A new study from the USC Davis School of Gerontology found that caregivers of different ethnicities showed few negative mental or physical health effects as a result of tending to a family member with dementia.
The findings, which appeared the journal Aging & Mental Health, analyzed mental health and physical health differences between African-American and white caregivers.
A population-based sample of 102 caregivers compared with 102 non-caregivers matched participants on ethnicity, gender and age. The study, funded by the National Institute on Aging, is the first to use a population-based or community sampling strategy, to focus specifically on ethnic differences among caregivers tending to people with dementia.
"Community samples show a wider range of responses to family caregiving than those surveyed from clinics and service agencies, where most show clinical levels of distress," said lead author Bob Knight, holder of the Merle H. Bensinger Professorship in Gerontology. "Some caregivers are coping well; others are clearly over-stressed and in need of help."
Well-known ethnic differences in health rather than a specific response to caregiving explain the findings that both African-American caregivers and non-caregivers had worse physical health than white caregivers and non-caregivers. Analysis was based upon self-reported diseases of the circulatory system and measures of blood pressure.
One exception was that diastolic blood pressure was uniquely elevated in African-American caregivers.
"If confirmed by future research, this finding is especially important since it points to a specific health risk for African-American caregivers and one not reflected in self-reported health," Knight said.
Another NIA funded study led by Knight examined the role of familism, or prioritizing the good of the family over one's self, on stress and coping between white and African-American caregivers.
The results, which appeared in the journal Health Psychology, found putting the needs of the family over personal well-being is related to lower educational levels rather than ethnic or cultural differences. These self-sacrificing caregivers were found to avoid coping with problems and as a result to be in poor physical and mental health.
Knight's team determined behavioral problems of the person with dementia to be the source of increased burden for less educated caregivers, which led to the use of unhealthy coping mechanisms, known as avoidant coping. These detrimental habits include denying a problem exists, substance abuse, drinking and simply giving up -- ultimately resulting in poor physical and mental health outcomes.
Diastolic blood pressure indicators were affected differently through the use active coping styles, which are a healthy way of dealing with the problems that come with caregiving. Active coping styles include planning, positive reappraisal of problems and choosing the best time to address problems. Researchers found these techniques provide some protection for the high levels of diastolic blood pressure in African-American caregivers.
"The results could serve as a basis for improving services for caregivers and to understanding when the services can cross cultural lines and when they need to be more culture specific," Knight said.
Contributing authors of the first study include C.V. Flynn Longmire of Medical University of South Carolina, J.H. Kim of Sejong Cyber University, South Korea, Steve David of the UCLA Semel Institute for Neuroscience and Human Behavior and Jennifer Dave of the Clinical Psychology Department at USC. Flynn and Kim also co-wrote the second article along with Knight.
четверг, 2 июня 2011 г.
среда, 1 июня 2011 г.
Alliance Between Disability Advocates, Bush Administration Officials Helped Develop Program To Encourage Home Care For Medicaid Beneficiaries
NPR's "Morning Edition" on Friday examined how an "unlikely alliance" between a group of disability advocates and Bush administration officials resulted in a major change to federal funding for long-term care of Medicaid beneficiaries (Shapiro, "Morning Edition," NPR, 9/15). HHS in July announced plans to award $1.75 billion in grants to states under a five-year program that would allow Medicaid beneficiaries to reside in their homes or in their communities, rather than in nursing homes. Under the program, states for one year will receive a higher rate of federal Medicaid matching funds for beneficiaries whom states move from nursing homes into their own homes or communities. States also can use the funds to make modifications to the homes of Medicaid beneficiaries to allow their continued residence and to provide respites for family caregivers. States must agree to continue to provide Medicaid beneficiaries with home or community care for at least one year after the higher rate of federal Medicaid matching funds ends. HHS said that the program could reduce costs because nursing home care is more expensive than home or community care (Kaiser Daily Health Policy Report, 7/27). According to NPR, the relationship began in 2002 when 200 protestors in wheelchairs blocked traffic at an intersection near the White House and started discussions with Mark McClellan, current CMS administrator and a member of the president's Council of Economic Advisers at the time. Since his appointment to CMS, McClellan met four times annually with Bob Kafka, executive director of the American Disabled for Attendant Programs Today. Although some health care and disability advocates criticize some of the program's provisions, such as one allowing states to change benefits and charge copayments, McClellan said the Money Follows the Person program is the "biggest change in long-term financing in decades" and that his work with ADAPT is one of his proudest accomplishments from his tenure. According to NPR, 30 states have told McClellan that they would like to participate in the program, which began accepting grant applications two weeks ago. The NPR segment includes comments from Kafka and McClellan ("Morning Edition," NPR, 9/15).
The complete segment is available online in RealPlayer. Expanded NPR coverage, including a transcript of the segment, additional audio from ADAPT members and photos, is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
The complete segment is available online in RealPlayer. Expanded NPR coverage, including a transcript of the segment, additional audio from ADAPT members and photos, is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
вторник, 31 мая 2011 г.
Bathing Disability In Elderly Strong Predictor Of Long-Term Admission To Nursing Homes
Researchers at Yale School of Medicine have found that persistent bathing disability among the elderly can increase the risk of long-term nursing home admission by 77 percent, but interventions aimed at prevention and remediation could reduce the need for these long-term care services.
The results are published in the August issue of Gerontology: Medical Sciences. Disability in bathing-the need for personal assistance to wash and dry one's whole body-is highly prevalent in older persons and is a strong predictor of morbidity and mortality. It is also the primary reason why older persons receive nursing aide assistance in the home.
Thomas Gill, M.D., professor of medicine and epidemiology and public health at Yale School of Medicine and colleagues conducted a longitudinal study of 754 community-living residents of New Haven aged 70 and older. These participants were non-disabled in four essential activities of daily living. They were followed with monthly telephone interviews for over six years to determine the occurrence of persistent (present for at least two consecutive months) disability in bathing and the time to the first long-term nursing home admission, defined as longer than three months.
Gill and his co-authors found that 15 percent of study participants had a long-term nursing home admission. At least one episode of persistent bathing disability occurred among 52.2 percent of participants with a long-term nursing home admission and 32.8 percent without a long-term admission. The occurrence of persistent bathing disability increased the risk of long-term nursing home admission by 77 percent. This elevation in risk accounted for several other factors including the occurrence of persistent disability in other essential activities of daily living, and was not observed for short-term nursing home admissions.
"The results show that the occurrence of persistent bathing disability is strongly associated with the risk of long-term nursing home admissions," said Gill, who is the recipient of a MERIT award from the National Institute on Aging. "Interventions directed at the prevention and remediation of bathing disability have the potential to reduce the burden and expense of long-term care services. Identifying potentially modifiable risk factors for bathing disability should be a high research priority."
The results are part of the ongoing Yale Precipitating Events Project (PEP), which seeks to better understand how older persons manage day-to-day activities and remain independent at home. Titled "Epidemiology of Disability and Recovery in Older Persons," the PEP study includes 754 participants age 70 or older from the Greater New Haven area.
Other authors on the study include Yale researchers Heather G. Allore and Ling Han.
The research was supported by grants from the National Institute on Aging.
Citation: J. Gerontol. Med. Sci., Vol. 61A, No. 8 (August, 2006)
# # #
Yale News Releases are available via the World Wide Web at yale/opa
For further information please go to:
Yale University
The results are published in the August issue of Gerontology: Medical Sciences. Disability in bathing-the need for personal assistance to wash and dry one's whole body-is highly prevalent in older persons and is a strong predictor of morbidity and mortality. It is also the primary reason why older persons receive nursing aide assistance in the home.
Thomas Gill, M.D., professor of medicine and epidemiology and public health at Yale School of Medicine and colleagues conducted a longitudinal study of 754 community-living residents of New Haven aged 70 and older. These participants were non-disabled in four essential activities of daily living. They were followed with monthly telephone interviews for over six years to determine the occurrence of persistent (present for at least two consecutive months) disability in bathing and the time to the first long-term nursing home admission, defined as longer than three months.
Gill and his co-authors found that 15 percent of study participants had a long-term nursing home admission. At least one episode of persistent bathing disability occurred among 52.2 percent of participants with a long-term nursing home admission and 32.8 percent without a long-term admission. The occurrence of persistent bathing disability increased the risk of long-term nursing home admission by 77 percent. This elevation in risk accounted for several other factors including the occurrence of persistent disability in other essential activities of daily living, and was not observed for short-term nursing home admissions.
"The results show that the occurrence of persistent bathing disability is strongly associated with the risk of long-term nursing home admissions," said Gill, who is the recipient of a MERIT award from the National Institute on Aging. "Interventions directed at the prevention and remediation of bathing disability have the potential to reduce the burden and expense of long-term care services. Identifying potentially modifiable risk factors for bathing disability should be a high research priority."
The results are part of the ongoing Yale Precipitating Events Project (PEP), which seeks to better understand how older persons manage day-to-day activities and remain independent at home. Titled "Epidemiology of Disability and Recovery in Older Persons," the PEP study includes 754 participants age 70 or older from the Greater New Haven area.
Other authors on the study include Yale researchers Heather G. Allore and Ling Han.
The research was supported by grants from the National Institute on Aging.
Citation: J. Gerontol. Med. Sci., Vol. 61A, No. 8 (August, 2006)
# # #
Yale News Releases are available via the World Wide Web at yale/opa
For further information please go to:
Yale University
понедельник, 30 мая 2011 г.
NHS Central Lancashire Pioneers New Home Health Monitoring Technology For Chronically Ill Patients
NHS Central Lancashire's community matrons have introduced an innovative remote patient care management tool to help chronically ill patients in Preston monitor and manage their health at home and remain independent for longer.
The technology is currently being piloted with 40 patients with chronic obstructive pulmonary disease (COPD) - a serious and incapacitating condition which affects over 3.7 million people in the UK and typically causes acute shortness of breath and susceptibility to lung infections. If successful, NHS Central Lancashire aims to expand the programme to help patients with other chronic illnesses such as diabetes, hypertension and heart failure across central Lancashire.
The Intel Health Guide was designed and developed by Intel to address the challenges of chronic conditions for patients, their families and the healthcare professionals responsible for their care. The device, currently available in the US and UK through GE Healthcare, allows patients to measure their vital signs such as blood pressure, pulse and weight, and respond to questions about their diseases on a daily basis, with all data reviewed by the community matron team. The technology, which also includes a videoconferencing capability enabling patients to talk with community matrons, allows the care team to assess the patient for signs that their condition is worsening. The hope is that early recognition and treatment of a change in symptoms will reduce the need for admissions to hospital. The technology also helps patients to manage their own condition, look out for particular symptoms and take medication at the right time.
Anne Walton, NHS Central Lancashire's community matron locality lead, said: "I am very excited to be leading on this project. My team and I have been working very hard to get this pilot up and running and we are getting lots of positive feedback from patients.
"This new technology allows patients to take a more active role in their own care and to learn more about their own condition. This will hopefully teach them how to spot signs of symptoms so they can act sooner to avoid being admitted to hospital.
"If this pilot is deemed a success it will potentially open up a new way of working for community matrons and other services, helping to improve the existing quality service we provide to our patients."
Jackie Vella, Preston Breatheasy Group's chair, said: "I personally think this new technology is fantastic and is a real step forward. I think it will be well received by patients. I know if I was offered it I would jump at the opportunity to be involved in this pioneering pilot."
The pilot - which started in June 2010 - will run for 12 months across Preston and will be evaluated at regular intervals to assess how the technology is helping improve patients' quality of life, their general satisfaction with the equipment and the opinion of carers.
Joe Rafferty, NHS Central Lancashire's chief executive, said: "This pilot fits with our pledge to ensure that the people of central Lancashire are treated using the most appropriate technology. We know that people would much rather receive care and treatment at home rather than have to make frequent trips to hospital. It is a win/win situation for our chronically ill patients and community matrons."
Richard Rees-Davies, GE Healthcare's Home Health UK general manager, said: "The increasing cost and burden of chronic disease is a huge problem in the UK and one which is only likely to intensify. This is where new health technologies like the IntelO Health Guide can make a real difference by extending care from the hospital to the home. In particular it will help to improve access, increase quality and reduce the cost of healthcare bringing benefits to patients, health practitioners and the health service.
"The trial with NHS Central Lancashire is an extension of our alliance with Intel to drive new models of care including more personalised care at home. Our experience with the IntelO Health Guide in the US shows that it can have a positive impact on many types of chronic disease. At NHS Central Lancashire we have also seen the benefits of collaboration working with the health trust to ensure the effective roll-out of the technology."
Case Study
Dennis Winder, 68, from Fulwood, Preston has had COPD for the past 25 years.
"My illness is getting progressively worse year on year," he said. "There are things I could do a year ago which I cannot do today. It is a very restrictive illness and can stop me from doing the things I love. I can't play in the park with my grandchildren or go out socialising down the pub as much I used to. I love my garden but I have to rely on my wife Stella to mow the lawn as I get short of breath pushing the lawn mower.
"I try not to let it interfere with my life too much. Life is for living. It's Stella who suffers most. She is the one who keeps me going. I don't know what I would do without her at times.
"The equipment is brilliant and very easy to use. It keeps me in constant contact with the community matron team while not being intrusive. If the matrons think there is a problem they give me a call to check I am ok. There was an occasion the other week when my measurements went up and John, my community matron, was round my house in no time to check on me.
"I find the educational videos are useful and I feel that I now have more contact with the matrons, even though it is not always face-to-face. It gives me and Stella peace of mind to know we are not alone and help is as hand."
Stella, 66, added: "In the past I have had to keep a close eye on Dennis and I felt it was my decision as to when to get in touch with the community matrons. I felt that I didn't want to be a nuisance to them and so quite often left it too late to get in touch. This would result in Dennis having to be admitted to hospital.
"This new system is a great relief to me as it is shares the decisions with the professionals. This way Dennis is treated sooner and before things get worse.
"I have also found that I am learning a lot about Dennis' condition too. Looking at his vital signs every day I can see the trends, which can indicate his symptoms are changing and can ensure action is taken.
"This technology is amazing and I am looking forward to seeing what the future holds."
The technology is currently being piloted with 40 patients with chronic obstructive pulmonary disease (COPD) - a serious and incapacitating condition which affects over 3.7 million people in the UK and typically causes acute shortness of breath and susceptibility to lung infections. If successful, NHS Central Lancashire aims to expand the programme to help patients with other chronic illnesses such as diabetes, hypertension and heart failure across central Lancashire.
The Intel Health Guide was designed and developed by Intel to address the challenges of chronic conditions for patients, their families and the healthcare professionals responsible for their care. The device, currently available in the US and UK through GE Healthcare, allows patients to measure their vital signs such as blood pressure, pulse and weight, and respond to questions about their diseases on a daily basis, with all data reviewed by the community matron team. The technology, which also includes a videoconferencing capability enabling patients to talk with community matrons, allows the care team to assess the patient for signs that their condition is worsening. The hope is that early recognition and treatment of a change in symptoms will reduce the need for admissions to hospital. The technology also helps patients to manage their own condition, look out for particular symptoms and take medication at the right time.
Anne Walton, NHS Central Lancashire's community matron locality lead, said: "I am very excited to be leading on this project. My team and I have been working very hard to get this pilot up and running and we are getting lots of positive feedback from patients.
"This new technology allows patients to take a more active role in their own care and to learn more about their own condition. This will hopefully teach them how to spot signs of symptoms so they can act sooner to avoid being admitted to hospital.
"If this pilot is deemed a success it will potentially open up a new way of working for community matrons and other services, helping to improve the existing quality service we provide to our patients."
Jackie Vella, Preston Breatheasy Group's chair, said: "I personally think this new technology is fantastic and is a real step forward. I think it will be well received by patients. I know if I was offered it I would jump at the opportunity to be involved in this pioneering pilot."
The pilot - which started in June 2010 - will run for 12 months across Preston and will be evaluated at regular intervals to assess how the technology is helping improve patients' quality of life, their general satisfaction with the equipment and the opinion of carers.
Joe Rafferty, NHS Central Lancashire's chief executive, said: "This pilot fits with our pledge to ensure that the people of central Lancashire are treated using the most appropriate technology. We know that people would much rather receive care and treatment at home rather than have to make frequent trips to hospital. It is a win/win situation for our chronically ill patients and community matrons."
Richard Rees-Davies, GE Healthcare's Home Health UK general manager, said: "The increasing cost and burden of chronic disease is a huge problem in the UK and one which is only likely to intensify. This is where new health technologies like the IntelO Health Guide can make a real difference by extending care from the hospital to the home. In particular it will help to improve access, increase quality and reduce the cost of healthcare bringing benefits to patients, health practitioners and the health service.
"The trial with NHS Central Lancashire is an extension of our alliance with Intel to drive new models of care including more personalised care at home. Our experience with the IntelO Health Guide in the US shows that it can have a positive impact on many types of chronic disease. At NHS Central Lancashire we have also seen the benefits of collaboration working with the health trust to ensure the effective roll-out of the technology."
Case Study
Dennis Winder, 68, from Fulwood, Preston has had COPD for the past 25 years.
"My illness is getting progressively worse year on year," he said. "There are things I could do a year ago which I cannot do today. It is a very restrictive illness and can stop me from doing the things I love. I can't play in the park with my grandchildren or go out socialising down the pub as much I used to. I love my garden but I have to rely on my wife Stella to mow the lawn as I get short of breath pushing the lawn mower.
"I try not to let it interfere with my life too much. Life is for living. It's Stella who suffers most. She is the one who keeps me going. I don't know what I would do without her at times.
"The equipment is brilliant and very easy to use. It keeps me in constant contact with the community matron team while not being intrusive. If the matrons think there is a problem they give me a call to check I am ok. There was an occasion the other week when my measurements went up and John, my community matron, was round my house in no time to check on me.
"I find the educational videos are useful and I feel that I now have more contact with the matrons, even though it is not always face-to-face. It gives me and Stella peace of mind to know we are not alone and help is as hand."
Stella, 66, added: "In the past I have had to keep a close eye on Dennis and I felt it was my decision as to when to get in touch with the community matrons. I felt that I didn't want to be a nuisance to them and so quite often left it too late to get in touch. This would result in Dennis having to be admitted to hospital.
"This new system is a great relief to me as it is shares the decisions with the professionals. This way Dennis is treated sooner and before things get worse.
"I have also found that I am learning a lot about Dennis' condition too. Looking at his vital signs every day I can see the trends, which can indicate his symptoms are changing and can ensure action is taken.
"This technology is amazing and I am looking forward to seeing what the future holds."
воскресенье, 29 мая 2011 г.
Dementia Load On Carers Lessened By Computerized COACH
An artificial intelligence coaching system has been developed that will help carers of older adults with moderate dementia. The COACH system (Cognitive Orthosis for Assisting aCtivities in the Home), described in the open access journal BMC Geriatrics, uses a camera and computer to deliver interactive advice - lessening the workload on often-overburdened carers.
Alex Mihailidis led a team of researchers from the University of Toronto, Canada, who tested the COACH's ability to help a group of six older adults with dementia remember how to wash their hands. Mihailidis said, "COACH employs various computer vision and artificial intelligence techniques to autonomously provide the user with verbal and/or visual reminders as necessary during their activities of daily living".
When COACH was used, the participants with moderate dementia showed an increase in the number of handwashing steps they were able to complete without assistance from the caregiver as well as a decrease in the number of times they required assistance from the caregiver during the activity.
COACH uses a camera to monitor the care recipient's progress and delivers relevant advice, either through speakers or on a television screen. According to the authors, "To be useful to both a person with dementia and their caregivers, a coaching device must be automatic and not require feedback like button presses, as this cannot reasonably be expected of the target audience or their overworked caregivers. Cognitive assistance should be personalized and appropriate to the deficits in question. Finally, assistance should only be given when needed to minimize confusion and keep the user as involved in the task as possible".
When the COACH system believes that a mistake has been made, a pre-recorded prompt is played. COACH gives the relevant advice, sometimes accompanied by an illustrative video, recorded from the point of view of the person doing the task. The authors found that of the five test subjects with moderate dementia, four were independent of human caregivers while the device was used. The other subject with moderate dementia notably and consistently failed to use soap, even when she received the correct prompts.
Notes
1. The COACH prompting system to assist older adults with dementia through handwashing: An efficacy study
Alex Mihailidis, Jennifer N Boger, Tammy Craig and Jesse Hoey
BMC Geriatrics (in press)
Article available at journal website: biomedcentral/bmcgeriatr/
All articles are available free of charge, according to BioMed Central's open access policy.
2. BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of health care in older people. BMC Geriatrics (ISSN 1471-2318) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
Alex Mihailidis led a team of researchers from the University of Toronto, Canada, who tested the COACH's ability to help a group of six older adults with dementia remember how to wash their hands. Mihailidis said, "COACH employs various computer vision and artificial intelligence techniques to autonomously provide the user with verbal and/or visual reminders as necessary during their activities of daily living".
When COACH was used, the participants with moderate dementia showed an increase in the number of handwashing steps they were able to complete without assistance from the caregiver as well as a decrease in the number of times they required assistance from the caregiver during the activity.
COACH uses a camera to monitor the care recipient's progress and delivers relevant advice, either through speakers or on a television screen. According to the authors, "To be useful to both a person with dementia and their caregivers, a coaching device must be automatic and not require feedback like button presses, as this cannot reasonably be expected of the target audience or their overworked caregivers. Cognitive assistance should be personalized and appropriate to the deficits in question. Finally, assistance should only be given when needed to minimize confusion and keep the user as involved in the task as possible".
When the COACH system believes that a mistake has been made, a pre-recorded prompt is played. COACH gives the relevant advice, sometimes accompanied by an illustrative video, recorded from the point of view of the person doing the task. The authors found that of the five test subjects with moderate dementia, four were independent of human caregivers while the device was used. The other subject with moderate dementia notably and consistently failed to use soap, even when she received the correct prompts.
Notes
1. The COACH prompting system to assist older adults with dementia through handwashing: An efficacy study
Alex Mihailidis, Jennifer N Boger, Tammy Craig and Jesse Hoey
BMC Geriatrics (in press)
Article available at journal website: biomedcentral/bmcgeriatr/
All articles are available free of charge, according to BioMed Central's open access policy.
2. BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of health care in older people. BMC Geriatrics (ISSN 1471-2318) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
суббота, 28 мая 2011 г.
Hospital At-Home Programs Provide Similar Patient Outcomes
For select patients, hospital at home treatment produces similar outcomes to inpatient care at similar or lower costs, found a study by researchers from the United Kingdom and Italy to be published in CMAJ cmaj.ca/press/pg175.pdf.
Hospital at home programs are popular alternatives to hospital stays given the demand for acute care beds and the need to cut costs.
The study, a systematic review and meta-analysis, sought to determine whether patients receiving at home care compared with in-patient hospital care have better or equivalent health outcomes. It looked at trials of patients 70 years of age or older with chronic pulmonary disease (COPD), stroke patients and older patients with acute medical conditions.
"Patients allocated to hospital at home had a significantly reduced risk of death at 6 months follow up," state Dr. Sasha Shepperd and coauthors. "This reduction was not significant at 3 months, possibly reflecting the lower number of events by that time point." They note patient satisfaction was high for treatment at home.
However, mortality rates were lower at 3 months for patients in hospital stroke care units compared with hospital at home care.
"Our findings do not mean that hospital care is hazardous," cautions Dr. Shepperd who led the team of researchers. "More work needs to be done to determine if there are particular types of patients who benefit from hospital at home care. This is especially important, as the level of treatment available to a person at home, and the ways of delivering care in both the home and the hospital, change."
Professor Mike Clarke, another member of the research team, from the UK Cochrane Centre, adds "We are also cautious because we had to rely on data from trials that have been published, and we were not able to find any unpublished trials. It may be that other research has taken place and that the trials we identified are not representative of all those that have been done. However, our findings still represent the most complete analysis yet of this topic and provide important knowledge for patients, doctors and policy makers."
The study was conducted by researchers from University of Oxford; University Hospital Aintree Hospitals NHS Trust; University College, London; King's & St. Thomas' School of Medicine; University of Leicester; and University of Torino, Italy.
In a related commentary cmaj.ca/press/pg156.pdf, Dr. Bruce Leff of Johns Hopkins University School of Medicine writes: "We must incorporate hospital at home into the continuum of care without it becoming yet another siloed health care delivery model." He suggests hospital at home could operate as one element in a portfolio of options to keep select patients out of hospital and to help patients' transition from hospital.
Hospital at home programs are popular alternatives to hospital stays given the demand for acute care beds and the need to cut costs.
The study, a systematic review and meta-analysis, sought to determine whether patients receiving at home care compared with in-patient hospital care have better or equivalent health outcomes. It looked at trials of patients 70 years of age or older with chronic pulmonary disease (COPD), stroke patients and older patients with acute medical conditions.
"Patients allocated to hospital at home had a significantly reduced risk of death at 6 months follow up," state Dr. Sasha Shepperd and coauthors. "This reduction was not significant at 3 months, possibly reflecting the lower number of events by that time point." They note patient satisfaction was high for treatment at home.
However, mortality rates were lower at 3 months for patients in hospital stroke care units compared with hospital at home care.
"Our findings do not mean that hospital care is hazardous," cautions Dr. Shepperd who led the team of researchers. "More work needs to be done to determine if there are particular types of patients who benefit from hospital at home care. This is especially important, as the level of treatment available to a person at home, and the ways of delivering care in both the home and the hospital, change."
Professor Mike Clarke, another member of the research team, from the UK Cochrane Centre, adds "We are also cautious because we had to rely on data from trials that have been published, and we were not able to find any unpublished trials. It may be that other research has taken place and that the trials we identified are not representative of all those that have been done. However, our findings still represent the most complete analysis yet of this topic and provide important knowledge for patients, doctors and policy makers."
The study was conducted by researchers from University of Oxford; University Hospital Aintree Hospitals NHS Trust; University College, London; King's & St. Thomas' School of Medicine; University of Leicester; and University of Torino, Italy.
In a related commentary cmaj.ca/press/pg156.pdf, Dr. Bruce Leff of Johns Hopkins University School of Medicine writes: "We must incorporate hospital at home into the continuum of care without it becoming yet another siloed health care delivery model." He suggests hospital at home could operate as one element in a portfolio of options to keep select patients out of hospital and to help patients' transition from hospital.
пятница, 27 мая 2011 г.
$1.9m To Improve Care For Thalidomide Survivors In Wales
First Minister Carwyn Jones announced on Friday ??1.9million for the Thalidomide Trust to improve the care and support for thalidomide survivors in Wales.
The funding which will be available from April will be distributed amongst survivors to help meet their health needs and minimise any further deterioration of their condition.
This funding will be in addition to ??20million announced by the Department of Health last month for the Thalidomide Trust for a pilot scheme to support thalidomiders, as they refer to themselves.
Between 1958 and 1961, the drug, thalidomide, was used by expectant mothers to control symptoms of morning sickness. Tragically, this led to many babies being born with often severe physical disabilities. There are 31 thalidomiders in Wales.
The First Minister, who will meet thalidomide survivors in Gorseinon, Swansea today, said: "I believe that addressing the ongoing needs of thalidomiders rests with the UK Government as it authorised the use of thalidomide. While survivors in Wales will have access to a share of the funding announced by the Department of Health, I wanted to provide additional funding to ensure that people affected by thalidomide in Wales receive the care and support they need.
"I am pleased that the UK Government has expressed its sincere regret and deep sympathy for the injury and suffering endured by all those affected
when expectant mothers took the drug between 1958 and 1961.
"The funding I am announcing today will help thalidomiders manage the continuing and increasing health needs as they get older.
"We will be working with the Thalidomide Trust on how this funding will be distributed to maximise the benefits for individuals."
Nick Dobrik, representative of the National Advisory Group for the Thalidomide Trust and leading campaigner, said: "On behalf of the thalidomide community, we would like to thank the Welsh Assembly Government for its speed and generosity in contributing to helping thalidomiders maintain their independence."
Source
Welsh Assembly Government
The funding which will be available from April will be distributed amongst survivors to help meet their health needs and minimise any further deterioration of their condition.
This funding will be in addition to ??20million announced by the Department of Health last month for the Thalidomide Trust for a pilot scheme to support thalidomiders, as they refer to themselves.
Between 1958 and 1961, the drug, thalidomide, was used by expectant mothers to control symptoms of morning sickness. Tragically, this led to many babies being born with often severe physical disabilities. There are 31 thalidomiders in Wales.
The First Minister, who will meet thalidomide survivors in Gorseinon, Swansea today, said: "I believe that addressing the ongoing needs of thalidomiders rests with the UK Government as it authorised the use of thalidomide. While survivors in Wales will have access to a share of the funding announced by the Department of Health, I wanted to provide additional funding to ensure that people affected by thalidomide in Wales receive the care and support they need.
"I am pleased that the UK Government has expressed its sincere regret and deep sympathy for the injury and suffering endured by all those affected
when expectant mothers took the drug between 1958 and 1961.
"The funding I am announcing today will help thalidomiders manage the continuing and increasing health needs as they get older.
"We will be working with the Thalidomide Trust on how this funding will be distributed to maximise the benefits for individuals."
Nick Dobrik, representative of the National Advisory Group for the Thalidomide Trust and leading campaigner, said: "On behalf of the thalidomide community, we would like to thank the Welsh Assembly Government for its speed and generosity in contributing to helping thalidomiders maintain their independence."
Source
Welsh Assembly Government
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