From clinical reasoning to ehealth interventions; a study on how nurses asses care and ehealth in home care.

The assessment of care in homecare today is complex. Nurses have to decide on care for clients with multiple health problems. Technological innovations promise solutions for support of self-management of older people. We do not know, however, how and when nurses assess eHealth. A qualitative study design was used, in which 43 homecare nurses participated in focus groups and think aloud interviews. The study shows that nurses believe a trusting relationship necessary in order to suggest eHealth interventions. Nurses say they need home visits for the assessment of eHealth. Nurses also have some strong opinions on eHealth, like the notion that eHealth isn't a fitting option for frail older people. It becomes clear that nurses need to see eHealth interventions fit for clients in a person-centred way and in close connection to health problems they've prioritised in order to assess it. Implications for practice and further research are to focus on how nurses can be convinced to assess and use eHealth in a person-centred way and how to discuss this with their clients. Next to that training and a tool that provides up to date information linked to frequently seen health problems are recommended.

Increasing Performance of Professional Soccer Players and Elite Track and Field Athletes with Peak Performance Training and Biofeedback: A Pilot Study.

The aim of this pilot study was to investigate the effects of an intervention consisting of mental coaching combined with either electro encephalogram (EEG) alpha power feedback or heart rate variability (HRV) feedback on HRV, EEG outcomes and self-reported factors related to stress, performance, recovery and sleep quality in elite athletes. A prospective pilot study was performed with two distinct cohorts. Soccer players were provided with four sessions of mental coaching combined with daily HRV biofeedback (Group A); track and field athletes were provided with four sessions of mental coaching in combination with daily neurofeedback (Group B). Measurements were performed at baseline, post intervention and at 5 weeks follow-up. Objective measures: EEG and ECG. Subjective measures: Numeric Rating Scale for performance, Pittsburgh Sleep Quality Index, Rest and Stress Questionnaire and Sports Improvement-60. Group characteristics were too distinct to compare the interventions. Linear mixed models were used to analyze differences within groups over time. In Group A, significant changes over time were present in alpha power at 5 of 7 EEG locations (p < 0.01-0.03). LF/HF ratio significantly increased (p = 0.02) and the concentration (p = 0.02) and emotional scale (p = 0.03) of the SIM-60 increased significantly (p = 0.04). In Group B, the HRV low frequency power and recovery scale of the REST-Q significantly increased (p = 0.02 and <0.01 resp.). Other measures remained stable or improved non-significantly. A mental coaching program combined with either HRV or EEG alpha power feedback may increase HRV and alpha power and may lead to better performance-related outcomes and stress reduction. Further research is needed to elucidate the effects of either type of feedback and to compare effects with a control group.

Redesign of diagnostic coding in pediatrics: from form-based to discharge letter linked.

Diagnostic coding after hospital discharge is mainly based on abstracting of paper medical records by medical record coders. Studies show that the quality of these data is often moderate, possibly because discharge registries play no role in daily patient care. Timely writing of discharge letters is needed to support continuity of care, at least in the Netherlands. This article describes the redesign and evaluation of diagnosis registration and discharge letter writing at a Dutch pediatric department.Formerly, pediatricians at this department completed discharge forms. However, many forms were completed with insufficient information or not at all. Pediatricians now provide diagnoses with codes in a special heading of the discharge letter. The medical record coder checks and corrects this diagnosis heading. A list of diagnoses for pediatrics, based on ICD-9-CM, was developed and alphabetically ordered into one booklet used by pediatricians when dictating discharge letters. A reminder system for in-time writing of letters was implemented. Since 1995, this discharge letter-linked registration has proven to be applicable in daily care. How accurately pediatricians filled in the diagnosis heading was analyzed during two periods. In 1995, 25 percent of the diagnoses were initially (before adjustments made by the medical record coder) not coded or incorrectly coded; nine percent of these shortcomings could be attributed to the pediatricians. In 1997, 67 percent of the diagnoses were initially not coded or incorrectly coded; 37 percent of these shortcomings were attributable to pediatricians. Initially, only half of the letters were written within six weeks after discharge. The correction function of the medical record coder is indispensable.