Search

Introduction: Balance disturbances in Parkinson's Disease (PD) are usually assessed in a single-task as well as standard balance physiotherapy is carried out in isolated environments. Conversely, daily activities are developed in highly challenging environments. Although functional balance training (FBT) is included in the latest protocols, several methodological issues have not yet been considered. In the proposed single-blinded randomized control trial with crossover (NCT04963894), the aims are (1) to quantify the effects achieved by domiciliary FBT (balanceHOME program) in participants with and without cognitive impairment, and (2) to compare them with the effects of a passive-control period and a conventional face-to-face physiotherapy program for PD. Methods: The initial recruitment was estimated at 112 people with idiopathic PD. Two-thirds of the participants will be randomized to one of the two groups to make the crossover. In contrast, the other third will do a face-to-face group program only. The balanceHOME protocol consists of challenging balance exercises incorporated into functional daily tasks, developed in-home and conducted two times per week for 60-min over an 8-weeks period. The primary strategy will consist of splitting functional tasks of daily life into static and dynamic balance components, besides standardized facilitate and disturbing strategies to execution of each exercise. Biomechanics and clinical performance of balance and gait, perception of quality of life, cognitive and mental functioning, and severity of PD will be measured at baseline (T0), post-8 weeks training (T1), and follow-up (T2). Results: The primary outcome of the study will be the center of pressure sway area. The secondary outcomes consist of biomechanics and clinical variables related to static and dynamic balance. Outcomes from biomechanical of gait, quality of life, cognitive and mental state, and severity of PD, represent the tertiary outcomes. Discussion: The balanceHOME program standardizes the FBT in demanding and daily environments for people with PD who prefer individualized treatment from home. This is the first time that the effects of group versus individual balance rehabilitation have been compared in people with and without cognitive impairment and evaluated in complex environments. This still-to-be-finished study will open the possibility of new strategies according to changes in post-pandemic therapeutic approaches. [ABSTRACT FROM AUTHOR]

With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed. [ABSTRACT FROM AUTHOR]

Bronchiectasis (BE) is a long-term, chronic lung condition featured by widened and scarred airways. These can alter the physiological mucociliary clearance, making it difficult to clear mucus and microorganisms, leading to frequent exacerbations. High-flow nasal therapy (HFNT) is a noninvasive respiratory support that delivers heated and humidified gas eventually enriched with oxygen, through a nasal cannula. Humidification is crucial for adequate airways mucociliary clearance, improving ciliary function and consequently reducing airways inflammation and recurrent infections. HFNT has been mostly used in patients with acute hypoxemic respiratory failure and in selected patients with chronic respiratory failure due to COPD. Still, evidence about its use in acute and longterm home setting in patients with clinically relevant BE are lacking. We report a case of severe widespread BE, already on top medical therapy and pulmonary rehabilitation, still suffering from difficult mucus expectoration and recurrent exacerbations, who has been additionally treated with HFNT, both in hospital and domiciliary, reporting significant improvements on relevant clinical and patientcentred outcomes. Thus, HFNT may confer additional benefits as an add-on treatment of patients with severe BE and respiratory failure. [ABSTRACT FROM AUTHOR]

IntroductionBalance disturbances in Parkinson’s Disease (PD) are usually assessed in a single-task as well as standard balance physiotherapy is carried out in isolated environments. Conversely, daily activities are developed in highly challenging environments. Although functional balance training (FBT) is included in the latest protocols, several methodological issues have not yet been considered. In the proposed single-blinded randomized control trial with crossover (NCT04963894), the aims are (1) to quantify the effects achieved by domiciliary FBT (balanceHOME program) in participants with and without cognitive impairment, and (2) to compare them with the effects of a passive-control period and a conventional face-to-face physiotherapy program for PD.MethodsThe initial recruitment was estimated at 112 people with idiopathic PD. Two-thirds of the participants will be randomized to one of the two groups to make the crossover. In contrast, the other third will do a face-to-face group program only. The balanceHOME protocol consists of challenging balance exercises incorporated into functional daily tasks, developed in-home and conducted two times per week for 60-min over an 8-weeks period. The primary strategy will consist of splitting functional tasks of daily life into static and dynamic balance components, besides standardized facilitate and disturbing strategies to execution of each exercise. Biomechanics and clinical performance of balance and gait, perception of quality of life, cognitive and mental functioning, and severity of PD will be measured at baseline (T0), post-8 weeks training (T1), and follow-up (T2).ResultsThe primary outcome of the study will be the center of pressure sway area. The secondary outcomes consist of biomechanics and clinical variables related to static and dynamic balance. Outcomes from biomechanical of gait, quality of life, cognitive and mental state, and severity of PD, represent the tertiary outcomes.DiscussionThe balanceHOME program standardizes the FBT in demanding and daily environments for people with PD who prefer individualized treatment from home. This is the first time that the effects of group versus individual balance rehabilitation have been compared in people with and without cognitive impairment and evaluated in complex environments. This still-to-be-finished study will open the possibility of new strategies according to changes in post-pandemic therapeutic approaches.

This paper reports learning points from a small pilot study using a portable diagnostic X-ray set to radiograph patients in novel settings such as the patient home or care home. This paper explores issues associated with regulatory compliance, staff training, oversight of radiation safety and the drafting of key risk safety documentation including risk assessments. Some limitations to diagnostic imaging are explored and a simple subjective assessment of the visual clarity presented. The pilot demonstrated potential for starting treatment sooner without recourse to a hospital visit. It was well received by patients and all images were of diagnostic quality but was more labour intensive compared with traditional methods. Likely barriers and potential advantages to implementing a full clinical service are discussed.

Christiaan Theunisse,1,2 Huibert H Ponssen,2 Netty T C de Graaf,1 Maaike Scholten-Bakker,1 Sten P Willemsen,3 David Cheung1 1Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, the Netherlands; 2Department of Intensive Care, Albert Schweitzer Hospital, Dordrecht, the Netherlands; 3Department of Biostatics, Erasmus University Medical Centre, Rotterdam, the NetherlandsCorrespondence: David CheungDepartment of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht, AT, NL-3318, the NetherlandsTel +31-78-6523328Fax +31-78-6523354Email d.cheung@asz.nlBackground: The effectiveness of non-invasive home ventilation in patients with severe chronic obstructive pulmonary disease (COPD) is lacking. Non-invasive home ventilation might be more effective when high ventilator settings are used. However, high ventilator settings might reduce patient adherence. We have developed a multidisciplinary approach (ventilation practitioners, 24 hours support of respiratory nurses, physicians) to non-invasive ventilation aimed at optimizing patient adherence using low ventilator settings in severe COPD patients with high disease burden irrespectively having hypercapnia.Methods: We included in a proof of concept, prospective interventional study, 48 GOLD stage III–IV COPD patients with a high disease burden (≥ 2 exacerbations in a year, and Medical Research Council dyspnea scores ≥ 3). Outcome measures included hospital admissions, capillary pCO2, Medical Research Council dyspnea scores (MRC), Clinical COPD Questionnaire scores (CCQ) and Hospital Anxiety and Depression Scale (HADS).Results: After 1 year 32 patients could be evaluated. Hospital admissions decreased by 1.0 admission (mean difference ± SD: 1.0 ± 1.48; p = 0.001). In-hospital days decreased by 10.0 days (10.0 ± 15.48; p = 0.001). Capillary pCO2 decreased by 0.33 kPa (0.33 ± 0.81: p = 0.03). The MRC dyspnea score decreased by 0.66 (0.66 ± 1.35; p = 0.02). The CCQ score decreased by 0.59 (0.59 ± 1.39; p = 0.03). The HADS anxiety score decreased by 1.64 (1.64 ± 3.12; p = 0.01). The HADS depression score decreased by 1.64 (1.64 ± 3.91; p = 0.04).Conclusion: A proof of concept multidisciplinary approach, using low pressure domiciliary non-invasive ventilation, aimed at optimizing patient adherence in severe COPD patients regardless having hypercapnia, reduced hospital admissions and improved symptoms and quality of life measures. This may imply that severe COPD patients with high disease burden, irrespective being hypercapnic, are candidates to be treated with low pressure domiciliary non-invasive ventilation.Keywords: COPD, non-invasive ventilation, domiciliary, hospitalization, compliance

Background Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert. [ABSTRACT FROM AUTHOR]

In 2019 NHS England and NHS Improvement announced their strategy to safely reduce the number of patients who are unnecessarily conveyed into a hospital setting by 2023. The recent coronavirus pandemic emphasised the importance of reducing avoidable conveyance. Consequently, a multidisciplinary team consisting of a Paramedic, Radiographer and Emergency Care Clinician was created to respond to Category 3 and 4 calls to assess patients in their own home using an array of specialised diagnostic equipment including a lightweight portable X-ray unit supplied by Fujifilm, the FDR Xair. This team was named the X-ray response team (XRT). Over a 7-month period the team attended 54 calls, the majority of which were in the patient's private residence (86%), the overall average age of the patients attended was 80 years. A patient survey found 100% of respondents rated the service as very good with 100% also feeling that they were treated with respect and dignity. The team reduced avoidable conveyance by 50% as 27 of the 54 patients were discharged on scene and kept at home. Proof of concept was achieved. The XRT improved patient care and experience as patients were assessed and diagnosed in their home environment which also minimised the risk of contracting hospital acquired infections. The XRT reduced avoidable conveyance by 50% with 100% of the patient's involved providing positive feedback. The team are exploring new pathways that would allow direct referral to specialist teams in the hospital such as care of the elderly and orthopaedics which would: improve patient experience, ease A&E pressures, reduce costs and make the most effective use of the resources available. [ABSTRACT FROM AUTHOR]

Objective: To look for bacterial colonization of parts of home nebulizers used for children with recurrent wheeze and asthma. Methods: Children aged 1 mo-12 y, using home nebulizers for recurrent cough and wheeze were enrolled from May to October, 2019. Caregivers were administered a structured questionnaire by a single researcher, during their hospital visit, to elicit information on their nebulizer cleaning practices. Samples were taken from nebulizer medicine chamber and tubing for bacterial culture and sensitivity. Results: Bacterial growth was observed in 17 culture samples obtained from medicine chamber and/or tubing of nebulizers used by 12 (20.3%) out of the 59 enrolled children. The bacteria isolated were Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus (Methicillin resistant S. aureus and Coagulase negative staphylococci) and these were resistant to many of the commonly used antimicrobials. Almost 20% parents had never cleaned the nebulizers. Diluent re-use was significantly associated with bacterial colonization of nebulizer parts [AOR (95% CI) 20.6 (2.26–188.5); P=0.007]. Conclusion: Home nebulizers, if not cleaned properly as per set protocols, may get colonized with potentially harmful bacteria. There is a need to increase awareness about their proper use amongst parents of children with recurrent wheeze. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) is a significant public health problem across all regions of the world. Overall evidence regarding outcomes is available from western regions. Detoxification is one of the first steps in treating AUDs. The following case note review looks at community detoxification outcomes in a naturalistic setting. We looked at 100 clients with domiciliary detoxification. We found only 35% had a favorable outcome (follow up as advised) while 65% had unfavorable outcomes (lost to follow up or required admission). Trends of higher alcohol use (units/day) were seen in the unfavorable group. We also found that having a medical co-morbidity was associated with unfavorable outcome. In resource poor setting like our country there is a need to look at ways to enhance home detoxification programs; use of technology and supervised monitoring could probably improve the outcomes. [ABSTRACT FROM AUTHOR]

Andriani Zikyri, Chaido Pastaka, Konstantinos I Gourgoulianis Department of Pulmonology, University Hospital of Larissa, Larissa, Greece Introduction: The benefits of long-term noninvasive ventilation (NIV) in stable COPD with chronic hypercapnic respiratory failure (CHRF) have been debated for many years due to the conflicting results observed in these patients. Materials and methods: We investigated the effects of domiciliary NIV in stable hypercapnic COPD patients for a period of 1 year using COPD Assessment Test (CAT), BODE Index, and the number of acute exacerbations. NIV was administered in 57 stable COPD patients with CHRF in the spontaneous/timed mode. Spirometry, 6 minute walk test, Medical Research Council dyspnea scale, arterial blood gases, number of acute exacerbations, BODE Index, and CAT were assessed. Study participants were reassessed in the 1st, 6th, and 12th months after the initial evaluation. Results: There was a significant improvement in COPD exacerbations (p70 years, while for those aged

Janine Dretzke,1 David Moore,1 Chirag Dave,2 Rahul Mukherjee,2 Malcolm J Price,1 Sue Bayliss,1 Xiaoying Wu,1 Rachel E Jordan,1 Alice M Turner2,3 1Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, 2Heart of England NHS Foundation Trust, Heartlands Hospital, 3Queen Elizabeth Hospital Research Laboratories, University of Birmingham, Edgbaston, Birmingham, UK Introduction: Noninvasive ventilation (NIV) improves survival among patients with hypercapnic respiratory failure in hospital, but evidence for its use in domiciliary settings is limited. A patient’s underlying risk of having an exacerbation may affect any potential benefit that can be gained from domiciliary NIV. This is the first comprehensive systematic review to stratify patients based on a proxy for exacerbation risk: patients in a stable state and those immediately post-exacerbation hospitalization. Methods: A systematic review of nonrandomized and randomized controlled trials (RCTs) was undertaken in order to compare the relative effectiveness of different types of domiciliary NIV and usual care on hospital admissions, mortality, and health-related quality of life. Standard systematic review methods were used for identifying studies (until September 2014), quality appraisal, and synthesis. Data were presented in forest plots and pooled where appropriate using random-effects meta-analysis. Results: Thirty-one studies were included. For stable patients, there was no evidence of a survival benefit from NIV (relative risk [RR] 0.88 [0.55, 1.43], I2=60.4%, n=7 RCTs), but there was a possible trend toward fewer hospitalizations (weighted mean difference -0.46 [-1.02, 0.09], I2=59.2%, n=5 RCTs) and improved health-related quality of life. For posthospital patients, survival benefit could not be demonstrated within the three RCTs (RR 0.89 [0.53, 1.49], I2=25.1%), although there was evidence of benefit from four non-RCTs (RR 0.45 [0.32, 0.65], I2=0%). Effects on hospitalizations were inconsistent. Post hoc analyses suggested that NIV-related improvements in hypercapnia were associated with reduced hospital admissions across both populations. Little data were available comparing different types of NIV. Conclusion: The effectiveness of domiciliary NIV remains uncertain; however, some patients may benefit. Further research is required to identify these patients and to explore the relevance of improvements in hypercapnia in influencing clinical outcomes. Optimum time points for commencing domiciliary NIV and equipment settings need to be established. Keywords: noninvasive ventilation, domiciliary, COPD, hospitalization, systematic review, meta-analysis

ABSTRACT Background and objective The benefits of domiciliary non-invasive ventilation ( NIV) post lung transplantation ( LTx) have not previously been described. This was a single-centre retrospective audit of patients requiring domiciliary NIV post- LTx. Our aim was to describe indications for NIV and outcomes in chronic lung allograft dysfunction ( CLAD) and diaphragmatic palsy. Methods All patients requiring domiciliary NIV post- LTx between 2010 and June 2016 were assessed. NIV indications, respiratory function and patient outcomes were collected. Results Out of 488 LTx recipients, 20 patients were identified as requiring NIV over the 6.5-year study period. The most common indications for NIV were CLAD and diaphragmatic palsy. Hypercapnia improved significantly with NIV. Patient outcomes were poor with nine (45%) patients dying, four (20%) undergoing redo- LTx, four (20%) continuing domiciliary NIV and only three (15%) patients weaned off NIV. Conclusion This is the first case series to describe the use of domiciliary NIV post- LTx. Patients commenced on NIV post- LTx had severely impaired lung function and severe hypercapnia. Patients with diaphragmatic palsy often recovered. The mortality rate was high in chronic allograft dysfunction. [ABSTRACT FROM AUTHOR]

The need for healthcare assistants (HCAs) to have clear policies and guidelines in relation to when falls occur in domiciliary care settings is paramount. If first-line responses are to be appropriately tailored to patient need and discernment is to be used in determining the necessity for intervention by emergency care workers such as paramedics, then standardised frameworks and policies ought to be clearly apparent across care sectors. Our work focused on the first-line response to patient falls in the independent care sector in a specific geographical region of north-east England. This article provides an insight into what our original findings revealed and how they might be used as a source of reflection for HCAs working in the residential independent care sector. Using a basic questionnaire, we surveyed 24 (75%) of the 32 independent care sector homes in South Tyneside to establish how policies and guidelines in these organisations were understood by staff. Our findings highlight a diverse array of responses to falls in care home settings. While 96% of homes claimed to have a specific policy on falls, only 80% of them included an assessment of possible injury or harm to residents and 13% included no direct guidance for care staff in instances where residents fell and were still on the floor. Even in instances where policies did include direct guidance, there was great variation in available information for staff, especially between domiciliary and care home settings. Most commonly, staff were advised to call an emergency ambulance, even in the absence of injury, if patients were found on the floor. HCAs are working in contexts where there is apparently a high degree of ambiguity around the assessment of injuries sustained as a consequence of falls, particularly where potentially nonvisible injuries occur, which are not immediately recognisable or symptomatic. There was also overlap between accident and falls policies, which added a further level of ambiguity to the most appropriate and immediate actions for HCAs to take. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure. Objective: To assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation. Data sources: Bibliographic databases, conference proceedings and ongoing trial registries up to September 2014. Methods: Standard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately. Results: Thirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective. Limitations: Evidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data. Conclusions: The cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings. Future work recommendations: The results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV. Study registration: This study is registered as PROSPERO CRD42012003286. Funding: The National Institute for Health Research Health Technology Assessment programme.

Background There is limited evidence regarding the provision of home-based postnatal care, resulting in a weak evidence-base for policy formulation and the further development of home-based postnatal care services. Aim To explore the structure and organisation of public hospital home-based postnatal care in Victoria, Australia. Methods An online survey including mostly closed-ended questions was sent to representatives of all public maternity providers in July 2011. Findings The response rate of 87% (67/77) included rural (70%; n = 47), regional (15%; n = 10) and metropolitan (15%; n = 10) services. The majority (96%, 64/67) provided home-based postnatal care. The median number of visits for primiparous women was two and for multiparous women, one. The main reason for no visit was the woman declining. Two-thirds of services attempted to provide some continuity of carer for home-based postnatal care. Routine maternal and infant observations were broadly consistent across the services, and various systems were in place to protect the safety of staff members during home visits. Few services had a dedicated home-based postnatal care coordinator. Discussion and conclusion This study demonstrates that the majority of women receive at least one home-based postnatal visit, and that service provision on the whole is similar across the state. Further work should explore the optimum number and timing of visits, what components of care are most valued by women, and what model best ensures the timely detection and prevention of postpartum complications, be they psychological or physiological. [ABSTRACT FROM AUTHOR]

Background: Stroke affects large number of people worldwide resulting in disability. The people in the northern region of India follow some domiciliary practices, which include administration of opioids at the onset of stroke to retard its progression. Aim: To study the effect of opioids on the outcome and severity of stroke when used as domiciliary treatment in peri-stroke period. Materials and Methods: A prospective, observational study on stroke patients was carried out in Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India from March 2012 to March 2013. Data were collected in a semi-structured proforma. The variables which were studied included socio-demographic characteristics such as age, gender, religion, socio-economic status, and place of inhabitation. The time of opioid administration, approximate amount administered, frequency of administration, duration of hospital stay, risk factors and co-morbid conditions were also studied. The stroke severity was analyzed by comparing National Institutes of Health Stroke Scale (NIHSS) score and outcome by comparing Modified Rankin Scale (MRS) score in both the groups at the time of admission and at the time of discharge. Results: Out of n = 100 recruited patients, n = 44 (Group A) reported opioid intake in the peri-stroke period and n = 56 (Group B) did not. Proportions of patients from rural areas were 61.4% in Group A and 37.5% in Group B. Mean age in groups A and B was 63 ± 9.15 and 59.8 ± 13.87 years, respectively; in these groups male proportions were 70.5% and 60.7%, respectively. At admission, mean NIHSS scores in Groups A and B were 10.0 ± 4.48 and 10.8 ± 4.51, respectively; on discharge, these scores were 6.3 ± 3.83 and 7.7 ± 3.79, respectively. At admission, mean MRS scores in Groups A and B were 3.7 ± 1.14 and 3.8 ± 1.32, respectively; upon discharge, these scores were 2.8 ± 1.18, 3.1 ± 1.23 respectively. Conclusion: In this cohort, we found that the domiciliary practice of opioids administration in the peri-stroke period is more common among the elderly and in the rural areas. There was no statistically significant difference in the mean NIHSS and MRS scores at admission as well as discharge implying that the opioid administration did not improve outcome or decrease the severity of the stroke. Our findings are robust enough to propose a larger sample size and follow-up in future studies to definitively ascertain the effect of opioids as pretreatment in stroke patients. [ABSTRACT FROM AUTHOR]

The Department of Health Stroke Strategy (2007) recommends that post stroke patients are reviewed within 6 weeks of discharge. Historically, a 6-week outpatient appointment was offered. This was primarily a medical review and not a full assessment of health, social care status and secondary prevention needs. An innovative joint domiciliary clinic was developed in order to meet these recommendations. The joint clinic reviews were conducted by a stroke consultant and an allied health professional. There were no readmissions at 6 weeks and 6 months post stroke. User satisfaction was very high and there were no missed appointments. Patient health and social status was fully captured, reported and acted upon holistically following each review. This form of integrated partnership working seems to promote seamless life after-stroke care, while enhancing patients' understanding. It includes the provision of secondary prevention and self-management strategies. This 'one-stop shop' approach would warrant formal evaluation. [ABSTRACT FROM AUTHOR]

Domiciliary carers (DCs) provide an invaluable service that enables people living with dementia (PLWD) to remain living in their own homes for as long as possible. We know a lot about the negative impacts of providing domiciliary care and recent evidence suggests that this was exacerbated by the COVID-19 pandemic. However, we know much less about how these DCs manage the stressors associated with their roles. The current study adopts a resilience perspective to identify the resources that DCs caring for PLWD draw on to manage the stress associated with their roles before and during the COVID-19 pandemic. We conducted semi-structured interviews with 19 DCs from across the UK. Data were analysed using a directed qualitative content analysis. Themes included: healthy boundaries; motivation to care; psychological attributes; managing work; and support. The findings have implications for employers and may go some way towards improving DC working conditions, retaining staff, and attracting new DCs in the future.

Aim: The study aimed to document home-based neonatal care practices and their association with type of birth attendance. Methods: This study was conducted in rural Haryana on mothers who had delivered a live baby one to 2 months prior to interview. The study instrument, administered through home visits, had questions related to cord care, breastfeeding, thermal care, baby handling and healthcare seeking. Logistic regression was performed to test for association [OR; 95% CI] of key newborn care practices with skilled birth attendance. Results: Of the 415 mothers interviewed, 26.7% applied nothing on umbilicus; 15% were kept in skin-to-skin contact with mother; 20.2% were exclusively breastfed in first month. Seeking care in private sector and cost incurred in the treatment for a neonatal illness was significantly higher for male babies. Delivery by skilled birth attendant (68.5%) was associated with applying nothing on the cord [1.8; 1.01-3.25], in skin-to-skin contact with mother for ≥6 h a day [2.21; 1.18-4.13], bathing the baby after third day [14.63; 6.85-31.21] and exclusive breastfeeding [8.84; 3.42-22.8]. Conclusion: The results of this study call for not only upscaling skilled birth attendance but also improving the quality of care currently provided. [ABSTRACT FROM AUTHOR]

Objective: To evaluate a pilot trial of a postdischarge physiotherapy intervention to improve patient function versus usual physiotherapy in patients undergoing total knee arthroplasty aiming to assess: recruitment rate, feasibility and acceptability of the intervention and control, suitability of outcomes, retention and adverse events and to inform sample size calculation for a definitive trial.Design: Exploratory pilot randomized controlled trial using independent assessment.Setting: Mixed urban and rural, UK.Participants: Patients undergoing primary, elective unilateral knee arthroplasty for osteoarthritis.Intervention: Two additional home physiotherapy visits of functional weight-bearing exercises, functional task-specific training versus treatment as usual.Main outcome: Oxford Knee Score at 12 months. Secondary outcomes: completion rates, adverse events, Knee Injury and Osteoarthritis Outcome Score, leg extensor power, timed 10-m walk, timed sit-to-stand, resource use diaries. Assessments completed at baseline (pre-operatively), 3, 6 and 12 months.Results: Of 181 eligible participants 107 (59.1%) were randomized over 13 months, one participant withdrew, no adverse events. Intervention group n = 56 (mean age 67.8), control group n = 51 (mean age 70.8). The difference in mean change of Oxford Knee Scores between groups (intervention – control) at 12 months was 0.2 (95% confidence interval (CI) –3.8, 4.2), P = 0.94. Patient diaries revealed non-trial additional physiotherapy requires improved measurement.Conclusions: Successful recruitment and retention rates were achieved. The intervention appeared feasible and acceptable but may be suboptimal in intensity given recent research. A sample size of 1271 participants would be required for a fully powered randomized controlled trial using the main outcome. However new outcomes, potentially of greater validity and responsiveness, require consideration. [ABSTRACT FROM PUBLISHER]

Purpose – This paper aims to highlight the benefits of the 360 SF diagnostic audit for assessing person centeredness of a domiciliary agency and to highlight the challenges they face with some suggested actions. These are exemplars of what is raised in policy and recent reports relating to personalisation, dignity and integration of health and social care and have wider implications for all agencies as they strive to resolve issues for the client. Design/methodology/approach – The approach is a case study describing results of the audit in relation to challenges that include practice development needs, inter agency co-ordination, collaboration and co-operation for the achievement of relationship based person centered outcomes in quality improvement work. The pilot study involved data gathered from the clients, relatives and staff, which were analyzed resulting in findings, conclusions and suggestions for ongoing improvement from which action plans were devised and implemented. Findings – The audit results provide examples of the primary interface relationship and co-ordination challenges, highlighting leaning needs for staff delivering person centred care in domiciliary settings. Practical implications – This paper raises important practice development issues both inside and outside the agency's responsibility. Use of the tool would support cultural and interface relationship issues affecting the client experience and highlight ways to assist the achievement of collaborative ways of working needed for the integration of health and social care. Social implications – The 360 SF (DS) can help organisations provide evidence to CQC and the public for their performance and identify the close interface relationships and their effectiveness in delivering co-ordinated and integrated health and social care. Originality/value – The 360 SF DOM has highlighted with evidence the challenges of the systemic culture at the interface, in particular the nature and quality of collaboration, communication and practice development needs across the organisational divide to deliver person centred care and support. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to describe a method of assessing and achieving a person-centred culture of care, developed for care homes. It considers the results of a pilot study adapted for domiciliary services and comments on the results of the evaluation.Design/methodology/approach - A case study describes the development of a framework and audit of a culture of care, from which practice development and quality improvement work flows, from an in-depth 360° feedback exercise. Data were garnered from clients, relatives, staff and managers, and triangulated with observation and documentary review.Findings - The audit results provide a route map for action planning towards continuous sustained improvement. Examples of specific actions taken demonstrate the positive benefits to the clients, families, staff and management with value added business and efficiency improvements. Practical implications - This paper raises important practice development issues both inside and outside the agency's responsibility. Use of the tool would enable cultural and interface issues affecting the client experience along with possible causes to help collaborative ways of working and integration of health and social care.Social implications - The 360 Standard Framework (SF) (Domiciliary Settings (DS)) will help organisations provide evidence for a journey towards excellence and give the public confidence that the client experience is at the heart of the business.Originality/value - The 360 SF is the first triangulated, diagnostic, assessment framework that measures the care culture based on the triangulated relationships for relationship activated care in DS. [ABSTRACT FROM AUTHOR]

Introduction: A high prevalence of nocturnal hypoxia is noted in patients with chronic heart failure (CHF). Nocturnal hypoxia can be reversed by nasal oxygen or non-invasive assisted ventilation. However, controversy exists over the use of oxygen in CHF. We studied the effects of nocturnal nasal oxygen in CHF to demonstrate its effects on 6-min walk test, quality of life (QOL), NTproBNP, and echocardiographic parameters. Methodology: Ten patients aged 70+/-9 years received domiciliary oxygen (4 l/min) for one month. Oxygen was administered for a minimum of 8h every night via nasal prongs. Results: A 17% improvement was seen in the 6-min walk test, 298+/-98 m to 351+/-100 m (p=0.005) and a 27% improvement in the QOL, which improved from 26+/-12 to 19+/-7 (p=0.017). Acquired echocardiographic measures including ejection fraction, pulmonary pressure and diastolic parameters did not change. Conclusion: Nocturnal nasal oxygen has a significant impact on sub-maximal exercise capacity and QOL in CHF. Although a previous study has demonstrated harmful haemodynamic effects of acute oxygen administration in CHF; we did not detect any change in echocardiographic parameters using current two-dimensional imaging and Doppler studies. The lack of improvement in cardiac parameters suggests a peripheral mode of action. [ABSTRACT FROM AUTHOR]

Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The rise in paid care workers has not, until very recently, included carers specifically trained to provide domiciliary postnatal care. In 2002 a new occupation of domiciliary postnatal carers was introduced in the catchment area of a large metropolitan hospital in Adelaide, South Australia. The carers work with professional midwives to provide home based postnatal support to women discharged early from hospital following childbirth. Carers were trained in a short, six month program, and were recruited from long term unemployed young women from the same geographically disadvantaged catchment area as the hospital. In this paper, findings from the evaluation of the program are described and analysed. These include its implications for the postnatal care workers themselves and for the professionals involved in training and working with them. In addition, the implications for birthing women of a program using young, minimally trained carers are considered. Finally, the more general lessons for the training and ‘insertion’ of paid carers into domiciliary work with professionals are reflected on. [ABSTRACT FROM AUTHOR]

Objective To compare the rate of non-attendance for new referrals to a hospital based clinic versus home assessment. Setting Two old age psychiatry services in an urban area. Method A four year prospective study comparing rates of non-attendance for new referrals to a hospital based clinic versus assessment at home in two parallel old age psychiatry services. Results The rate of non-attendance for new referrals seen at home was considerably lower (1.7%) than the hospital based clinic (21.2%). Conclusions Assessing new outpatient referrals to old age psychiatry services at home reduces non-attendance. This improves efficient use of medical time in a small geographical catchment area but may not apply to rural or larger areas. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BackgroundMeasurement of domiciliary nasal peak inspiratory flow rate (PIFR) may have a role in the objective assessment of treatment response in seasonal allergic rhinitis (SAR). ObjectiveWe wished to evaluate the relationship between domiciliary measurement of nasal PIFR and a variety of symptoms associated with rhinitis. MethodsThirty-eight nonasthmatic patients, mean age (SEM) 30 years (1.4), with symptomatic SAR were evaluated in a placebo-controlled, single-blind, double-dummy, three way parallel group study. Patients received oral cetirizine 10 mg once daily and were randomized to receive, in addition, either: (i) intranasal mometasone furoate 200 μg (n = 14); (ii) oral montelukast 10 mg (n = 11); or (iii) placebo (n = 13). All treatments were given once daily for 4 weeks and were preceded by a 1 week placebo period. Domiciliary diary cards were used to record morning (am) and evening (pm) domiciliary nasal PIFR and symptom (nasal, eye, throat) scores and impact on daily activity. A total daily symptom score was then calculated from the sum of these separate symptom scores. ResultsBaseline values for symptom scores and PIFR after placebo run-in were not significantly different when comparing the three groups. After 4 weeks of active treatment, there were significant (P < 0.05) improvements in nasal symptoms, total daily symptoms and PIFR with all treatments, with there being no significant confounding effect of pollen count, when analysed as a covariate. There were significant (P < 0.01) correlations for nasal symptom scores vs PIFRam (r = - 0.51) and PIFRpm (r = - 0.56), and similarly for daily activity vs PIFRam (r = - 0.42) and PIFRpm (r = - 0.48). ConclusionsThese results suggest that domiciliary measurements of nasal peak flow correlate significantly with symptoms of seasonal allergic rhinitis and may therefore be a potentially useful objective short-term marker of treatment response. [ABSTRACT FROM AUTHOR]

Abstract Background Parkinson's Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinson's disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinson's is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life. Methods A pragmatic three parallel group randomised controlled trial involving people with Parkinson's Disease and live-in carers (family friends or paid carers), and comparing: management by a specialist multidisciplinary team for six weeks, according to a care plan agreed between the professionals and the patient and carer (Group A); multidisciplinary team management and additional support for four months from a trained care assistant (Group B); usual care, no coordinated team care planning or ongoing support (Group C). Follow up will be for six months to determine the impact and relative cost-effectiveness of the two interventions, compared to usual care. The primary outcomes are disability (patients) and strain (carers). Secondary outcomes include patient mobility, falls, speech, pain, self efficacy, health and social care use; carer general health; patient and carer social functioning, psychological wellbeing, health related quality of life. Semi structured interviews will be undertaken with providers (team members, care assistants), service commissioners, and patients and carers in groups A and B, to gain feedback about the acceptability of the interventions. A cost - effectiveness evaluation is embedded in the trial. Discussion The trial investigates components of recent national policy recommendations for people with long term conditions, and Parkinson's Disease in particular, and will provide guidance to inform local service planning and commissioning. Trial registration ISRCTN: ISRCTN44577970

Background: The effectiveness of home visits is well discussed for children with asthma, but limited in adults., Objective: The present systematic review aimed to investigate the potential role of home visits in improving outcomes among adult patients with asthma., Methods: The systematic review was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An extensive literature search was conducted using databases such as PubMed, ProQuest, CINAHL, The Cochrane Library, PsycINFO, and Google Scholar from inception to June 2019. The studies included were randomized controlled trials, which reported asthma outcomes in adult patients., Results: The literature search yielded 8331 publications, of which 63 studies were selected for full-text review, and of these studies, 9 studies with a total of 2011 patients were included in the final analysis. The included randomized controlled trials reported quality of life, asthma symptoms, exacerbations, health care utilization, and pulmonary function. Improvements in asthma outcomes were observed predominantly in quality of life. The effects on asthma symptom control were inconsistent. The evidence on the impact of home visits in asthma exacerbations and health care utilization was rather limited. There were no significant differences observed between intervention versus control arms in terms of pulmonary function; however, 1 study reported significant improvements in peak expiratory flow rate., Conclusions: Home visits may serve as an adjuvant activity that complements the existing health care system-based initiatives. It may be concluded that home visits have the potential to improve outcomes in adult patients with asthma; however, the randomized controlled trials reviewed in the present systematic review reported several limitations that warrant further investigation., (Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)