1.
Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review.
Holland, AE, Malaguti, C, Hoffman, M, Lahham, A, Burge, AT, Dowman, L, May, AK, Bondarenko, J, Graco, M, Tikellis, G, et al
Chronic respiratory disease. 2020;:1479973120952418
Abstract
OBJECTIVES To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease. METHODS Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties. RESULTS 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. DISCUSSION The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.
2.
Parenteral and Enteral Nutrition-From Hospital to Home: Will It Be Covered?
Bonnes, SL, Salonen, BR, Hurt, RT, McMahon, MT, Mundi, MS
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2017;(6):730-738
Abstract
With scientific advances allowing for the safe delivery of parenteral and enteral nutrition in the home setting, challenges have risen with determining how this will be financially feasible for patients. In the United States, the government is one of the major payers for home parenteral and enteral nutrition (HPEN). Thus, it is important for nutrition providers to have an understanding of the Medicare criteria that must be met in order for these services to be covered. It can be difficult for clinicians to sift through these requirements and decipher for whom and when HPEN is covered. As our nutrition science knowledge and delivery continue to grow and evolve, potential barriers to this coverage may arise. This article provides background on those currently on HPEN in the United States, the current Medicare HPEN coverage criteria, and challenges we may face in the future.
3.
Supporting Self-management of Asthma Care.
Keep, SM, Reiffer, A, Bahl, TE
Home healthcare now. 2016;(3):126-34; quiz E1-2
Abstract
Asthma is a major public health concern, with an estimated 18.8 million adults in the United States having the disease. Asthma can be controlled with a variety of effective treatment options; however, only half the people with asthma report their asthma is well controlled. Uncontrolled asthma leads to high direct and indirect costs as well as decreased quality of life. The pathophysiology of asthma, current asthma practice guidelines, and common barriers to self-management will be discussed. Through use of motivational interviewing techniques and knowledge of available self-management tools, the home care clinician is poised to help increase self-management of asthma, decrease hospitalizations, and improve quality of life.
4.
The interdisciplinary approach to the implementation of a diabetes home care disease management program.
Rosa, MA, Lapides, S, Hayden, C, Santangelo, R
Home healthcare nurse. 2014;(2):108-16; quiz 116-8
Abstract
Diabetes is a national epidemic and a leading cause of hospitalizations in the United States. Home care agencies need to be able to provide effective Diabetes Disease Management to help prevent avoidable hospitalizations and assist patients to live a good quality of life. This article describes one organization's journey toward providing patients with better diabetes care resulting in an improved quality of life.
5.
Adherence of subjects with cystic fibrosis to their home program: a systematic review.
O'Donohoe, R, Fullen, BM
Respiratory care. 2014;(11):1731-46
Abstract
BACKGROUND The management of cystic fibrosis (CF) includes adherence to a home management program (airway clearance, medication, nutritional advice, and exercise). This has led to an increase in life expectancy, although the benefits depend greatly on a patient's level of adherence to daily treatments at home. To date, no systematic review has established adherence rates to all World Health Organization guidelines in the home setting; hence, this review was undertaken. METHODS The review comprised 3 phases. A methodological assessment of databases (Embase, CINAHL, PsychINFO, PEDro, PubMed, Cochrane Central Register of Controlled Trials) identified potentially relevant papers. These papers were screened for inclusion criteria by 2 independent reviewers, data were extracted, and the internal validity was rated using a valid and reliable scale. Results were categorized into 4 themes: medication, nutrition, airway clearance techniques, and exercise. RESULTS The search generated a total of 26 papers, 24 of which were rated as being poor quality. Adherence to a treatment program for CF patients is generally low (from 22% for nutritional guidelines to 130% for oral antibiotics), and it varies greatly depending on the type of treatment and the method of assessment employed (objective tool vs self-reported questionnaires). CONCLUSIONS Consensus on how to measure adherence is lacking, and the quality of studies addressing adherence in this population is generally poor. Overall, studies using self-reported measures yielded higher adherence scores than those that used objective measures, suggesting that current efforts to improve methods of adherence are appropriate. The prevalence of non-adherence remains unclear due to these limitations.