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Critical Care (London, England) Nov 2019Although mortality due to critical illness has fallen over decades, the number of patients with long-term functional disabilities has increased, leading to impaired... (Review)
Review
BACKGROUND
Although mortality due to critical illness has fallen over decades, the number of patients with long-term functional disabilities has increased, leading to impaired quality of life and significant healthcare costs. As an essential part of the multimodal interventions available to improve outcome of critical illness, optimal nutrition therapy should be provided during critical illness, after ICU discharge, and following hospital discharge.
METHODS
This narrative review summarizes the latest scientific insights and guidelines on ICU nutrition delivery. Practical guidance is given to provide optimal nutrition therapy during the three phases of the patient journey.
RESULTS
Based on recent literature and guidelines, gradual progression to caloric and protein targets during the initial phase of ICU stay is recommended. After this phase, full caloric dose can be provided, preferably based on indirect calorimetry. Phosphate should be monitored to detect refeeding hypophosphatemia, and when occurring, caloric restriction should be instituted. For proteins, at least 1.3 g of proteins/kg/day should be targeted after the initial phase. During the chronic ICU phase, and after ICU discharge, higher protein/caloric targets should be provided preferably combined with exercise. After ICU discharge, achieving protein targets is more difficult than reaching caloric goals, in particular after removal of the feeding tube. After hospital discharge, probably very high-dose protein and calorie feeding for prolonged duration is necessary to optimize the outcome. High-protein oral nutrition supplements are likely essential in this period. Several pharmacological options are available to combine with nutrition therapy to enhance the anabolic response and stimulate muscle protein synthesis.
CONCLUSIONS
During and after ICU care, optimal nutrition therapy is essential to improve the long-term outcome to reduce the likelihood of the patient to becoming a "victim" of critical illness. Frequently, nutrition targets are not achieved in any phase of recovery. Personalized nutrition therapy, while respecting different targets during the phases of the patient journey after critical illness, should be prescribed and monitored.
Topics: Convalescence; Critical Care; Critical Illness; Humans; Intensive Care Units; Long-Term Care; Nutrition Therapy; Nutritional Status
PubMed: 31752979
DOI: 10.1186/s13054-019-2657-5 -
Journal of Wound, Ostomy, and... 2015Patients in acute and long-term care settings receive daily routine skin care, including washing, bathing, and showering, often followed by application of lotions,... (Review)
Review
Patients in acute and long-term care settings receive daily routine skin care, including washing, bathing, and showering, often followed by application of lotions, creams, and/or ointments. These personal hygiene and skin care activities are integral parts of nursing practice, but little is known about their benefits or clinical efficacy. The aim of this article was to summarize the empirical evidence supporting basic skin care procedures and interventions and to develop a clinical algorithm for basic skin care. Electronic databases MEDLINE, EMBASE, and CINAHL were searched and afterward a forward search was conducted using Scopus and Web of Science. In order to evaluate a broad range of basic skin care interventions systematic reviews, intervention studies, and guidelines, consensus statements and best practice standards also were included in the analysis. One hundred twenty-one articles were read in full text; 41documents were included in this report about skin care for prevention of dry skin, prevention of incontinence-associated dermatitis and prevention of skin injuries. The methodological quality of the included publications was variable. Review results and expert input were used to create a clinical algorithm for basic skin care. A 2-step approach is proposed including general and special skin care. Interventions focus primarily on skin that is either too dry or too moist. The target groups for the algorithm are adult patients or residents with intact or preclinical damaged skin in care settings. The goal of the skin care algorithm is a first attempt to provide guidance for practitioners to improve basic skin care in clinical settings in order to maintain or increase skin health.
Topics: Algorithms; Dermatitis; Evidence-Based Nursing; Humans; Long-Term Care; Self Care; Skin Care
PubMed: 26165590
DOI: 10.1097/WON.0000000000000162 -
Sleep Medicine Clinics Mar 2018Long-term care (LTC) involves a range of support and services for people with chronic illness and disabilities who can not perform activities of daily living... (Review)
Review
Long-term care (LTC) involves a range of support and services for people with chronic illness and disabilities who can not perform activities of daily living independently. Poor sleep increases the risk of LTC placement, and sleep disturbance is extremely common among LTC residents. The identification and management of sleep disturbance in LTC residents is a vital, but perhaps underappreciated, aspect of offering high-quality care for this already compromised population. This review describes the nature and consequences of sleep disturbances in LTC, clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.
Topics: Activities of Daily Living; Aged; Humans; Long-Term Care; Nursing Homes; Quality of Health Care; Sleep Wake Disorders
PubMed: 29412978
DOI: 10.1016/j.jsmc.2017.09.011 -
Health Systems in Transition Mar 2016This analysis of the Dutch health system reviews recent developments in organization and governance, health financing, healthcare provision, health reforms and health... (Review)
Review
This analysis of the Dutch health system reviews recent developments in organization and governance, health financing, healthcare provision, health reforms and health system performance. Without doubt, two major reforms implemented since the mid-2000s are among the main issues today. The newly implemented long-term care reform will have to realize a transition from publicly provided care to more self-reliance on the part of the citizens and a larger role for municipalities in its organization. A particular point of attention is how the new governance arrangements and responsibilities in long-term care will work together. The 2006 reform replaced the division between public and private insurance by one universal social health insurance and introduced managed competition as a driving mechanism in the healthcare system. Although the reform was initiated almost a decade ago, its stepwise implementation continues to bring changes in the healthcare system in general and in the role of actors in particular. In terms of performance, essential healthcare services are within easy reach and waiting times have been decreasing. The basic health insurance package and compensations for lower incomes protect citizens against catastrophic spending. Out-of-pocket payments are low from an international perspective. Moreover, the Dutch rate the quality of the health system and their health as good. International comparisons show that the Netherlands has low antibiotic use, a low number of avoidable hospitalizations and a relatively low avoidable mortality. National studies show that healthcare has made major contributions to the health of the Dutch population as reflected in increasing life expectancy. Furthermore, some indicators such as the prescription of generics and length of stay reveal improvements in efficiency over the past years. Nevertheless, the Netherlands still has one of the highest per capita health expenditures in Europe, although growth has slowed considerably after reverting to more traditional sector agreements on spending.
Topics: Delivery of Health Care; Health Care Reform; Health Expenditures; Health Policy; Healthcare Financing; Humans; Insurance, Health; Long-Term Care; Netherlands; Quality of Health Care
PubMed: 27467715
DOI: No ID Found -
Lancet (London, England) Oct 2020
Topics: Humans; Long-Term Care
PubMed: 34338197
DOI: 10.1016/S0140-6736(20)32202-9 -
BMC Geriatrics Apr 2022
Topics: Humans; Long-Term Care
PubMed: 35395720
DOI: 10.1186/s12877-022-02909-8 -
Journal of Gerontological Nursing Dec 2021
Topics: Humans; Long-Term Care; Nursing Homes
PubMed: 34846254
DOI: 10.3928/00989134-20211109-01 -
Chest May 2021The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including... (Review)
Review
The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including clinical, administrative, and physical modifications to current standards of operations. Innovative use and adaptation of long-term acute care hospitals (LTACHs) can safely and effectively care for patients during the ongoing COVID-19 pandemic. A framework for the rapid changes, including increasing collaboration with external health-care organizations, creating new methods for enhanced communication, and modifying processes focused on patient safety and clinical outcomes, is described for a network of 94 LTACHs. When managed and modified correctly, LTACHs can play a vital role in managing the national health-care pandemic crisis.
Topics: COVID-19; Critical Care; Duration of Therapy; Humans; Intensive Care Units; Long-Term Care; Organizational Innovation; SARS-CoV-2
PubMed: 33309523
DOI: 10.1016/j.chest.2020.12.001 -
International Journal of Health Policy... Aug 2019Long-term care (LTC) must be carefully delineated when expenditures are compared across countries because how LTC services are defined and delivered differ in each...
Long-term care (LTC) must be carefully delineated when expenditures are compared across countries because how LTC services are defined and delivered differ in each country. LTC's objectives are to compensate for functional decline and mitigate the care burden of the family. Governments have tended to focus on the poor but Germany opted to make LTC universally available in 1995/1996. The applicant's level of dependence is assessed by the medical team of the social insurance plan. Japan basically followed this model but, unlike Germany where those eligible may opt for cash benefits, they are limited to services. Benefits are set more generously in Japan because, prior to its implementation in 2000, health insurance had covered long-stays in hospitals and there had been major expansions of social services. These service levels had to be maintained and be made universally available for all those meeting the eligibility criteria. As a result, efforts to contain costs after the implementation of the LTC Insurance have had only marginal effects. This indicates it would be more efficient and equitable to introduce public LTC Insurance at an early stage before benefits have expanded as a result of ad hoc policy decisions.
Topics: Aged; Community Health Services; Humans; Insurance, Health; Insurance, Long-Term Care; Japan; Long-Term Care; Population Dynamics; Social Welfare
PubMed: 31441285
DOI: 10.15171/ijhpm.2019.35 -
The Journal of International Medical... Feb 2020Based on theoretical and methodological research and the results of a literature review, we evaluated and comparatively analyzed the quality of long-term care for older... (Review)
Review
OBJECTIVE
Based on theoretical and methodological research and the results of a literature review, we evaluated and comparatively analyzed the quality of long-term care for older populations in China and in Western countries.
METHODS
We performed a literature review, using the search terms long-term care and care services for older adults, in the databases ProQuest, CNKI, and Wanfang Data.
RESULTS
Our comparative analysis demonstrated that the overall quantity of articles related to long-term care for older populations was relatively large. The literature comprises advanced accumulated experiences in terms of theoretical and methodological perspectives in developed countries. The field of long-term care is relatively young in China and we could retrieve only a few related studies.
CONCLUSIONS
The system of long-term care for older populations in China has much room for improvement. In addition, the evaluation criteria for long-term care quality remain controversial. Relevant research focusing on the quality of long-term care services in the country lacks comprehensive, systematic, and scientific validation, comparison, and evaluation. This topic warrants further evidence-based investigation in China.
Topics: Aged; China; Humans; Long-Term Care
PubMed: 31679414
DOI: 10.1177/0300060519865631