scholarly journals Unmet Needs of Families of Adults With Intellectual and Development Disabilities on Waiting Lists

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 690-690
Author(s):  
Tamar Heller
Keyword(s):  
Unmet Needs ◽  
Waiting Lists ◽  
Aging Parents ◽  
Home Based ◽  
Home Modifications ◽  
Waiver Program ◽  
Medicaid Waiver Program ◽  
The Impact ◽  
At Home

Abstract Most adults with intellectual and developmental disabilities live at home with their aging parents. Given the large waiting lists for residential and home-based services, families face many unmet service and support needs. The author will present results of a study that examined the impact of a Medicaid waiver program that provided either home-based or residential placements to 444 families of adults with IDD who were living at home at baseline through surveys at baseline and two years later. Families who did not receive the waiver services still had high unmet needs for person-centered planning training, networking with other families, respite, advocacy services, assistive technology, and home modifications at follow up. Regardless of services received, class members from minority backgrounds had more unmet needs than white class members, indicating the need for more targeted efforts to reach minority families.

scholarly journals Assistive devices: self-reported use by older people in Victoria

2002 ◽  
Vol 25 (4) ◽  
pp. 169 ◽  
Author(s):  
Robyn Smith ◽  
Susan Quine ◽  
Julie Anderson ◽  
Kirsten Black
Keyword(s):  
Older People ◽  
Service Providers ◽  
Assistive Devices ◽  
Factors Affecting ◽  
Payment Policy ◽  
Home Based ◽  
Home Modifications ◽  
Adequate Education ◽  
Almost All

A qualitative study was conducted in Victoria to explore factors affecting the acceptability and use of assistive devices by older people. Four focus groups and fifteen home-based interviews were conducted with older people (mean age 77 years) who had been issued with 2 or more assistive devices. Analysis of the data indicated that almost all participants were content to be advised by professionals on suitable equipment. Most considered the equipment and home modifications safe and easy to use, and appreciated the benefits for mobility, confidence and independence. Reasons for non-use were commonly related to changes in functional ability. Cost was a major deterrent for a small number who opted to 'make do'. Recommendations are made for improvements to the existing system of equipment provision and use, including: review and development of consistency of provision and payment policy among service providers; flexibility of payment options; adequate education and follow-up support for clients.

Colorectal cancer survivors’ quality of life: a qualitative study of unmet need

2020 ◽  
pp. bmjspcare-2020-002190
Author(s):  
Amanda Drury ◽  
Sheila Payne ◽  
Anne-Marie Brady
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Supportive Care ◽  
Cancer Survivors ◽  
Unmet Needs ◽  
Unmet Need ◽  
Safety Net ◽  
The Impact

ObjectiveCancer survivors’ perceptions of healthcare have been identified as a predictor of quality of life (QoL) outcomes. This study aims to explore colorectal cancer (CRC) survivors’ perceptions of how cancer-related healthcare affects their QoL.MethodsSemistructured interviews were conducted with 22 CRC survivors receiving follow-up care between 1 and 5 years post diagnosis. Interviews were recorded, transcribed and analysed thematically.ResultsFive themes described the impact of healthcare experiences on CRC survivors’ QoL. While cancer survivors spoke positively of their relationships with healthcare professionals, many experienced a range of unmet information and supportive care needs. Participants described a range of positive and negative experiences, as power dynamics and navigation of healthcare systems had implications for their QoL. Where negative healthcare events aligned, survivors’ autonomy, dignity and confidence were undermined, and survivorship issues could be inadequately addressed. To address persistent unmet needs, survivors developed a safety net(work) of supports to bridge the gap of unmet needs in healthcare with varying outcomes.ConclusionsCancer survivors’ experience of follow-up and healthcare can positively or negatively affect their QoL. Preparation for cancer survivorship must be incorporated into the acute phase of diagnosis and treatment and interlinked with clear pathways of survivorship care and accessible supportive care, which support survivors to be equal partners in their healthcare. Understanding cancer survivors’ knowledge, expertise and mastery of their condition is essential to ensure delivery of person-centred supportive care that adequately addresses the survivor’s unmet needs.

Effect of home-based follow-up intervention on readmissions and mortality in heart failure patients: a meta-analysis

2019 ◽  
Vol 15 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Aaqib H Malik ◽  
Senada S Malik ◽  
Wilbert S Aronow ◽  
Keyword(s):  
Heart Failure ◽  
Discharge Planning ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Randomized Controlled ◽  
Home Based ◽  
Home Based Intervention ◽  
The Impact

Aim: We investigated whether the home-based intervention (HBI) for heart failure (HF), restricted to education and support, improves readmissions or mortality compared with usual care. Patients & methods: We searched PubMed and Embase for randomized controlled trials that examined the impact of HBI in HF. A random-effects meta-analysis was performed using R. Result: Total 17/409 articles (3214 patients) met our inclusion criteria. The pooled estimate showed HBI was associated with a reduction in readmission rates and mortality (22 and 16% respectively; p < 0.05). Subgroup analysis confirmed that the benefit of HBI increases significantly with a longer follow-up. Conclusion: HBI in the form of education and support significantly reduces readmission rates and improves survival of HF patients. HBI should be considered in the discharge planning of HF patients.

scholarly journals The Impact of Study-at-Home During the COVID-19 Pandemic on Myopia Progression in Chinese Children

2022 ◽  
Vol 9 ◽  
Author(s):  
Dandan Ma ◽  
Shifei Wei ◽  
Shi-Ming Li ◽  
Xiaohui Yang ◽  
Kai Cao ◽  
...  
Keyword(s):  
Baseline Period ◽  
Exposed Group ◽  
Control Group ◽  
Myopia Progression ◽  
Historical Cohort ◽  
Difference Analysis ◽  
Uncorrected Visual Acuity ◽  
The Impact ◽  
At Home

Background: To assess the impact of study-at-home during the COVID-19 pandemic on myopia development in Chinese schoolchildren.Methods: This historical cohort involved two groups with a total of 154 children. The exposed group was formed from 77 children aged 8 to 10 years who studied at home in the 7-month period during the COVID-19 pandemic (follow-up period: January – August 2020) and did not study at home in the 7-month period before the COVID-19 outbreak (baseline period: July 2019 – January 2020). Seventy-seven children who did not undergo study-at-home (baseline period: 7 months in 2015, follow-up period: 7 months in 2016) were included in the control group. Cycloplegic refraction, axial length and uncorrected visual acuity were measured 3 times. The questionnaire mainly focused on collecting visual habits.Results: Myopia progression was similar between the two groups in the baseline period. However, in the follow-up period the exposed group had a greater change in refraction toward myopia (−0.83 ± 0.56 D) than the control group (−0.28 ± 0.54 D; p &lt; 0.001). In addition, the exposed group exhibited a significantly greater change in refraction toward myopia in the follow-up period (−0.83 ± 0.56 D) than in the baseline period (−0.33 ± 0.46 D; p &lt; 0.001). Difference-in-difference analysis indicated that study-at-home accelerated the change in refraction toward myopia (t = −0.567; p &lt; 0.001).Conclusions: During the COVID-19 pandemic study-at-home accelerated the change of refraction toward myopia in children.

scholarly journals STUDY PROTOCOL The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: A study protocol for the TEAMS pilot randomized controlled trial

2020 ◽  
Author(s):  
Alon Kalron ◽  
Anat Achiron ◽  
Massimiliano Pau ◽  
Eleonora Cocco
Keyword(s):  
Multiple Sclerosis ◽  
Virtual Reality ◽  
Study Protocol ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Home Based ◽  
Custom Made ◽  
The Impact

Abstract Background: Approximately 60% of people with multiple sclerosis (PwMS) suffer from upper limb dysfunction. Our primary goal is to implement a single-blind, randomized control trial (RCT) designed to compare the effectiveness of an 8-week home-based telerehab virtual reality (VR) program with conventional therapy in PwMS with manual dexterity difficulties. Secondary aims include: a) evaluating the impact of the programs on quality of life after the intervention and a follow up 1 month later; and b) evaluating the impact of the programs on adherence and satisfaction. Methods: Twenty-four PwMS will be recruited to the study which will be conducted at two established MS centers: (1) The Regional Center for Diagnosis and Treatment of Multiple Sclerosis, Binaghi Hospital, Cagliari, Italy; (2) The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants will complete a total of three assessments focusing on upper limb functions. Both groups will receive 16 training sessions focusing on functional upper limb activities. The home-based telerehab VR intervention will comprise a custom-made software program running on a private computer or laptop. PwMS will perform several activities of daily living (ADL) functions associated with self-care, dressing and meal preparation. Conventional therapy will focus on task-related upper-limb treatments while in a sitting position, indicative of the standard care in MS. Following 8-weeks of training, participants will complete a further outcome assessment. The same tests will be conducted 1 month (as a follow-up) after completion of the intervention. Discussion: The outcomes of this study have tremendous potential to improve the quality of evidence and informed decisions of functional upper limb activities in PwMS. If comparable results are found between the treatments in improving upper limb outcomes, this would suggest that PwMS can choose the program that best meets their personal needs, e.g., financial concerns, transportation or accessibility issues. Secondly, this information can be used by healthcare providers and medical professionals in developing upper limb exercise programs that will most likely succeed in PwMS. Trial registration: ClinicalTrials.gov NCT04032431. Registered on 19 July 2019.

scholarly journals Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants versus warfarin

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Deitelzweig ◽  
A Keshishian ◽  
A Kang ◽  
A Jenkins ◽  
N Atreja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Index Date ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Nursing Facility ◽  
Home Setting ◽  
The Impact ◽  
At Home

Abstract Background Clinical trials and real-world database studies have shown the benefits of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin; however, measures of functional outcomes are critical in evaluating a patient's quality of life. Previous measures of time spent out of hospital in a home setting and time spent receiving disease-related care among non-valvular atrial fibrillation (NVAF) patients are lacking in the current literature. Purpose This analysis was based on the previously published ARISTOPHANES study, and used multiple data sources to evaluate the amount of time spent at a patient's home among NVAF patients who were prescribed NOACs versus warfarin. Methods This retrospective observational study used US data from CMS Medicare and four commercial databases to select adult NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30SEP2015). Time at home and time at home without external AF-related care were measured during the 180 days after the index date (OAC prescription). Time at home was defined as days from index date without any of the following: an inpatient, skilled nursing facility or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days away from home and days with a claim for bleeding, stroke/systemic embolism, AF, or an INR test. Each day a claim was observed was counted as one day. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. After PSM, a subgroup of patients who were alive and had ≥180 days of follow-up was created. Poisson regression was conducted in each NOAC-warfarin matched cohort to compare time at home and time at home without external AF-related care. Results After matching, a total of 100,977 apixaban-warfarin, 36,990 dabigatran-warfarin, and 125,068 rivaroxaban-warfarin patient pairs were selected. Of those patients, 38–46% had 180 days of follow-up available. Across treatment cohorts, approximately 75% of patients were at home for the 180-day follow-up. Apixaban, dabigatran, and rivaroxaban patients had 1.3, 0.9, and 0.8 more days at home, respectively, compared to warfarin patients. Patients treated with apixaban had 13.4 more days at home without AF-related care compared to warfarin, while dabigatran and rivaroxaban had 11.6 and 11.7 more days at home without AF-related care compared to warfarin. A greater proportion of warfarin patients than NOAC patients had an INR test (81–82% vs 14–21%), and days with INR testing were the main driver for external AF-related care for warfarin patients. Conclusion Among NVAF patients treated with OACs, NOACs were associated with a longer time at home and time at home without external AF-related care compared to warfarin. These results can help inform healthcare providers and patients regarding the impact of NOAC treatment in NVAF patients. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.

scholarly journals A rapid review of home-based activities that can promote mental wellness during the COVID-19 pandemic

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243125
Author(s):  
Joseph H. Puyat ◽  
Haroon Ahmad ◽  
Ana Michelle Avina-Galindo ◽  
Arminee Kazanjian ◽  
Aanchel Gupta ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Risk Of Bias ◽  
Rapid Review ◽  
Review Author ◽  
Beneficial Effects ◽  
Home Based ◽  
Mental Wellness ◽  
The Impact ◽  
At Home

Background During the COVID-19 pandemic, public health measures such as isolation, quarantine, and social distancing are needed. Some of these measures can adversely affect mental health. Activities that can be performed at home may mitigate these consequences and improve overall mental well-being. In this study, home-based activities that have potential beneficial effects on mental health were examined. Methods A rapid review was conducted based on a search of the following databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies include randomized controlled trials and non-randomized studies published between 1/1/2000 and 28/05/2020 and that examined the impact of various activities on mental health outcomes in low-resource settings and contexts that lead to social isolation. Studies of activities that require mental health professionals or that could not be done at home were excluded. Two review authors performed title/abstract screening. At the full-text review stage, 25% of the potentially eligible studies were reviewed in full by two review authors; the rest were reviewed by one review author. Risk of bias assessment and data extraction were performed by one review author and checked by a second review author. The main outcome assessed was change or differences in mental health as expressed in Cohen’s d; analysis was conducted following the synthesis without meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082. Results Of 1,236 unique records identified, 160 were reviewed in full, resulting in 16 included studies. The included studies reported on the beneficial effects of exercise, yoga, progressive muscle relaxation, and listening to relaxing music. One study reported on the association between solitary religious activities and post traumatic stress disorder symptoms. While most of the included studies examined activities in group settings, particularly among individuals in prisons, the activities were described as something that can be performed at home and alone. All included studies were assessed to be at risk of bias in one or more of the bias domains examined. Conclusions There is some evidence that certain home-based activities can promote mental wellness during the COVID-19 pandemic. Guidelines are needed to help optimize benefits while minimizing potential risks when performing these activities.

The Norm Bourke Box: A Patient-Led Initiative to Improve Care for Rural Patients Requiring Peritoneal Dialysis

2019 ◽  
Vol 39 (4) ◽  
pp. 390-391 ◽  
Author(s):  
Nicole Scholes-Robertson
Keyword(s):  
Peritoneal Dialysis ◽  
Rural Communities ◽  
Financial Burden ◽  
South Wales ◽  
Home Based ◽  
Out Of Pocket Expenses ◽  
Barriers And Challenges ◽  
Rural Patients ◽  
At Home

Patients living in rural communities face many barriers and challenges in accessing peritoneal dialysis (PD) because it often requires travelling long distances, and accommodation away from home for training and follow-up. Patient perception is that there is a lack of financial support for out-of-pocket expenses, which makes home-based treatments less appealing. It can be difficult for patients to source equipment required to do PD safely and effectively at home, and more difficult for those who live in rural or remote settings. This article describes a patient-led initiative—the “Norm Bourke Box” (NBB) for patients requiring PD in rural New South Wales, Australia. The NBB provides necessary equipment including bathroom scales and a blood pressure machine, that are not supplied by the health service. For patients, this has enabled a “good start” to PD and has helped to alleviate the financial burden and stress of needing to source the equipment required for PD. This also gave patients and staff reassurance because patients could undertake training with the equipment that they would be using at home to support efficient and safe practice at home. Efforts are now underway to expand the distribution of the NBB to help improve access and care for rural patients on PD.

scholarly journals Positive impact of facility-based isolation of mild COVID-19 cases on effectively curbing the pandemic: a mathematical modelling study

2020 ◽  
Author(s):  
Simiao Chen ◽  
Qiushi Chen ◽  
Juntao Yang ◽  
Lin Lin ◽  
Linye Li ◽  
...  
Keyword(s):  
United States ◽  
Positive Impact ◽  
High Capacity ◽  
The United States ◽  
Sensitivity Analyses ◽  
Effective Capacity ◽  
Home Based ◽  
Primary Model ◽  
The Impact ◽  
At Home

Abstract Background In many countries, patients with mild coronavirus disease 2019 (COVID-19) are told to self-isolate at home, but imperfect compliance and shared living space with uninfected people limit the effectiveness of home-based isolation. We aim to examine the impact of facility-based isolation compared to self-isolation at home on the continuing epidemic in the United States. Methods We developed a compartment model to simulate the dynamic transmission of COVID-19 and calibrated it to key epidemic measures in the United States from March to September. We simulated facility-based isolation strategies with various capacities and starting times under different diagnosis rates. The primary model outcomes included the reduction of new infections and deaths over two months from October onwards. We further explored different effects of facility-based isolation under different epidemic burdens by major US Census Regions, and performed sensitivity analyses by varying key model assumptions and parameters. Results We projected that facility-based isolation with moderate capacity of 5 beds per 10 000 total population could avert 4.17 (95% Credible Interval 1.65–7.11) million new infections and 16 000 (8000-23 000) deaths in two months compared with home-based isolation, equivalent to relative reductions of 57% (44–61%) in new infections and 37% (27–40%) in deaths. Facility-based isolation with high capacity of 10 beds per 10 000 population would achieve greater reduction of 76% (62–84%) in new infections and 52% (37–64%) in deaths when supported by the expanded testing with a 20% daily diagnosis rate. Delays in implementation would substantially reduce the impact of facility-based isolation. The effective capacity and the impact of facility-based isolation varied by epidemic stage across regions. Conclusion Timely facility-based isolation for mild COVID-19 cases could substantially reduce the number of new infections and effectively curb the continuing epidemic compared to home-based isolation. The local epidemic burden should determine the effective scale of facility-based isolation strategies.

A pilot RCT of sarcopenia-focused prehabilitation in pancreas cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS10127-TPS10127 ◽  
Author(s):  
Elizabeth Hile ◽  
Leah Hoffman ◽  
Russell Postier ◽  
Kai Ding ◽  
Jingxuan Yang ◽  
...  
Keyword(s):  
Strength Function ◽  
Pancreatic Head ◽  
High Dose ◽  
Home Based ◽  
Mechanistic Approach ◽  
Baseline Status ◽  
Pilot Rct ◽  
Poor Outcomes ◽  
The Impact

TPS10127 Background: Now the 3rd leading cause of US cancer deaths, pancreatic cancer (PanC) incidence is rising. Surgery is the only chance at cure, but sarcopenia (low muscle mass, strength, function) can eliminate surgical and chemotherapy options, and independently predicts poor outcomes. Strengthening (Str) with protein combats sarcopenia of aging, and pre-op exercise (prehab) benefits other cancer survivors. But the impact of Str in a brief pre-Whipple window, and a host with PanC-mediated catabolism, is unknown. We aim to quantify the post-op QoL impact of adding Str to our standard clinical aerobic instruction before Whipple for pancreatic head and related cancers. Methods: Pilot RCT of 130 PanC survivors age 30+ randomized (stratified by neo-chemo) to 2 home-based prehab arms: Standard/NPRE = aerobic + protein, or Sarcopenia/SPRE = Standard + Str. To explore PanC-sarcopenia as moderating Str's impact, a 3rd pre-malignancy Whipple group (p-mal, n=50) also receives SPRE. All participants get protein and exercise instruction personalized to baseline status, adherence diaries, actigraphy, and phone follow-up in pre-op period only. Endpoints are QoL (primary) as Functional Assessment of Cancer Therapy (FACT), performance as 6 Minute Walk (6MW) & Short Physical Performance Battery (SPPB); and self-reported symptoms & activities of daily living (ADL). Assessments at baseline, 1-3 days pre-op, and post-op week 4 & month 4 (primary) are blind. Sarcopenia measures are clinical (dynamometry, bioimpedance, CT body composition) and preclinical (ZIP4/ catabolic mediators in blood, muscle, tumor & duodenum). Analyses: QoL change at post-op month 4 will be compared across PanC arms (SPRE & NPRE) with mixed-models before Baron-Kenny and Preacher/Hayes' mediator analyses. To explore impact of PanC catabolic host environment on Str, outcomes will be compared by SPRE group (PanC & p-mal). To our knowledge, this is the first PanC prehab RCT with sarcopenia focus, comprehensive mechanistic approach, and high dose (60 min daily)/short duration (2-3 week) intervention. With local feasibility established, we continue to accrue (n=30), and seek multicenter collaboration to target NCI funding. Clinical trial information: pending - in submission.

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