scholarly journals Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population

2017 ◽  
Vol 35 (2) ◽  
pp. 316-323 ◽  
Author(s):  
Veerawat Phongtankuel ◽  
Ronald D. Adelman ◽  
Kelly Trevino ◽  
Erika Abramson ◽  
Phyllis Johnson ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Retrospective Cohort ◽  
Hospice Care ◽  
Care Transitions ◽  
Median Number ◽  
P Value ◽  
Medicare Data ◽  
Hospice Patients ◽  
Home Hospice Care ◽  
Patients Experience

Background: Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment. Objectives: The study’s purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment. Design: A retrospective cohort study using Medicare data. Participants: Medicare hospice beneficiaries who were ≥18 years old in 2012. Outcome measured: Hospitalization within 2 days of hospice disenrollment. Results: The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001). Conclusions: More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.

scholarly journals Accounts of Family Conflict in Home Hospice Care: The Central Role of Autonomy for Informal Caregiver Resilience

2019 ◽  
Vol 25 (2) ◽  
pp. 190-218 ◽  
Author(s):  
Jacquelyn J. Benson ◽  
Debra Parker Oliver ◽  
George Demiris ◽  
Karla Washington
Keyword(s):  
Family Conflict ◽  
Health Care Professionals ◽  
Hospice Care ◽  
Secondary Analysis ◽  
Relational Dialectics ◽  
Relational Dialectics Theory ◽  
Hospice Patients ◽  
Stressful Experience ◽  
Home Hospice Care

End-of-life caregiving is a highly stressful experience often fraught with conflict and tension. However, little is known about the ways family conflict manifests for informal caregivers of home hospice patients (IHCs). Framed by relational dialectics theory, the purpose of this study was to provide nurses and other health care professionals with an empirical understanding of how IHCs experience family conflict and tensions associated with caregiving. A second aim was to determine what strategies IHCs use to manage these family conflicts. Data used in this qualitative secondary analysis were originally collected as part of a randomized clinical trial of an IHC support intervention. Based on thematic analysis of data from 25 IHCs who reported family conflict, a conceptual model of caregiver resilience was developed from the themes and categories that emerged during the coding stage. Autonomy was identified as a central tension. IHCs used several strategies to address family conflict including communication, formal support, and emotional self-care.

Home Hospice Care and the Arts: Arts @ the Bedside

2013 ◽  
Vol 67 (1-2) ◽  
pp. 241-246
Author(s):  
Dayna Wood
Keyword(s):  
New York ◽  
Qualitative Data ◽  
Hospice Care ◽  
Healthcare Settings ◽  
Hospice Volunteers ◽  
The Arts ◽  
Hospice Patients ◽  
Home Hospice Care ◽  
Professional Artists ◽  
The Impact

The arts, in their multiplicity of forms, have shown to be of benefit to patients in healthcare settings and their family members. Benefits can include expression, relaxation, and distraction. Arts @ the Bedside, an initiative of the Visiting Nurse Service of New York Hospice Care, sought to train hospice volunteers with an art background, or interest, to safely and confidently introduce the arts in a variety of mediums to hospice patients and families. Monthly trainings sessions, led by professional artists, were offered to volunteers. Volunteers who participated in six or more trainings received a “Certificate of Completion.” The number of volunteer art visits, session reports, and the impact on volunteers were recorded. Qualitative data suggests that patients, staff, and volunteers gain from the introduction of the arts in home hospice care.

Caregiver Challenges Seen From the Perspective of Certified Home Hospice Medical Directors

2021 ◽  
pp. 104990912110563
Author(s):  
Ankita Agarwal ◽  
Sulaiman Alshakhs ◽  
Elizabeth Luth ◽  
Ritchell Dignam ◽  
Manney C. Reid ◽  
...  
Keyword(s):  
Hospice Care ◽  
Financial Burden ◽  
Critical Role ◽  
Terminal Condition ◽  
Home Setting ◽  
Physical Burden ◽  
Hospice Patients ◽  
Medical Directors ◽  
Home Hospice Care ◽  
Eol Care

Background: Hospice medical directors (HMDs) play an important role as part of the interdisciplinary hospice team. Family caregivers (CGs) play a critical role in caring for patients receiving home hospice care. Understanding the challenges HMDs face when working with CGs is important when addressing potential gaps in care and providing quality end of life (EoL) care for the patient/CG dyad. Objectives: To understand issues HMDs encounter when working with and caring for CGs and to determine how they manage these issues in the home hospice setting. Design: Twelve semistructured phone interviews with certified HMDs were conducted. Data were analyzed using standard qualitative methods. Subjects: Participants included certified HMDs obtained from a public website. Results: Participants’ responses regarding the major issues HMDs faced when working with CGs were categorized into 6 themes: (1) assessing CG competency, (2) CG financial burden, (3) physical burden of caregiving, (4) managing CG expectations, (5) CGs denial of patient’s terminal condition, and (6) CGs unwilling or unable to engage with providers about their needs or the patient’s needs. Conclusions: HMDs confirmed the important role CGs play in providing care to home hospice patients. Challenges faced by HMDs vary from assessing CG competency in providing care to the patient, dealing with the physical and financial toll that CGs face, and addressing CGs’ expectations of hospice care. Future studies are needed to explore solutions to these issues to better support CGs in the home setting.

scholarly journals A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Timothy Becker ◽  
Kevin Y Pei
Keyword(s):  
Odds Ratio ◽  
Retrospective Cohort ◽  
Operation Time ◽  
P Value ◽  
Abdominal Abscess ◽  
Similar Frequency ◽  
Acs Nsqip ◽  
Potential Impact ◽  
And Training ◽  
Relative Scarcity

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies.  Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies.  Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive).  Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis.   Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1)    Laparoscopic  Robotic    Complications  N = 49,800  N = 50  P Value  Odds ratio  Any Complication  5302 (10.6%)  5 (10%)  1  1.06  Superficial surgical site infection    423 (0.8%)  0   >0.9    Organ Space SSI    1,355 (2.7%)  0  >0.9    Postoperative Intra-abdominal Abscess  1353 (2.7%)  0  >0.9    Sepsis  1,696 (3.4%)  1 (2%)  >0.9  1.7  Table 1. Complications for Laparoscopic versus Robotic appendectomy.   Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training. 

scholarly journals Which Hospice Patients With Cancer Are Able to Die in the Setting of Their Choice? Results of a Retrospective Cohort Study

2012 ◽  
Vol 30 (22) ◽  
pp. 2783-2787 ◽  
Author(s):  
Neha Jeurkar ◽  
Sue Farrington ◽  
Teresa R. Craig ◽  
Julie Slattery ◽  
Joan K. Harrold ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospice Care ◽  
Multivariable Logistic Regression Model ◽  
Patients With Cancer ◽  
Hospice Patients ◽  
Dying At Home ◽  
Performance Scale ◽  
At Home

Purpose To determine which hospice patients with cancer prefer to die at home and to define factors associated with an increased likelihood of dying at home. Methods An electronic health record–based retrospective cohort study was conducted in three hospice programs in Florida, Pennsylvania, and Wisconsin. Main measures included preferred versus actual site of death. Results Of 7,391 patients, preferences regarding place of death were determined at admission for 5,837 (79%). After adjusting for other characteristics, patients who preferred to die at home were more likely to die at home (adjusted proportions, 56.5% v 37.0%; odds ratio [OR], 2.21; 95% CI, 1.77 to 2.76). Among those patients (n = 3,152) who preferred to die at home, in a multivariable logistic regression model, patients were more likely to die at home if they had at least one visit per day in the first 4 days of hospice care (adjusted proportions, 61% v 54%; OR, 1.23; 95% CI, 1.07 to 1.41), if they were married (63% v 54%; OR, 1.35; 95% CI, 1.10 to 1.44), and if they had an advance directive (65% v 50%; OR, 2.11; 95% CI, 1.54 to 2.65). Patients with moderate or severe pain were less likely to die at home (OR, 0.56; 95% CI, 0.45 to 0.64), as were patients with better functional status (higher Palliative Performance Scale score: < 40, 64.8%; 40 to 70, 50.2%; OR, 0.79; 95% CI, 0.67 to 0.93; > 70, 40.5%; OR, 0.53; 95% CI, 0.35 to 0.82). Conclusion Increased hospice visit frequency may increase the likelihood of patients being able to die in the setting of their choice.

Hubungan Pengetahuan, Usia Dan Paritas Dengan Kejadian Komplikasi Kehamilan Pada Ibu Hamil Trimester Iii Di Rumah Sakit Ibu Dan Anak Aisyiyah Samarinda

2020 ◽  
Vol 5 (2) ◽  
pp. 83
Author(s):  
Siti Komariah ◽  
Hary Nugroho
Keyword(s):  
Odds Ratio ◽  
P Value ◽  
Cross Sectional ◽  
Purposive Sampling

Latar Belakang:Komplikasi kehamilan adalah kegawat daruratan obstetrik yang dapat menyebabkan kematian pada ibu dan bayi. Penyebab komplikasi kehamilan diantaranya kurangnya pengetahuan ibu tentang deteksi dini kehamilannya, usia pasien < 20 tahun dan > 35 tahun serta anak lebih dari 3.Tujuan :Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan, usia dan paritas dengan kejadian komplikasi kehamilan pada ibu hamil trimester III.Metode Penelitian:Jenis penelitian observasional analitik dengan pendekatan cross sectional. Teknik pengambilan sampel menggunakan purposive sampling, sehingga sampel adalah ibu hamil trimester III yang berkunjung di Rumah Sakit Ibu dan Anak Aisyiyah Samarinda berjumlah 84 orang. Analisis yang digunakan uji chi square.Hasil : Hasil penelitian menunjukkan terdapat responden yang memiliki pengetahuan kurang baik, terdapat usia berisiko antara < 20 tahun dan > 35 tahun, terdapat paritas berisiko > 3 orang anak dan komplikasi kehamilan berupa hipertensi, anemia, preeklempsia dan plasenta previa. Ada hubungan pengetahuan dengan kejadian komplikasi kehamilan (p value : 0,001 < α : 0,05 dan odds ratio : 6,800 > 1). Ada hubungan usia dengan kejadian komplikasi kehamilan (p value : 0,003 < α : 0,05 dan odds ratio : 5,837 > 1). Ada hubungan paritas dengan kejadian komplikasi kehamilan (p value : 0,002 < α : 0,05 dan odds ratio : 6,250 > 1).Kesimpulan: Terdapat pengetahuan kurang baik berjumlah 27 responden (32,1%), usia berisiko (< 20 tahun dan ≥ 35 tahun) berjumlah 25 responden (29,8%), paritas berisiko (1 atau ≥ 3 orang anak) berjumlah 21 responden (25%) dan ada komplikasi kehamilan berjumlah 18 responden (21,4%), Ada hubungan pengetahuan, usia dan paritas dengan kejadian komplikasi kehamilan pada ibu hamil trimester III di Rumah Sakit Ibu dan Anak Aisyiyah Samarinda.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

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