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International Journal of Environmental... Feb 2023Exploring the experience and impact of aneurysmal subarachnoid hemorrhage (aSAH) from three perspectives, that of those directly affected (AFs), their next of kin (NoK),...
Aneurysmal Subarachnoid Hemorrhage and Clinical Decision-Making: A Qualitative Pilot Study Exploring Perspectives of Those Directly Affected, Their Next of Kin, and Treating Clinicians.
BACKGROUND
Exploring the experience and impact of aneurysmal subarachnoid hemorrhage (aSAH) from three perspectives, that of those directly affected (AFs), their next of kin (NoK), and treating clinicians, is a way to support and empower others to make informed medical decisions.
METHODS
In a Swiss neurosurgical intensive care unit (ICU), eleven semi-structured interviews were conducted as part of a Database of Individual Patient Experiences (DIPEx) pilot project and thematically analyzed. Interviews were held with two clinicians, five people experiencing aSAH, and four NoK 14-21 months after the bleeding event.
RESULTS
Qualitative analysis revealed five main themes from the perspective of clinicians: emergency care, diagnosis and treatment, outcomes, everyday life in the ICU, and decision-making; seven main themes were identified for AFs and NoK: the experience of the aSAH, diagnosis and treatment, outcomes, impact on loved ones, identity, faith, religion and spirituality, and decision-making. Perspectives on decision-making were compared, and, whereas clinicians tended to focus their attention on determining treatment, AFs and NoK valued participation in shared decision-making processes.
CONCLUSIONS
Overall, aSAH was perceived as a life-threatening event with various challenges depending on severity. The results suggest the need for tools that aid decision-making and better prepare AFs and NoK using accessible means and at an early stage.
Topics: Humans; Subarachnoid Hemorrhage; Pilot Projects; Religion; Spirituality; Clinical Decision-Making
PubMed: 36833886
DOI: 10.3390/ijerph20043187 -
Journal of Rehabilitation Medicine Apr 2021To measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases.
OBJECTIVE
To measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases.
METHODS
Seventeen hospital and outpatient medical centres from 13 regions of the Pilot Project. Baseline questionnaires assessed the involvement of multidisciplinary teams, staffing, and the equipment in healthcare facilities. These questionnaires covered 3 rehabilitation phases: inpatient rehabilitation in the intensive care units and departments of myocardial infarction/cardiac surgery; early in-hospital rehabilitation; and outpatient rehabilitation.
RESULTS
The pilot project was initiated in 2013. At the 5-year follow-up, phase I was established across all 17 sites, phase II at 13 sites, and phase III at 9 sites. By 2017, multidisciplinary teams were deployed to manage patients at all sites. Early rehabilitation in regional vascular centres, reduced patients' stay from 13.7 (2.1) days in 2013 to 7.6 (1.1) days in 2017.
CONCLUSION
Despite successful implementation of the 3-phase rehabilitation programme based on the multidisciplinary approach, further improvement is required, with the main focus shifted to patients routing between healthcare facilities. Particular attention should be paid to the standards for providing phase III cardiac rehabilitation, in order to ensure continuity of cardiac rehabilitation. The next step should include assessment of the effectiveness of the implemented cardiac rehabilitation programme and its translation to other regions of the country.
Topics: Cardiac Rehabilitation; Female; Humans; Male; Pilot Projects; Rehabilitation Centers; Surveys and Questionnaires
PubMed: 33871034
DOI: 10.2340/16501977-2833 -
Hawai'i Journal of Medicine & Public... Sep 2018The Kona WIC oral health pilot project was developed to assess the oral health beliefs and behaviors of parents of children and pregnant women at the Kona WIC site and...
The Kona WIC oral health pilot project was developed to assess the oral health beliefs and behaviors of parents of children and pregnant women at the Kona WIC site and to demonstrate the ease of providing oral health education to families in order to improve oral health behaviors. Data were collected from 50 families about the oral health behaviors and dental care of a total of 73 children, including 5 pregnant women, four of whom had a child enrolled in WIC and one pregnant woman without any previous children. Data revealed that 68% of children with teeth had been seen by a dentist within 6 to 12 months of the study visit. Mothers were seen less often, with 55% stating that they had not been seen for a dental visit for over one year. Parental knowledge about the effects of fluoride on teeth was limited; however, 90% of the parents would allow fluoride varnish applied to their child's teeth, 88% would give daily fluoride drops/tablets to their child, and 78% would support water fluoridation if it would help to improve their children's oral health. Additionally, for children old enough to receive fluoride supplementation, 60% were not given a prescription by their health care providers, and 58% had not received any fluoride varnish applications. By offering oral health education in a WIC clinic and assisting clients to seek out comprehensive care within a dental home, children and caregivers can be provided essential education and resources early in a child's life or women's pregnancies to reduce poor oral health outcomes.
Topics: Adolescent; Adult; Child; Child, Preschool; Dental Health Services; Education, Dental, Graduate; Female; Food Assistance; Humans; Infant; Male; Middle Aged; Oral Health; Pilot Projects; Pregnancy
PubMed: 30221076
DOI: No ID Found -
Revue Medicale de Liege Nov 2019Following a solicitation of INAMI in 2016, a team of the CHU Liège pneumology department has proposed a telemonitoring pilot project in severe chronic obstructive...
Following a solicitation of INAMI in 2016, a team of the CHU Liège pneumology department has proposed a telemonitoring pilot project in severe chronic obstructive pulmonary disease (COPD) patients. The main objective of the study was to reduce the number of hospitalizations for COPD exacerbation. The patients included in the study had been at least hospitalized once in 12 months before the beginning of the telemonitoring. A close collaboration with the general practitioner was required. Patients were educated in the manipulation of the application and connected objects. The numerous technical difficulties encountered limited the number of patients studied within the short time allowed by INAMI. However, some interesting observations could be made and a first experience in the field acquired. A project on a large scale seems necessary.
Topics: Hospitalization; Humans; Pilot Projects; Pulmonary Disease, Chronic Obstructive; Telemedicine
PubMed: 31729844
DOI: No ID Found -
BMC Health Services Research Aug 2022Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript...
INTRODUCTION
Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript describes the establishment of an online video consultation service in a clinic and its broad health care region to exemplify challenges and solutions for potential future approaches from a management perspective.
METHOD
The underlying pilot project was planned and implemented for follow-up monitoring and consultative presentation of orthopedic and trauma patients within the Bundeswehr Medical Service from 2018 to 2020. With predominantly positive evaluation results regarding quality and acceptance among users, this research investigated organizational and processual aspects including total quality management, strategic control and change management approaches.
RESULTS
The affected main and subprocesses of patient treatment could be streamlined by the project, as physician recommendations and arrangements could be accelerated and patient travel could be significantly reduced. A SWOT and portfolio analysis showed a high potential for improving existing patient treatment processes for health care enterprises via the use of digital technology. The involved staff should be strategically included at an early stage and continuously involved. By means of a PDCA cycle, the processes of the given project could be exemplarily illustrated with an outlook in the future.
DISCUSSION
It has proven successful to consciously use management approaches to establish telemedical integrated care structures in a health region. Recommendations for the strategic introduction of an online video consultation for regional network strengthening and care development for a patient-oriented increase in efficiency could be compiled.
Topics: Feasibility Studies; Humans; Orthopedics; Pilot Projects; Referral and Consultation; Telemedicine
PubMed: 35962358
DOI: 10.1186/s12913-022-08352-0 -
Israel Journal of Health Policy Research May 2019Dementia is a terminal illness making the palliative and hospice approach to care appropriate for older people with advanced dementia.
BACKGROUND
Dementia is a terminal illness making the palliative and hospice approach to care appropriate for older people with advanced dementia.
OBJECTIVE
To examine clinical and health services outcomes of a quality improvement pilot project to provide home hospice care for older people with advanced dementia.
STUDY DESIGN
Twenty older people with advanced dementia being treated in the Maccabi Healthcare Services homecare program, received home hospice care as an extension of their usual care for 6-7 months (or until they died) from a multidisciplinary team who were available 24/7. Family members were interviewed using validated questionnaires about symptom management, satisfaction with care, and caregiver burden. Hospitalizations prevented and medications discontinued, were determined by medical record review and team consensus.
FINDINGS
The findings are based on 112 months of care with an average of 5.6 (SD 1.6) months per participant. The participants were on average 83.5 (SD 8.6) years old, 70% women, in homecare for 2.8 (SD 2.0) years, had dementia for 5.6 (SD 3.6) years with multiple comorbidities, and had been hospitalized for an average of 14.0 (SD 18.1) days in the year prior to the project. Four patients were fed via artificial nutrition. During the pilot project, 4 patients died, 2 patients withdrew, 1 patient was transferred to a nursing home and 13 returned to their usual homecare program. The home hospice program lead to significant (p < 0.001)improvement in: symptom management (score of 33.8 on admission on the Volicer symptom management scale increased to 38.3 on discharge), in satisfaction with care (27.5 to 35.3,), and a significant decline in caregiver burden (12.1 to 1.4 on the Zarit Burden index). There were five hospitalizations, and 33 hospitalizations prevented, and an average of 2.1(SD 1.4) medications discontinued per participant. Family members reported that the professionalism and 24/7 availability of the staff provided the added value of the program.
CONCLUSIONS
This pilot quality improvement project suggests that home hospice care for older people with advanced dementia can improve symptom management and caregiver satisfaction, while decreasing caregiver burden, preventing hospitalizations and discontinuing unnecessary medications. Identifying older people with advanced dementia with a 6 month prognosis remains a major challenge.
Topics: Aged; Aged, 80 and over; Caregivers; Dementia; Female; Hospices; Hospitalization; Humans; Male; Patient Satisfaction; Pilot Projects; Quality Improvement; Surveys and Questionnaires
PubMed: 31060626
DOI: 10.1186/s13584-019-0304-x -
International Journal of Health Policy... Oct 2019To improve the performance of the healthcare system, Mali's government implemented a pilot project of performance-based financing (PBF) in the field of reproductive...
BACKGROUND
To improve the performance of the healthcare system, Mali's government implemented a pilot project of performance-based financing (PBF) in the field of reproductive health. It was established in the Koulikoro region. This research analyses the process of implementing PBF at district hospital (DH) level, something which has rarely been done in Africa.
METHODS
This qualitative research is based on a multiple, explanatory, and contrasting case study with nested levels of analysis. It covered three of the 10 DHs in the Koulikoro region. We conducted 36 interviews: 12 per DH with council of circle's members (2) and health personnel (10). We also conducted 24 non-participant observation sessions, 16 informal interviews, and performed a literature review. We performed data analysis using the Consolidated Framework for Implementation Research (CFIR).
RESULTS
Stakeholders perceived the PBF pilot project as a vertical intervention from outside that focused solely on reproductive health. Local actors were not involved in the design of the PBF model. Several difficulties regarding the quality of its design and implementation were highlighted: too short duration of the intervention (8 months), choice and insufficient number of indicators according to the priority of the donors, and impossibility of making changes to the model during its implementation. All health workers adhered to the principles of PBF intervention. Except for members of the district health management team (DHMT) involved in the implementation, respondents only had partial knowledge of the PBF intervention. The implementation of PBF appeared to be easier in District 3 Hospital compared to District 1 and District 2 because it benefited from a pre-pilot project and had good leadership.
CONCLUSION
The PBF programme offered an opportunity to improve the quality of care provided to the population through the motivation of health personnel in Mali. However, several obstacles were observed during the implementation of the PBF pilot project in DHs. When designing and implementing PBF in DHs, it is necessary to consider factors that can influence the implementation of a complex intervention.
Topics: Cross-Sectional Studies; Health Personnel; Hospitals, District; Humans; Mali; Motivation; Pilot Projects; Qualitative Research; Quality of Health Care; Reimbursement, Incentive; Reproductive Health; Stakeholder Participation
PubMed: 31657185
DOI: 10.15171/ijhpm.2019.45 -
Rhode Island Medical Journal (2013) Mar 2021The COBRE Center for Neuromodulation (CCN) at Butler Hospital supports clinical research in neuromodulation and investigators' career development in this field. The work...
The COBRE Center for Neuromodulation (CCN) at Butler Hospital supports clinical research in neuromodulation and investigators' career development in this field. The work couples brain stimulation methods with readouts of brain activity (e.g., using various neuroimaging, behavioral, and physiological assessment methods) in clinical or clinically relevant populations. Its guiding principle is that for noninvasive brain stimulation to gain efficacy and implementation, it is essential to better characterize clinically relevant target circuits and mechanisms of action. The CCN includes a Design and Analysis Core (DAC) to support rigorous and innovative experimental design and data analytic strategies and a Neuromodulation and Neuroimaging Core (NNC) to facilitate the acquisition and processing of high-quality data using noninvasive neurostimulation and neuroimaging methods. This article will describe the CCN's research focus and how it enhances research capacity in neuromodulation in our state. It will introduce our current investigator Project Leaders, their projects, and our pilot project program. It will also detail the CCN's links to Centers and research cores in Rhode Island researching allied areas of clinical neuroscience, neurology, psychiatry, and psychology, current collaborative efforts across those centers, and opportunities to collaborate in research and training.
Topics: Brain; Hospitals; Humans; Pilot Projects; Transcranial Magnetic Stimulation; Translational Research, Biomedical
PubMed: 33648316
DOI: No ID Found -
Nutrients Mar 2022School meals can have a key function in promoting children's health. However, simply providing a free school meal is not a guarantee that pupils will eat the food. The...
School meals can have a key function in promoting children's health. However, simply providing a free school meal is not a guarantee that pupils will eat the food. The purpose of this study was to explore factors influencing pupils' participation in free school meal schemes in Oslo. The study has a qualitative research design, inspired by grounded theory. Data were collected through interviews with pupils, teachers, and parents, and participant observations in two schools participating in a pilot project funded by Oslo Municipality. Line-by-line coding, memo writing, and a constant comparative technique were used to analyze the data. One primary school and one lower-secondary school in different districts in Oslo that were implementing two different free school meal models took part in the study. In total, 39 pupils (5th-10th grade), 15 parents, and 12 school employees were included. Four main factors related to pupils' participation in free school meals emerged from the analysis: the popularity of the food served, the attraction to the nearby shopping center, social aspects, and predictability. To promote pupils' participation in free school meal schemes, schools need to solve the challenges of balancing between healthy food and popular but often unhealthy food. To implement school meals further, children and parents' involvement, regularity of the meals provision, a good flow of information, and the creation of a friendly eating environment are recommended.
Topics: Child; Food Services; Humans; Meals; Parents; Pilot Projects; Qualitative Research; Schools
PubMed: 35334940
DOI: 10.3390/nu14061282 -
Waste Management & Research : the... May 2021Bearing in mind that only 42% of plastic packaging post-consumer waste is recycled in Europe, the European Directive 2018/852 established the key target of a 55% plastic...
Bearing in mind that only 42% of plastic packaging post-consumer waste is recycled in Europe, the European Directive 2018/852 established the key target of a 55% plastic packaging waste recycling rate by 2030. For this reason, PlastiCircle, funded by the European Union's Horizon 2020 research and innovation program project, aims to foster the recycling of packaging, improve all stages of the waste collection, and promote responsible consumption. Three European cities have been selected as locations for pilot implementation: Valencia (Spain), Utrecht (The Netherlands) and Alba Iulia (Romania). The main objective of the present study has been to evaluate the participants' opinion and attitudes on plastic recycling. This paper presents the results from the district of San Marcelino in the city of Valencia, the first PlastiCircle pilot to face the challenges of encouraging households to participate more in plastic waste sorting and recycling.
Topics: Attitude; Cities; Europe; Habits; Netherlands; Pilot Projects; Plastics; Product Packaging; Recycling; Refuse Disposal; Romania; Spain; Waste Management
PubMed: 33749406
DOI: 10.1177/0734242X21996415