Postoperative Care: In Hospital or at Home?

1972 ◽  
Vol 2 (1) ◽  
pp. 101-110 ◽  
Author(s):  
O. Echeverri ◽  
C. Manzano ◽  
A. Gomez ◽  
M. Quintero ◽  
A. Cobo
Keyword(s):  
Hernia Repair ◽  
Home Care ◽  
Surgical Procedures ◽  
Postoperative Care ◽  
Average Cost ◽  
Hospital Care ◽  
Care Patient ◽  
Care Group ◽  
Socioeconomic Characteristics ◽  
Economical Alternative

This study was carried out, first, to determine the feasibility of postoperative home care for three elective operations and, second, to explore the feasibility of introducing postoperative home care as a more economical alternative for the following surgical procedures: herniorrhaphy, vaginal hysterectomy, and vein stripping. Clinical, environmental, operative, and socioeconomic criteria were applied to 487 outpatients of which 44 pairs were selected and matched by age, sex, diagnosis, environmental, and socioeconomic characteristics. Each member of a pair was randomly assigned to either hospital care or home care. The place of postoperative care was disclosed only after the operation. After three to five hours in the recovery room, the hospital care patient was transferred to the general surgical wards and the home care patient was transferred by ambulance to his home. There were two minor complications in the home care group and three in the hospital care group. The duration of convalescence was significantly shorter for home care patients with post–hernia repair and with hysterectomy. Economic analysis showed that from the hospital viewpoint, the average cost for both herniorrhaphy and hysterectomy home care patients is one–fourth of the average cost of hospital care. The home care alternative also provides for other savings which are described in the study.

scholarly journals Gambaran kadar serum magnesium pada pasien penyakit ginjal kronik stadium 5 non dialisis di Manado

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Medhyka S.A. Kawilarang ◽  
Arthur E. Mongan ◽  
Maya Memah
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Home Care ◽  
Hospital Care ◽  
Serum Magnesium ◽  
Chronic Kidney Disease Stage ◽  
Muscular Contraction ◽  
Care Patient ◽  
Disease Stage ◽  
Ckd Stage

Abstract: Magnesium is a metal, one of the eight most abundant element in universe. Magnesium also is a mineral that responsible for bone metabolism control, neural transmission, cardiac excitability, neuromuscular conduction, muscular contraction, vasomotor, and blood pressure. In chronic kidney disease stage 4-5, compensation mechanism become inadequate that caused a hypermagnesemia. Objectives: This study aimed to know the picture of magnesium serum in non dialysis CKD stage 5 in Manado. Material Methods: This is a descriptive study, conducted by selecting 35 blood samples in Nephrology-Hypertension Polyclinic and IRINA of Interna of Prof. Dr. R.D Kandou Hospital and Teling Adventist Hospital. Result: There are 16 samples (45.7%) experience hypomagnesemia consisted of 8 home-care patient (22.9%) and 8 hospital-care patient (22.9%), 10 samples (28.6%) are in normal range consisted of 3 home-care patient (8.6%) and 7 hospital-care patient (20.0%), and 9 samples (25.7%) are experience hypermagnesemia consisted of 6 home-care patient (17.1%) and 3 hospital-care patient (8.6%) from total non dialysis CKD stage 5 samples result from laboratory examination. Conclusion: Patient with hypomagnesemia most frekuent than patient with hypermagnesemia.Keywords: magnesium, chronic kidney disease, non dialysisAbstrak: Magnesium merupakan logam yang masuk dalam delapan elemen paling melimpah di alam semesta. Magnesium juga merupakan mineral yang bertanggung jawab dalam pengaturan metabolisme tulang, transmisi saraf, eksitabilitas jantung, konduksi neuromuskular, kontraksi muscular, vasomotor, dan tekanan darah. Pada penyakit ginjal kronik stadium 4-5 mekanisme kompensasi ginjal menjadi inadekuat sehingga dapat menghasilkan hipermagnesemia. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran kadar serum magnesium pada pasien PGK non dialisis stadium 5 di Manado. Metode Penelitian: Penelitian ini adalah penelitian yang bersifat deskriptif yang dilaksanakan dengan cara mengambil sampel darah di Poliklinik Nefrologi-Hipertensi dan IRINA bagian Penyakit Dalam RSUP Prof. DR. R. D. Kandou Manado dan RS Advent Teling sebanyak 35 sampel. Hasil: Tercatat 16 orang yang mengalami hipomagnesemia (45,7%) diantaranya 8 orang pasien rawat jalan (22,9%) dan 8 orang pasien rawat inap (22,9%), 10 orang dalam batas nilai normal (28,6%) diantaranya 3 orang pasien rawat jalan (8,6%) dan 7 orang pasien rawat inap (20,0%), serta 9 orang mengalami hipermagnesemia (25,7%) diantaranya 6 orang pasien rawat jalan (17,1%) dan 3 orang pasien rawat inap (8,6%) dari total jumlah pasien terdiagnosis dokter PGK stadium 5 non dialisis yang didapatkan dari hasil pemeriksaan laboratorium. Simpulan: Frekuensi pasien yang mengalami hipomagnesemia lebih banyak dibandingkan pasien hipermagnesemiaKata kunci: magnesium, penyakit ginjal kronik, non dialisis

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

2021 ◽  
pp. 108482232098691
Author(s):  
Elizabeth Bien ◽  
Kermit Davis ◽  
Susan Reutman ◽  
Gordon Gillespie
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Occupational Safety ◽  
Occupational Exposures ◽  
Care Patient ◽  
Home Healthcare ◽  
Occupational Hazards ◽  
Cross Sectional ◽  
Direct Observations ◽  
Occupational Setting

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

scholarly journals Connected care for endocarditis and heart failure patients: a hospital-at-home programme

2021 ◽  
Author(s):  
J. van Ramshorst ◽  
M. Duffels ◽  
S. P. M de Boer ◽  
A. Bos-Schaap ◽  
O. Drexhage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Nurse Practitioners ◽  
Care Group ◽  
Proof Of Concept ◽  
Home Setting ◽  
Curative Care ◽  
Care At Home ◽  
Hospital At Home ◽  
At Home

Abstract Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

scholarly journals Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Health Scope ◽  
2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Maryam Khoramrooz ◽  
Asra Asgharzadeh ◽  
Saeide Alidoost ◽  
Zeynab Foroughi ◽  
Saber Azami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Home Care ◽  
Hospital Care ◽  
Cost Effective ◽  
Stroke Patients ◽  
Life Years ◽  
Effective Option ◽  
The Cost

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

scholarly journals Use of the Internet by Patients Undergoing Elective Hernia Repair or Cholecystectomy

2009 ◽  
Vol 91 (6) ◽  
pp. 460-463 ◽  
Author(s):  
AP Tamhankar ◽  
FAK Mazari ◽  
NJ Everitt ◽  
K Ravi
Keyword(s):  
Hernia Repair ◽  
Surgical Procedures ◽  
Significant Proportion ◽  
Abdominal Wall Hernia ◽  
The Internet ◽  
Additional Information ◽  
Information Leaflets ◽  
Directed Information ◽  
Use Of The Internet ◽  
Operative Assessment

INTRODUCTION Patient-directed information available on the internet is not always regulated; it may be confusing and sometimes just overwhelming. We aimed to establish the proportion of patients undergoing two common surgical procedures, who searched the internet for information about their operations and to assess the usefulness of the information they received. PATIENTS AND METHODS A total of 105 consecutive patients undergoing elective abdominal wall hernia repair (n = 54) or laparoscopic cholecystectomy (n = 51) in a single surgical firm were included in the study. Patients were counselled about their operation in pre-operative assessment clinics and standard trust information leaflets were provided without any mention of this study. Patients were then asked to complete a questionnaire on the morning of their operation. RESULTS All patients completed the questionnaire. Of the patients, 59% stated that they had access to the internet and 77% of these accessed the internet over 2 h a week. Of the patients with internet access, 31% used it to acquire additional information about their operations and 58% used internet search engines. Of the patients who searched the internet regarding their operations, 26% were confused and/or worried by the information they received. CONCLUSIONS A significant proportion of patients undergoing common surgical procedures used the internet and about one-third of them specifically sought information about their operation on the internet. Such information can cause worry and confusion in patients. Our study highlights the need for regulated, comprehensible, patient information on hospital websites to which patients should be directed.

Comparison of Home and Hospital Care of Advanced Cancer Patients

1989 ◽  
Vol 75 (6) ◽  
pp. 619-625 ◽  
Author(s):  
Vittorio Ventafridda ◽  
Franco De Conno ◽  
Antonio Viganò ◽  
Carla Ripamonti ◽  
Michele Gallucci ◽  
...  
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Care Service ◽  
Performance Status ◽  
Care Group ◽  
Terminal Cancer ◽  
Advanced Cancer Patients ◽  
Terminal Cancer Patients ◽  
Hospital Patients

Treatment and care of terminal cancer patients are conducted in different ways, according to the cultural, social, political and economical situations of the countries which have progressively adopted and developed them. In Italy there are no specialized structures such as « hospices » or the « palliative care units » like in the Anglo-Saxon world: the care of terminal cancer patients is carried out either in a general hospital or at their own home. In Milan and elsewhere there are home care teams in which doctors, nurses, social workers and volunteers, all work in connection with hospital structures. In this way, patients can receive specialized care for physical, psycological and social problems at home too. To evaluate costs and effectiveness of this program, a comparison was made between the home care and the conventional treatment carried out in general hospitals. Two groups of thirty terminal cancer patients have been studied: the first group was composed of hospital patients in Desio and the second one included patients cared for by the home care service organized by the Floriani Foundation and the Italian League against Cancer (Milan Section). We evaluated intensity and duration of pain, hours of sleep and hours of standing, sitting and lying, presence of side-effects, performance status and therapies. Data were also collected on the quality of life (Spitzer QLI), social and economical needs of the patients, type and quality of care, degree of awareness of the diagnosis by the patient and the family. This data were collected by the nurse who looked after the patient. Care costs were also quantified. The comparison between the two groups significantly favours the home care group as shown by the performance status after 2 weeks of care, the « health scale » and the Total Index of the Spitzer QLI and in general the greater satisfaction of the care received. Home care produces results equivalent to those achieved in hospitals as far as clinical parameters are concerned. An approximate quantification of the costs shows that an average cost for a day's home care was about Lit. 52,500 as compared with Lit. 360,000 for a day's hospitalization.

Rehabilitation for the Home Care Patient With COPD

2005 ◽  
Vol 23 (9) ◽  
pp. 578-584 ◽  
Author(s):  
Joseph A. Cigna ◽  
Lauren M. Turner-Cigna
Keyword(s):  
Home Care ◽  
Care Patient

Is Onlay Polypropylene Mesh Repair an Available Option for Incisional Hernia Repair? A Retrospective Cohort Study

2019 ◽  
Vol 85 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Oscar Cano-Valderrama ◽  
JosÉ L. Porrero ◽  
Esther Quirós ◽  
Oscar Bonachia ◽  
MarÍA J. Castillo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Surgical Procedures ◽  
Polypropylene Mesh ◽  
Mesh Repair ◽  
Incisional Hernia Repair ◽  
Hernia Recurrence ◽  
Onlay Mesh

Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% vs 13.1%, P = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% vs 7.1%, P = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.

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