scholarly journals Infuusiohoidot turvallisesti kotona – selvitys älykkään teknologian mahdollisuuksista

2017 ◽  
Vol 9 (2-3) ◽  
pp. 184
Author(s):  
Eija Kivekäs ◽  
Eija Toppinen ◽  
Hannu Kokki ◽  
Pekka Mäntyselkä ◽  
Ulla-Mari Kinnunen ◽  
...  

The purpose of the research project titled “Safety at Home and in Institutional Care: Utilizing remote monitoring and smart pump -technology in infusion care” was to identify the profile of patients, who require institutional care for infusion therapy for medical and nutrition management, in district hospital area. The digital technology, monitoring, and action models currently use is mapped. The overall purpose is to study the extended implementation of infusion care at home, utilizing smart technology. The data was collected through interviews and statistics. The aim was to explore how home infusion therapy is used, and how willing health care providers are to change current practices. The results showed that infusion therapy was common at outpatient clinics and quite common at home care. Collaboration with home care and emergency care made the infusion therapy possible at patient’s home. The use of smart technology in home care was less usual. The participants were enthusiastic and willing to use smart technology in infusion care and remote monitoring of patients’ status.

2021 ◽  
Author(s):  
Maryam Esmaeili ◽  
Nahid Dehghan nayeri ◽  
Fatemeh Bahramnezhad ◽  
Samrand Fattah Ghazi ◽  
Parvaneh Asgari

Abstract Background: The number of patients with chronic diseases requiring invasive mechanical ventilation at home is increasing. Family caregiving for patients with home mechanical ventilation (HMV) is associated with a particularly heavy workload. Thus, identifying the challenges of this valuable type of care can be an elective step for achieving health-related goals. This study was carried out to determine the challenges faced by home health care providers.Methods: 15 participants (9 family caregivers, 3 home nurses, and 3 home care attendants) were selected. Data were collected through semi-structured interviews and structured observation. All the interviews were recorded, transcribed, and then analyzed using qualitative content analysis and Max Qualitative Data Analysis 2010.Results: Three themes emerged from the data analysis: (1) Hospital-based challenges with two subthemes the family unpreparedness for home care and the lack of continuous education, (2) Home health care agency challenges with two sub themes. Home health care workers and the deficiency in organizational policies, and (3) Economic challenges.Conclusions: Three themes of hospital-related challenges, home health care agency challenges, and economic challenges emerged in the study showed that support from the insurance system, improvement of home care agency policies, and holistic care for patients through a multidisciplinary team approach are essential for addressing the current challenges of home care for patients under invasive mechanical ventilation at home.


2005 ◽  
Vol 37 (4) ◽  
pp. 385-411 ◽  
Author(s):  
ZOË MATTHEWS ◽  
JAYASHREE RAMAKRISHNA ◽  
SHANTI MAHENDRA ◽  
ASHA KILARU ◽  
SARASWATHY GANAPATHY

Maternal morbidity and mortality are high in the Indian context, but the majority of maternal deaths could be avoided by prompt and effective access to intrapartum care (WHO, 1999). Understanding the care seeking responses to intrapartum morbidities is crucial if maternal health is to be effectively improved, and maternal mortality reduced. This paper presents the results of a prospective study of 388 women followed through delivery and traditional postpartum in rural Karnataka in southern India. In this setting, few women use the existing health facilities and most deliveries occur at home. The analysis uses quantitative data, collected via questionnaires administered to women both during pregnancy and immediately after delivery. By virtue of its prospective design, the study gives a unique insight into intentions for intrapartum care during pregnancy as well as events following morbidities during labour. Routine care in the intrapartum period, both within institutions and at home, and impediments to appropriate care are also examined. The study was designed to collect information about health seeking decisions made by women and their families as pregnancies unfolded, rather than trying to capture women’s experience from a retrospective instrument. The data set is therefore a rich source of quantitative information, which incorporates details of event sequences and health service utilization not previously collected in a Safe Motherhood study. Additional qualitative information was also available from concurrent in-depth interviews with pregnant women, their families, health care providers and other key informants in the area. The level of unplanned institutional care seeking during the intrapartum period within the study area was very high, increasing from 11% planning deliveries at a facility to an eventual 35% actually delivering in hospitals. In addition there was a significant move away from planned deliveries with the auxiliary nurse midwive (ANM), to births with a lay attendant or dai. The proportion of women who planned for an ANM to assist was 49%, as compared with the actual occurrence, which was less than half of this proportion. Perceived quality of care was found to be an important factor in health seeking behaviour, as was wealth, caste, education and experience of previous problems in pregnancy. Actual care given by a range of practitioners was found to contain both beneficial and undesirable elements. As a response to serious morbidities experienced within the study period, many women were able to seek care although sometimes after a long delay. Those women who experienced inadequate progression of labour pains were most likely to proceed unexpectedly to a hospital delivery.


Author(s):  
Awad Al-Zaben ◽  
Lina M.K. Al-Ebbini ◽  
Badr Qatashah

In many situations, health care professionals need to evaluate the respiration rate (RR) for home patients. Moreover, when cases are more than health care providers’ capacity, it is important to follow up cases at home. In this paper, we present a complete system that enables healthcare providers to follow up with patients with respiratory-related diseases at home. The aim is to evaluate the use of a mobile phone’s accelerometer to capture respiration waveform from different patients using mobile phones. Whereas measurements are performed by patients themselves from home, and not by professional health care personnel, the signals captured by mobile phones are subjected to many unknowns. Therefore, the validity of the signals has to be evaluated first and before any processing. Proper signal processing algorithms can be used to prepare the captured waveform for RR computations. A validity check is considered at different stages using statistical measures and pathophysiological limitations. In this paper, a mobile application is developed to capture the accelerometer signals and send the data to a server at the health care facility. The server has a database of each patient’s signals considering patient privacy and security of information. All the validations and signal processing are performed on the server side. The patient’s condition can be followed up over a few days and an alarm system may be implemented at the server-side in case of respiration deterioration or when there is a risk of a patient’s need for hospitalization. The risk is determined based on respiration signal features extracted from the received respiration signal including RR, and Autoregressive (AR) moving average (ARMA) model parameters of the signal. Results showed that the presented method can be used at a larger scale enabling health care providers to monitor a large number of patients.


2017 ◽  
Author(s):  
Lianne Jeffs ◽  
Trevor Jamieson ◽  
Marianne Saragosa ◽  
Geetha Mukerji ◽  
Arsh K Jain ◽  
...  

BACKGROUND Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. OBJECTIVE In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. METHODS This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. RESULTS The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. CONCLUSIONS Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home.


2020 ◽  
Author(s):  
Naomi Dhollander ◽  
Tinne Smets ◽  
Aline De Vleminck ◽  
Lore Lapeire ◽  
Koen Pardon ◽  
...  

Abstract Background: To support the early integration of palliative home care (PHC) in cancer treatment, we developed the EPHECT intervention and pilot tested it with 30 advanced cancer patients in Belgium using a pre post design with no control group. We aim to determine the feasibility, acceptability and perceived effectiveness of the EPHECT intervention.Methods: Interviews with patients (n=16 of which 11 dyadic with family caregivers), oncologists and GPs (n=11) and a focus group with the PHC team. We further analyzed the study materials and logbooks of the PHC team (n=8). Preliminary effectiveness was assessed with questionnaires EORTC QLQ C-30, HADS and FAMCARE and were filled in at baseline and 12, 18 and 24 weeks.Results: In the interviews after the intervention period, patients reported feelings of safety and control and an optimized quality of life. The PHC team could focus on more than symptom management because they were introduced earlier in the trajectory of the patient. Telephone-based contact appeared to be insufficient to support interprofessional collaboration. Furthermore, some family caregivers reported that the nurse of the PHC team was focused little on them.Conclusion: Nurses of PHC teams are able to deliver early palliative care to advanced cancer patients. However, more attention needs to be given to family caregivers as caregiver and client. Furthermore, the home visits by the PHC team have to be further evaluated and adapted. Lastly, professionals have to find a more efficient way to discuss future care.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract The importance of the relationship between health and migration has been recognised for a long time with a more recent focus on refugee health. The experience of life threatening situations in countries of origin, the flight itself, but also the legal status of a refugee in the destination country brings about many health-related challenges. One area, in which these challenges become particularly visible, is the housing situation of refugees. In contrast to many voluntary migrants, refugees are often required to live in shared accommodations. These can be flats but also buildings constructed for other purposes, such as old factories, gyms, or hotels, container buildings, or tents. Thus, the living conditions of refugees in destination countries are often below the average housing standard of the native population. This situation can on the one hand reinforce challenges to refugees’ physical, psychological and social health, and on the other hand it can hinder the good provision of healthcare at home. This workshop addresses these challenges for the case of Germany - which had the highest number of asylum applications between 2015 and 2017 - by analysing different aspects of refugee health from an interdisciplinary perspective. The contributions bring together the results from theoretical/philosophical reflections, as well as qualitative and quantitative empirical data, including the perspective of refugees and health care providers. The contributions raise questions about the characteristics of accommodations that affect the subjective well-being and health of refugees. The results show that there are particular challenges for health and healthcare provision related to the general situation of accommodation of refugees in Germany. These include the potential transmission of germs and related risks for the physical health of refugees, the creation of a situation of exclusion from society which can worsen psychological stressors, as well as the distance from worshipping places, which can hinder the beneficial effects of communities of faith for the social health of refugees. In addition, the possibilities of maternity care in shared accommodations are often limited due to the lack of privacy, which can represent a stressor for pregnant women and young families. The results presented in this workshop are the outcomes of some projects developed in the graduate school “Challenges and Opportunities of Global Refugee Migration for Healthcare in Germany - FlüGe”. FlüGe encompasses 12 doctoral students, supervised by 12 professors from five faculties at Bielefeld University. It covers a broad range of disciplines (public health, psychology, microbiology, theology, and law) with an active involvement of practice partners, such as clinical and governmental institutions. In taking this approach, the graduate school aims to identify the short-, medium-, and long-term challenges and opportunities posed to global migration for healthcare in Germany and seeks to develop practical solutions. Key messages Despite the diversity in refugee accommodation in Germany, shared housing in general negatively affects refugee health in various ways. The accommodation of refugees poses challenges to the physical, mental and social health of refugees and to the efficient provision of healthcare at home.


PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Jane Qu ◽  
Laura N. Goldman ◽  
Joanne E. Wilkinson

Introduction: Although there is an increasing need for geriatricians, fewer physicians are entering the field. Family medicine residents find geriatrics, especially nursing home care, unsatisfying. Life stories of older adult patients may help providers cope with the challenges of nursing home care and increase provider satisfaction by offering a way to connect with patients. Methods: We conducted a qualitative study on life stories’ effects on attitudes towards nursing home care. Fourteen patient stories were created. Seven Boston University family medicine residents and one nurse practitioner participated in a semistructured interview both before and at least 2 months after learning about their patients’ stories. Data were analyzed using qualitative techniques from grounded theory. Results: Participants found nursing home care challenging, particularly for patients who were nonverbal due to advanced dementia, because they had difficulties forming meaningful relationships or discussing medical decisions with their patients. Life stories increased empathy, deepened relationships with patients, and led participants to feel more satisfied in their role as providers. The stories were considered useful for end-of-life discussions. Conclusion: Life stories incorporated into physician practice may help health care providers feel more connected to their patients and ultimately more satisfied in the care of nursing home patients.


2020 ◽  
Author(s):  
Sarah Bandeira ◽  
Patricia Batista ◽  
Cristina Cristóvão Ribeiro Silva ◽  
Ruth Caldeira Melo ◽  
Monica Rodrigues Perracini

Abstract Background The 2019‑nCoV pandemic represents a high risk for older people that sustain higher mortality rates compared to young adults. Limited social contact and restriction of mobility in the community (stay-at-home precautions) are recognised as measures to prevent SARS-CoV-2 infection among older people. The impact of these measures on health, physical function and emotional wellbeing are numerous, and might result in long-term adverse outcomes such as disability, falls and limited mobility. Thus, the objective of this scope review is to map the estimated impact of measures of social restrictions on the mobility of older people living in the community and to systematize the existing recommendations, anticipating possible intervention strategies gaps.Methods The search will be carried out using a standardized protocol in Latin American and Caribbean Literature on Health Sciences (LILACS), consulted by the Virtual Health Library (VHL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), via PubMed; Web of Science, via Main Collection (Thomson Reuters Scientific) and SCOPUS. Documents and reports with recommendations from governmental and nongovernmental organizations will be consulted. Complete studies available in the English, Spanish or Portuguese languages included in the different methodological approaches (original articles, literature reviews, editorials and guidelines) that necessarily address the recommendations of social restriction measures for preventing Covid-19 disease and their impacts on mobility of older people will be included. Two reviewers will select the studies based on their titles and abstracts. The manuscripts and documents selected for full reading will be analysed by reviewers concerning the eligibility criteria. When disagreements occurred in any phase of the selection process, a third reviewer will be included for a consensus analysis. Data will be extracted using a template form and the PRISMA-ScR checklist will be used to guarantee quality and transparency. Results will be presented as a narrative summary, including tables and figures.Discussion Globally, recommendations to stay-at-home and social distancing are substantially affecting health and wellbeing of older people. Preserving mobility is crucial to active and healthy ageing. The evidence summarized in the selected studies will be analysed in order to answer the research questions. The results of this review will help clinical practitioners, health care providers and policy makers to estimate the impact of measures to protect older people from 2019‑nCoV and to identify gaps and anticipate needs for targeted interventions to prevent mobility decline. Systematic review registrationsubmitted on 10-09-2020 in https://osf.io/registries


2021 ◽  
Vol 9 (C) ◽  
pp. 170-173
Author(s):  
Idaliya Rakhimova ◽  
Talgat Khaibullin ◽  
Yerbol Smail ◽  
Zhanar Urazalina ◽  
Vitalii Koval`chuk ◽  
...  

BACKGROUND: Patients with heart failure (HF) and implanted heart devices constitute a vulnerable category during the coronavirus disease –2019 (COVID-19) pandemic. The remote monitoring function allows the physician to detect atrial fibrillation (AF) in these patients and to prevent thromboembolic complications by prescribing anticoagulants. Under quarantine conditions, such patients can receive fully remote consultation and treatment, which will protect them from the risk of infection, and also reduce the burden on medical institutions. CASE REPORT: A 56-year-old man presented to the clinic with shortness of breath when climbing the second floor, moderate non-specific fatigue, general weakness, and a decrease in exercise tolerance. The patient received standard treatment for HF for at least 3 months (ACEI, beta blockers, MR antagonists, and loop diuretics) in individually selected adequate doses. ECG on admission showed a QRS of 150 ms, left bundle branch block (LBBB). Echo showed dilatation of all heart chambers, diffuse hypokinesis of the walls with akinesis of the apical, middle anterior LV segments, as well as hypokinesis of the basal, middle apical, and anterior septal segment of the LV. The ejection fraction was reduced to 35%. RV function is reduced. After a detailed discussion with the team, it was decided to do implantation of a cardioverter-defibrillator with resynchronization function, equipped with remote monitoring (Biotronik, and Home monitoring). Date of implantation is June 19, 2014. Due to the fact that the patient was connected to the remote monitoring system, May 5, 2020, he was diagnosed with asymptomatic AF. The episode lasted 1 min 22 s. On the following days of monitoring, episodes of AF were also recorded. The duration of the episodes ranged from a few seconds to 12 h/day. The patient received a doctor’s consultation through phone call, his risk of stroke was four when assessed using the CHA2DS2VASc scale. In treatment, it was recommended to add antiarrhythmic drugs (amiodarone 600 mg a day) and oral anticoagulants (rivaroxaban 20 mg × 1 time/day). Later, periodic IEGM showed absence of AF. CONCLUSION: In the context of the COVID-19 pandemic, health-care providers should rethink their approach to managing patients with implanted heart devices. Modern cardiovascular implantable electronic devices allow the physician to monitor the status of patients and immediately respond to situations requiring a change in treatment. Consultations can be carried out completely online.


2018 ◽  
Vol 18 (s2) ◽  
pp. 304
Author(s):  
Justine Lauren Giosa ◽  
Paul Stolee ◽  
Kerry Byrne ◽  
Samantha Meyer ◽  
Paul Holyoke

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