Burden of informal caregivers of chronic respiratory failure patients in Croatia

The aim of this study was to determine the level of burden of informal caregivers of chronic respiratory failure patients measured by the Zarit Burden Interview Questionnaire (ZBI) and to identify overburdened informal caregivers who can become hidden patients. We recruited the respondents in two hospitals for lung disease and a home healthcare service in Zagreb during 2020. After they had been identified as primary informal caregivers who provided high intensity informal care for more than six months, they were asked to complete the Croatian version of the ZBI questionnaire and a question­naire on sociodemographic characteristics. We used descriptive methods for statistical analysis in this cross-sectional study. We presented the data in tables as absolute frequencies, percentages and measures of the central tendency, and graphically by using diagrams. The study included 150 informal caregivers. The majority were female, over 50 years of age with high school education. The largest percentage of informal caregivers was retired. The highest scores were given to the statements on worrying about future and patient dependency while the lowest scores were given to the statements on leaving the care to someone else and feelings such as anger or embarrassment caused by the patient. The results of this study show that more than half of informal caregivers of chronic respiratory failure patients are moderately to severely burdened.

“We tend to get pad happy”: a qualitative study of health practitioners’ perspectives on continence care for older people in hospital

BackgroundBladder and bowel control difficulties affect twenty and ten per cent of the UK population respectively, touch all age groups and are particularly prevalent in the older (65+) population. However, the quality of continence care is often poor, compromising patient health and wellbeing, increasing the risk of infection and is a predisposing factor to nursing and residential home placement.ObjectiveTo identify factors that help or hinder good continence care in hospital.MethodsWe conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software.ResultsInterviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training.ConclusionsFindings help explain the persistence of barriers to providing good quality care for patients with incontinence. Resolute continence promotion, in hospitals and throughout the NHS, would reduce reliance on products and the accompanying risks of patient dependency and catheter associated gram negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.

Early and late complications of stroke

‘Early and late complications of stroke’ refers to the medical complications of acute stroke and the importance of these in the context of the outcome, morbidity, dependency, and mortality in these individuals. It explores the temporal profile of these complications. Infections, neurological, cardiac, pulmonary, gastrointestinal urinary, thrombotic, spasticity, sexual, and perceptual complications are described. A quarter of all stroke patients suffer at least one serious medical complication (defined as prolonged, immediately life-threatening, or resulting in hospitalization or death). Approximately 85% of patients suffered from a medical complication during their hospital stay. Depression, emotionalism, and anxiety are the common psychological syndromes encountered. Long-term complications are related to patient dependency and duration after stroke. Medical complications account for approximately half of stroke mortality.

Examination of the dependency and complexity of patients admitted to in-patient rehabilitation in Australia

Objective The aim of this study was to determine whether there has been a measurable change in the dependency and complexity of patients admitted to in-patient rehabilitation in Australia between 2007 and 2016. Methods A retrospective cohort study design was used to examine in-patient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database for the period 2007–16. Epidemiological descriptive analysis was used to examine datasets for difference between four discrete years (2007, 2010, 2013 and 2016). Datasets included patient demographics, length of stay (LOS), comorbidities, complications and the Functional Independence Measure (FIM™). Results Between 2007 and 2016, rehabilitation in-patients as a whole: (1) had a mean decrease in total admission FIM score; (2) became more complex, as evidenced by the increased proportion of particular comorbidities impacting on rehabilitation, namely cardiac and respiratory disease, dementia, diabetes and morbid obesity; and (3) had a mean decrease in total discharge FIM score. However, there was an increase in the proportion of patients discharged home from rehabilitation (from 86.5% to 92%) and decreases in onset and rehabilitation LOS of 2.2 and 2.5 days respectively. Conclusion The dependency and complexity of patients admitted to in-patient rehabilitation in Australia has increased between 2007 and 2016. What is known about the topic? Anecdotal reports suggest that rehabilitation patients in Australia have become more complex, necessitating increased active management of their presenting health condition and comorbid health conditions. However, to date, no systematic investigation has been undertaken to examine trends in rehabilitation in-patient dependency and complexity over time. What does this paper add? This study provides measurable evidence of increased dependency and complexity in patients admitted to rehabilitation in Australia. Further, compared with 2007, rehabilitation in-patients as a whole had an increased burden of care on discharge from rehabilitation in 2016. What are the implications for practitioners? The changes in patient dependency and complexity reported in this study have implications for rehabilitation service delivery. This is because the increased need for illness or injury and comorbidity management may result in increased potential for acute complications and health deterioration, and compensatory care for patients during rehabilitation. Clinicians may need to widen their skill set to include more acute and chronic illness management.

Effects of Positive Thinking on Dementia Caregivers’ Burden and Care-Recipients’ Behavioral Problems

Most dementia care is provided at home by family members. This caregiving places an additional burden on the family members, which can negatively impact their physical and psychological well-being. The caregivers’ burden can also contribute to behavioral problems in the care-recipients. The purpose of this study was to examine the mediating/moderating effects of positive thinking (PT) on the relationship between caregivers’ burden (embarrassment/anger, patient’s dependency, and self-criticism) and their care-recipients’ behavioral problems (memory, depression, and disruption) in a sample of 100 dementia caregivers. Results indicated that caregivers’ embarrassment, self-criticism, and perception of patient dependency predicts depression in care-recipients, and these relationships are moderated by PT. Results also indicated that as PT increases, the relationship between embarrassment and disruption goes down as well as does the relationship between self-criticism and depression. The study provided direction for the development of a PT training intervention to help caregivers to combat their burden.

Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients’ logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components.

Influence of bone microstructure distribution on developed mechanical energy for bone remodeling using a statistical reconstruction method

The development of a predictive model for bone remodeling is becoming increasingly important for medical applications such as bone surgery or bone substitutes like prostheses. However, as bone remodeling is a complex multiphysics phenomenon and difficult to quantify experimentally, predictive numerical models remain, at best, phenomenologically driven. Patient dependency is often ignored as its influence is usually considered secondary, although it is known to play an important role over long periods of time. Another difficulty to study this patient dependency is the availability of experimental samples to carry out extensive analyses. Using our recently developed statistical reconstruction framework, a set of “bone like” microstructures with variety of distributions has been created to study pseudo “patient variabilities.” The method provides similar effective stiffness tensor, equivalent stresses, and strain energy distributions for the original and the statistically reconstructed samples. The main outcome of this study is the correlation of similar effective mechanical properties between samples when bone remodeling will depend on the local strain energy distribution as a function of each bone microstructure. It is expected that two different microstructures with equivalent bone volume fraction will lead to identical bone remodeling in a short period of time, whereas this needs to be proven for long term evolution. This work could be used to develop precise predictive numerical models while developing parametric studies on an infinite number of virtual samples and correlating patient dependency with more precise mechanobiological numerical models.

The Effect of Educational Intervention on Family Caregivers’ Perceived Threat of the Risk of Dependence among Patients with Stroke

1) Background: The present study aimed to examine the effect of the instructional intervention in family caregivers’ perceived threat of stroke patients’ dependency risk. 2) Methods: This was a randomized controlled clinical trial in which two patient and family caregiver groups of 45 were randomly divided into intervention and control groups based on the inclusion/exclusion criteria. Instructional intervention for family caregivers in the intervention group was in the form of four one-hour sessions. The data were collected before and immediately after instructional intervention at the hospital as well as two weeks and two months following the intervention via postal service. The data analysis was done using SPSS ver.22. 3) Results: The pre-intervention family caregivers’ perceived threat was not significantly different in the two groups (P = 0.591). However, the family caregivers’ perceived threat of the intervention group increased after the intervention compared with the control group (P < 0.001). In addition, the family caregivers’ perceived threat of the intervention group was significantly different in all post instructional intervention stages compared with pre-intervention (P < 0.001), whereas no such difference was observed in the control group (p = 0.245). 4) Conclusions: It is recommended that stroke patients' caregivers be provided with instructional programs to enhance their understanding of patient dependency risks and challenges.

The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse Outcomes

This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.