scholarly journals Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0262085
Author(s):  
Sara Campagna ◽  
Alberto Borraccino ◽  
Gianfranco Politano ◽  
Marco Dalmasso ◽  
Aldo Ravaglia ◽  
...  
Keyword(s):  
Home Care ◽  
Northern Italy ◽  
Administrative Databases ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Organizational Variables ◽  
Paediatric Patients ◽  
Ed Visits ◽  
Retrospective Investigation

Objective To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. Methods A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. Results A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). Conclusion The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use.

scholarly journals Determinants related to the risk of using ED among paediatric patients receiving home care services

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Scattaglia ◽  
S Campagna ◽  
G Politano ◽  
M Dalmasso ◽  
V Dimonte ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Home Care ◽  
Emergency Departments ◽  
Musculoskeletal Diseases ◽  
Home Care Services ◽  
Cross Sectional ◽  
Care Services ◽  
Paediatric Patients ◽  
Ed Visits

Abstract Introduction Pediatric home care services (PHC) are recommended to avoid hospital visits or readmission in children with chronic or complex conditions and to reduce the use of emergency departments. It would be useful to know the association of sociodemographic, clinical and health supply factors with Emergency Department (ED) access by patients receiving PHC. Methods A cross sectional retrospective cohort study was held from 2012 to 2017 in Pediatric home care services in Italy. Participants are children aged 0-18 years receiving pediatric home care services. Collected data are: sociodemographic variables (sex, age, presence or absence of an unfamiliar caregiver); distance from the ED in minutes; clinical variables (mortality rate at home, mortality rate in the ED, pathology responsible for the PHC activation and pathology determining the ED access); health supply variables (PHC proposed duration as stated by the proponent, subjects directing the patient to the ED, place of discharge after ED access, and arrival time to the ED). Results A total of 1236 PHC events contributed to 769 ED accesses. Receiving PHC services after hospital discharge (RR:1.26) and longer duration of charge-taking significantly increased the risk of experiencing ED access. The RR significantly decreased among children >5 years-of-age (RR:0.84; RR:0.62; RR;0.57; in 5-9; 10-14; 15-18 years respectively) and among children with neoplastic (RR:0.7), respiratory (RR:0.69), trauma (RR:0.4) or musculoskeletal diseases (RR:0.31) at first evaluation. Conclusions Confirming that ED accesses are issue present among children receiving home care services, this study has the main strength of demonstrating which risk factors are associated with ED accesses by children using home care services. Knowledge of them is necessary in order to implement adequate prevention strategies on both management and quality of care. Key messages Determinants associated with the risk of using emergency departments among paediatric patients receiving integrated paediatric home care services. ED visit is shown to be an issue among children receiving PHC and some determinants emerged as associated with ED visits by children in PHC.

scholarly journals Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna M. Hood ◽  
Melanie Kölbel ◽  
Hanne Stotesbury ◽  
Jamie Kawadler ◽  
April Slee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Executive Function ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pain Coping ◽  
Cell Disease ◽  
Paediatric Patients ◽  
Ed Visits

Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8–15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.

The Use of Total Contact Orthoses in Patients with Foot Problems in Foot Clinic, Siriraj Hospital

2020 ◽  
Vol 103 (12) ◽  
pp. 1292-1299
Keyword(s):  
Odds Ratio ◽  
Univariate Analysis ◽  
Stepwise Logistic Regression ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Stepwise Logistic Regression Analysis ◽  
Cross Sectional ◽  
Siriraj Hospital ◽  
Foot Problems ◽  
Foot Clinic

Objective: To study the use rate, outcome, and concomitant factors of the use of the total contact orthoses (TCO) in the Foot Clinic, Siriraj Hospital Materials and Methods: The present study was a cross-sectional descriptive study collecting data from patient medical records and questionnaires. Patients who had foot problems without impairment of foot sensation and received the TCO from the Foot Clinic between July 2015 and April 2016 were interviewed before and after using the latest TCO for one month. Results: One hundred seven participants were recruited. Most were female (84.1%) with a median age of 59.3 years. The majority had chronic plantar fasciitis (26.2%), posterior tibial tendon dysfunction (PTTD) (25.2%), hallux valgus (21.5%), or metatarsalgia (21.5%). The TCO user was defined as a participant who had to use the TCO for more than three days per week and for more or equal to 50% of daily walking and standing duration. The use rate was 67.3%. The TCO provides standing and walking stability (p=0.008). For patients with metatarsalgia, using the TCO could significantly reduce pain (p=0.002). Using univariate analysis, many factors were found to be associated with the use of the TCO including having level of convenience of putting on or taking off shoes with TCO at 9 or more (odds ratio 2.66, 95% CI 1.16 to 6.12), having difficulty to find proper shoes that fit with the TCO (odds ratio 0.36, 95% CI 0.15 to 0.89), receiving more than one pair of TCO (odds ratio 4.09, 95% CI 1.51 to 11.05), and having level of comfort satisfaction during the TCO use at 9 or more (odds ratio 3.61, 95% CI 1.55 to 8.40). The latter two factors were found to be associated with the use of the TCO from stepwise logistic regression analysis (adjusted odds ratio 3.39, 95% CI 1.18 to 9.71 and 3.02, 95% CI 1.07 to 8.47, respectively). Conclusion: The use of the TCO in the Foot Clinic, Siriraj Hospital was 67.3%. Using the TCO could promote walking stability. Factors affecting the use of the TCO included receiving more than the first pair of TCO and having comfort satisfaction level of 9 or more. Keywords: Use, Total contact orthoses, Total contact insole, Foot problems

Considerations of the technological quality assessment of sugarbeet

2011 ◽  
pp. 85-89 ◽  
Author(s):  
Giorgio Pezzi
Keyword(s):  
Quality Parameters ◽  
Northern Italy ◽  
Glucose Content ◽  
Long Term Storage ◽  
Interesting Correlation ◽  
Technological Quality ◽  
Thick Juice

No real improvement in the technological quality of beet has been recorded over the last 15 years in Northern Italy. Among the possible explanations for the quality stagnation is that the traditional formulae cannot correctly differentiate between sugarbeet varieties which produce thick juice of very high purity. This seems to be connected with the role of potassium. The use of a standard purification procedure gives reliable and accurate data which is immediately comparable with the factory data. Research projects on medium/long term storage are currently being performed by Co.Pro.B., Italy, in cooperation with Syngenta and Beta. Up to now the results have shown that storage of sugarbeet in autumn time in northern Italy is possible provided that suitable varieties and proper handling of the roots are employed. Results obtained in the storage trials are reported. Correlations have been found between quality parameters (purity, color and lime salts) of the purified juice with the glucose content of the raw juice. An interesting correlation is reported between purified juice purity and raw juice purity.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

Patterns of care in Italian psychiatric services and psychosocial outcome of schizophrenic patients. A three-year prospective study

1989 ◽  
Vol 4 (1) ◽  
pp. 23-31 ◽  
Author(s):  
D. Kemali ◽  
M. Maj ◽  
B. Carpiniello ◽  
R.D. Giurazza ◽  
M. Impagnatiello ◽  
...  
Keyword(s):  
Psychosocial Adjustment ◽  
Ad Hoc ◽  
Social Withdrawal ◽  
Skills Training ◽  
Favourable Outcome ◽  
Stepwise Logistic Regression ◽  
Psychosocial Outcome ◽  
Stepwise Logistic Regression Analysis ◽  
Schizophrenic Patients ◽  
The Difference

Summary141 patients with an ICD-9 diagnosis of schizophrenic psychosis were followed up prospectively for 3 years in 7 Italian centres, representative of the different degrees of application of the psychiatric reform law (Law 180) passed in 1978. It was agreed that each centre would treat the patients according to its routine, and that all contacts with the patients and each intervention performed would be carefully recorded in an ad hoc schedule. The baseline evaluation of psychosocial adjustment was performed by the Disability Assessment Schedule (DAS), and this assessment was then repeated every 6 months during the follow-up period. At the end of this period, the rating on the DAS section 5 was taken as a global measure of patients’ psychosocial outcome. On a stepwise logistic regression analysis, 2 variables were found to be significantly predictive of psychosocial outcome, that is the use of social and/or vocational skills training (associated with a favourable outcome) and the number of days/year of full hospitalization (associated with a poor outcome). Trieste and Arezzo were the only centres in which a significant improvement of the score on some DAS subscales (namely, “occupational role, interest” and “social withdrawal”) was detected. In the whole patient sample, the difference between the final and the baseline score on these subscales correlated significantly with the number/year of outpatient contacts and of home visits. These findings confirm the favourable impact of the community-oriented care provided in some Italian centres on the Psychosocial outcome of schizophrenic patients.

scholarly journals A rapid screening model for early predicting novel coronavirus pneumonia in Zhejiang Province of China: a multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yi-Ning Dai ◽  
Wei Zheng ◽  
Qing-Qing Wu ◽  
Tian-Chen Hui ◽  
Nan-Nan Sun ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Clinical Manifestations ◽  
Cost Effective ◽  
Rapid Screening ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Screening Model ◽  
Epidemiological Features ◽  
Geographical Regions ◽  
Novel Coronavirus

AbstractNovel coronavirus pneumonia (NCP) has been widely spread in China and several other countries. Early finding of this pneumonia from huge numbers of suspects gives clinicians a big challenge. The aim of the study was to develop a rapid screening model for early predicting NCP in a Zhejiang population, as well as its utility in other areas. A total of 880 participants who were initially suspected of NCP from January 17 to February 19 were included. Potential predictors were selected via stepwise logistic regression analysis. The model was established based on epidemiological features, clinical manifestations, white blood cell count, and pulmonary imaging changes, with the area under receiver operating characteristic (AUROC) curve of 0.920. At a cut-off value of 1.0, the model could determine NCP with a sensitivity of 85% and a specificity of 82.3%. We further developed a simplified model by combining the geographical regions and rounding the coefficients, with the AUROC of 0.909, as well as a model without epidemiological factors with the AUROC of 0.859. The study demonstrated that the screening model was a helpful and cost-effective tool for early predicting NCP and had great clinical significance given the high activity of NCP.

How can we ensure the success of specialised palliative home-care? A qualitative study (ELSAH) identifying key issues from the perspective of patients, relatives and health professionals

2021 ◽  
pp. 026921632110265
Author(s):  
Hannah Seipp ◽  
Jörg Haasenritter ◽  
Michaela Hach ◽  
Dorothée Becker ◽  
Lisa-R Ulrich ◽  
...  
Keyword(s):  
Home Care ◽  
Focus Groups ◽  
Health Professionals ◽  
Care Delivery ◽  
Death And Dying ◽  
Theory Approach ◽  
Palliative Home Care ◽  
Palliative Care Teams ◽  
Key Issues

Background: Specialised palliative home-care supports patients with life-limiting diseases in their familiar surroundings. The number of palliative care teams and patients being cared for is increasing worldwide. To assess and improve quality, it is needed to understand, how specialised palliative home-care can be provided successfully. For this purpose we examined the views of all involved stakeholders. Aim: To identify the issues that patients, their relatives and involved health professionals view as important in ensuring the success of specialised palliative home-care. Design: We used a qualitative design based on participant observations, interviews and focus groups following the principles of a Grounded Theory approach. Setting/participants: All specialised palliative home-care teams ( n = 22) caring for adults in Hesse, Germany, participated. We conducted participant observations ( n = 5), and interviewed patients ( n = 14), relatives ( n = 14) and health professionals working in or collaborating with specialised palliative home-care ( n = 30). We also conducted focus groups ( n = 4) with health professionals including a member check. Results: Successful specialised palliative home-care needs to treat complex symptoms, and provide comprehensive care including organisation of care, involving relatives and addressing issues of death and dying. Sense of security for patients and relatives is key to enable care at home. Care delivery preferences include a focus on the quality of relationships, respect for individuality and the facilitation of self-determination. Conclusions: Consideration of the identified key issues can help to ensure successful specialised palliative home-care. Knowledge of these should also be considered when researching and assessing quality of care. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00012421; http://www.germanctr.de .

The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

Dementia ◽  
2021 ◽  
pp. 147130122110126
Author(s):  
Alexandra E Harper ◽  
Lauren Terhorst ◽  
Marybeth Moscirella ◽  
Rose L Turner ◽  
Catherine V Piersol ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Scoping Review ◽  
Informal Caregivers ◽  
Nursing Home Care ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

Background Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers’ dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual’s care. However, little is known of the informal caregivers’ perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. Methods In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com , CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. Results We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. Conclusion Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers’ perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers’ satisfaction with nursing home care for residents with dementia.

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