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At least 361 records · Page 20Linked to original sources

PubMed2005

Nurse follow-up of patients with diabetes: randomized controlled trial.

AIM: This paper reports a study comparing the outcomes of diabetic patients undergoing either early discharge or routine care. BACKGROUND: The hospital is not the best place to monitor the glycaemic control of patients with diabetes with no other morbidity or complications. It is an unnatural environment in which diet is planned and the activity level is low. The hospital is also an expensive place in which to treat patients. METHODS: This randomized controlled trial was conducted in the medical department of a regional hospital in Hong Kong. A total of 101 patients who needed glycaemic monitoring, but who were otherwise fit for discharge, were recruited. The control group continued to receive routine hospital care. The study group was discharged early and received a follow-up programme which included a weekly or biweekly telephone call from a nurse. FINDINGS: When compared with the control group, the study group had a greater decrease in HbA1c at 24 weeks, although the statistical difference was marginal (7.6 vs. 8.1, P = 0.06), a higher blood monitoring adherence score at both 12 weeks (5.4 vs. 3.6, P < 0.001) and 24 weeks (5.3 vs. 3.5, P < 0.001), and a higher exercise adherence score at 12 weeks (5.3 vs. 3.4, P = 0.001) and 24 weeks (5.5 vs. 3.2, P < 0.001). The study group had a shorter hospital stay (2.2 vs. 5.9, P < 0.001), and the net savings were HK$11,888 per patient. CONCLUSION: It is feasible to integrate treatment into the real life environments of patients with diabetes, and nurse-led transitional care is a practical and cost-effective model. Nurse follow-up is effective in maintaining optimal glycaemic control and enhancing adherence to health behaviours. Management of glycaemic control is better done in the community than in the hospital.

Adult↗

PubMed2003

Subacute ruminal acidosis (SARA): a review.

Subacute ruminal acidosis (SARA) is likely to arise when an easily palatable, high-energy diet meets a ruminal environment not adapted to this type of substrate. Increase of short-chained fatty acids (SCFA) will occur. Eventually, this may result in a transient nadir of ruminal pH below 5.5. Two situations are likely to represent the risk of SARA. First, fresh lactating cows are confronted with a diet considerably differing from that in the dry-period. A diet change carried out too rapidly or without proper transition management will put the animals at risk. Secondly, further in lactation, inaccurate calculation of dry-matter-intake (DMI) leading to wrong roughage/concentrate ratio, an inadequate content of structure within the diet or mistakes in preparing of total mixed rations may produce SARA. The consequences of SARA are diverse and complex. Laminitis is regularly connected to SARA and the negative impact of organic acids on the ruminal wall may lead to parakeratosis enabling translocation of pathogens into the bloodstream provoking inflammation and abscessation throughout the ruminant body. Moreover, milk-fat depression (MFD) can be related to SARA. In order to achieve a proper diagnosis, SARA has to be understood as a herd-management problem. A screening of the herd for SARA by means of a rumenocentesis, performed on a sample-group, preferably 12 individuals, may reveal the presence of SARA. The herd screening should include the risk group suspected, preferably. The prevention of SARA applies to the principles of ruminant feeding. Careful transition management from the dry to the lactation period and control of fibre-content and ration quality should be more yielding than the use of buffers or antibiotic drugs.

Acidosis↗

PubMed2006

Discontinuity of chronic medications in patients discharged from the intensive care unit.

BACKGROUND: Intensive care unit (ICU) admission may connote an elevated risk of unintentional chronic medication discontinuation because of its focus on acute illnesses and the multiple care transitions. OBJECTIVE: To determine the proportion of patients discharged from the ICU whose previously prescribed chronic medications were unintentionally discontinued during their hospitalization. DESIGN AND PARTICIPANTS: Hospital records of consecutive ICU discharges at 1 academic and 2 community hospitals in Toronto, Canada, throughout 2002 were reviewed. Eligible patients were prescribed at least 1 of 6 medication groups before hospitalization: (1) HMG co-A reductase inhibitors (statins); (2) antiplatelets/anticoagulants (aspirin, clopidogrel, ticlopidine, warfarin); (3) l-thyroxine; (4) non-prn inhalers (anticholinergic, beta-agonist, or steroid); (5) acid-suppressing drugs (H2 antagonists and proton pump inhibitors); and (6) allopurinol. MEASUREMENTS: Use of explicit criteria to assess the proportion of patients whose previously prescribed chronic medications were unintentionally discontinued at hospital discharge. RESULTS: A total of 1,402 charts were eligible for the study and 834 had prescriptions for at least 1 of the medication groups. Thirty-three percent (251/834) of patients had 1 or more of their chronic medications omitted at hospital discharge. Multivariable logistic regression analysis found that patients from the academic hospital (adjusted odds ratio [OR] = 0.70, 95% confidence interval [CI] 0.49 to 1.0) and those with medical diagnoses (adjusted OR=0.48, 95% CI 0.31 to 0.75) had a decreased risk for chronic medication discontinuation. CONCLUSIONS: Patients discharged from the ICU often leave the hospital without note of their previously prescribed chronic medications. Careful review of medication lists at ICU discharge could avoid potential adverse outcomes related to unintentional discontinuation of chronic medications at hospital discharge.

Aged↗

PubMed2004

Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities.

BACKGROUND: Care transitions are commonplace for ill older adults, but no studies to our knowledge have examined the occurrence of iatrogenic harm from medication changes during patient transfer. OBJECTIVES: To identify medication changes during transfer between hospital and nursing home and adverse drug events (ADEs) caused by these changes. METHODS: Participants were residents of 4 nursing homes in the New York City metropolitan area admitted to 2 academic hospitals. Nursing home and hospital medical records were reviewed to identify changes in medication regimens between sites. Medications were matched and compared regarding dosage, route, and frequency of administration. Two physician investigators used structured implicit review to identify ADEs attributable to transfer-related medication changes. RESULTS: During a total of 122 admissions, the mean numbers of medications altered during transfer from nursing home to hospital and hospital to nursing home were 3.1 and 1.4, respectively (P<.001 for comparison). Most changes in drug use were discontinuations, followed by dose changes and class substitutions. Of 71 bidirectional transfers that were reviewed by 2 physician investigators, ADEs attributable to medication changes occurred during 14 (20%). The overall risk of ADE per drug alteration (n = 320) was 4.4% (95% confidence interval, 2.5%-7.4%). Although most medication changes (8/14) implicated in causing ADEs occurred in the hospital, most ADEs (12/14) occurred in the nursing home after nursing home readmission. CONCLUSIONS: Medication changes are common during transfer between hospital and nursing home and are a cause of ADEs. Research is needed on interinstitutional patient care and systems interventions designed to prevent ADEs.

Adverse Drug Reaction Reporting Systems↗

PubMedDate not supplied

Older persons' opinions about life-sustaining procedures in the face of dementia.

OBJECTIVE: To investigate the attitudes of cognitively normal older adults toward various life-sustaining procedures in the face of dementia. METHODS: Participants were 84 cognitively normal men and women (70% response rate), 65 years and older, from a variety of urban and suburban settings, including private homes, assisted-living apartments, transitional care facilities, and nursing homes. In-person interviews were conducted with each participant to obtain information about demographic characteristics, life and health, and desire for various life-sustaining procedures for 4 hypothesized levels of dementia. RESULTS: Approximately three fourths of participants said they would not want cardiopulmonary resuscitation, use of a respirator, or parenteral or enteral tube nutrition with the milder forms of dementia, and 95% or more of participants would not want these procedures with severe dementia. In addition, only one third or fewer participants thought they would want to be hospitalized or given antibiotics if they were severely demented. Logistic regression analysis showed a relationship between participants' desire for life-sustaining procedures and having less education, greater independence, and a higher perceived quality of life. CONCLUSIONS: Most surveyed individuals did not desire life-sustaining treatments with any degree of dementia, and the proportion of individuals not desiring such treatments increased with the projected severity of dementia. These findings indicate a need for including dementia in advance directives planning.

Advance Directives↗

PubMed2000

Outcome for older burn patients.

BACKGROUND: Physicians will be increasingly responsible for an aging society whose members demonstrate a notable striving for independence. HYPOTHESIS: With standard treatment of burns, older patients will have a survival rate of more than 70%, with at least 60% of patients becoming fully functional 6 months after hospital discharge. METHODS: A 7-year retrospective medical review of burn unit patients was performed, and 221 ( 11%) of 1957 patients who were at least 59 years old were identified. RESULTS: Of 97 women (44%) and 124 men (56%), 64 (29%) had an associated smoke inhalation injury; 146 (66%), flame injury; and 44 (20%), scald injury. The bedroom and/or living room were the most common areas of injury (90 [41%]), followed by outdoors and the workplace (62 [28%]), the kitchen (40 [18%]), the bathroom ( 18 [8%]), and the garage or basement (11 [5%]) (P<.005). One hundred twenty-six injuries (57%) were associated with impaired judgment, mobility, or both. On hospital admission, 74 patients (36%) were intubated, 60 (30%) required intubation postoperatively, and 34 (18%) required both. The survival rate was 159 patients (72%) overall. Findings from an ethanol screening and a drug toxicology screening were positive in 22 and 32 patients (10% and 29%) on admission, respectively. Of the survivors, most were discharged to home with (87 [64%) or without visiting nurse supervision, and at 6 months after discharge, 16 patients (50%) in transitional care facilities were able to return to an independent level of functioning. Of the 59- to 69-year-old age group, 83 (86%) survived compared with 59 (69%) in the 70- to 79-year-old age group and 18 (47%) in the 80 years and older age group. CONCLUSIONS: In contrast to the usual male preponderance in patients with thermal injury, older women, many of whom are widowed, constituted almost half of the older patients admitted to the hospital. Modalities for injury prevention are necessary to provide optimal and safe household environments for a growing population of older persons.

Age Factors↗

PubMed1994

Re-examination of the psychometric characteristics of the La Monica-Oberst Patient Satisfaction Scale.

The purpose of this study was to provide further psychometric testing of the 41-item La Monica-Oberst Patient Satisfaction Scale (LOPSS). Data were drawn from three studies designed to study a model of nurse specialist transitional care (n = 307). Previously, the scale had been tested with oncology patients. This study included three groups of nononcologic female patients. Potential scores on the LOPSS range from 41 to 205; actual scores ranged from 93 to 205, with a mean of 175 (SD = 24), indicating a positively skewed distribution. Coefficient alpha for the entire scale was .98. An examination of the individual items indicated that the LOPSS might be shortened without subsequent loss of information. Thirteen items with low item-total correlations or low variability were dropped. The resulting 28-item scale had a mean of 118.7 and a SD of 17.3. Coefficient alpha was .97. The results of a factor analysis of the revised scale were similar to those reported by La Monica, Oberst, Madea, and Wolf (1986). The results indicate that the scale is useful for nononcologic patients. The difficulty remains the positively skewed distribution of scores. More sensitive items need to be developed.

Adult↗

PubMed2002

Disease progression in amyotrophic lateral sclerosis. Identifying the cost-utility of riluzole by disease stage.

This study reports the results of a long-term economic evaluation of riluzole in the treatment of amyotrophic lateral sclerosis (ALS) versus best supportive care in the United Kingdom. The analysis included in this contribution aims to provide an update of the determination of the phase of the disease that is prolonged by riluzole and also to assess the quality of the life extension offered by riluzole by taking into account the patients' utility score. Specifically, the analysis provides a more specific estimate of the cost-utility of riluzole dependent disease stage, thereby providing a useful insight of the cost-effectiveness of therapy. A Markov model was used to assess the cost-effectiveness of riluzole versus best supportive care. Transition possibilities and the distribution of patients by health states were taken from a cohort of 954 patients drawn from a large randomised, double blind, placebo-controlled, multicentre trial between 1992 and 1994. Costs associated with riluzole included the acquisition cost and bi-monthly monitoring for raised ALT levels. Patient assessed utilities were collected by use of the SG technique from two centres (King's, London and Preston) in the UK. Four distinct health states were used corresponding to mild, moderate, severe and terminal states. Applying the Markov model and extending the transitional probabilities using linear interpolation, the base case cost per life year gained was estimated at 15,192 pounds while applying Standard Gamble utility scores, the base case cost per quality-adjusted life-year (QALY) was assessed at 22,086 pounds. Carrying out a probabilistic sensitivity analysis, the cost per QALY was estimated at 22,236 pounds with standard deviation of 612 pounds. The results of the long-term analysis also show that riluzole on average increases survival in ALS patients by 6 months with approximately 5 months of the additional life gained in the early disease states, of which 4 months is spent in disease state 2, where quality of life is relatively high. However, the model is sensitive in the way in which the long-term transitional probabilities are estimated. Using averages of the first nine cycles, the cost per QALY would increase to 33,420 pounds with standard deviation of 972 pounds. Thus, this analysis highlights some of the difficulties associated with extending the short clinical effectiveness data; one way forward would be to obtain long-term observations data for both groups.

Journal Article↗

PubMed2005

Associated factors with urogenital score in natural and surgical menopause.

OBJECTIVE: To anticipate the factors associated with urogenital symptoms in both natural and surgical menopause. METHODS: A retrospective analysis was performed comprising 267 cases with spontaneous menopause and 87 surgical menopause cases without any use of hormone replacement therapy. Sociodemographic characteristics, reproductive and medical history, urogenital scale and psychological subscale of Greene Climacteric Scale were assessed and correlated with the age of menopause, time past since last menstrual period, parity, body mass index (BMI), mode of delivery among two groups. RESULTS: Mean age of women enrolled to the study were 46.8+/-0.3 years and 44.4+/-0.25 years, for natural and surgical menopause cases, respectively. Mean parity had no correlation with urogenital scale in two groups. However, a positive correlation was apparent between the time since last menstrual period, psychological subscore of Green Climacteric Scale and urogenital score in both women with natural and surgical menopause. BMI was negatively correlated with urogenital score among two groups (r(p)=-0.85, p=0.04). CONCLUSIONS: Intensity and frequency of urogenital symptoms and climacteric complaints as expressed in the Greene Climacteric Scale increase during menopausal transition. Care should be taken to ameliorate the quality of life (QOL) and to confront these problems in post-menopausal women.

Adult↗

PubMed2001

Revisiting treatment in the home.

In the past few years, the notion of home treatment has found new currency. This article reviews psychiatric nursing's roles and interest in this subject. Based on articles written more than 30 years ago, the issue of home treatment is examined from the standpoint of psychiatric nursing's particular talents for this modality and the "fit" of home treatment to the education of nurses. The advantages of home treatment are discussed, as are the purposes for choosing this intervention. Studies of home visiting by nursing researchers in other specialty areas are briefly summarized. Cost-effectiveness has been shown in all this work, but in most cases this transitional care has not been built into payment structures. The author continues to believe that treatment in the home is a natural and useful adjunct to psychiatric nursing, but its use will depend on the reimbursement system and, even more importantly, on the interest of psychiatric nurses in this modality of treatment.

Child↗

PubMed2004

Inflammatory bowel diseases in pediatric and adolescent patients: clinical, therapeutic, and psychosocial considerations.

Inflammatory bowel diseases (Crohn's disease and ulcerative colitis) primarily affect young adults, but in 15%-25% of cases, the initial disease starts in childhood. Many aspects of inflammatory bowel disease, including initial evaluation, nutritional support, medical and surgical intervention, and the direction of future research, are encountered in both adult and pediatric patients. However, it is important to delineate issues specific to pediatric patients, especially growth velocity impairment, derangements in and treatment of abnormal bone mineralization, and transitional care issues; the lack of extensive randomized, controlled pediatric therapeutic trials is also a concern. This article reviews the epidemiology of pediatric inflammatory bowel disease incidence and prevalence worldwide, clinical issues (including impairments of growth velocity and bone density), diagnostic and therapeutic interventions, and psychosocial issues unique to pediatric patients. Future research directions defined by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and opportunities provided by existing pediatric research databases are highlighted.

Adolescent↗

PubMed2003

Reproductive medicine in a late effects of cancer clinic.

This review discusses the most commonly observed problems in young people who have survived childhood cancer, with particular emphasis on the issues of fertility. It also describes the role of the late effects clinic in transitional care and the multidisciplinarity of the clinicians required to meet the needs of these young people. There is a need for evidence-based guidelines for management of long-term survivors.

Adolescent↗

PubMed2026

Medication safety in older adults in India: an integrative PhD synthesis of direct evidence and contextual implementation evidence.

BACKGROUND: Unsafe medication practices among older adults are an important global health concern, particularly in low- and middle-income countries where multimorbidity, fragmented care, self-medication, and informal healthcare provision intersect. OBJECTIVE(S): To synthesize direct evidence on medication safety among older adults in India and contextual evidence on deprescribing and community-level provider interventions relevant to safer medication use. METHODS: This PhD synthesis integrates four studies: a record-based cross-sectional study on polypharmacy and cardiovascular autonomic function in Kolkata; a six-city community study of 600 Indian older adults; a systematic review and meta-analysis on deprescribing preventive medications in frail or end-of-life older adults; and a systematic review of informal healthcare provider interventions in low- and middle-income countries. Studies I-II provided direct Indian older-adult evidence, while Studies III-IV provided indirect contextual evidence for their optimization and implementation. RESULTS: Polypharmacy was associated with higher anticholinergic burden and numerically higher cardiac autonomic neuropathy although residual confounding limits causal interpretation. In the multicity study, one-third had polypharmacy, while potentially inappropriate medications, prescribing omissions, and self-medication were common. Risks were higher with multimorbidity, recent hospitalization, care transitions, or living alone. Deprescribing showed no statistically significant increase in mortality, hospitalization, or major cardiovascular events, but heterogeneity was high and certainty low to very low. Informal-provider interventions showed the potential to improve knowledge, referral, case management, and medication-related practices. CONCLUSIONS: Medication safety among older adults in India requires an integrated continuum approach, but direct evidence supports only some components and implementation strategies that need prospective evaluation.

Humans↗

PubMed1997

Health and well-being of spouse caregivers and the widowed.

The appropriateness of the stress-coping and life transitions models for late life experiences was assessed by examining psychosocial correlates of spouse caregiving in association with widowhood. Data were from the Health Status of Older People (HSOP) survey of 1,000 people aged 65 and over living in the community in Melbourne, Australia. Caregiving was found to be a usual precursor to widowhood and may have prepared older people for widowhood. However, these two life experiences had different consequences. While widowhood appears to be the more severe transition, caring for a spouse often seriously threatens the meaningfulness of life.

Adaptation, Psychological↗

PubMed2005

Sociocultural aspects of transitions from assisted living for residents with dementia.

PURPOSE: Negotiating transitions and residential relocation are especially difficult for residents with dementia and their families. This article examined the decision-making process regarding retention or transfer of persons with dementia in assisted living facilities. DESIGN AND METHODS: Using an ethnographic approach, this study observed residents and facility life, and interviewed residents, staff, and family members in three assisted living facilities. RESULTS: Facility managers and administrators are pivotal figures in determining the timing of transitions and transitional care. Operating within the context of care requirements of dementia, they, the facility culture, and the family members' involvement in resident care mediate interpretations of and responses to change and decline, and ultimately influence decision making regarding retention or transfer. IMPLICATIONS: Transfer or retention may occur differently depending on whether managers are on- or off-site, the assisted living culture is dementia-friendly, and families are involved in care. Sensitizing assisted living managers and educating potential residents and family members to the importance of these factors may affect the eventual likelihood and timing of discharge.

Aged, 80 and over↗

PubMed2001

Progressive resistance muscle strength training of hospitalized frail elderly.

OBJECTIVE: To determine whether frail elderly patients recuperating from acute illnesses could safely participate in and gain appreciable improvement in muscle strength from progressive resistance muscle strength training. DESIGN: Muscle strength (one repetition maximum), functional abilities (sit-to-stand maneuver and 20-sec maximal safe gait speed), and body composition were measured before and at the conclusion of a 10-wk program of lower limb progressive resistance muscle strength training. The nonrandomized study was conducted in a 30-bed geriatric rehabilitation unit of a university-affiliated Veterans Affairs hospital and a 28-bed transitional care unit of a community nursing home. Participants included 19 recuperating elderly subjects (14 male, 5 female; 13 ambulatory, 6 nonambulatory) >64 yr (mean age, 82.8+/-7.9 yr). RESULTS: The one repetition maximum increased an average of 74%+/-49% (median, 70%; interquartile range, 38%-95%, and an average of 20+/-13 kg (P = 0.0001). Sit-to-stand maneuver times improved in 15 of 19 cases (79%). Maximum safe gait speeds improved in 10 of 19 cases (53%). Four of the six nonambulatory subjects progressed to ambulatory status. No subject experienced a complication. CONCLUSIONS: A carefully monitored program of progressive resistance muscle strength training to regain muscle strength is a safe and possibly effective method for frail elderly recuperating from acute illnesses. A randomized control study is needed to examine the degree to which progressive resistance muscle strength training offers advantages, if any, over routine posthospital care that includes traditional low-intensity physical therapy.

Activities of Daily Living↗

PubMed2002

Surviving the perfect storm: staff perceptions of mandatory overtime.

Historically, mandatory overtime has been used to provide adequate staffing in times of crisis; however, as a result of today's severe nursing shortage, hospitals and other healthcare institutions are more commonly using mandatory overtime as a daily management tool to meet staffing requirements. This practice has created turmoil between management and staff in providing quality healthcare. Nursing literature describing staff nurses' views of overtime is limited. This article offers a description of the environment at the Hospital for Sick Children, a private nonprofit rehabilitation and transitional care pediatric hospital in Washington, DC, and the challenges the hospital faces in staffing the patient care units. This article also reports the results of the hospital's efforts to poll the nursing staff on their opinions regarding both voluntary and mandatory overtime and identifies conditions that influence the nursing staff's decisions and perceptions about overtime. Survey results will be used to modify existing staffing strategies and implement new staffing policies.

Attitude of Health Personnel↗

PubMedDate not supplied

Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure.

Multidisciplinary disease management programs for congestive heart failure have been shown to substantially reduce readmission rates, resulting in a reduction of costs. These interventions, however, have typically included changes in medical management, making it difficult to quantitate the key elements of a successful program involving education, discharge planning, and transitional care in the outpatient setting. The investigators utilized an experienced cardiac nurse educator to coordinate a targeted inpatient congestive heart failure education program coupled with comprehensive discharge planning and immediate outpatient reinforcement through a coordinated nurse-driven home health care program. The comprehensive intervention resulted in a marked reduction in 6-month readmission rates, from 44.2% to 11.4% (p=0.01). The average total cost saving for each subject in the interventional group was $1541, based on the decreased utilization of both skilled nursing services and home health care during outpatient follow-up. The costs to implement an inpatient education program were negligible, at $158 per subject. There was no difference in discharge medications or medical management protocols that would have influenced these results.

Aged↗