients to help us gain clinical wisdom in treating patients who can be classified together into recognizable groups. Because we do not have infinite resources to provide ideal services to every patient, we need to find ways to share resources across groups of patents based on well-founded clinical priorities. We also need to ensure that the health care system within which our patients receive care is optimally designed. We must use the information obtained from treating individual patients and groups of patients to design appropriate changes to the system so that future patients will benefit (Figure 1). Most of us spend most of our time working with people we call patients, that is, people who have undergone some sort of injury or trauma. But we also work with people who may be at risk for disease or injury; often these people are referred to as clients. Epidemiologists have defined terms to describe intervention at different times in the cycle of disease. Primary prevention describes interventions designed to prevent the occurrence of disease or injury. Secondary prevention describes interventions designed to prevent or reduce sequellae from disease or injury once it has occurred. …