Interventions Within the Scope of Occupational Therapy to Address Preventable Adverse Events in Inpatient and Home Health Postacute Care Settings: A Systematic Review

Importance: Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care. Objective: To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings. Data Sources: Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice. Findings: Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission. Conclusions and Relevance: The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury.

A Novel Real-Coded Genetic Algorithm for Dynamic Economic Dispatch Integrating Plug-In Electric Vehicles

Massive popularity of plug-in electric vehicles (PEVs) may bring considerable opportunities and challenges to the power grid. The scenario is highly dependent on whether PEVs can be effectively managed. Dynamic economic dispatch with PEVs (DED with PEVs) determines the optimal level of online units and PEVs, to minimize the fuel cost and grid fluctuations. Considering valve-point effects and transmission losses is a complex constrained optimization problem with non-smooth, non-linear, and non-convex characteristics. High efficient DED method provides a powerful tool in both power system scheduling and PEVs charging coordination. In this study, firstly, PEVs are integrated into the DED problem, which can carry out orderly charge and discharge management to improve the quality of the grid. To tackle this, a novel real-coded genetic algorithm (RCGA), namely, dimension-by-dimension mutation based on feature intervals (GADMFI), is proposed to enhance the exploitation and exploration of conventional RCGAs. Thirdly, a simple and efficient constraint handling method is proposed for an infeasible solution for DED. Finally, the proposed method is compared with the current literature on six cases with three scenarios, including only thermal units, units with disorderly PEVs, and units with orderly PEVs. The proposed GADMFI shows outstanding advantages on solving the DED with/without PEVs problem, obtaining the effect of cutting peaks and filling valleys on the DED with orderly PEVs problem.

Covid child in a Vaccine Center Observation - Sanitary Service Agency West Bergamo in Italy

New Coronavirus 2019 pandemic has created problems in the Health & Care System and we have seen additional changes in the managements of babies during transition period between post-partum or hospitalization and the across of vaccine and routine well child screening. International indications suggest the post-partum discharge management of newborns and preventive take care of basic pediatrician, like referents before one mount of life in the ambulatory setting and start of universal immunization about 2 mounts of age in base of health status for a routine childhood screening during Sars-Covid-19 pandemic.

Covid child in a Vaccine Center of Local Service Agency – West Bergamo - Italy

New Coronavirus 2019 pandemic has created problems in the Health & Care System and we have seen additional changes in the managements of babies during transition period between post-partum or hospitalization and the across of vaccine and routine well child screening. International indications suggest the post-partum discharge management of newborns and preventive take care of basic pediatrician, like referents before one mount of life in the ambulatory setting and start of universal immunization about 2 mounts of age in base of health status for a routine childhood screening during Sars-Covid-19 pandemic.

Hospital discharge management of premature newborns: nurses’ knowledge / O manejo da alta hospitalar do recém nascido prematuro: saberes dos enfermeiros

Objetivo: analisar os saberes dos enfermeiros durante o processo de alta hospitalar do recém nascido prematuro.Método: estudo descritivo, exploratório, qualitativo, realizado entre janeiro e maio de 2019 em uma unidade neonatal do Hospital Municipal Dra. Naelma Monteiro da Silva, vinculado ao Município de Rio das Ostras, Estado do Rio de Janeiro. Participaram do estudo onze enfermeiros atuantes na Unidade, sendo os dados coletados por meio de entrevista semiestruturada submetidos à análise de conteúdo na modalidade temática. Resultados: constatou-se que os enfermeiros demonstraram conhecimento dos saberes acerca dos cuidados ao recém nascido na alta hospitalar, destacando-se a amamentação, a higiene corporal, o coto umbilical, a criação de vínculo e o plano de alta hospitalar com o propósito de evitar as reinternações. Conclusão: há necessidade de uma assistência qualificada, segura e humanizada, com acolhimento e respeito às subjetividades, tendo como propósito conhecer as necessidades do recém nascido, e promover estratégias para a educação em saúde, em especial no que tange aos cuidados do recém-nascido prematuro.

Continuity in palliative care – analysis of intersectoral palliative care based on routine data of a statutory health insurance

Background The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death. Methods The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square. Results In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice. Conclusions The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.