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BACKGROUND: Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. METHODS: Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. RESULTS: A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. CONCLUSIONS: The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.
- MeSH
- činnosti denního života MeSH
- etnicita MeSH
- geriatrické hodnocení metody statistika a číselné údaje MeSH
- kohortové studie MeSH
- kvalita života * MeSH
- lidé MeSH
- organizační modely MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- služby domácí péče * organizace a řízení normy statistika a číselné údaje MeSH
- stárnutí * fyziologie psychologie MeSH
- ukazatele kvality zdravotní péče normy MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Dánsko MeSH
- Finsko MeSH
- Itálie MeSH
- Německo MeSH
- Nizozemsko MeSH
OBJECTIVE: This study aimed to analyze the complications of planned home births treated at healthcare facilities in the Czech Republic. METHODS: This prospective cohort observational study is based on analysis of women hospitalized with complications related to planned home deliveries in the Czech Republic between 2016 and 2017. The data were collected using an online form made accessible to the directors of all maternity hospitals in the Czech Republic. The results were statistically evaluated. RESULTS: We identified 45 complications during planned home deliveries. Complications occurred most often among women living in largely populated cities with higher levels of education. Overall, 40% of patients did not receive routine antenatal care, and 38% of women gave birth after the 41st week of pregnancy. In 60% of cases, no professionals attended the birth. Hospital transfer frequencies were 42% after delivery, 36% at third-stage labour, 11% first-stage labour, 9% second-stage labour, and 2% before delivery. We recorded four neonatal deaths and one severe newborn morbidity. There was one maternal death unrelated to the home-birthing process and six cases of severe maternal haemorrhagic shock requiring intensive care. CONCLUSION: Complications of planned home births occurred more frequently in women living in largely populated cities and with higher education levels. Planned home births were also observed among women who were at a higher risk of complications. Risk factors included nulliparity, postdate pregnancy, and lack of prenatal care. Hospital transfers occurred most often in the third stage of labour and postpartum.
- Klíčová slova
- complication, home birth, maternal morbidity, neonatal death,
- MeSH
- komplikace těhotenství epidemiologie MeSH
- lidé MeSH
- novorozenec MeSH
- porod doma škodlivé účinky MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: Due to the rapid ageing of the population, there is increasing demand for long-term care in the people's home environment. Such care aims to allow the people to stay at home and avoid hospitalisation or other institutional care. In home health care, care must be provided at the highest possible quality, with the focus on the people's needs and experiences. OBJECTIVES: This study explores the experiences and needs of frail older people receiving home health care. DESIGN AND METHODS: An exploratory descriptive qualitative approach was chosen. Audio-taped semi-structured interviews were conducted with fifteen older people receiving home health care. A content analysis was used to analyse the data collected. RESULTS: The content analysis identified one main theme, three categories and seven subcategories related to frail older people's needs and experiences of home health care. The main theme was quality of care. The first category, Safe and Secure Care, consisted of three subcategories: Education and Experience of Nurses, Information, and Continuity of Care in terms of personnel continuity and regular care. The second category, Autonomy, contained two subcategories: Decision-making and Self-sufficiency. The last category, Relationship with Professionals, consisted of two subcategories: Personality of Nurse and Partnerships. CONCLUSION: Older people are able to express their satisfaction or dissatisfaction with home health care. The results of this study revealed that the quality of care is crucial for frail older people. IMPLICATION FOR PRACTICE: The provision of home health care is inherently highly specific; home care nurses should work to provide the highest possible quality of care. In particular, nurses should focus on ensuring that the care they provide is safe, effective, timely, efficient and person-centred.
- Klíčová slova
- experiences, home health care, needs, older people, quality of care,
- MeSH
- domácí životní podmínky MeSH
- křehký senior * MeSH
- kvalitativní výzkum MeSH
- lidé MeSH
- senioři MeSH
- služby domácí péče * MeSH
- spokojenost pacientů MeSH
- zdravotnické služby - potřeby a požadavky MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
AIMS: Intracardiac electrograms (IEGMs) are essential for the assessment of implantable cardioverter-defibrillator (ICD) function. The Biotronik Home Monitoring systems transmit an 'IEGM Online' that is shorter than the full-length programmer IEGM due to technical constrains. The aim of this study was to evaluate the accuracy of the physician's classification of the underlying rhythm based on the second-generation IEGM Online. METHODS AND RESULTS: In total, 1533 patients treated with single- and dual-chamber ICDs and cardiac resynchronization therapy defibrillators were enrolled at 67 investigational sites and followed for 15 months. The investigators classified the rhythm shown in IEGM Online as ventricular tachycardia, ventricular fibrillation, atrial fibrillation, other supraventricular tachyarrhythmia, oversensing due to lead failure, T-wave oversensing, or other rhythm. At the next in-office follow-up, the investigators classified independently the rhythm seen in the corresponding programmer IEGM. The two rhythm classifications were compared thereafter. Both IEGM Online and programmer IEGM were available in 2099 arrhythmic or oversensing events, of which 146 (7.0%) were classified as other rhythm or artefacts and were excluded as inconclusive or atypical. The remaining 1953 events, affecting 352 patients (23.0%), were classified correctly in 1803 cases (92.3%). The accuracy of rough rhythm classification as ventricular, supraventricular, or oversensing was 97.2%. CONCLUSION: The Lumax and IEGM Online HD Evaluation study demonstrates that remote IEGM analysis is reasonably accurate in a remote monitoring system that transmits shorter IEGM than the full-length programmer IEGM for the sake of frequent, fully automatic data transmission.
- Klíčová slova
- Arrhythmia detection, Home monitoring, Implantable cardioverter-defibrillator, Intracardiac electrogram, Remote monitoring, Telemedicine,
- MeSH
- defibrilátory implantabilní * MeSH
- elektrokardiografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- odchylka pozorovatele MeSH
- on-line systémy MeSH
- reprodukovatelnost výsledků MeSH
- senzitivita a specificita MeSH
- srdeční arytmie diagnóza terapie MeSH
- telemedicína metody MeSH
- uživatelské rozhraní počítače MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
According to the hygiene and biodiversity hypotheses, increased hygiene levels and reduced contact with biodiversity can partially explain the high prevalence of immune-mediated diseases in developed countries. A disturbed commensal microbiota, especially in the gut, has been linked to multiple immune-mediated diseases. Previous studies imply that gut microbiota composition is associated with the everyday living environment and can be modified by increasing direct physical exposure to biodiverse materials. In this pilot study, the effects of rural-second-home tourism were investigated on the gut microbiota for the first time. Rural-second-home tourism, a popular form of outdoor recreation in Northern Europe, North America, and Russia, has the potential to alter the human microbiota by increasing exposure to nature and environmental microbes. The hypotheses were that the use of rural second homes is associated with differences in the gut microbiota and that the microbiota related to health benefits are more diverse or common among the rural-second-home users. Based on 16S rRNA Illumina MiSeq sequencing of stool samples from 10 urban elderly having access and 15 lacking access to a rural second home, the first hypothesis was supported: the use of rural second homes was found to be associated with lower gut microbiota diversity and RIG-I-like receptor signaling pathway levels. The second hypothesis was not supported: health-related microbiota were not more diverse or common among the second-home users. The current study encourages further research on the possible health outcomes or causes of the observed microbiological differences. Activities and diet during second-home visits, standard of equipment, surrounding environment, and length of the visits are all postulated to play a role in determining the effects of rural-second-home tourism on the gut microbiota.
- Klíčová slova
- cottage, elderly, fecal microbiota, gut microbiota, immune-mediated diseases, outdoor recreation, rural areas, second home, stool sample,
- MeSH
- lidé MeSH
- mikrobiota * MeSH
- pilotní projekty MeSH
- RNA ribozomální 16S genetika MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
- Finsko MeSH
- Rusko MeSH
- Severní Amerika MeSH
- Názvy látek
- RNA ribozomální 16S MeSH
We studied the relationships of automated blood pressure (BP), measured in the healthcare centre, with manual office BP and home BP. Stable outpatients treated for hypertension were measured automatically, seated alone in a quiet room, six times after a 5 min rest with the BpTRU device, and immediately afterwards using the auscultatory method. Home BP was measured in a subgroup during 7 days preceding the visit. The automated, office and home BP values were 131.2 ± 21.8/77.8 ± 12.1 mmHg, 146.9 ± 20.8/85.8 ± 12.4 mmHg and 137.7 ± 17.7/79.4 ± 8.2 mmHg, respectively. Limits of agreement between office and automated BP (2 SDs in Bland-Altman plots) were +42.6 to -12.6/+22.6 to -6.6 mmHg for systolic/diastolic BP; for home and automated BP they were +45.8 to -25.8/+20.8 to -12.6 mmHg. For patients with two visits, intraclass correlation coefficients of BP values measured during the first and second visits were 0.66/0.72 for systolic/diastolic automated BP and 0.68/0.74 for systolic/diastolic office BP. Automated BP was lower than home BP and no more closely related to home BP than to office BP. It did not show better repeatability than office BP. Whether automated BP and the "white-coat effect", calculated cas the office BP-automated BP difference, have clinical and prognostic importance deserves further studies.
- Klíčová slova
- Automated office blood pressure, blood pressure measurement, home blood pressure, white-coat effect,
- MeSH
- ambulantní monitorování krevního tlaku metody MeSH
- hypertenze diagnóza patofyziologie MeSH
- krevní tlak * MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku metody MeSH
- prognóza MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
BACKGROUND: Central blood flow measurements include the estimation of right and left ventricular output (RVO, LVO), superior vena cava (SVC) flow, and calculated patent ductus arteriosus (PDA) flow. We aimed to provide an overview of the maturation patterns of these values and the relationship between PDA flow and the need for home oxygen therapy. METHODS: This prospective single-center study was conducted in infants born at <26 weeks of gestation. We performed echocardiographic measurements five times during their life (from the 4th post-natal day to the 36th postmenstrual week). RESULTS: Sixty patients with a mean birth weight of 680 (590, 760) g were included. Postnatal development of LVO and PDA flow peaked at the end of the second postnatal week (427 and 66 mL/kg/min, respectively). The RVO increased between days 4 and 7-8. The SVCF was most stable. The development curves of PDA flow differed between the groups with (n = 28; 47%) and without home oxygen therapy. CONCLUSION: We present the central blood flow values and their postnatal development in infants <26 weeks of gestation. This study demonstrates the association between PDA flow and the future need for home oxygen therapy. IMPACT: This study enriches our knowledge of the long-term development of central blood flow parameters and derived patent ductus arteriosus (PDA) flow in extremely preterm infants (<26 weeks). While pulmonary resistance decreased, PDA flow continued to increase from day 4 to the end of the second week of life. Similarly, left ventricular output increased as a marker of preload. The superior vena cava flow remained stable. The observed association between PDA flow and an unfavorable respiratory outcome is important for future studies focusing on the prevention of chronic lung disease.
- MeSH
- echokardiografie MeSH
- gestační stáří MeSH
- hemodynamika MeSH
- lidé MeSH
- novorozenci extrémně nezralí * MeSH
- novorozenec MeSH
- otevřená tepenná dučej * patofyziologie terapie diagnostické zobrazování MeSH
- oxygenoterapie * MeSH
- prospektivní studie MeSH
- služby domácí péče MeSH
- vena cava superior patofyziologie diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The aim of this study was to determine the prevalence of potentially inappropriate medications (PIMs) in nursing home residents across eight countries and investigate differences between residents with and without cognitive impairment, as well as those with and without life expectancy of six months or less. METHODS AND DEIGN: The study utilized the second edition of the STOPP-Frail criteria to operationalize PIMs in the baseline assessment of nursing home residents participating in the Services and Health for Elderly in Long TERm care (SHELTER) project. The data were collected between 2009 and 2012. The project was conducted in eight countries: Czech Republic, England, Finland, France, Germany, Italy, the Netherlands, and Israel. Cognitive impairment was measured by the cognitive performance scale (CPS). The presence of end-stage disease with a life expectancy of six months or less was recorded. The study included residents aged 60 years or older who underwent a valid medication assessment. RESULTS: Among the 3,832 eligible residents, 87.9% had at least one PIM. Specifically, 24.3%, 23.5%, 18.8%, and 19.3% of residents had one, two, three, and four or more PIMs, respectively. On average, each person was prescribed 2.16 PIMs. Cognitively impaired residents (n = 1999) had an average of 1.96 PIMs (SD 1.49) per person, while residents with a low CPS score (n = 1783) had an average of 2.40 PIMs (SD 1.57) per person, showing a statistically significant difference (P < 0.001). Similarly, NH residents with life expectancy of six months or less had an average of 1.66 PIMs (SD 1.30), whereas those without had an average of 2.17 PIMs (SD 1.55) (p < 0.001). The average number of PIMs varied across countries, ranging from 3.23 in Finland to 2.15 in the UK (P < 0.001). Anti-platelets and aspirin were the most prescribed PIMs, accounting for over 38.0% of prescriptions. CONCLUSIONS: This study highlights the high prevalence of PIMs among nursing home residents. However, PIMs were somewhat lower in residents with cognitive impairment and life expectancy of six months or less. Efforts must continue to improve the rationale behind prescribing practices in nursing homes.
- Klíčová slova
- Adverse effects, Cognitive impairment, End-of-life, Nursing home residents, Potentially inappropriate medications,
- MeSH
- domovy pro seniory MeSH
- křehký senior MeSH
- lidé středního věku MeSH
- lidé MeSH
- nevhodné předepisování statistika a číselné údaje MeSH
- pečovatelské domovy * MeSH
- prevalence MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- seznam potenciálně nevhodných léčiv * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Německo epidemiologie MeSH
BACKGROUND: Second primary cancers (SPCs) are increasing due to improving survival in first primary cancers. Previous studies on SPCs in renal cell carcinoma (RCC) have focused on treatment and other risk factors, but data of RCC as an SPC are scarce. OBJECTIVE: In this study, we want to elucidate the risk for any SPC after RCC, and in reverse order, for RCC as an SPC after any cancer. We additionally consider how family histories influence the risks. DESIGN SETTING AND PARTICIPANTS: Patient data were obtained from the Swedish Cancer Registry from years 1990 through 2015, and family data were obtained from the Multigeneration Register. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We employed standardized incidence ratios to estimate bidirectional relative risks of subsequent cancer associated with RCC. RESULTS AND LIMITATIONS: We identified 17 587 RCCs (60% in male patients). The highest increases for SPCs were observed for nervous system hemangioblastoma (HB; 26.8), adrenal (12.09) tumors, and renal pelvic cancer (6.32). In the reverse order, RCC as an SPC, nervous system HB (17.01), and adrenal tumors (15.34) were associated with the highest risks. Risks for many other sites (12 sites and subsites) were increased bidirectionally. For women, a total of seven sites and subsites were increased bidirectionally, and many were shared with men. The only significant sex difference in SPCs was the higher lung cancer risk in women (2.41) than in men (1.28). Patients with a family history of HBs or of prostate, colorectal and lung cancers showed high risks of these cancers as SPCs after RCC. Family history accounted for 30% of prostate cancers after RCC. CONCLUSIONS: The bidirectional study design was able to suggest risk factors for SPCs and offered a clinical take-home message urging to consider strategies for early detection and prevention of SPCs. Readily available information on lifestyle (eg, smoking) and family history (eg, prostate cancer) may reveal targets for risk reduction with prognostic benefits. PATIENT SUMMARY: Close to 10% of kidney cancer patients develop another cancer. The cause for these other cancers may not depend on kidney cancer.
- Klíčová slova
- Cancer etiology, Cancer incidence, Relative risk, Second primary cancer, Sex difference,
- Publikační typ
- časopisecké články MeSH
In the nursing home in Břevnice, 21 out of 23 seniors were infected with the SARS-CoV-2 virus in the spring of 2020. Three of them died from the infection. This study monitors the antibodies formation in group of seniors who have overcome the infection. Between April and November (1-8 months after the infection), the antibodies were measured repeatedly within the period of several weeks. The virus neutralizing tests was used as well as the ECLIA assay by Roche (total immunoglobulins), CMIA assay by Abbott (IgG) and ELISA assay by Euroimmun (IgG and IgA). Six months from the infection, neutralizing antibodies were detected in 18 out of 20 seniors. High levels of neutralizing antibodies correlated with higher levels of immunoglobulins and were a good predictor of an increase of IgG in the autumn during the second wave of the epidemic in the Czech Republic. During the autumn wave, neither any of the clients, nor any staff contracted the virus, although the prevalence of PCR positivity in the Vysočina region reached around 5 %. The antigen tests also came out all negative. This study shows that in the senior population, the production of protective antibodies follows a normal pattern, and the seniors are probably immune to a repeated infection for at least 8 months from the first infection. Based on these results, we would like to open the discussion on the testing for seroprevalence in nursing homes, possible changes to the epidemiologic regime in relation to the risk of infection, and about vaccination schemes in these centers.
- Klíčová slova
- Antibodies, COVID-19, Dynamics, SARS-CoV-2, antibodies, dementia, elderly, nursing home, reinfection, senior,
- MeSH
- COVID-19 * MeSH
- lidé MeSH
- pečovatelské domovy MeSH
- protilátky virové MeSH
- SARS-CoV-2 * MeSH
- séroepidemiologické studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Názvy látek
- protilátky virové MeSH