Home Care Support Research Articles

Impact of social support for mothers as caregivers of cerebral palsy children in Japan

PurposeSocial supports are critical to alleviate the psychological and physical burden of primary caregivers of children with disabilities. This study aims to (1) clarify how cerebral palsy in children affects caregiving burden of the mother, and (2) identify the social supports that can effectively reduce that burden. Design and methodsThis is a cross-sectional study in which mothers of children with cerebral palsy completed questionnaires and provided data regarding their child's condition, family support, social support usage, degree of satisfaction with supports, and caregiving burden. ResultsWe analyzed responses from 1190 mothers. Support usage, particularly of home-visit nursing, home care, home-visit rehabilitation, and mobility support, was higher in severely burdened groups. However, the proportion of satisfaction with social support in groups with light or no burden were higher, particularly in home care, home-visit rehabilitation, training/treatment, and short stays. Mothers whose children have an intellectual disability and gross exercise ≥1 in addition to tube feeding or intravenous nutrition especially felt a strong sense of burden. The most effective measure in reducing mother's sense of burden was short stays. ConclusionsMothers with children who can move and have an intellectual disability felt more burden compared with mothers of bedridden children. The findings clarify that supports, such as home care and short stays, have a significant impact on reducing the mother's sense of burden. Practice implicationsDue to the large sample size, we believe that the results can inform efforts to increase social support for caregivers.

Intersectoral costs of sexually transmitted infections (STIs) and HIV: a systematic review of cost-of-illness (COI) studies

BackgroundSexually transmitted infections (STIs) and HIV can generate costs both within and outside the health sector (i.e. intersectoral costs). This systematic review aims (i) to explore the intersectoral costs associated with STIs and HIV considered in cost-of-illness (COI) studies, (ii) to categorise and analyse these costs according to cost sectors, and (iii) to illustrate the impact of intersectoral costs on the total cost burden.MethodsMedline (PubMed), EMBASE (Ovid), Web of Science, CINAHL, PsycINFO, EconLit and NHS EED were searched between 2009 and 2019. Key search terms included terms for cost-of-illness, cost analysis and all terms for STIs including specific infections. Studies were included that assessed intersectoral costs. A standardised data extraction form was adopted. A cost component table was established based on pre-defined sector-specific classification schemes. Cost results for intersectoral costs were recorded. The quality of studies was assessed using a modified version of the CHEC-list.Results75 COI studies were considered for title/abstract screening. Only six studies were available in full-text and eligible for data extraction and narrative synthesis. Intersectoral costs were captured in the following sectors: Patient & family, Informal care and Productivity (Paid Labour). Patient & family costs were addressed in four studies, including patient out-of-pocket payments/co-payments and travel costs. Informal care costs including unpaid (home) care support by family/friends and other caregiver costs were considered in three studies. All six studies estimated productivity costs for paid labour including costs in terms of absenteeism, disability, cease-to-work, presenteeism and premature death. Intersectoral costs largely contributed to the total economic cost burden of STIs and HIV. The quality assessment revealed methodological differences.ConclusionsIt is evident that intersectoral costs associated with STIs and HIV are substantial. If relevant intersectoral costs are not included in cost analyses the total cost burden of STIs and HIV to society is severely underestimated. Therefore, intersectoral costs need to be addressed in order to ensure the total economic burden of STIs and HIV on society is assessed, and communicated to policy/decision-makers.

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

Background/aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

在宅療養支援病院から入院前と同じ療養環境へ退院できなかった事例の要因検討

在宅療養支援病院から入院前と同じ療養環境へ退院できなかった事例の要因検討

Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta-analysis.

To synthesize evidence on the ability of specialist care home support services to prevent hospital admission of older care home residents, including at end of life. Systematic review, without meta-analysis, with vote counting based on direction of effect. Fourteen electronic databases were searched from January 2010 to January 2019. Reference lists of identified reviews, study protocols and included documents were scrutinized for further studies. Papers on the provision of specialist care home support that addressed older, long-term care home residents' physical health needs and provided comparative data on hospital admissions were included. Two reviewers undertook study selection and quality appraisal independently. Vote counting by direction of effect and binomial tests determined service effectiveness. Electronic searches identified 79 relevant references. Combined with 19 citations from an earlier review, this gave 98 individual references relating to 92 studies. Most were from the UK (22), USA (22) and Australia (19). Twenty studies were randomized controlled trials and six clinical controlled trials. The review suggested interventions addressing residents' general health needs (p<.001), assessment and management services (p<.0001) and non-training initiatives involving medical staff (p<.0001) can reduce hospital admissions, while there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training-only initiatives. End-of-life care services may enable residents to remain in the home at end of life (p<.001), but the high number of weak-rated studies undermined confidence in this result. This review suggests specialist care home support services can reduce hospital admissions. More robust studies of services for residents at end of life are urgently needed. The review addressed the policy imperative to reduce the avoidable hospital admission of older care home residents and provides important evidence to inform service design. The findings are of relevance to commissioners, providers and residents.

Impact on caregivers of adult patients receiving parenteral support for short-bowel syndrome with intestinal failure: A multinational, cross-sectional survey.

BackgroundPatients with short‐bowel syndrome and intestinal failure (SBS‐IF) require parenteral support (PS) and may need long‐term home‐care support. This survey assessed the impact of care provision on adult caregivers of adult patients receiving PS for SBS‐IF.MethodsAn online, cross‐sectional survey of caregivers of adults with a self‐reported physician diagnosis of SBS‐IF was conducted in France, Germany, Italy, the UK, and USA. Impact on caregivers was evaluated using the 18‐item Caregiver Strain Index (CSI), the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP), and self‐reporting impact questionnaires.ResultsCaregivers (N = 121; aged 51 ± 13.7 years; 59% women) provided assistance for a mean of 9.9 ± 12.53 years; 77% were providing care 7 days per week. Patients (51 ± 16.4 years; 56% women) of caregivers were typically family members: spouse/partner (61%), adult son/daughter (19%), or parent (10%). Caregivers reported experiencing some strain (CSI score 4 ± 3.4). Among 71 of 73 employed caregivers, the WPAI:SHP assessment showed that caregivers missed 7% ± 12.7% of work hours in the preceding week and were present but not productive at work 37% ± 23.1% of the time; 28% of caregivers reported a reduced number of working hours because of caregiving. Many caregivers reported limitations in recreational activities (53%), and ≥30% had difficulty spending time with family and friends. Caregivers (87%) also reported worrying about the patient's health.ConclusionsCaregivers of adult patients with SBS‐IF experience negative daily personal impacts and loss of productivity arising from their caregiving responsibilities.

Practice Based Approaches to Supporting the Work Related Wellbeing of Frontline Care Workers in Care Homes: A Scoping Review

The COVID-19 pandemic has reinforced the need to ensure that strategic and operational approaches to retain high quality, resilient frontline care home workers are informed by context specific, high quality evidence. A targeted scoping review asked the question: what is the current evidence base for practice based approaches that support the work related wellbeing of frontline care workers in care homes? The aim was to map the extent and nature of the care home specific evidence base and identify key interventions, theories and practice components. Thirty studies were included. Thematic synthesis identified the following four key themes: Culture of Care; Content of Work; Connectedness with Colleagues and Characteristics and Competencies of Care Home Leaders. Evidence for best practice in supporting care home work related wellbeing is extremely limited, of variable quality and lacks generalisability. Overall, the evidence base was found to be theoretically, empirically and practically fragmented and as a result, there is at present, no consensus about which areas of work related wellbeing, if addressed, would have most impact. Compounding this lack of coherence, is the limited specificity of the studies. The implicit nature of the current evidence base is also a result of the limited number of care home specific studies, their variable focus and quality, and the marked heterogeneity in the outcome measures and related indicators used by different studies. This scoping review has distilled important areas that warrant further exploration and research from within a very limited and diffuse evidence base, for example, the potential of Person Centred Care (PCC) as a protective mechanism for both resilience and retention and the more nebulous concepts of support and job satisfaction. The insight provided by the scoping review will inform future strategic and operational approaches to retain high quality, resilient frontline care home workers. However, the evidence base must move from its current state of implicitness to one of detailed explication. Future research should focus on high quality, adequately powered and co-designed intervention studies to determine which practice-based approaches are of most importance, how they ‘work’ or ‘don’t work’ alone or in combination to support the work related wellbeing of frontline care workers in care homes.

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

Background/Aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

A Proposed Vision To Strengthen The Psychological And Social Support For Orphans In Care Homes

The study aimed to identify the necessity of building a proposed vision to enhance the psychological and social support of orphans in care homes, and the researcher reviews in this study the definition of the study terms represented in psychological and social support and orphanages and care homes, as well as the difficulties and challenges facing orphan care institutions in providing psychological and social support to orphans The researcher used the descriptive desktop approach to identify the literature related to developing the proposed vision to enhance psychological and social support for orphans in care homes. The study showed that providing psychological and social support helps orphans Depositors in care homes to face life stresses and positive adaptation to the circumstance of loss and overcome difficulties before them in order to develop their psychological and social compatibility, as well as enable them through programs to explore their capabilities and develop their capabilities and raise their competencies. The study recommended providing orphan care institutions with the amenities, entertainment and educational games aimed at contributing to creating a positive atmosphere aimed at achieving psychological and social compatibility for the orphans in which they are placed1. Ibrahim, Zakaria (1973 AD) The Artist and the Man, Egypt: Dar Gharib for Printing and Publishing.2. Istiti, Tasnim, Muhammad Jamal. Hassan (2007 CE): Orphan's Rights in Islamic Jurisprudence, Master Thesis, College of Graduate Studies, An-Najah National University, Nablus, Palestine.3. Al-Buraq, Amna (2011): The needs of adults of unknown parentage after leaving institutions for orphans, the first Saudi conference for orphan care.4. Jalal, Nusseibeh (2017): Psychological care for Syrian refugee orphans, "a field study", Research Center for Studies, Syria.5. Al-Halibi, Khalid bin Saud (1425 AH): How can you contribute to developing the positive character of an orphan by making use of educational experiences, a working paper in a symposium entitled: “Future visions for orphan care in the Kingdom of Saudi Arabia,” Ministry of Social Affairs, Ministry Agency For Social Affairs, Social Affairs Office, Dammam, Tuesday 21/8/1425 AH corresponding to 5/10/20046. Hamzah, Ahmad (2011): The Effectiveness of an Integrated Counseling Program in Reducing Violence for a Sample of Orphaned Delinquent Children, The First Saudi Conference for Orphan Care.7. Al-Khayyat, Abdul Aziz (1981): Interdependent Society in Islam, 2nd Edition, Al-Risalah Foundation, AmmanAl-Sadhan, Abdullah bin Nasser (2001); Children without families, Obeikan Library, Riyadh.9. Al-Sulami, Musleh Salih (1415 AH), raising orphans in the Kingdom of Saudi Arabia, an evaluation study, an unpublished master's thesis, Department of Islamic Education, College of Education, Umm Al-Qura University, Makkah Al-Mukarramah.10. Al-Suwairi, Ali Abdullah; (2009 AD); “Psychological and Social Problems among Orphans in the Charitable Society of Makkah Al-Mukarramah”, Master Thesis, College of Education, Department of Psychology, Umm Al-Qura University, Makkah Al-Mukarramah.11. Amer, Adel (2004 AD); Orphan children have no legal and legal protection, a study published (in :) The House of Legal, Islamic and Human Sciences Forum, http://adel-amer.catsh.12. Al-Anani, Hanan Abdel-Hamid (2005): Development of Social, Religious and Ethical Concepts in Early Childhood, Jordan: House of Fikr.13. Al-Matrafi, Fawzia Muhammad Abdel Mohsen; (2001): “Study of the relationship between the nutritional status and meals provided to children of orphanages in Makkah Al-Mukarramah region for school-age children (12-6 years old)”, PhD Thesis, College of Education for Home Economics, Department of Nutrition and Food Sciences, Makkah Al-Mukarramah.14. Al-Nuwaiser, Khalid bin Abdulaziz, (2011): The role of national systems in protecting and caring for orphans' rights, The First Saudi Conference for Orphan Care.15. Browne, K. (2009). The Risk of Harm to Young Children in Institutional Care. Typeset by Grasshopper Design Company. Printed by Stephen Austin &amp; Sons Ltd.16. Carter R. (2005). Family Matters: A study of institutional childcare in Central and Eastern Europe and the Former Soviet Union. London:Everychild.

病棟看護師の終末期がん患者の在宅に向けた退院支援と緩和ケアの知識・実践・困難感および今後を予測した看護実践との関連

病棟看護師の終末期がん患者の在宅に向けた退院支援と緩和ケアの知識・実践・困難感および今後を予測した看護実践との関連

The decision‐making processes and preferences of older Australians purchasing home support services: An explorative inquiry using a “think‐aloud” technique

ABSTRACTConsumer‐directed care (CDC) programmes, in principle, provide consumers with choices around who provides care services to them, what services and when. However, literature around consumer behaviour of older adults, especially concerning the factors that may support home care choices, is sparse. The purpose of this study was to understand the decision‐making processes and spending preferences of community‐dwelling seniors assessed eligible for CDC home care services. We completed an explorative inquiry using a “think‐aloud” technique with eligible consumers in South Australia. The inquiry had two components. First, consumers used imitation money to simulate the purchase of home care supports while talking out loud their decision‐making processes. Then, semi‐structured interviews were completed to identify underlying thoughts that informed the decisions made and spending preferences. Fifteen consumers, mean age 82 years (range 70–94), participated. The most frequently prioritised choice was domestic assistance. However, choices were made based on a perceived hierarchy of need (due to limits placed on available budgets for care). Interview data revealed that the decision making and service preferences were also based on limited knowledge about what was available. Consumers revealed perceived value in purchasing expert advice to guide their choices and preference for relational not transactional service delivery.

Typology of Family Support in Home Care for Iranian Older People: A Qualitative Study.

The world population is rapidly aging. In older people, age-related biological decline in most body systems causes functional decline, an increase in dependence, and an increased need for support, especially by their family members. The aim of this study was to explore the main aspects of family support for older parents in home care. This qualitative study was conducted using a deductive qualitative content analysis approach. Participants were 21 older parents living in their own homes, as well as four family members of some participants. Data were collected using semi-structured interviews and then were analyzed using the primary matrix developed based on the existing literature. The main aspects of family support for older parents were grouped into five predetermined categories and one new category: “instrumental support”, “financial support”, “psycho-emotional support”, “healthcare-related support”, “informational-technological support”, and “social preference support “. Family support for older people in home care is a multi-dimensional phenomenon. Family members can identify the needs of their older parents and provide them with appropriate support in collaboration with healthcare professionals to enhance their quality of life, autonomy, and satisfaction with life.

Improved quality of care and reduced healthcare costs at the end-of-life among older people with dementia who received palliative home care: A nationwide propensity score-matched decedent cohort study

Background: While palliative home care is advocated for people with dementia, evidence of its effectiveness is lacking. Aim: To evaluate the effects of palliative home care on quality and costs of end-of-life care for older people with dementia. Design: Decedent cohort study using linked nationwide administrative databases and propensity score matching. Setting/participants: All home-dwelling older people who died with dementia between 2010 and 2015 in Belgium (N = 23,670). Exposure: Receiving palliative home care support for the first time between 360 and 15 days before death. Results: Five thousand six hundred and thirty-seven (23.8%) received palliative home care support in the last 2 years of life, of whom 2918 received it for the first time between 360 and 15 days before death. Two thousand eight hundred and thirty-nine people who received support were matched to 2839 people who received usual care. After matching, those using palliative home care support, in the last 14 days of life, had lower risk of hospital admission (17.5% vs 50.5%; relative risk (RR) = 0.21), undergoing diagnostic testing (17.0% vs 53.6%; RR = 0.20) and receiving inappropriate medications, but were more likely to die at home (75.7% vs 32.6%; RR = 6.45) and to have primary care professional contacts (mean 11.7 vs mean 5.2), compared with those who did not. Further, they had lower mean total costs of care in the last 30 days of life (incremental cost:−€2129). Conclusions: Palliative home care use by home-dwelling older people with dementia is associated with improved quality and reduced costs of end-of-life care. Access remains low and should be increased.

MO1047DEVELOPMENT OF A HOME CARE SUPPORT SYSTEM FOR PERITONEAL DIALYSIS PATIENTS II - MEDICAL INFORMATION SHARING CLOUD SYSTEM AND ITS EVALUATION

Background and AimsCOVID-19 and the aging of the Japanese population are increasing the number of people requiring peritoneal dialysis at home. However, the rate of computer system utilization among the elderly is low in Japan, and the Ministry of Health, Labour and Welfare (MHLW) of Japan is currently considering permission for telemedicine. Therefore, home care support systems for home peritoneal dialysis patients are not sufficient, and even if a patient desires home medical care it may not be possible.The MHLW emphasized the need for home care patients to share information with medical institutions and improve quality of life (QOL), including COVID-19 measures. Therefore, we have built a system that allows home-based peritoneal dialysis patients and medical institutions to share medical information and provide home-based care with peace of mind. Here, we also discuss evaluation of the developed system.MethodA system for sharing medical information was developed in the PHP programming language on a personal computer system using Microsoft Azure cloud services, including databases and a social networking service (SNS). In the developed system, medical information, affected area, and photographs of meal contents for each patient can be uploaded and visually confirmed. The patient’s vital records can also be visually confirmed on a graph. In addition, it is possible for patients to share opinions and treatment schedules with the medical staff of medical institutions.The developed system was evaluated by 12 simulated patients consisting of one woman and four men in their 20s, two men in their 30s, one woman and one man in their 40s, and one woman and two men in their 50s. The evaluation items were task achievement and Web usability evaluation scale (WUS). The characteristics of each age group were analyzed according to the WUS. The medical information in this system was shared using SNS, which could only be accessed by invitation.ResultsThe information exchange system allowed the medical staff at the institute to receive and respond to the opinions of patients. In addition, medical staff were able to share important patient data. Figure 1 shows an example of the developed system displayed on the patient side (a) and on the medical staff side (b) at the institute. The patient filled in each item and uploaded photographs if necessary. The medical staff at the institute were able to view the medical information and uploaded photographs of each patient.MO1047 Figure 1: Example of system display (a) Patient side. Example of system display (b) Patient sideOne subject required a manual to operate the system, but the task completion rate was 100%. The system developed in this study could also be used by patients in age groups unfamiliar with personal computers. With the continued adoption of Internet access, the developed system built using a web application framework has been well received by patients.The WUS evaluation results are shown in Fig. 2. Subjects in their 20s showed the greatest increase in overall judgment of 4.0 in the 5-point WUS. The item showing differences between age groups was “display.” The standard deviation of “useful” was small, about 3.5 for all age groups. Using the system a second time was easier for the users than the first time. In addition, clinical evaluations showed that use of this system allowed home-based patients to be treated in the same way as those in hospital.MO1047 Figure 2: Clinical assessment of the system according to the WUSConclusionWhen using the system developed in this study, there was no relationship between age group and task achievement. The overall result of the 5-point WUS was very high (4.0). The system developed here can be recommended for use by home patients. The patient was able to receive almost the same treatment as in the hospital while at home. As a result, the system developed here can be used for treatment of peritoneal dialysis patients at home.

MO1045DEVELOPMENT OF A HOME CARE SUPPORT SYSTEM FOR PERITONEAL DIALYSIS PATIENTS I - USING DIGITAL WATERMARKING AND STEGANOGRAPHY*

Background and AimsAs it is necessary to refrain from going out due to the COVID-19 pandemic, a system that allows dialysis patients to be treated at a remote location or at home, i.e., a home care support system, is required. Information and communications technology (ICT) used for these purposes is widely applied in various medical fields. Using ICT has the advantage of allowing the sharing of patients’ electronic patient records (EPR) among medical staff, but increases the risk of copyright infringement and privacy leaks during archiving and transmission.We have developed a home care support system for peritoneal dialysis patients using information hiding technology consisting of both digital watermarking technology for copyright protection and steganography technology for communication security when treating patients at home using ICT. In addition, we evaluated the developed system.MethodThe system for sharing medical information was developed in the PHP programming language on a personal computer system using Microsoft Azure cloud services. Figure 1 shows an explanation of the digital watermarking technology and steganography technology used in the developed system.1. Digital watermarking technologyThe patient’s data, such as EPR data, facility name, etc., were hidden in the region of non-interest (RONI) of the patient’s chest CT image series and stored in a database.2. Steganography technologyWe call scene photos “cover pictures.” Medical information (CT images, etc.) was hidden in the cover picture. In this study, the cover picture containing the medical information was designated as a Stego image. A body CT image series (16-bit, 512 × 512, 100 slices) was used to verify the steganography technique. These CT images were compressed using 7-Zip and then saved in a folder, which was then embedded in the cover photo. The Stego image was then sent from the patient’s home to the medical institution via the home care support system.ResultsWe investigated the hash value, peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) of the image series (Fig. 2). If the structure of the image or photograph was exactly the same, the SSIM shows a value of 1. If the PSNR is ≥ 40 dB, the image quality can be maintained without affecting diagnosis. If part of the ROI is changed during transmission, the hash value decoded from the received Stego image will be different from that before transmission. For Stego images containing watermarked or hidden CT images with 4000 words embedded, SSIM and PSNR were ≥ 0.99 dB and 65.3 dB, respectively.If the medical information was embedded in a low bit plane, such as a 1-bit or 2-bit plane, the radiologist could not identify the embedded information.When our technology was applied, there were no changes in the capacity of CT images or Stego images before and after embedding. Therefore, it was not possible to tell that medical information was embedded due to changes in capacity.ConclusionUsing ICT, we have built a home care support system that can conceal medical information by combining digital watermarking technology and steganography technology to ensure the copyright of images and to ensure privacy and secure transmission of EPR and CT images. Using the developed system, daily medical information of dialysis patients could be transmitted safely to the institute, and the medical staff could share the information safely. Both techniques can be applied to all digital image information, and is not just limited to CT images.

The Case Manager: Driving Medical Reasoning in a Distributed Environment for Home Patient Monitoring.

The CAPABLE project has been funded by the EU Horizon 2020 Programme over the years 2020-24 to support home care. A system is being designed and implemented supporting remote monitoring and virtual coaching for cancer patients. The system is based on a distributed modular architecture involving many components encapsulating various knowledge. The Case Manager has been designed as a separate component with the aim of coordinating the problem solving strategies. A first version of the Case Manager has been released and used by the components in a prototypical scenario shown at the first project review.

Examining the Relationship between Older Adults' Readiness for Discharge after Surgery and Satisfaction with Nursing Care and the Associated Factors.

This study aimed to examine the relationship between older adults' readiness for discharge after surgery and satisfaction with nursing care and effects factors, using a descriptive, cross-sectional design that included 204 older adults. Examining the state of readiness for the discharge of older adults who underwent surgery in terms of the expected support sub-dimension of patients revealed that the presence of someone to support home care, the existence of health insurance, living with someone, undergoing emergency surgery, and being illiterate were statistically significant predictors. Thought of improvement in terms of nursing care between prior hospitalization and the latest hospitalization, use of intensive care unit, male, nursing care satisfaction, and the existence of health insurance were statistically significant predictors of the readiness for discharge in older adults after surgery in terms of personal status sub-dimension. Accordingly, an individual approach that takes these characteristics/variables into account is recommended when planning discharge.

Cost-effectiveness of a Province-wide Quality Improvement Initiative for Reducing Potentially Inappropriate Use of Antipsychotics in Long-Term Care in British Columbia, Canada.

BackgroundPotentially inappropriate use of antipsychotics (PIUA) raises serious concerns about safety, quality, and cost of care for residents in long-term care (LTC).ObjectiveThis study aimed to estimate the cost-effectiveness of the Call for Less Antipsychotics in Long-Term Care (Clear) initiative compared with the status quo (pre-Clear, baseline).MethodsA model-based cost-utility analysis, from a public-payer perspective in British Columbia, was conducted using secondary data of residents in LTC homes from 2013 to 2019. Residents’ health resource utilization and quality-adjusted life-year (QALY) measures were extracted from multiple administrative databases. Six Markov states were modelled for post-antipsychotic progression representing PIUA, appropriate use of antipsychotic, complete withdrawal, and death. The primary outcome was the incremental cost per QALY gained.ResultsA cohort of 35,669 residents was included in the primary analysis. The Clear initiative, over 10 years, was estimated to have an incremental cost-effectiveness ratio (ICER) of CA$26,055 (2020 Canadian dollars) per QALY gained at an incremental cost of CA$5211 per resident and a QALY gain of 0.20. In the subgroup analyses, our findings were even more favourable for Clear wave 2 (ICER of CA$24,447 per QALY gained) and Clear wave 3 (ICER of CA$25,933 per QALY gained). At a willingness-to-pay of CA$50,000 per QALY gained, the probabilities of Clear waves 2 and 3 were 82% cost-effective.ConclusionThis study demonstrated incremental costs and yielded favourable ICERs for Clear compared with the baseline. More research is needed to understand the level of support for individual care homes to sustain the Clear initiative in the long run.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00267-6.

Validation testing to determine the sensitivity of lateral flow testing for asymptomatic SARS-CoV-2 detection in low prevalence settings: Testing frequency and public health messaging is key.

Lateral flow devices (LFDs) are quickly being implemented for use in large-scale population surveillance programs for SARS-CoV-2 infection in the United Kingdom. These programs have been piloted in city-wide screening in the city of Liverpool and are now being rolled out to support care home visits and the return home of University students for the Christmas break. Here, we present data on the performance of LFDs to test almost 8,000 students at the University of Birmingham between December 2 and December 9, 2020. The performance is validated against almost 800 samples using PCR performed in the University Pillar 2 testing lab and theoretically validated on thousands of Pillar 2 PCR testing results performed on low-prevalence care home testing samples. Our data show that LFDs do not detect infections presenting with PCR Ct values over 29 to 30 as determined using the Thermo Fisher TaqPath asssay. This may be of particular importance in detecting individuals that are either at the early, or late stages of infection, and reinforces the need for frequent, recurrent testing.

The effect of a supportive home care program on caregiver burden with stroke patients in Iran: an experimental study

BackgroundStroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients.MethodsThis was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance.ResultsCaregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η2 = 0.305, P < 0.001).ConclusionsCaregiver burden increased significantly after the discharge without proper interventions in the caregivers of stroke patients. Providing support for home care providers can help to decrease or prevent the intensification of caregiver burden.