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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.
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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.
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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.
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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.
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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.
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Home-based care for reducing morbidity and mortality in people infected with HIV/AIDS.
Young, T, Busgeeth, K
The Cochrane database of systematic reviews. 2010;(1):CD005417
Abstract
BACKGROUND Home-based care (HBC), to promote quality-of-life and limit hospital care, is used in many countries, especially where public health services are overburdened. OBJECTIVES This review assessed the effects of HBC on morbidity and mortality in those with HIV/AIDS. SEARCH STRATEGY Randomised and controlled clinical trials of HBC including all forms of treatment, care and support offered in the home were included. A highly sensitive search strategy was used to search CENTRAL, MEDLINE, EMBASE, AIDSearch, CINAHL, PsycINFO/LIT. Risk of bias of all trials was assessed. SELECTION CRITERIA All randomised and controlled clinical trials were included of HIV/AIDS positive individuals, adults and children, of any gender, and from any setting. Home-based care, provided by family, lay and/or professional people, including all forms of treatment, care and support offered in the HIV/AIDS positive person's home as compared to hospital or institutional based care DATA COLLECTION AND ANALYSIS Titles, abstracts and descriptor terms of the electronic search results were screened independently by two authors for relevance based on the types of participants, interventions, and study design. Full text articles were obtained of all selected abstracts and an eligibility form was used to determine final study selection. Data extraction and assessment of risk of bias were done independently. Narrative synthesis of results were done. Relevant effect measures and the 95% confidence intervals were reported. MAIN RESULTS Ten studies randomised individuals and trial sizes varied from n=31 to n=549. One study randomised 392 households and enrolled a total of 509 persons with HIV and 1,521 HIV-negative household members. Two ongoing studies were identified. Intensive home-based nursing significantly improved self-reported knowledge of HIV and medications, self-reported adherence and difference in pharmacy drug refill (1 study). Another study, comparing proportion of participants with greater than 90% adherence, found statistically significant differences over time but no significant change in CD4 counts and viral loads. A third study found significant differences in HIV stigma, worry and physical functioning but no differences in depressive symptoms, mood, general health, and overall functioning. Comprehensive case management by trans-professional teams compared to usual care by primary care nurses had no significant difference in quality-of-life after 6-months of follow-up (n=57) and average length of time on service (n=549). Home total parenteral nutrition had no significant impact on overall survival and rate of re-hospitalisation. Two trials comparing computers with brochures/nothing/standard medical care found no significant effect on health status, and decision-making confidence and skill, but a reduction in social isolation after controlling for depression. Two trials evaluating home exercise programmes found opposing results. Home-based safe water systems reduced diarrhea frequency and severity among persons with HIV in Africa. AUTHORS' CONCLUSIONS Studies were generally small and very few studies were done in developing countries. There was a lack of studies truly looking at the effect of home based care itself or looking at significant end points (death and progression to AIDS). However, the range of interventions and HBC models evaluated can assist in making evidence-based decisions about HIV care and support.
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[Home care for the high-risk newborn infant].
Puddu, M
Minerva pediatrica. 2010;(3 Suppl 1):11-4
Abstract
With increased survival of extremely low birth weigh (ELBW) and very ill infants, a lot of them are discharged with unresolved medical issues that complicate their subsequent care. Infants born preterm with low birth weight who require neonatal intensive care experience a much higher rate of hospital readmission and death during the first year after birth compared with healthy term infants. Despite initial hospital care which is one of the most expensive of all kind of hospitalization, home care services are sometimes still sparse though the high risk of this group for failure to thrive, respiratory problems, developmental delays, parenting problems. In addition, societal and economic forces have come to bear on the timing and process of discharge and home care. Moreover it takes time for the family of a high-risk infant to prepare to care for their infant in a home setting and to obtain the necessary support services and mobilize community resources. Careful preparation for discharge, good follow-up and medical home after discharge may reduce these risks.
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Management of type 2 diabetes: implications for the home healthcare clinician.
Luger, S, Chabanuk, AJ
Home healthcare nurse. 2009;(2):92-101; quiz 102-3
Abstract
Type 2 diabetes mellitus is on the rise in the United States. National statistics show that 6.3% of the population currently has diabetes, and this percentage is expected to grow (). Recent research has identified a correlation between cardiovascular risk factors and diabetes, complicating the care of those persons with diabetes (PWDs) even further. Due to the complexities of related cardiovascular and other comorbidities, it often has been difficult for the home health clinician to provide comprehensive holistic care to the individual with type 2 diabetes mellitus. This article can assist clinicians from all disciplines in providing evidence-based quality care to the PWDs.
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WITHDRAWN: Home-based support for disadvantaged adult mothers.
Bennett, C, Macdonald, GM, Dennis, J, Coren, E, Patterson, J, Astin, M, Abbott, J
The Cochrane database of systematic reviews. 2008;(1):CD003759
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Abstract
BACKGROUND Babies born to socio-economically disadvantaged mothers are at higher risk of a range of problems in infancy. Home visiting programs are thought to improve outcomes, both for mothers and children, largely through advice and support. OBJECTIVES To assess the effectiveness of home visiting programmes for women who have recently given birth and who are socially or economically disadvantaged. SEARCH STRATEGY We searched the following electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2006); MEDLINE (1966 to March 2006); EMBASE (1980 to 2006 week 12); CINAHL (1982 to March week 4 2006); PsycINFO (1872 to March week 4 2006); ASSIA (1987 to March 2006); LILACS (1982 to March 2006); and Sociological Abstracts(1963 to March 2006). We searched grey literature using ZETOC (1993 to March 2006); Dissertation Abstracts International (late 1960s to 2006); and SIGLE (1980 to March 2006). We also undertook communication with published authors about ongoing or unpublished research. SELECTION CRITERIA Included studies were randomised controlled trials investigating the efficacy of home visiting directed at disadvantaged adult mothers. DATA COLLECTION AND ANALYSIS Two reviewers (EC and JP or CB) independently assessed titles and abstracts identified in the search for eligibility. Data were extracted and entered into RevMan (EC, JP and CB), synthesised and presented in both written and graphical form (forest plots). Outcomes included in this review were established at the protocol stage by an international steering group. The review does not report on all outcomes reported in included studies. MAIN RESULTS We included 11 studies with 4751 participants in this review. Data show no statistically significant differences for those receiving home visiting, either for maternal outcomes (maternal depression, anxiety, the stress associated with parenting, parenting skills, child abuse risk or potential or breastfeeding) or child outcomes (preventive health care visits, psychosocial health, language development, behaviour problems or accidental injuries. Evidence about uptake of immunisations is mixed, and the data on child maltreatment difficult to interpret. AUTHORS' CONCLUSIONS This review suggests that for disadvantaged adult women and their children, there is currently no evidence to support the adoption of home visiting as a means of improving maternal psychosocial health, parenting or outcomes for children. For reasons discussed in the review, this does not amount to a conclusion that home visiting programmes are ineffective, but indicates a need to think carefully about the problems that home visiting might influence, and improvements in the conduct of outcome studies in this area.
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Morbid obesity: issues and challenges in home health.
Brzezinski, S
Home healthcare nurse. 2008;(5):290-7; quiz 298-9
Abstract
People coping with morbid obesity face many complex issues and challenges, as do the home healthcare providers who care for them. Morbid obesity among adults in the United States has reached epidemic proportions. It is estimated that 1 in 20 Americans has class 3 morbid obesity, also known as extreme obesity (Arterburn, Maciejewski, & Tsevat, 2005). Morbid obesity is on the rise. Understanding the emotional and physical needs of this population allows the home health clinician to optimize the chances for successful outcomes.