scholarly journals The Long and Winding Road: A Caregiver’s Journey

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 306-306
Author(s):  
Theresa Harvath
Keyword(s):  
Healthcare Professional ◽  
Hospital Stay ◽  
Healthcare System ◽  
Cancer Diagnosis ◽  
Personal Experience ◽  
Medical System ◽  
System Response ◽  
Policy Decisions ◽  
Caregiver Needs ◽  
The Voice

Abstract In a discussion about innovative caregiving programs, it is important to hear the voice of the caregiver. In this section, using her personal experience, this healthcare professional will explore her interactions with the medical system as a caregiver for her partner. She will discuss her caregiver journey from the cancer diagnosis in 2014 through her partner’s final days in hospice, which occurred during the pandemic. She will discuss pertinent issues regarding in what ways the healthcare system response was helpful, which responses were problematic, and where it outright failed to address caregiver needs. Issues, such as caregiver perceived invisibility during the hospital stay, how ageism affected policy decisions and what effect those policies had on her as the caregiver, and other important issues will be explored, including the how the pandemic affected her as a caregiver.

scholarly journals Outcomes of COVID-19 Negative Hip Fracture Patients During the Acute and Subacute Pandemic

2021 ◽  
Vol 12 ◽  
pp. 215145932110066
Author(s):  
Naoko Onizuka ◽  
Lauren N. Topor ◽  
Lisa K. Schroder ◽  
Julie A. Switzer
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Healthcare System ◽  
Perioperative Complications ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Surgical Care ◽  
Admission Rate ◽  
System Response ◽  
Fragility Hip Fracture

Objectives: To better elucidate how the COVID-19 pandemic has affected the operatively treated geriatric hip fracture population and how the health care system adapted to pandemic dictated procedures. Design: Retrospective cohort study. Setting: A community hospital. Participants: Individuals ≥65 years of age presented with a proximal femoral fracture from a low-energy mechanism undergoing operative treatment from January 17, 2020 to July 2, 2020 (N = 125). Measurements: We defined 3 phases of healthcare system response: pre-COVID-19, acute phase, and subacute phase. Thirty-day mortality, time to operating room (OR), length of stay, time to start physical therapy, perioperative complications, delirium rate, hospice admission rate, discharge dispositions, readmission rate, and the reason of surgery delay were assessed. Results: The number of hip fractures has remained constant during the pandemic. The 30-day mortality rate, time to OR, and length of stay were higher in the pandemic compared to the pre-pandemic. Those who had a longer wait time to OR (≥ 24 hours) had more complications and increased 30-day mortality rates. Some of the surgery delays were related to OR unavailability as a consequence of the COVID-19 pandemic. Surgery was delayed in 3 patients who were on direct oral anticoagulants (DOACs) in pandemic but none for pre-pandemic period. Conclusion: This is the first study to compare the effect of the acute and subacute phases of the pandemic on uninfected hip fracture patients. In the age of COVID-19, to provide the best care for the vulnerable geriatric orthopedic populations, the healthcare system must adopt new protocols. We should still aim to promote prompt surgical care when indicated. It is important to ensure adequate resource availability, such as OR time and staff so that hip fracture patients may continue to receive rapid access to surgery. A multidisciplinary approach remains the key to the management of fragility hip fracture patients during the pandemic.

“In Sorrow Thou Shalt Bring Forth Children”: Docu-Poetic Theatre in Israel

2019 ◽  
Vol 63 (3) ◽  
pp. 20-35
Author(s):  
Naphtaly Shem-Tov
Keyword(s):  
Healthcare System ◽  
Medical System ◽  
Jewish Children ◽  
The 1950S

Yoldot is a docu-poetic performance that critically presents the affair of the abduction of Jewish children from families that immigrated primarily from Yemen in the 1950s. Facilitated by the healthcare system, the abducted children were put up for illegal adoption. Yoldot frames the events as less of an exception and more a regular phenomenon enabled by the overall orientalist and racist nature of the Israeli medical system.

scholarly journals Improvement work in mental healthcare: an example from Region Jönköping County, Sweden

2020 ◽  
Vol 17 (4) ◽  
pp. 80-82
Author(s):  
Axel Ros ◽  
Anna Österström ◽  
Göran Henriks ◽  
Boel Andersson-Gäre
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Hospital Stay ◽  
Healthcare System ◽  
Hospital Admissions ◽  
Mental Healthcare ◽  
Number Of Visits ◽  
Psychiatric Department ◽  
Quality In Healthcare

Region Jönköping County (RJC) in Sweden is a healthcare system that is characterised by sustainable work with quality in healthcare and long-term system-wide improvement. This article describes important factors behind the improvement work in RJC, and how the improvement methods and initiatives have been adopted also in mental healthcare. For example, patients otherwise eligible for admission to a psychiatric department were treated at home after introduction of home treatment teams. Patient satisfaction was high and the number of visits to the emergency department, hospital admissions and hospital stay decreased.

Mini-invasive Aortic Surgery: Personal Experience

2014 ◽  
Vol 9 (5) ◽  
pp. 354-360 ◽  
Author(s):  
Francesco Spinelli ◽  
Francesco Stilo ◽  
Michele La Spada ◽  
Filippo Benedetto ◽  
Giovanni De Caridi ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Personal Experience ◽  
Operative Time ◽  
Aortic Surgery ◽  
Abdominal Cavity ◽  
Length Of Hospital Stay ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Solid Diet ◽  
Postoperative Morphine

Objective In this study, we retrospectively evaluated our experience in minilaparotomy (MINI) and compared the results with conventional open repair (OPEN). Methods From January 2005 to December 2012, we surgically treated 234 consecutive patients with elective infrarenal abdominal aortic aneurysms, 195 men and 39 women, with a mean age of 74 years. Inclusion criteria for MINI were not ruptured abdominal aortic aneurysm, increased surgical risk, anatomical limits for endovascular repair, no previous surgical invasion of the abdominal cavity, and no requirement for concomitant abdominal surgical invasion. Surgical treatment was OPEN in 113 patients (48.3%) and MINI through an 8- to 14-cm incision in 121 patients (51.7%). Epidural anesthesia has been added in 26.5% and in 19.3% of the MINI and OPEN patients, respectively. Mortality, complications, aortic clamping time, operative time, need for postoperative morphine therapy, time to solid diet, and length of hospital stay were registered. Results The MINI has been performed in all patients selected, with 72 aortoaortic grafts and 49 aortobisiliac grafts. Early mortality was 1.6% versus 3.5% ( P > 0.5); 1-, 3-, and 5-year mortality were 7% versus 9%, 19% versus 22%, and 29% versus 34% ( P > 0.5); complications were 12.2% versus 26.6% ( P > 0.05); mean (SD) clamping time was 48 (12) versus 44 (14) minutes ( P > 0.5); mean (SD) operative time was 218.72 (41.95) versus 191.44 (21.73) minutes ( P > 0.025); mean (SD) estimated intraoperative blood loss was 425.64 (85.95) versus 385.30 (72.41) mL ( P > 0.1); mean (SD) morphine consumption in the group given epidural and the group not given epidural was 0 (2) and 2 (2) mg intravenously (IV) versus 2 (4) ( P < 0.5) and 4 (3) mg IV ( P > 0.1); mean (SD) ambulation was 2.1 (0.6) versus 4.1 (2.7) ( P < 0.5); mean (SD) time to solid diet was 2.1 (0.4) versus 3.5 (1.6) ( P < 0.5); and mean (SD) length of hospital stay was 4.9 (1.64) versus 7.35 (1.95) days ( P > 0.05), in the MINI and OPEN groups, respectively. Postoperative hernia at 3 years was 18% versus 23% in the MINI and OPEN groups ( P < 0.5), respectively. Conclusions The MINI gives the patients a significantly shorter period of recovery with the quality and safety of the OPEN. This experience suggested extending the indication to all surgical candidates without local limitations.

Timing of referral for palliative radiation therapy and length of hospital stay.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 57-57
Author(s):  
Moeko Nagatsuka ◽  
Ryan T. Hughes ◽  
Chase Glenn ◽  
Doris R. Brown
Keyword(s):  
Radiation Therapy ◽  
Hospital Stay ◽  
Cancer Diagnosis ◽  
Radiation Oncology ◽  
Symptomatic Relief ◽  
Length Of Hospital Stay ◽  
Continuous Variable ◽  
Palliative Radiation ◽  
Significant Difference ◽  
Palliative Radiation Therapy

57 Background: Palliative radiation therapy (PRT) offers effective symptomatic relief to cancer patients. Increased focus on quality of care and healthcare efficiency necessitate a better understanding of the temporal relationships between consultation for/initiation of PRT and length of hospital stay (LOS). This study aims to assess whether durations from admission to PRT consult/PRT initiation affect LOS. Methods: In an institutional review of patients who received PRT as inpatients between January 2017 and December 2018, 67 met inclusion criteria. Duration of time from admission to consultation or start of PRT were categorized using various thresholds. LOS was compared across groups using the Wilcoxon rank sum test and factors were evaluated as predictors of LOS using bivariate linear regression. Results: PRT was given for pain (37%), neurologic deficits/brain metastases (31%), and respiratory symptoms (19%). Multiple sites were treated in 31%; treatment sites included spine (45%), non-spine bone (27%), chest (22%), abdomen/pelvis (12%), brain (10%) and soft tissue (6%). At admission, patients had known metastases (66%), no prior cancer diagnosis (19%), or known primary cancer (15%). Median LOS was 12 days (IQR 7-18) for all patients. There was a significant difference in LOS for patients referred for PRT within 3 days of admission versus greater than 3 days (11 v. 21 days, p < 0.01). This difference was slightly greater using a threshold of 4 days (11 v. 25 days, p < 0.01) and 5 days (11 v. 26 days, p < 0.01), both of which remained significant when analyzing only patients with prior cancer diagnosis (n = 54). There was no difference in LOS using a threshold of 1 or 2 days. As a continuous variable, duration from admission to PRT was associated with LOS (OR 2.40, p < 0.01). Similar patterns were noted when analyzing by time from admission to PRT start. Conclusions: Earlier radiation oncology consultation for PRT is associated with shorter LOS in patients treated with PRT for symptomatic malignancy. Further research is needed to better define this relationship and improve systematic processes to facilitate early consultation and treatment. A palliative radiation oncology clinic was recently developed to address these issues at our institution.

scholarly journals Telemedicine in Slovenia

2021 ◽  
Author(s):  
Živa Rant ◽  
Keyword(s):  
Healthcare Professional ◽  
Healthcare System ◽  
Business Processes ◽  
Healthcare Professionals ◽  
Healthcare Services ◽  
The State ◽  
Research Participants ◽  
The Future

Telemedicine could be one of the solutions for challenges in healthcare, especially in this time of the Covid-19 pandemic. The results of the research about the state of telemedicine services in Slovenia are presented in this article. We found several telemedicine solutions in Slovenian healthcare. Metadata for them were collected. The solutions are placed in groups of telemonitoring, provision of healthcare services by remotely connecting patients with a doctor or healthcare professional and remote cooperation for the patient's treatment between doctors or healthcare professionals who are physically at different locations. The opinions of the research participants regarding the challenges associated with telemedicine services in Slovenia were also collected. They are placed in three main groups: financing, healthcare system and healthcare professionals. Telemedicine is a necessity and the future of Slovenian healthcare services. If a solution is to be applied successfully, business processes must be changed so that a practically useful service can arise from the solution.

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