Characteristics of people with dementia lost to follow‐up from a dementia care center

Improving the care of people with dementia in general hospitals: evaluation of a whole-system train-the-trainer model

International Psychogeriatrics ◽

10.1017/s1041610216002222 ◽

2016 ◽

Vol 29 (4) ◽

pp. 605-614 ◽

Cited By ~ 12

Author(s):

Elizabeth L. Sampson ◽

Victoria Vickerstaff ◽

Stephanie Lietz ◽

Martin Orrell

Keyword(s):

Dementia Care ◽

T Test ◽

Organizational Level ◽

Train The Trainer ◽

Sense Of Competence ◽

Information Leaflets ◽

People With Dementia ◽

Paired T Test

ABSTRACTBackground:There are concerns about the quality of care that people with dementia receive in the general hospital. Staff report a lack of confidence and inadequate training in dementia care.Methods:A train-the-trainer model was implemented across eight acute hospital trusts in London via a large academic health and science network. Impact was evaluated using mixed methods. Data were collected at (a) individual level: “Sense of Competence in Dementia Care” (SCID), (b) ward level: Person Interaction and Environment (PIE) observations, (c) organization level: use of specific tools, i.e. “This Is Me,” (d) systems level: numbers and types of staff trained per trust. Results were analyzed with descriptive statistics and paired t-test with thematic framework analysis for PIE observations.Results:The number of staff trained per trust ranged from 67 to 650 (total 2,020). A total of 1,688 (85%) baseline questionnaires and 456 (27%) three month follow-up questionnaires were completed. Mean SCID score was 43.2 at baseline and 50.7 at follow-up (paired t-test, p < 0.001). All sub-scales showed a small increase in competence, the largest being for “building relationships.” Organizational level data suggested increased use of carer's passport, “This Is Me” documentation, dementia information leaflets, delirium screening scales, and pathways. PIE observations demonstrated improved staff–patient interactions but little change in hospital environments.Conclusions:There was a significant improvement in staffs’ sense of competence in dementia care and the quality of interactions with patients. More hospitals adopted person-centered tools and pathways. Work is required to investigate if these changes improve hospital outcomes for people with dementia.

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Norwegian remote and rural dementia care

Remote and Rural Dementia Care ◽

10.1332/policypress/9781447344957.003.0004 ◽

2020 ◽

pp. 57-72

Author(s):

Oyvind Kirkevold ◽

Kari Midtbo Kristiansen

Keyword(s):

Dementia Care ◽

Rural People ◽

Medical Practitioners ◽

Rural Workforce ◽

People With Dementia ◽

District Nurses ◽

Rural Places ◽

General Medical Practitioners ◽

Home Helpers

A fifth of Norwegians (one million people) live rurally and approximately 80,000 rural people currently live with dementia. Diagnosis and follow-up support for people with dementia takes place in municipalities (local government areas). Most municipalities have a memory team that assists general medical practitioners in assessing dementia. In-home care is from district nurses and home helpers employed directly, or through contracts, by the municipalities. An early adopter of national dementia planning, Norway has instituted and adapted several innovative approaches that help to contextualise care to rural places, including service collaborations, joint upskilling and developing local workers that focus on people with dementia. While rural Norwegians with dementia experience many challenges shared internationally, such as long distances to access specialists, rural people tend to benefit from ‘everybody knows everybody’ communities and a relatively stable rural workforce.

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Clinical Characteristics and Outcome of Staphylococcus aureus Prostate Abscess From Ten Years of Experience at a Tertiary Care Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz372 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 1

Author(s):

Bryan Walker ◽

Eric Heidel ◽

Mahmoud Shorman

Keyword(s):

Staphylococcus Aureus ◽

Rare Complication ◽

Care Center ◽

Tertiary Care ◽

Care Hospital ◽

Risk Patients ◽

History Of ◽

A Site ◽

Lost To Follow Up

Abstract Objective Prostatic abscess (PA) is an uncommon infection that is generally secondary to Escherichia coli and other members of the Enterobacteriaceae family. In recent years, although rare, more reports of Staphylococcus aureus (S. aureus) PA have been reported, especially with increasing reports of bacteremia associated with injection drug use (IDU). Method This was a retrospective review of adult patients admitted to a tertiary care hospital between 2008 and 2018 and who had a diagnosis of S. aureus PA. Results Twenty-one patients were included. The average age was 46 years. Fourteen (67%) patients presented with genitourinary concerns. Main risk factors included concurrent skin or soft tissue infections (52%), history of genitourinary disease or instrumentation (48%), IDU (38%), and diabetes mellitus (38%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 57% and concomitant bacteremia in 81% of patients. Surgical or a radiologically guided drainage was performed in 81% of patients. Antibiotic treatment duration ranged from 3 to 8 weeks. Six patients were lost to follow-up. Clinical resolution was observed in the remaining 15 (81%) patients who had follow-up. Conclusions S. aureus PA continues to be a rare complication of S.aureus infections. In most published reports, MRSA is the culprit. In high risk patients with persistent bacteremia, physicians need to consider the prostate as a site of infection.

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Outcome of distal femoral fractures treated with locking compression plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172076 ◽

2017 ◽

Vol 3 (4) ◽

pp. 676

Author(s):

Girisha B. A. ◽

Somanath Manchani ◽

Rahul Shah ◽

Muralidhar N.

Keyword(s):

Care Center ◽

Femoral Fractures ◽

Functional Score ◽

Lateral Plate ◽

Health Care Center ◽

Distal Femoral Fractures ◽

Satisfactory Outcome ◽

Locking Compression Plates ◽

Lost To Follow Up

Background: Fixation of distal femoral fractures with a lateral plate alone is associated with nonunion and/or malunion with varus collapse. Locking compression plates may reduce the tendency of varus collapse. Hence, we evaluated the union rates and functional and anatomical outcome in patients of distal femoral fractures who were treated with locking compression plates.Methods: This prospective study was conducted at a tertiary health care center at Bangalore between July 2010 and June 2012. Patients with distal femoral fractures were treated with locking compression plates and were followed up for at least 6 months. Outcomes were evaluated using Neer’s score to assess outcomes in adult distal femoral fractures.Results: The study included 22 patients (10 males and 11 females) among whom one patient was lost to follow up within 6 months after the procedure. All the fractures were post-traumatic. Nineteen (91%) patients had closed fractures whereas two (9%) had open fractures. Muller’s A1 type was the most common (n=7) type of fracture followed by C2, C1, A2 (n=4 each) and B1, A3 (n= 1 each). Median duration of follow-up was 8 months (range: 6-18 months). The mean NEER’s functional score was 80 points. Overall results were excellent in 5 (24%) out of 21 cases and were satisfactory in 15 (71%) cases and only one had an unsatisfactory result.Conclusions: Locking compression plates offer excellent-satisfactory outcome in patients with distal femoral fractures.

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Adherence to Long-Term Follow-up in Patients With Sporadic Vestibular Schwannomas Managed With Serial Observation

OTO Open ◽

10.1177/2473974x211036653 ◽

2021 ◽

Vol 5 (3) ◽

pp. 2473974X2110366

Author(s):

Mallory Raymond ◽

Arian Ghanouni ◽

Kaitlyn Brooks ◽

Sarah M. Clark ◽

Douglas E. Mattox

Keyword(s):

Vestibular Schwannoma ◽

Tumor Size ◽

Care Center ◽

Demographic Data ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Long Term Follow Up ◽

Lost To Follow Up

Objectives To examine the long-term adherence to serial imaging of patients with sporadic vestibular schwannoma and analyze factors associated with being lost to follow-up. Study Design Retrospective chart review with telephone interview. Setting Single tertiary care center. Methods Patients with a sporadic vestibular schwannoma and started on observational surveillance management between January 2005 and December 2010 were included. Demographic data, tumor size, hearing and vestibular changes, and follow-up length were recorded. Patient factors were analyzed for association with being lost to follow-up. Results In total, 122 patients were included with a median length of follow-up of 5 months (range, 0-146). After initial surveillance, 22.1% (n = 27) of patients had a change in management to either microsurgery or radiosurgery. Of the remaining 77.9% (n = 95), nearly half (44.2%, n = 42) never returned for a second visit, and all but 3 were eventually lost to follow-up. There was no association between sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital and being lost to follow-up. Of 26 interviewed patients initially lost to follow-up, 11 (42.3%) sought care at another institution, 5 (19.2%) chose to no longer receive care, 1 (3.8%) had transportation difficulties, and 9 (36.4%) had poor understanding of their diagnosis or instructions. Conclusions The length of follow-up for patients undergoing surveillance of sporadic vestibular schwannoma varies widely, and patients are commonly lost to follow-up. Further efforts should be made to identify at-risk patients and provide adequate education to improve long-term surveillance.

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Patients Lost to Follow-Up for Cervical Cancer in the Limbe Regional Hospital

Journal of Global Oncology ◽

10.1200/jgo.18.00067 ◽

2019 ◽

pp. 1-5

Author(s):

Robert Tchounzou ◽

André Gaetan Simo Wambo ◽

Théophile Nana Njamen ◽

Ingrid Ofakem Ilick ◽

Humphry Tatah Neng ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Care ◽

Care Center ◽

Treatment Options ◽

Public Health Problem ◽

Care Providers ◽

Unequal Distribution ◽

Care Services ◽

Lost To Follow Up

PURPOSE Cervical cancer constitutes a public health problem in Cameroon where it represents 13.8% of cancers in women. We wanted to evaluate compliance with cervical cancer care with a focus on patients who are lost to follow-up from the time that symptoms suggestive of cervical cancer are clinically recognized to treatment. PATIENTS AND METHODS Sociodemographic data, attitude toward diagnosis and treatment, and reason for discontinuing care were recorded and analyzed for a period of 5 years from January 2010 to December 2015. RESULTS One hundred twenty-six patients had symptoms suggestive of cervical cancer, but only 110 (87.30%) could pay for biopsy, 29 (26.36%) of those did not collect their results, 17 (18.7%) denied their results, and 20 (19%) did not benefit from treatment. Only 44 of 110 patients were able to finish their cancer care treatment program. Reasons for discontinuing the cancer care included lack of financial means to pay for it, distance from the care center, and belief in alternative treatments. CONCLUSION This study highlights the magnitude of the difficulties of accessing and receiving cancer care in semiurban areas in Cameroon. Poverty, belief in alternative treatment options, and unequal distribution of care services determined which patients would be lost to follow-up. Redistribution of resources and cancer care providers is mandatory to improve this situation.

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Drawing on narrative accounts of dementia in education and care

Illness Narratives in Practice: Potentials and Challenges of Using Narratives in Health-related Contexts ◽

10.1093/med/9780198806660.003.0016 ◽

2018 ◽

pp. 188-200

Author(s):

Joyce Lamerichs ◽

Manna Alma

Keyword(s):

Dementia Care ◽

Vocational Education And Training ◽

Video Clips ◽

People With Dementia ◽

Metaphoric Language ◽

Moderate Dementia ◽

Education And Care ◽

Course Material ◽

Informal Carers

This chapter shows how a selection of narrative videotaped accounts of people with dementia and their informal carers are used to develop course material on dementia care for students in Dutch secondary Vocational Education and Training (VET). It provides illustrative segments of two pilot lessons on dementia care to show how the narrative clips stimulate students’ empathic response, invite reflection on their own practices as professional carers, and demonstrate the strength of metaphoric language available in the clips as a cue for follow-up discussions. Although further research is needed, working with narrative video clips in which people with dementia and their informal carers recount what it means to live with dementia seems a promising educational tool. It proved particularly well-suited to provide opportunities to learn from people who experience mild/moderate dementia, and what it means to live with this condition.

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Awake vs Sedated Tracheostomies: A Review and Comparison at a Single Institution

Otolaryngology ◽

10.1177/0194599818789079 ◽

2018 ◽

Vol 159 (5) ◽

pp. 830-834 ◽

Cited By ~ 3

Author(s):

Michael R. Kaufman ◽

Kristan P. Alfonso ◽

Kristen Burke ◽

Rony K. Aouad

Keyword(s):

Care Center ◽

Tertiary Care ◽

Postoperative Bleeding ◽

Case Series ◽

Patient Demographics ◽

Primary Indication ◽

Academic Medical ◽

Male Sex ◽

Lost To Follow Up

Objective The literature surrounding awake tracheostomies is sparse, particularly comparing awake tracheostomy patients to that of the sedated tracheostomy population. This study sought to compare tracheostomy patient demographics, indications, and outcomes of the 2 populations. Study Design Case series with chart review. Setting Tertiary care center. Materials and Methods All tracheostomies performed at our tertiary academic medical institution between January 2013 through November 2015 were reviewed. The data collected included demographics, comorbidity, anticoagulation, and outcomes. Results A total of 978 tracheostomies performed during this period met inclusion criteria, with 78 (8.0%) on awake patients. Most awake procedures were performed by otolaryngology (97.4%). Male sex predominated (73.1% awake vs 57.8% sedated). Forty-four patients (56.4%) were smokers in the awake group vs 326 of 900 (36.2%) in the sedated group. Malignancy was the primary indication for awake tracheostomy (68/78, 87.1%). One patient (1.3%) had significant postoperative bleeding compared to 26 of 900 (2.9%) of the sedated tracheostomy patients ( P = .406). Only 9 (11.4%) were ever decannulated. Thirty-one (39.2%) patients ultimately underwent total laryngectomy, 3 could not be decannulated secondary to anatomical causes (stenosis or vocal fold paralysis), and 19 were lost to follow-up after discharge. There were 12 of 78 (15.4%) overall deaths in the awake cohort, with 215 of 900 (23.9%) in the sedated cohort ( P = .088). Conclusion Despite all the differences between the 2 patient populations, the urgent awake tracheostomy appears to be safe and its complications do not appear significantly different from the sedated population.

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