Un plan protocolizado de rehabilitación domiciliaria tuvo mejores resultados que el tratamiento habitual en pacientes operados de prótesis total de rodilla: cohorte prospectiva / A protocolized home rehabilitation program had better outcomes than the usual care following total knee replacement: a prospective cohort study

Objetivo: comparar los resultados funcionales y de calidad de vida, y algunos indicadores de calidad y satisfacción, entre dos estrategias de cuidados posoperatorios de prótesis total de rodilla: 1) Cuidados protocolizados brindados por la Unidad de Rehabilitación del Hospital Italiano (URED) para pacientes que residen en CABA; 2) Cuidados habituales brindados por el sistema tercerizado de rehabilitación kinésica. Materiales y métodos: cohorte prospectiva de pacientes que fueron sometidos a una cirugía de reemplazo articular de la rodilla en el Hospital Italiano. Fueron evaluados mediante cuestionarios de funcionalidad y calidad de vida percibida, y goniometría, a los 45 días, por kinesiólogos entrenados. Resultados: se incluyeron 81 pacientes en el grupo de cuidados protocolizados y 28 en el de cuidados habituales. Se observaron diferencias estadísticamente significativas en todas las variables evaluadas y destacamos la relevancia clínica de que solamente el 2,43% de los pacientes atendidos en la URED continuaban usando andador a los 45 días frente al 35,71% de los que habían sido atendidos con los cuidados habituales (p = 0,004), así como la menor proporción de pacientes con déficit de flexión (2,47% vs. 46%, respectivamente; p < 0,001) y de extensión (18,52 vs. 75%; p < 0,001) en el mismo lapso, requisitos que son importantes para lograr una marcha funcional. Conclusión: un programa de rehabilitación domiciliaria protocolizada y supervisada por kinesiólogos entrenados mostró ser eficaz para una progresión más rápida hacia una marcha independiente con un menor riesgo de déficit de flexión o de extensión a los 45 días. (AU)

Objective: to compare functionality and quality of life, and some indicators of patient satisfaction, between two postoperative rehabilitation care following total knee replacement: 1) Protocolized care provided by the Italian Hospital Rehabilitation Unit for patients who live in CABA; 2) Usual care provided by the outsourced rehabilitation system. Materials and methods: prospective cohort of patients who underwent total knee replacement at the Italian Hospital were evaluated using questionnaires of functionality and quality of life at 45 days. Results: 81 patients were included in the protocolized care group and 28 in the usual care group. Statistically significant differences were observed in all the variables evaluated, highlighting clinical relevance that only 2.43% of the patients treated by the URED continued using the walker at 45 days vs 35.71% of those who had been treated with the usual care (p = 0.004); as well as the lower proportion of patients with flexion deficit (2.47 vs. 46%, respectively; p < 0.001) and extension (18.52 vs. 75%; p < 0.001) at the same time. Conclusion: a home protocolarized rehabilitation program supervised by a physical therapist proved to be effective for a quicker progression to an independent walk with lower risks of flexion or extension deficits at 45 days. (AU)

Assessment of Community-Based Home Health Programs among Children with Chronic Disease in Tertiary Care Center, Riyadh

Background: Home health care (HHC) is a newly developed model of care that helps patients to be treated at their home and avoid hospital admission with the aim of promoting, maintaining or restoring health as part of their comprehensive services. Objective: To assess the effectiveness of HHC in reducing the days of admissions and ED visits for children with chronic diseases. Materials and methods: A cross-sectional study held at a tertiary care center. Consecutive sampling technique was used to review all patients’ files registered for HHC program from 2016 to 2018. Continuous variables were reported as mean and standard deviation, whereas categorical were reported as percentages and frequencies. Wilcoxon rank test was used to assess differences before and after enrolment in the HHC program. SPSS V22.0 was used for analysis. Results: A total of 92 patients were involved in this study; 57% were males and 44% were females. 42% of them had neurodevelopmental diseases. Among all the services provided, nursing care was the most needed service. The total number of days of admission was reduced from 28 ± 0.6 to 6.75 ± 0.39 days in 4 months period and from 38.37 ± 62 to 9.02 ± 14 days in 6 months period with p-value<0.001. However, the ED visits were not affected by the p-value of 0.19 and 0.33 for both 4 months and 6 months period, respectively. Conclusion: HHC program showed an effective result in reducing the frequency of hospital admission and days of children’s admission, yet it had no effect on lowering the ED visits.

Pain Management of Community-dwelling Older Adults with Dementia Practiced by Visiting Nurses

To clarify nursing practices in pain management of community-dwelling older adults with dementia by visiting nurses, we conducted semi-structured interviews with 10 visiting nurses and analyzed their responses qualitatively and inductively. As a result, 24 subcategories and 8 categories were identified. Visiting nurses were found to conduct pain assessment and assessment based on behavioral changes in usual daily life because of characteristics of health assessment in home care, in which the goal is to comprehensively support clients as living people, in addition to standard pain management of older people with dementia. The results suggest that the viewpoint to integrate information from other professionals and family members and assess daily life comprehensively is important, and some mechanism to facilitate multidisciplinary information sharing is required. When visiting nurses were unsure of whether a patient is in pain, they evaluated the patient’s pain on the basis of behavioral changes in his or her normal daily life after medication or nondrug treatment. A nationwide survey is necessary for further clarification.

An Investigation on Nursing Demands of Home Healthcare among Elderly in Yunnan Province / 昆明医科大学学报

Objective To establish programs of home healthcare service by investigation and analyzing the current status of the elderly requirements towards community nursing in yunnan province.Methods A self-administrated questionnaire which includes functional status,living situations,and home healthcare demands was distributed in 105 community elderly around Yunnan Province by professional staff. Results 76.20% of the community elderly people had different home care nursing service demands. The highest needs for community elderly is daily medical and nursing care.Conclusion Developing home healthcare can effectively improve the self- care consciousness of aged people, and also improving the quality of life in elderly has important significance for healthcare insurance of elderly.

Electro-Mechanical Safety Testing of Portable ECG Devices for Home Healthcare Usage / 대한의료정보학회지

OBJECTIVES: This paper suggests the experimental guidelines to evaluate the electro-mechanical safety of belt type equipment. The electro-mechanical safety was determined by using the International Electrotechnical Commission guidelines, which are widely used as important factors for assessing the electro-mechanical safety of belt type equipment. However, the local guidelines on wearable healthcare sensors are currently not well-established. Therefore, safety guidelines suited for the actual circumstances in Korea are required, and this paper attempts to try a new experimental safety test procedure of the wearable healthcare sensor. METHODS: This belt type device measures the electrocardiogram (ECG) and heart rates by attaching to the chest. Examination lists were selected by analyzing the common standards ofelectro-mechanical safety (IEC 60601-1) and environment tests (IEC 60068-1, IEC 60068-2) of home-healthcare equipment. RESULTS: The essential electrical safety, which was required for the RS300G3 as a medical device, was evaluated, and most of the examination lists were selected by considering the circumstances of the users. The device passed all the selected examinable lists that are applicable to the Korean environment. CONCLUSIONS: This study has limitations to estimate and to conduct electro-mechanical safety experiments because our study focused on the belt type of heart-rates equipment. We are not taking into account the overall electro-mechanical home-healthcare measurements. According to industrial and technological development, there are infinite possibilities for the advancement of home-healthcare equipment, so more examination lists for safety are being added in addition to what we have done.

A Study on Participation in Clinical Decision Making by Home Healthcare Nurses

PURPOSE: This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making. METHODS: A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used. RESULTS: Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses. CONCLUSION: In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses' participation in clinical decision making in cases where they can identify and solve the patient health problems.

The Development of Certificates Criteria and Curriculum in Home Healthcare Nurse Specialist Program / 간호학회지

PURPOSE: To make a contribution to raising the quality of nursing and home healthcare services through reviewing the present state of home healthcare nurse specialist training institutions and education programs and creating concrete measures to establish high-quality education courses. METHOD: International comparative study of accreditation criteria and curriculum in home healthcare nurse specialist program. RESULT: The Authorization Standards of home healthcare nurse training institutions consists of 8 items, 23 evaluation criteria and 72 evaluation indexes. Proposal to develop a specialist training program: Curriculum. Modify and complement a present homecare nurse education program. Curriculum 1. Designate two forms of certification. The first certification has been granted the authority to serve as a manager and open a home healthcare agency to nurses having masters degrees and clinical experience for five years. The second certification is allowed to perform general home healthcare after having completed a short term training course. Currculum 2. To meet increasing demands, granting a certification to perform home healthcare to registered nurses having clinical experience of more than three years. CONCLUSION: These results can be utilized in the home healthcare educational program for raising the quality of nurses and home healthcare services.