Transitional care from the hospital to the home in heart failure: implementation of best practices

ABSTRACT Objectives: Assess the compliance of the implementation of better evidence in the transitional care of the person with heart failure from the hospital to the home. Methods: Evidence implementation project according to the JBI methodology in a cardiology hospital in São Paulo. Six criteria were audited before and after implementing strategies to increase compliance with best practices. 14 nurses and 22 patients participated in the audits. Results: In the baseline audit, compliance was null with five of the six criteria. Strategies: training of nurses; reformulation of the hospital discharge form and guidance on self-care in care contexts; and making telephone contact on the 7th, 14th and 21st days after discharge. In the follow-up audit, there was 100% compliance with five of the six criteria. Conclusion: The project made it possible to increase the compliance of transitional care practices in people with heart failure with the recommendations based on the best evidence.

Nonoperative Management for Peri-Appendiceal Abscesses after Percutaneous Drainage Without Interval Appendectomy

Background: Initial non-operative management (NOM) with percutaneous drainage for peri-appendiceal abscesses has been proven to be safe and effective. However, the appropriateness of interval appendectomy after NOM is still a matter of debate. The aim of this study was to investigate the feasibility of NOM without performing interval appendectomy.Methods: A retrospective review of medical records was performed for patients who were admitted with peri-appendiceal abscesses between January 2009 and December 2019. After percutaneous drainage for the abscesses, whether to undergo interval appendectomy was decided by the patients. Their clinical courses were reviewed thoroughly through their medical records. Telephone contact with these patients was made when necessary. Results: Twenty-seven patients were enrolled, with a mean age of 63.1 years (± 11.9 years). The median follow-up period was 25.7 months. The most common co-morbidities were cardiovascular disorders (eight patients) and underlying malignancies (eight patients). The mean size of the abscesses was 5.4 x 4.1 ㎝. Three patients consequently received surgery for the recurrence of appendicitis or peri-appendiceal abscesses. One patient received a right hemicolectomy, and another two received open appendectomies. Four patients (14.8%) died within the follow-up period due to underlying diseases.Conclusion: Initial NOM without interval appendectomy was a safe option in selected patients with peri-appendiceal abscess.

Direct phone communication to primary care physician to plan discharge from hospital: feasibility and benefits

Background The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. Methods This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 h prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians’ opinions on the benefits of this contact and its effect on readmission rates. Results 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average call completion rate was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. Conclusions Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. Trial registration French C.N.I.L. registration number 2108852. Registration date October 12, 2017.

Association between halitosis and female fecundability in China: a prospective cohort study

Background Periodontal diseases and poor oral hygiene are potentially associated with decreased female fecundability. Fecundability refers to the probability of conception during a given period measured in months or menstrual cycles. This study aims to examine whether halitosis is associated with female fecundability in a large sample of Chinese women who planned to be pregnant. Methods In 2012, a total of 6319 couples came for preconception care in eight districts in Shanghai, China and were followed by telephone contact. Three thousand nine hundred fifteen women who continued trying to be pregnant for up to 24 months remained for final statistical analyses. Halitosis was self-reported at the preconception care visit. Time to pregnancy (TTP) was reported in months and was censored at 24 months. Fecundability ratio (FR) was defined as the ratio of probability of conception among those with and without halitosis. FR and 95% confidence interval (CI) were estimated using the discrete-time Cox model. Results 80.1 and 86.1% of women had self-reported clinically confirmed pregnancy within 12 and 24 months, respectively. Halitosis was reported in 8.7% of the women. After controlling for potential confounders, halitosis was associated with a reduced probability of spontaneous conception (for an observation period of 12 months: adjusted FR 0.82, 95% CI 0.72–0.94; for an observation period of 24 months: adjusted FR 0.84, 95% CI 0.74–0.96). Conclusions Halitosis is associated with reduced fecundability in Chinese women.

Impact of the COVID-19 pandemic on the life of Bissau-Guinean religious (Quranic) schoolboys during a state of emergency: a qualitative study

BackgroundCOVID-19 is mainly a disease of adults but can affect vulnerable children indirectly through social containment measures. The study aimed to explore the impact of the pandemic on the lives of Quranic schoolboys, almudos, who beg on behalf of their teachers, chernos, in Guinea-Bissau.MethodsData were collected in July 2020 during a state of emergency. Data rest on semistructured interviews with 14 almudos and observations. The almudos, aged 12–16 years, were identified in the capital Bissau and the regional centre Gabú.ResultsFour interconnected themes were found. The first, hardship, was brought by the COVID-19 pandemic and caused by lockdown and police threats, resulting in a decrease in alms and hunger. The second, circumvention of calamity, included preventive measures the boys undertook and concerns with crowdedness impeding social distancing. Relations with others is the third theme. These had changed with sharply reduced contacts with neighbours and other providers of alms. The parents had more frequent telephone contact with their sons, and encouraged them to continue their studies. At the same time, the chernos and almudos passed more time together, and they dedicated more time than earlier to the studies and prayers. The fourth theme has to do with the boys’ concerns about their long-term aspirations—to complete their studies and become respected chernos, for which begging was seen as an integral part.ConclusionThe almudos suffered from decreased alms, resulting in hunger. COVID-19 was only an additional burden to the boys, who are used to facing challenges while begging to complete their religious education. According to the Convention on the Rights of the Child, children have a right to develop their capabilities in line with their future aspirations. Governments and child rights organisations need to address the specific needs of almudos in respectful collaboration with them, their parents, the chernos and their communities.

Putting a face to a name: Telephone contact as part of a blended approach to probation supervision

This article is about the experience of telephone supervision from the perspective of practitioners. It is set in the context of the Covid-19 pandemic, which changed and challenged the nature of probation supervision and required service users and supervisors to communicate remotely, using the telephone, rather than by meeting face-to-face. The article explores some of the impacts and consequences of telephone contact and examines the extent to which this approach has a part to play in future, post-pandemic, ways of working. The article draws on findings from a research project examining remote supervision practice during the pandemic. Fieldwork (comprising an online survey and a series of semi-structured interviews) was conducted between July and September 2020 in three divisions within an English community rehabilitation company. The article reinforces the importance of face-to-face work in probation practice but suggests that there is scope to retain some use of telephone supervision as part of a future blended practice model. Further thinking about telephone supervision might consider these three themes identified in the research: remote working limits the sensory dimension of supervision, relationships remain at the heart of practice, and good practice requires professional discretion.

Survey on the Evasion Factors of a Psychology School Clinic

The Psychology School Clinic enables the practice of internships inwhich students apply their theoretical knowledge in procedures madeavailable free of charge by the university to the community. Through thecharacterization of the reasons for evasion of cases dismissed in 2019, it isproposed to identify the causes of the psychological services offered and,therefore, to outline possible parameters for discussion and adjustment forthe given procedure. A descriptive survey of information collected fromclosed records was carried out.We surveyed 422 medical records that wereclosed in 2019, of which made it possible to identify the factors, namely:waiting time for care, telephone contact difficulties and the specificity ofemotional demand. These results allowed for a better understanding of theserved clientele and, therefore, it was possible to consider new strategiesin an attempt to reduce the evasion rate of the service, as greater visibilityof the device, reaching a larger population, as well as the propagation ofgood results. We emphasize the importance of the constant production ofstudies like this one, aiming, through the availability of data, to maintainthe teaching process and improve service to the public.

Behavior of the Community’s Older Adults During 12 Months of COVID-19 Social Restriction.

BACKGROUND: In a short time, COVID-19 adopted the proportions of a pandemic. Consequently, measures as social distancing were adopted to try to slow down the spread of the disease. The objective of this study was to understand the behavior of the Brazilian older adults during a period of social restriction by Covid-19.METHODS: 61 healthy older adults participated in this study. A questionnaire was applied over 12 months from the beginning of the social restriction recommendations using only telephone contact. The questionnaire included the profile of falls during the evaluation period and 4 questions based on fear and risk of infection by Covid-19, the practice of physical activity and compliance with measures of social restriction. The chi-square test (X2) was used to observe the possible associations between the independent and dependent variables.RESULTS: Most participants were female (90.2%), with mean age of 67 years and secondary education level. 78.7% adopted social restriction measures in the first month while in the last six months 54.1% of the participants complied with restrictive measures. The analysis of the chi-square test showed significant association between the evaluation period and social restriction [X2 (2) = 22.072; p = 0.000] and the risk of being infected [X2 (2) = 17.561; p = 0.000].CONCLUSION: There was a reduction in the number of older adults who complied with social restriction over time and a decrease in the practice of physical exercises in the sample evaluated.

The individual approach to management of patients with atrial fibrillation and its influence on patient adherence to anticoagulant therapy

Background The key points in the treatment of patients with atrial fibrillation (AF) with the ABC (Atrial Fibrillation Better Care) pathway are the prevention of stroke and increasing patient adherence to therapy. The basis for increasing adherence to therapy is regular communication between medical staff and the patients. Purpose To assess the effect of telephone contact (TC) frequency on patient adherence to anticoagulant therapy (ACT). Methods A prospective, non-interventional observational study was carried out, during which 84 patients with non-valvular AF were observed remotely after being discharged from the hospital. Patient education was provided in the hospital, which included an explanation of the importance of ACT. The observation period was 12 months. All enrolled patients were 18 years of age or older; AF was documented before enrolment on the basis of objective electrocardiographic evaluation; all patients had indications for taking anticoagulants (AC) for stroke prevention. Adherence to therapy was assessed using the Morisky-Green test. Results The patients were randomized into 2 groups: group 1 – TC monthly, group 2 – TC every 6 months. In the first group, 85.7% of patients received the non–vitamin K antagonist oral anticoagulants (NOAC), and 14.3% received warfarin; in the 2nd group, 92.9% of patients received NOAC, and 7.1% received warfarin. The mean score of the adherence to therapy according to the Morisky-Green test was initially 3.3±0.8 in group 1, and 3.3±0.7 in group 2, p=0.78. After 12 months: in group 1, 14.6% of patients refused to take AC; and in group 2, 25.0% did the same. The mean value score of the adherence to therapy in group 1 underwent a statistically insignificant change over time (from 3.3±0.8 to 3.1±1.5, p=0.48). In group 2, after 12 months, the mean score of adherence to therapy saw a significant decrease from 3.3±0.7 to 2.7±1.6, p=0.03. Both in group 1 and in group 2, the decrease in the mean score of adherence to therapy occurred mainly due to patients with an initially insufficient level of adherence. Conclusions The results of our study confirm the need for individual strategy for managing patients through the ABC pathway. In most cases, face-to-face or telephone contact with medical staff once every six months is sufficient for patients who are initially adherent to therapy, after receiving an introductory briefing. Patients with insufficient level of adherence require more frequent contact. FUNDunding Acknowledgement Type of funding sources: None.

Direct Phone Communication To Primary Care Physician To Plan Discharge From Hospital: Feasibility and Benefits

Background The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. Methods This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 hours prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians' opinions on the benefits of this contact and its effect on readmission rates. Results 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average success rate for calls was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. Conclusions Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. Trial registration French C.N.I.L. registration number 2108852. Registration date October 12, 2017.