Does physical performance and muscle strength predict future personal and nursing care services in community-dwelling older adults aged 75+?

AIM: The objective of this study was to investigate if grip strength or the short physical performance battery could predict the rate of receiving two different types of home care services: (a) personal care and (b) home nursing care for community-dwelling older adults aged 75+ years. METHODS: A secondary data analysis of a prospective cohort study including 323 community-dwelling older adults. Measures of grip strength and the short physical performance battery were incorporated in a nationally regulated preventive home visit programme. Referral to personal and home nursing care were obtained from an administrative database with an average follow-up of 4.1 years. The rate of receiving the individual home care services and the study measures were determined using multivariable Cox proportional hazards models controlling for a priori selected covariates (age, sex, living status, obesity, smoking and prior use of home care). RESULTS: The mean age was 81.7 years with 58.8% being women. The rate of receiving personal care differed between the short physical performance battery groups but not between the grip strength groups after adjusting for all covariates with hazard ratios (95% confidence intervals) of 1.90 (1.29-2.81) and 1.41 (0.95-2.08), respectively. The rate of receiving home nursing care differed between both the short physical performance battery and grip strength groups after adjusting for all covariates with hazard ratios of 2.03 (1.41-2.94) and 1.48 (1.01-2.16), respectively. CONCLUSIONS: The short physical performance battery was associated with the rate of receiving both personal care and home nursing care. The short physical performance battery can be used to predict home care needs of community-dwelling older adults aged 75+ years.

Impact of stress on nurses working in the district nursing service.

This literature review aimed to identify the consequences of working in a highly stressful environment within district nursing teams and the implications this has on nursing practice and the welfare of nurses. The review analysed 10 primary research studies, resulting in three emerging themes that formed the foundation of a discussion; burnout and compassion fatigue; reduced job satisfaction and retention; and emotional injury. The results identified that healthy behaviours, emotional intelligence and effective caseload and staffing management can reduce the negative impact that stress can have on nurses. Organisations need to promote healthy behaviours through support and training and need to reassess how caseloads are managed in correlation with staffing levels. Coaching in emotional intelligence skills is vital and should be provided to all nurses within the DN service.

A qualitative evaluation of a stress management programme for HIV and AIDS home-based care workers in Tshwane, South Africa.

The HIV and AIDS pandemic resulted in increased demands on the South African healthcare system and contributed to elevated stress levels among healthcare workers, including home-based care workers. The goal of the study was to evaluate a stress management programme for HIV and AIDS home-based care workers in Tshwane, South Africa. Social constructionism was adopted as the theoretical framework of the study. The study implemented intervention research and adopted a qualitative research approach, specifically the instrumental case study. Non-probability sampling, specifically volunteer sampling was utilised to recruit a group of twelve HIV and AIDS home-based care workers (n = 12). The data were collected through semi-structured interviews and administered before and after exposure to the stress management programme. The research findings, based on thematic analysis, revealed that the programme was effective in mitigating the impact of stress experienced by the HIV and AIDS home-based care workers in Tshwane. Recommendations are proffered for the refinement of the newly developed stress management programme for implementation among HIV and AIDS home-based care workers in similar field settings.

Incidence and Prevalence of Infectious Diseases and Their Risk Factors among Patients Who Use Visiting Nursing Services in Japan.

This study aimed to clarify the incidence of infectious diseases and the associated risk factors among patients who use visiting nursing services in Japan. We conducted a one-year follow up cohort study with 419 participants. The incidence and period prevalence rate of infectious diseases were 0.63 and 15.0%, respectively. In the multiple logistic regression analysis, the presence of chronic respiratory failure, Parkinson's disease, dermatosis other than pressure ulcers, and the inability to perform oral self-care were significantly related to the contraction of an infectious disease.

Intensity of care for cancer patients treated mainly at home during the month before their death: An observational study.

BACKGROUND: Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS: This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS: Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS: In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.

Nurse safety culture in the services of a university hospital.

OBJECTIVE: To evaluate nurse safety culture in a teaching hospital, as well as to verify differences in the safety culture dimensions between services. METHOD: cross-sectional, quantitative study, conducted from October to December 2015, in a university hospital. The instrument Hospital Survey on Patient Safety Culture was applied. RESULTS: A total of 195 nurses from four different services participated in the study. Significant difference between services were identified for five dimensions of safety culture: organizational learning (P=0.012); return of information and communication about error (P=0.014); management support for patient safety (P=0.001); general perceptions about patient safety (P=0.005); and frequency of event notification (P=0.003). CONCLUSION: The medical clinic service had the highest statistical difference between the dimensions. These evaluations allow managers to identify the differences between the same hospital's services, serving as a warning and assisting in the services' improvement.

Nurse safety culture in the services of a university hospital / La cultura de seguridad de enfermeros entre servicios en un hospital universitario / Cultura de segurança dos enfermeiros entre os serviços de um hospital universitário

ABSTRACT Objective: To evaluate nurse safety culture in a teaching hospital, as well as to verify differences in the safety culture dimensions between services. Method: cross-sectional, quantitative study, conducted from October to December 2015, in a university hospital. The instrument Hospital Survey on Patient Safety Culture was applied. Results: A total of 195 nurses from four different services participated in the study. Significant difference between services were identified for five dimensions of safety culture: organizational learning (P=0.012); return of information and communication about error (P=0.014); management support for patient safety (P=0.001); general perceptions about patient safety (P=0.005); and frequency of event notification (P=0.003). Conclusion: The medical clinic service had the highest statistical difference between the dimensions. These evaluations allow managers to identify the differences between the same hospital's services, serving as a warning and assisting in the services' improvement.

RESUMEN Objetivo: Analizar la cultura de seguridad de los enfermeros de un hospital escuela y examinar las diferencias de los aspectos de esa cultura entre los servicios realizados. Método: Estudio transversal y cuantitativo, realizado de octubre a diciembre de 2015, en un hospital universitario. Se utilizó el instrumento Hospital Survey on Patient Safety Culture. Resultados: Participaron 195 enfermeros de cuatro servicios. Se identificó una diferencia significativa entre los servicios en los cinco aspectos de la cultura de seguridad: el aprendizaje organizacional (p = 0,012); la información de retorno y la comunicación con respecto al error (p = 0,014); el soporte de la gestión para la seguridad del paciente (p = 0,001); las percepciones generales sobre la seguridad del paciente (p = 0,005); y la frecuencia de comunicación de eventos (p = 0,003). Conclusión: El servicio en clínica médica presentó una mayor diferencia estadística entre los aspectos identificados. Estas evaluaciones pueden permitir que los gestores identifiquen las diferencias entre los servicios del mismo hospital, sirviendo como advertencia y perfeccionando los servicios.

RESUMO Objetivo: Avaliar a cultura de segurança dos enfermeiros de um hospital de ensino e verificar as diferenças das dimensões dessa cultura entre os serviços. Método: Estudo transversal e quantitativo, realizado em outubro a dezembro de 2015, em um hospital universitário. Foi aplicado o instrumento Hospital Survey on Patient Safety Culture. Resultados: Participaram 195 enfermeiros de quatro serviços. Identificou-se diferença significativa entre os serviços para cinco dimensões de cultura de segurança: aprendizado organizacional (p = 0.012); retorno da informação e comunicação a respeito de erro (p = 0.014); suporte da gestão para segurança do paciente (p = 0.001); percepções gerais sobre segurança do paciente (p = 0.005); e frequência da notificação de eventos (p = 0.003). Conclusão: O serviço de clínica médica apresentou maior diferença estatística entre as dimensões. Essas avaliações permitem que os gestores identifiquem as diferenças entre os serviços do mesmo hospital, servindo de alerta e aperfeiçoando os serviços.

Home care nursing after elective vascular surgery: an opportunity to reduce emergency department visits and hospital readmission.

BACKGROUND: Events occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research. OBJECTIVE: To quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission. METHODS: Patients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006-2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge. RESULTS: The cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario's 14 administrative health regions (range 16%-84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92. CONCLUSION: Home care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.

Prevalence and Risk Factors for Chronic Edema in U.K. Community Nursing Services.

Background and Study Design: Chronic edema (CO) is believed to be a major clinical problem within community nursing services in the United Kingdom. This study was undertaken as part of the LIMPRINT international study to determine the number of people with CO and its impact on health services. Methods and Results: Three urban-based community nursing services participated in the United Kingdom with prospective evaluation for 4 weeks of all patients receiving nursing care using a questionnaire-based interview and clinical assessment using the LIMPRINT tools. Of the total 2541 patients assessed, 1440 (56.7%) were considered to have CO, comprising Leicester City [768/1298 (59.2%)], Nottingham West [124/181 (68.5%)], and Nottingham City [548/1062 (51.6%)]. The mean age for women with CO was 78.6 (standard deviation [SD] 12.8) years and that for men with CO was 72.9 (SD 14.5). More patients with CO suffered from diabetes (32.1% vs. 27.9%, p = 0.027), heart failure/ischemic heart disease (27.3% vs. 14.0%, p < 0.001), and peripheral arterial occlusive disease (5.5% vs. 1.9%, p < 0.001). By far the greatest association was with the presence of a wound (73.6% vs. 37.9%, p < 0.001). Cellulitis affected 628 patients (24.7%) and 688 patients (47.8%) had a concurrent leg ulcer. Rates of reduced mobility (71.6% vs. 61.9%) and obesity were higher in those with CO. Six independent factors associated with CO were service location, age, ethnicity, obesity, heart failure, and the presence of a wound. Conclusion: CO is a major and growing health care problem within primary care that has been previously unrecognized and requires effective service provision.

Estudio de la hiperfrecuentación en un distrito de atención primaria / Frequent attendance in a Primary Health Care District

Objetivo: Describir la distribución de los pacientes hiperfrecuentadores en los diferentes centros de atención primaria del Distrito Sanitario Córdoba-Guadalquivir. Métodos: Estudio de diseño ecológico, que incluye datos de 2011 a 2015. Se define hiperfrecuentador como aquel paciente que realiza más de 12 visitas por año. Se analiza de manera independiente para enfermería, medicina familiar y pediatría. Las variables dependientes son la prevalencia de hiperfrecuentación y la ratio de pacientes hiperfrecuentadores por profesional. Otras variables examinadas son las características demográficas de los usuarios del Distrito, el número de profesionales de la salud de cada centro y la utilización de las consultas por la población general. Para el estudio de la distribución de los hiperfrecuentadores se clasifican los centros de atención primaria en función del tamaño y del medio territorial (urbano, suburbano y rural). Resultados: La prevalencia media de hiperfrecuentadores es, para enfermería, del 10,86% (error estándar [EE]: 0,5); para medicina familiar, del 21,70% (EE: 0,7); y para pediatría, del 16,96% (EE: 0,7). Las ratios de pacientes hiperfrecuentadores en las diferentes categorías profesionales son 101,07 (EE: 5,0) para enfermería; 239,74 (EE: 9,0) para medicina familiar y 159,54 (EE: 9,8) para pediatría. Conclusiones: Existe una parte importante de usuarios de atención primaria que realiza un número elevado de consultas. De este grupo, las mujeres utilizan más las consultas de enfermería y medicina que los hombres. Se observa una mayor prevalencia en centros de menor tamaño en áreas rurales. Tomando como medida la ratio de pacientes hiperfrecuentadores por profesional, los centros de tamaño intermedio son los que presentan mayor hiperfrecuentación

Objective: To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain). Methods: An ecological study was performed, including data from 2011 to 2015. Defining FA as those subjects who made12 or more appointments per year; independently analysed for nursing, general practice and paediatrics. Prevalence of frequent attendance and FA/professional ratio were used as dependent variables. Demographic characteristics from district population, number of health professionals and use of general facilities were also examinated. Aiming to understand FA distribution, primary health settings were classified according to facility size and environmental location (urban, suburban and rural). Results: The mean prevalence for FA was 10.86% (0.5 SE) for nursing; general practice 21.70% (0.7 SE) and for paediatrics 16.96% (0.7 SE). FA/professional ratios for the different professional categories were: 101.07 (5.0 SE) for nursing, 239.74 (9.0 SE) for general practice and 159.54 (9.8 SE) for paediatrics. Conclusions: A major part of primary health care users make a high number of consultations. From this group, women overuse nursing and general practitioner services more compared to men. A higher prevalence of FAs was observed in smaller settings, in rural areas. Although taking the FAs:professional ratio as the bar, medium-size practices are more highly overused

Usage of healthcare services and preference for mental healthcare among older Somali immigrants in Finland.

Objectives: The aims of the study were, first, to describe and analyze healthcare services utilization patterns of older immigrants in Finland, and particularly to compare the availability and accessibility of health services between older Somalis and Finns. The second aim was to examine the preferences for mental healthcare within the group of Somalis. The third aim was to test the existence of a service usage gap expected to be characteristic of the Somali group, in which high levels of mental health problems occur alongside simultaneous low levels of mental health service usage. Design: The participants were 256 men and women between the ages of 50-85; half were Somali migrants and the other half Finnish matched pairs. The participants were surveyed regarding their usage of somatic, mental, and preventive health services, as well as symptoms of depression, general distress, and somatization. The Somali participants were also surveyed regarding their usage of traditional healing methods and preferences for mental healthcare. Results: The Somali group had significantly lower access to personal/family doctors at healthcare centers as well as a lower availability of private doctors and occupational health services than the Finns. Instead, they used more nursing services than Finnish patients. The Somali participants attended fewer age-salient preventive check-ups than the Finns. The majority of the Somalis preferred traditional care, most commonly religious healing, for mental health problems. The hypothesized service gap was not substantiated, as a high level of depressive symptoms was not associated with a low usage of health services among the Somalis, but it was found unexpectedly among the Finns. Conclusion: Our findings call for culturally appropriate general and mental health services for older immigrants, which requires awareness of clients' preferences, needs, and alternative healing practices. Somali participants encountered institutional barriers in accessing healthcare, and they preferred informal mental healthcare, especially religious healing instead of Western practices.

Association between the perspective of adult inpatients with digestive cancer regarding the nursing service and their quality of recovery on postoperative day 3.

Although qualitative research that focuses on inpatients' experience immediately after surgery has continued to elucidate the efficacy of the nursing service for postoperative recovery, there has been little quantitative research. Our aim was to quantitatively clarify the association between inpatients' perception of the nursing service and the quality of postoperative recovery. Seventy-one digestive cancer patients who underwent surgery were recruited. Participants completed two self-administered questionnaires, including the Japanese version of the 40-item postoperative Quality of Recovery scale (QoR-40J) and the Nursing Service Quality Scale for Japan (NURSERV-J) which has 22 items and five dimensions (tangibles, reliability, responsiveness, assurance, and empathy) on postoperative day 3. There were significant positive associations between the global scores of the NURSERV-J and the QoR-40J. The global score of the QoR-40J was compared between patients who gave full marks for each dimension of the NURSERV-J (the entirely satisfied group) and those who did not (the not entirely satisfied group). The entirely satisfied groups regarding tangibles, reliability and responsiveness had a significantly higher global score for the QoR-40J than the respective not entirely satisfied groups. Adjusted for age, gender, operative procedure, and duration of surgery, the entirely satisfied groups regarding tangibles and responsiveness had a significant higher global score for the QoR-40J than the respective not entirely satisfied groups. Patients who perceived that they had received a nursing service of high quality were likely to attain a high quality of postoperative recovery. Nursing services related to tangibles, reliability, and responsiveness especially contributed to postoperative recovery.

Informal and formal care: Substitutes or complements in care for people with dementia? Empirical evidence for 8 European countries.

BACKGROUND: In order to contain public health care spending, European countries attempt to promote informal caregiving. However, such a cost reducing strategy will only be successful if informal caregiving is a substitute for formal health care services. We therefore analyze the effect of informal caregiving for people with dementia on the use of several formal health care services. STUDY DESIGN: The empirical analysis is based on primary data generated by the EU-project 'RightTimePlaceCare' which is conducted in 8 European countries. 1223 people with dementia receiving informal care at home were included in the study. METHODS: Using a regression framework we analyze the relationship between informal care and three different formal health care services: the receipt of professional home care, the number of nurse visits and the number of outpatient visits. RESULTS: The relationship between formal and informal care depends on the specific type of formal care analyzed. For example, a higher amount of informal caregiving goes along with a lower demand for home care services and nurse visits but a higher number of outpatient visits. CONCLUSION: Increased informal caregiving effectively reduces public health care spending by reducing the amount of formal home care services. However, these effects differ between countries.

Collaborative nurse-led self-management support for primary care patients with anxiety, depressive or somatic symptoms: Cluster-randomised controlled trial (findings of the SMADS study).

BACKGROUND: Collaborative, nurse-led care is a well-established model of ambulatory care in many healthcare systems. Nurses play a key role in managing patients' conditions as well as in enhancing symptom- and self-management skills. OBJECTIVE: The SMADS trial evaluated the effectiveness of a primary care-based, nurse-led, complex intervention to promote self-management in patients with anxiety, depressive or somatic symptoms. Change in self-efficacy 12 months post baseline was used as the primary outcome. DESIGN: The SMADS trial set up a two-arm, cluster randomised controlled trial in the city of Hamburg, a large metropolitan area in the North West of Germany. SETTING: We randomly allocated participating primary care practices to either the intervention group (IG), implementing a nurse-led collaborative care model, or to the control group (CG), where patients with the above psychosomatic symptoms received routine treatment. PARTICIPANTS: Patients from 18 to 65 years of age, regularly consulting a participating primary care practice, scoring≥5 on the anxiety, depressive or somatic symptom scales of the Patient Health Questionnaire (PHQ-D), German version. METHODS: A mixed model regression approach was used to analyse the outcome data. Analyses were based on the intention-to-treat population: All enrolled patients were analysed at their follow-up. Additionally, we reported results as effect sizes. The robustness of the results was investigated by performing an observed cases analysis. RESULTS: 325 participants (IG N=134, CG N=191) from ten practices in each study arm consented to take part and completed a baseline assessment. The mean group difference (ITT-LOCF, IG vs. CG) in self-efficacy at the post baseline follow-up (median 406days) was 1.65 points (95% CI 0.50-2.8) in favour of IG (p=0.004). This amounts to a small Cohen's d effect size of 0.33. An observed cases analysis (168 participants, IG=56, CG=105) resulted in a mean difference of 3.13 (95% CI 1.07-5.18, p=0.003) between the groups, amounting to a moderate effect size of d=0.51. CONCLUSION: A complex, nurse-led intervention, implemented as a collaborative care model, increased perceived self-efficacy in patients with symptoms of anxiety, depression or somatisation compare to control patients. For the first time in the German healthcare system, the SMADS trial validated the belief that a nurse can successfully complement the work of a general practitioner - particularly in supporting self-management of patients with psychosomatic symptoms and their psychosocial needs.

Atención prenatal: acciones esenciales desempeñadas por los enfermeros / Assistência pré-natal: ações essenciais desenvolvidas pelos enfermeiros / Prenatal care: essential actions developed by nurses

Objetivo: Investigar el perfil, el conocimiento y la práctica de las enfermeras que trabajan la atención prenatal de bajo riesgo. Métodos: Estudio cuantitativo, descriptivo, transversal realizado en las Unidades Básicas de Salud Familiar Campina Grande / Paraíba, Brasil. Se incluyeron quince UBSF’s del distrito sanitario I de Campina Grande, totalizando 15 enfermeros que respondieron a un cuestionario. La colecta de datos se llevó a cabo entre marzo y junio de 2013. El análisis de datos se realizó de forma manual, en mapa resumen, según la población estudiada y posteriormente se analizaron mediante estadística descriptiva y organizados en gráficosy tablas de frecuencias absoluta y relativa. Resultados: Se puede considerar satisfactoria la atención prenatal realizada por los enfermeros, ya que además de los procedimientos y las pruebas de rutina, se observó que también llevan a cabo los procedimientos y pruebas consideradas como complementaria, de acuerdo con el Ministerio de Salud Conclusión: Es necesario proporcionar un mayor número de orientación con respecto al uso de métodos anticonceptivos tras el periodo gestacional. Se revela también la necesidad de estudios de evaluación de la calidad y el impacto de la atención prenatal realizados por enfermeros especializados en la reducción de la morbilidad y mortalidad materna y neonatal en el municipio, este enfoque sería de gran importancia para la consolidación de una práctica exitosa en Campina Grande (AU)

Objetivo: investigar o perfil, o conhecimento e prática dos enfermeiros que atuam na atenção pré-natal de baixo risco. Método: pesquisa quantitativa, descritiva, transversal, realizada nas Unidades Básicas de Saúde da Família do município de Campina Grande/Paraíba, Brasil. Foram incluídas quinze UBSF's do distrito sanitário I de Campina Grande, totalizando 15 enfermeiros que responderam a um questionário. A coleta dos dados ocorreu entre os meses de março a junho de 2013. A análise dos dados foi realizada manualmente, em mapa resumo, de acordo com a população estudada e posteriormente foram analisados através da estatística descritiva e organizados em gráficos e tabelas de frequência absoluta e relativa. Resultados: pode-se considerar satisfatória a assistência pré-natal realizada pelos enfermeiros, uma vez que além dos procedimentos e exames de rotina, observou-se que estes realizam os procedimentos e exames considerados como complementares, de acordo com o Ministério da Saúde. Conclusão: faz-se necessário o fornecimento de um maior número de orientação no que tange ao uso de métodos contraceptivos após o período gestacional. Revela-se ainda a necessidade da realização de estudos sobre avaliação de qualidade e impacto do atendimento pré-natal realizado por enfermeiros na redução de morbimortalidade materna e neonatal no município, abordagem esta que seria de grande relevância para a consolidação de uma prática bem-sucedida em Campina Grande

Objective: Investigating the profile, knowledge and practice of nurses who work in low-risk prenatal. Methods: This is a quantitative, descriptive, cross-sectional study conducted at the Family Health Basic Units of the city of Campina Grande/Paraiba, Brazil. The study included fifteen Basic Health Units of the Family of the sanitary district I of Campina Grande, totaling 15 nurses who responded to a questionnaire. Data were collected between March and June 2013. Data analysis was performed manually in map summary, according to the population studied and later the results were analyzed through descriptive statistics and organized into charts and tables of absolute and relative frequency. Results: the data analysis revealed satisfactory the prenatal care performed by nurses, since in addition to procedures and routine tests it was observed that they also carry out the procedures and tests considered as complementary, according to the Ministry of Health. Conclusion: it becomes necessary to give a larger guidance regarding the use of contraceptives after pregnancy. Also the study revealed the need for studies about evaluation of quality and impact of prenatal care conducted by nurses in decreasing maternal and neonatal morbidity and mortality in the municipality. This approach would be of great relevance for the consolidation of a successful practice in Campina Grande (AU)

[Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study]. / Behandlungsqualität des Diabetes mellitus und Inzidenz schwerer Hypoglykämien in stationären und ambulanten Versorgungseinrichtungen: Heidelberger Diabetesstudie.

AIM: The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. METHODS: In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. RESULTS: Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). CONCLUSION: Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

Utilisation and costs of nursing agencies in the South African public health sector, 2005-2010.

BACKGROUND: Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. OBJECTIVE: The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. DESIGN: A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6-2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). RESULTS: Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year, a total of 5369 registered nurses could have been employed in lieu of nursing agency expenditure. CONCLUSIONS: The study findings should inform workforce planning in South Africa. There is a need for uniform policies and improved management of commercial nursing agencies in the public health sector.

Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management.

BACKGROUND: International and national bodies promote interdisciplinary care in the management of people with chronic conditions. We examine one facilitative factor in this team-based approach - the co-location of non-physician disciplines within the primary care practice. METHODS: We used survey data from 330 General Practices in Ontario, Canada and New Zealand, as a part of a multinational study using The Quality and Costs of Primary Care in Europe (QUALICOPC) surveys. Logistic and linear multivariable regression models were employed to examine the association between the number of disciplines working within the practice, and the capacity of the practice to offer specialized and preventive care for patients with chronic conditions. RESULTS: We found that as the number of non-physicians increased, so did the availability of special sessions/clinics for patients with diabetes (odds ratio 1.43, 1.25-1.65), hypertension (1.20, 1.03-1.39), and the elderly (1.22, 1.05-1.42). Co-location was also associated with the provision of disease management programs for chronic obstructive pulmonary disease, diabetes, and asthma; the equipment available in the centre; and the extent of nursing services. CONCLUSIONS: The care of people with chronic disease is the 'challenge of the century'. Co-location of practitioners may improve access to services and equipment that aid chronic disease management.