Long-term ventilation in the UK in patients 0-24 years – demographics and quality of care

Author(s):  
Heather Freeth ◽  
Kathy Wilkinson ◽  
Mark Juniper
Author(s):  
Seamus V McNulty ◽  
Graham A Jackson

Scotland is a small nation which has a devolved legislature, while still remaining part of the United Kingdom (UK). As the health service has become increasingly divergent from that of the remainder of the UK, more innovative approaches to dementia care have been allowed to develop. The Scottish Dementia Strategy, now in its third iteration, is unique in that it adopts a human rights-based method of dementia care, an approach that has subsequently been followed by other European countries. The Strategy is in continual evolution, with the third Strategy focusing more on care at the end stages of dementia, especially for those in nursing homes or long-term hospital care. Other novel approaches, such as the Dementia Champions programme, have shown benefits in the quality of care for patients with dementia in acute general hospitals, although less so for those in social care settings. Scotland was also a pioneer in enacting incapacity legislation, although this is now under review as shortcomings in the current procedures are becoming unmasked.


2020 ◽  
Vol 81 (9) ◽  
pp. 1-4
Author(s):  
Heather Freeth ◽  
Nicholas Mahoney ◽  
Mark Juniper ◽  
Rachael Moses ◽  
Kathy Wilkinson

Assessing the quality of care for patients receiving long-term ventilation is complex given the diversity of this population (0–24 years in this case) and their differing requirements for treatment. This article details how and why such reviews are necessary.


2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 960-960
Author(s):  
Sara Luck ◽  
Katie Aubrecht

Abstract Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.


2019 ◽  
Vol 144 (04) ◽  
pp. 282-285 ◽  
Author(s):  
Dieter Köhler

AbstractSince 2005, invasive long-term ventilation in Germany has increased significantly from around 1000 to 20 000 patients in Germany. Due to complex home care, the health care system incurs additional costs of around 4 billion euros per year. In addition, in the last 2 – 3 years more tracheostomized patients have been discharged home without ventilation (usually after stroke), and they receive the same complex home care. These patients have almost never been given the chance of a professional weaning trial by a weaning center. They are discharged from hospitals directly into the care. As a result, the quality of care is significantly worse than traditional care with structured discharge management via a weaning center. The solutions are difficult to find due to the interface problems between inpatient and outpatient care and the different organizational structures with different delivery systems. Possible solutions are shown, but most of them require a change in the law.


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