scholarly journals Medical Cooperation System for Acute-Sub Acute Care and Post-ICU as Long-Term Ventilation Unit in The Community Care System

2015 ◽  
Vol 64 (4) ◽  
pp. 661-670
Author(s):  
Michio TAKAMATSU ◽  
Toshio KOBAYASHI ◽  
Kumi HIRABAYASHI ◽  
Toshiharu MURAOKA
Keyword(s):  
Acute Care ◽  
Community Care ◽  
Long Term Ventilation ◽  
Cooperation System ◽  
Care System

scholarly journals Paediatric invasive long-term ventilation -- A ten-year review

2021 ◽  
Author(s):  
Aoibhinn Walsh ◽  
Mairead Furlong ◽  
Paul McNally ◽  
Ruth O'Reilly ◽  
Sheila Javadpour ◽  
...  
Keyword(s):  
Community Care ◽  
Global Trends ◽  
Paediatric Hospital ◽  
Medical Diagnoses ◽  
Number Of Children ◽  
Adult Services ◽  
Chronic Respiratory Insufficiency ◽  
Long Term Ventilation ◽  
Over Time

Background and objective: The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive LTMV in an Irish setting. Our data over a 10-year period was reviewed to see if our demographics and outcomes are in line with global trends. Methods: Children’s Health Ireland (CHI) at Crumlin, Dublin is Ireland’s largest tertiary paediatric hospital. A retrospective review analysed data from children in our centre commenced on LTMV via a tracheostomy over 10 years (2009 – 2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. Results: Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated co-morbidities. Far less children, 30.4% (n=14) commenced on LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe has enabled us to isolate trends specific to this cohort. Less patients commenced LTMV on a year on year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. Conclusion: Over the period reviewed, less patients over time necessitated long-term invasive therapy and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.

scholarly journals Geriatrics Perspectives From Japan

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 385-385
Author(s):  
Satoru Mochizuki ◽  
Masahiro Akishita
Keyword(s):  
Community Care ◽  
Geriatric Medicine ◽  
Term Care ◽  
Care Services ◽  
Medical Facilities ◽  
Significant Burden ◽  
Emerging Issues ◽  
The Government ◽  
Care System

Abstract In 2025, Japan’s baby boomers will cross the threshold of 75 years of age; a phenomenon that has been referred to as “the 2025 crisis”, resulting in a significant burden on the healthcare system. To address this issue, the Japanese government is establishing the Integrated Community Care System, to provide comprehensive medical and long-term care services in each community. In cooperation with government and affiliated organizations, the Japan Geriatrics Society (JGS) has been working to develop the Integrated Community Care System. As a result of this effort, geriatric medicine is being integrated into the health care system through incentives for practitioners. For instance, medical facilities can be reimbursed if they perform comprehensive geriatric assessments (CGA) and CGA-based management/care. Additionally, home care medicine and polypharmacy are emerging issues of interest to the government. In this symposium, I will discuss how JGS has been trying to achieve “Aging in Place” in Japan.

scholarly journals How Long Does it Take to Initiate a Child on Long-Term Invasive Ventilation? Results From A Canadian Pediatric Home Ventilation Program

2015 ◽  
Vol 22 (2) ◽  
pp. 103-108 ◽  
Author(s):  
Reshma Amin ◽  
Aarti Sayal ◽  
Faiza Syed ◽  
Cathy Daniels ◽  
Andrea Hoffman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Coordinated Care ◽  
Median Length ◽  
Rehabilitation Hospital ◽  
Long Term Ventilation

OBJECTIVE: To assess the length of stay required to initiate long-term invasive ventilation at the authors’ institution, which would inform future interventional strategies to streamline the in-hospital stay for these families.METHODS: A retrospective chart review of children initiated on invasive long-term ventilation via tracheostomy at the authors’ acute care centre between January 2005 and December 2013 was performed.RESULTS: Thirty-five children were initiated on long-term invasive ventilation via tracheostomy at the acute care hospital; 19 (54%) were male. The median age at time of admission was 0.52 years (interquartile range [IQR] 0.06 to 9.58 years). Musculoskeletal disease (n=11 [31%]) was the most common reason for tracheostomy insertion. Two children died during the hospital admission. Fifteen children were discharged home directly from the acute care hospital and 18 were moved to the rehabilitation hospital. Six are current inpatients of the rehabilitation centre and were never discharged home. Combining the length of stay at the acute care and rehabilitation hospitals for the entire cohort, the median length of stay was 162.0 days (IQR 98.0 to 275.0 days) and 97.0 days (IQR 69.0 to 210.0 days), respectively, from the time of tracheostomy insertion.CONCLUSIONS: The median length of stay from the initiation of invasive long-term ventilation to discharge home from the rehabilitation hospital was somewhat long compared with other ventilation programs worldwide. Additionally, approximately 20% of the cohort never transitioned home. There is a timely need to benchmark across the country and internationally, to identify and implement strategies for cohesive, coordinated care for these children to decrease overall length of stay.

scholarly journals Current Status of Traditional Korean Medicine Services in Public Sector: A Study for Integrating Traditional Korean Medicine into Community Care System

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 493
Author(s):  
Soo-Hyun Sung ◽  
Minjung Park ◽  
Jihye Kim ◽  
Sun-Woo Jeon ◽  
Angela Dong-Min Sung ◽  
...  
Keyword(s):  
Local Governments ◽  
Community Care ◽  
Central Government ◽  
The Elderly ◽  
Current Status ◽  
Traditional Korean Medicine ◽  
Korean Medicine ◽  
Service Programs ◽  
Care Systems ◽  
Care System

Korea is currently executing a pilot program for community care of its aging population and aims to implement community care systems on a national scale by 2025. This study examines the traditional Korean medicine (TKM) service to be provided within community care by understanding the current status of TKM services. The Ministry of Health and Welfare (MoHW) sent official letters to 242 local governments (cities, districts, and counties) from October to November 2019 to survey the status of the public TKM services provided in 2018. The items of the survey included basic demographic information as well as information that could reveal how the program was implemented. In 112 local government jurisdictions (response rate 46.3%), a total of 867 TKM service programs were in place. As a result of the survey, it was revealed that they did not have any service manuals or evaluation results. To provide home-care-based TKM service for the elderly as an integrated part of a community care system, it is necessary to develop, distribute, and evaluate a standard service manual including an evaluation index by the central government.

scholarly journals Impact of Diagnosed and Undiagnosed Respiratory Pseudomonas on VAP and VAE During Long-Term Acute Care

2020 ◽  
Vol 41 (S1) ◽  
pp. s258-s259
Author(s):  
James Harrigan ◽  
Ebbing Lautenbach ◽  
Emily Reesey ◽  
Magda Wernovsky ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Bacterial Community ◽  
Acute Care ◽  
Statistical Significance ◽  
Rrna Gene ◽  
Care Hospital ◽  
16S Sequencing ◽  
Increased Risk ◽  
Wide Range ◽  
The Impact

Background: Clinically diagnosed ventilator-associated pneumonia (VAP) is common in the long-term acute-care hospital (LTACH) setting and may contribute to adverse ventilator-associated events (VAEs). Pseudomonas aeruginosa is a common causative organism of VAP. We evaluated the impact of respiratory P. aeruginosa colonization and bacterial community dominance, both diagnosed and undiagnosed, on subsequent P. aeruginosa VAP and VAE events during long-term acute care. Methods: We enrolled 83 patients on LTACH admission for ventilator weaning, performed longitudinal sampling of endotracheal aspirates followed by 16S rRNA gene sequencing (Illumina HiSeq), and bacterial community profiling (QIIME2). Statistical analysis was performed with R and Stan; mixed-effects models were fit to relate the abundance of respiratory Psa on admission to clinically diagnosed VAP and VAE events. Results: Of the 83 patients included, 12 were diagnosed with P. aeruginosa pneumonia during the 14 days prior to LTACH admission (known P. aeruginosa), and 22 additional patients received anti–P. aeruginosa antibiotics within 48 hours of admission (suspected P. aeruginosa); 49 patients had no known or suspected P. aeruginosa (unknown P. aeruginosa). Among the known P. aeruginosa group, all 12 patients had P. aeruginosa detectable by 16S sequencing, with elevated admission P. aeruginosa proportional abundance (median, 0.97; IQR, 0.33–1). Among the suspected P. aeruginosa group, all 22 patients had P. aeruginosa detectable by 16S sequencing, with a wide range of admission P. aeruginosa proportional abundance (median, 0.0088; IQR, 0.00012–0.31). Of the 49 patients in the unknown group, 47 also had detectable respiratory Psa, and many had high P. aeruginosa proportional abundance at admission (median, 0.014; IQR, 0.00025–0.52). Incident P. aeruginosa VAP was observed within 30 days in 4 of the known P. aeruginosa patients (33.3%), 5 of the suspected P. aeruginosa patients (22.7%), and 8 of the unknown P. aeruginosa patients (16.3%). VAE was observed within 30 days in 1 of the known P. aeruginosa patients (8.3%), 2 of the suspected P. aeruginosa patients (9.1%), and 1 of the unknown P. aeruginosa patients (2%). Admission P. aeruginosa abundance was positively associated with VAP and VAE risk in all groups, but the association only achieved statistical significance in the unknown group (type S error <0.002 for 30-day VAP and <0.011 for 30-day VAE). Conclusions: We identified a high prevalence of unrecognized respiratory P. aeruginosa colonization among patients admitted to LTACH for weaning from mechanical ventilation. The admission P. aeruginosa proportional abundance was strongly associated with increased risk of incident P. aeruginosa VAP among these patients.Funding: NoneDisclosures: None

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