RESUMEN

OBJECTIVES: The etiology of fibromyalgia (FM) is disputed, and there is no established cure. Quantitative data on how this may affect patients' healthcare experiences are scarce. The present study aims to investigate FM patients' pain-related healthcare experiences and explore factors associated with high satisfaction and pain relief. METHODS: An anonymous, online, and patient-administered survey was developed and distributed to members of the Norwegian Fibromyalgia Association. It addressed their pain-related healthcare experiences from both primary and specialist care. Odds ratios for healthcare satisfaction and pain relief were estimated by binary logistic regression. Directed acyclic graphs guided the multivariable analyses. RESULTS: The patients (n = 1,626, mean age: 51 years) were primarily women (95%) with a 21.8-year mean pain duration and 12.7 years in pain before diagnosis. One-third did not understand why they had pain, and 56.6% did not know how to get better. More than half had not received satisfactory information on their pain cause from a physician, and guidance on how to improve was reported below medium. Patients regretted a lack of medical specialized competence on muscle pain and reported many unmet needs, including regular follow-up and pain assessment. Physician-mediated pain relief was low, and guideline adherence was deficient. Only 14.8% were satisfied with non-physician health providers evaluating and treating their pain, and 21.5% were satisfied (46.9% dissatisfied) with their global pain-related healthcare. Patients' knowledge of their condition, physicians' pain competence and provision of information and guidance, agreement in explanations and advice, and the absence of unmet needs significantly increased the odds of both healthcare satisfaction and pain relief. CONCLUSIONS: Our survey describes deficiencies in FM patients' pain-related healthcare and suggests areas for improvement to increase healthcare satisfaction and pain relief. (REC# 2019/845, 09.05.19).

Asunto(s)

RESUMEN

PURPOSE: To investigate the effect of perioperative nurse-led counselling intervention on unmet needs, sexual function and quality of life in colorectal cancer patients. METHOD: This quasi-experimental study included 82 patients who underwent colorectal cancer surgery (control n = 45, intervention n = 37). The telephone-based perioperative nurse-led counselling intervention, which contained implementation, follow-up, and assessment, was applied to start from pre-surgery to post-surgery 3rd month. Data were collected with the Unmet Needs of Cancer Survivors Scale, European Organisation for Treatment and Research of Cancer Quality of Life Scale-30, Colorectal-29, Female Sexual Function Index, and International Index of Erectile Function pre- and post-surgery 3rd-6th months. The control data was collected before the pandemic, and the intervention group throughout the pandemic. The Mann-Whitney-U, Wilcoxon rank test was used. RESULTS: Compared to the control group, intervention group patients reported lower unmet and total needs scores (p = 0.000); higher quality of life (p = 0.000), physical, emotional (p = 0.000), role (p = 0.001), and social functioning scores (p = 0.002); lower fatigue (p = 0.000), constipation (p = 0.034), pain (p = 0.018), nausea-vomiting (p = 0.004), and insomnia scores (p = 0.003); and higher body image, anxiety (p = 0.000) and weight scores (p = 0.003), lower urinary frequency buttock pain (p = 0.000), dysuria (p = 0.001), abdominal pain (p = 0.001), fluctuance (p = 0.000), stool frequency (p = 0.002), and faecal incontinence (p = 0.006) scores at the sixth month (p < 0.05). There were no statistically significant differences between male and female sexual function scores (p > 0.05). CONCLUSIONS: Perioperative nurse-led counselling reduced unmet needs and increased the overall quality of life by decreasing symptom levels but did not affect sexual health outcomes in patients with colorectal cancer surgery.

Asunto(s)

RESUMEN

Background: Alzheimer's disease and related dementias (ADRD) disproportionately impact Latinx and other communities of color in the United States. The challenges for patients with ADRD and their informal caretakers can be attributed, in part, to the gaps that exist within health care services and systems. Objective: To understand the perspectives of barriers, beliefs, knowledge, and needs for the Latinx informal caregivers that take care of relatives with ADRD in the Upstate of South Carolina, region of Appalachia. Methods: This study was approved by the GHS-Prisma Health and Clemson University IRB, Study #Pro00086707. In-depth phone interviews were conducted with a sample of Latinx informal caregivers. A descriptive and interpretive phenomenological approach was used for analysis. Participants were recruited through community partnerships with local organizations. Results: Salient themes identified in this study included the relevance of caregiver's degree of awareness about the disease and a perspective of Alzheimer's disease as a progressive and degenerative disease. Critical moments identified encompassed challenges related to patient engagement with the outside world, their attitudes, and behaviors, as well as caregiver-related challenges with access to culturally and linguistically relevant resources needed to provide proper care. Caregivers identified several culturally relevant coping strategies used and motivators in providing care for their relatives with ADRD. Conclusions: Linguistically and culturally sensitive programs and resources that account for knowledge, assets, and needs of Latinx informal caregivers of ADRD patients are needed to improve the quality of care and decrease disparities in health outcomes for Latinx older adults.

RESUMEN

AIMS: To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA). METHODS: Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI. RESULTS: Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI. CONCLUSIONS: UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.

Asunto(s)

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient's daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance. The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease. METHODS: Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs. RESULTS: The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32-70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families. CONCLUSIONS: These results could aid in the creation of new ideas and concepts to improve our patient's quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.

Asunto(s)

RESUMEN

Introduction: Registered nurses are crucial in home care nursing for elderly patients, as detecting geriatric conditions can be difficult due to age-related changes or communication barriers. Disability is often overlooked in elderly care, requiring different assessment tools to determine patient status and necessary nursing interventions. During the COVID-19 pandemic, the subacute functional decline in the elderly (SAFE) instrument was implemented in some Oslo districts to detect early signs of sub acute functional decline in hospital and home care settings. However, the nurses' perception of this new assessment tool and its effectiveness has not been evaluated. Objectives: This study aims to explore home care nurses' experiences and perceptions regarding the introduction and use of the new assessment tool, SAFE. Objectives were to conduct focus group interviews and perform qualitative analysis. Method: The study followed Consolidated Criteria for Reporting Qualitative Research guidelines, had a qualitative design, and included 15 out of 60 permanently employed RNs at Oslo municipality's home care service in Frogner district. Data was collected via three focus group interviews and analyzed thematically. Results: The study identified three themes: (1) Nurses learned to use SAFE through direct experience due to a lack of standard introduction or training. (2) SAFE supported patient-centred care by enabling communication, preventive work, and identifying patients' needs. (3) Integrating SAFE into electronic databases and daily clinical work could improve nursing efficiency. Conclusion: Overall, using SAFE can improve patient outcomes and care quality in home care, but clear guidelines, ongoing support, and standardized procedures are crucial for its effectiveness. Regular updates and complete management support are also necessary. The study's findings align with previous research and can guide the development and implementation of tools in home care to enhance patient outcomes and the quality of care delivered.

RESUMEN

BACKGROUND: As their disease evolves, most patients with progressive forms of multiple sclerosis (MS) develop particular healthcare needs that are not always addressed with usual follow-up. To adapt neurological care to these patients, we created a specific consultation for patients with progressive MS in our centre in 2019. OBJECTIVES: To explore the main unmet care needs of patients with progressive MS in our setting, and to establish the usefulness of the specific consultation to address them. METHODS: Literature review and interviews with patients and healthcare professionals were conducted to identify the main unmet needs in routine follow-up. Two questionnaires were developed, assessing the importance of the unmet needs identified and the usefulness of the consultation to meet them, for patients under follow-up in the specific consultation and their informal caregivers. RESULTS: Forty-one patients and nineteen informal caregivers participated. The most important unmet needs were the information about the disease, access to social services and coordination between specialists. A positive correlation was found between the importance of these unmet needs and the responsiveness to each of them in the specific consultation. CONCLUSIONS: The creation of a specific consultation may improve attention to the healthcare needs of patients with progressive MS.

Asunto(s)

RESUMEN

Background: Due to globalization, an increasing number of international visitors comes to China. The needs of their medical care are understudied, which can cause low patient satisfaction and lead to poor clinical outcomes for the clients. To meet those international clients' medical care needs, hospitals in China are seeking strategies to improve services. Purpose: The aim of this study was to explore international clients' medical care experiences in China, and their perceptions of the quality of these international healthcare services. Patients and Methods: In May 2020, focus group interviews with 24 clients and four healthcare professionals were conducted in the international clinic at Sir Run Run Shaw Hospital (SRRSH). In the client group, 24 representatives of international clients from nine countries were invited and divided into three groups to discuss healthcare needs of international clients who seek healthcare in China. Four healthcare providers, including two nurses and two physicians who usually serve in the international clinic, were also interviewed. Data were analyzed using hybrid inductive/deductive thematic analysis. Results: Six major healthcare needs of international clients were identified, namely: needs for privacy and confidentiality; effective communication; multicultural sensitive care; pleasant environments; qualified care and procedures; and respect. International healthcare is a complex process for both international clients and healthcare professionals. Conclusion: The government and institutional administrators around the world should construct the policies and protocols and integrate cultural competence, communication skills, and privacy and confidentiality protection into health professionals training program to ensure the quality services in the international clinics.

RESUMEN

BACKGROUND: There is a need for effective health service solutions to provide greater structure and support for implementing evidence-based practice in back pain care. Patient involvement in developing these solutions is crucial to increase relevance, acceptability and uptake. OBJECTIVES: To determine patients' perceived needs and barriers to best-practice back pain care, and potential solutions to better address care needs. The study is the third in a series of needs assessment studies feeding into the 'idea generation' for service design in a large teaching hospital in a culturally and linguistically diverse community in metropolitan Sydney, Australia. DESIGN: We conducted a combination of focus groups and in-depth interviews using an interpretive description approach. We used inductive thematic analysis to identify the main themes. SETTING AND PARTICIPANTS: We purposively sampled patients with diverse characteristics from the neurosurgery and physiotherapy outpatient clinics, in particular those whose primary language was English, Arabic, Persian or Mandarin. Non-English audio recordings were translated and transcribed by bilingual researchers. RESULTS: There were 24 participants (focus groups = 9; individual interviews = 15) when data saturation was reached. The analysis identified three key themes with several subthemes around what service designers needed to understand in helping people with back pain in this setting: (1) This is who I am; (2) It's not working for me; and (3) What I think I need. DISCUSSION AND CONCLUSION: This study highlights that perceived unmet needs of patients are underpinned by unhelpful beliefs about the causes of and solutions for back pain, misaligned care expectations, unclear expectations of the hospital role and fragmentations in the health system. To design and implement a service that can deliver better back pain care, several solutions need to be integrated around: developing new resources that challenge unhelpful beliefs and set realistic expectations; improving access to education and self-management resources; focusing on individualized care; using a collaborative multidisciplinary approach within the hospital; and better connecting with and directing primary health care services. PATIENT OR PUBLIC CONTRIBUTION: A consumer representative of the Western Sydney Local Health District provided input during study conceptualisation and is duly recognized in the Acknowledgements section.

Asunto(s)

RESUMEN

Objective: This study investigated whether there was a difference in unmet supportive care needs between older and younger cancer patients who receive chemotherapy. Background: Physiological, physical, cognitive, and social functions, which play a key role in coping with cancer, are impaired due to aging. Age-related physiological changes and psychosocial factors and comorbid medical conditions make some of the needs of older cancer patients unique and complex. At the heart of meeting these needs lies the concept of supportive care. First step of meeting their needs is to determine these needs. Study Design and Methods: The study was conducted in the Daytime Treatment Unit of the oncology hospital of a university in Ankara, Turkey. The study sample consisted of 93 patients aged 65 years or older and 93 patients under 65 years of age. Both groups were similar in terms of sex, cancer type, and chemotherapy protocols. Data were collected using a Patient Information Form and Supportive Care Needs Scale-Short Turkish Version and analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and Bonferroni correction. Results: Participants had a median total score of 1.92. Their "daily life needs" and "sexuality needs" subscale scores were highest and lowest, respectively. Older patients had lower median total scores than younger patients. Younger patients had higher median "health care and information needs" and "sexuality needs" subscale scores than older patients. Conclusion: Elderly patients reported fewer unmet needs than younger patients. This may be due to age-related cultural factors as they may have difficulty expressing their needs. Implications: Results suggest to focus on the fact that patients' needs change with age and that they have difficulty expressing their needs.

RESUMEN

Objetivo: Adaptar y validar en Chile el instrumento NECPAL-CCOMS-ICO 3.1©. Diseño: Estudio prospectivo, longitudinal, analítico para la validación de un instrumento en cinco etapas: adaptación cultural, validación de contenido, pilotaje, aplicación y análisis estadístico. Emplazamiento: Cuatro centros de atención primaria del Servicio de Salud Metropolitano Sur Oriente, en Santiago, Chile. Participantes: personal médico y de enfermería de atención primaria para la adaptación cultural y aplicación, y expertos en cuidados paliativos para la validación del contenido. Mediciones principales: La adaptación cultural se realizó mediante entrevistas cognitivas. Se midió la validez de contenido con el método Delphi y se obtuvo la razón de validez de contenido de Lawshe (RVC). En el pilotaje se evaluó la estabilidad (test-retest), la armonía interjueces y el tiempo de aplicación en 14 enfermos crónicos avanzados (ECA). La aplicación se hizo a este mismo grupo, calculando la muestra según la recomendación de Nunally. Resultados: Se obtuvo una muestra de 118 ECA. La RVC fue de 0,75 y el tiempo promedio de aplicación de 6,7 min (DE = 4,01). El test-retest obtuvo un índice de concordancia del test Kappa entre 0,632 y 1,0; y la concordancia interjueces entre 0,192 y 0,692. La pregunta sorpresa (PS) fue positiva en el 20,3% de la muestra. Las principales condiciones asociadas al ítem de severidad enfermedad-específico fueron fragilidad (23,7%), enfermedad cardiaca crónica (21,2%) y enfermedad pulmonar crónica (12,7%). El grupo de demanda e indicadores específicos de severidad obtuvieron una mayor capacidad predictora de PS +, con un área bajo la curva de 0,808 (IC 95% 0,697 a 0,918).ConclusionesNECPAL es factible de ser aplicado en Chile, posee adecuadas propiedades psicométricas y permitirá la detección precoz de pacientes con necesidad de atención paliativa.(AU)

Objective: Adapt and validate the NECPAL instrument in Chile. Design: Prospective, longitudinal, analytical study for validation of the instrument in 5 stages: cultural adaptation, content validation, pilot test, application, and statistical analysis. Place: Four primary care centers of the South East Metropolitan Health Service, in Santiago, Chile. Participants: Primary health care physicians and nurses for cultural adaptation and application, and palliative care experts for content validation. Main measurements: Cultural adaptation was carried out through cognitive interviews. Content validity was measured using Delphi method and the Lawshe content validity ratio (CVR) was obtained. In the pilot test, we measured stability (test–retest), inter judge harmony and application time in 14 chronic advanced patients (CAP). The test was applied to this same group, calculating the sample according to Nunally's recommendation. Results: A sample of 118 CAP was obtained. The CVR was 0.75 and the average testing time was 6.7 min (SD = 4.01). The test–retest obtained a Kappa test concordance index between 0.632 and 1.0; and the interjudge harmony agreement between 0.192 and 0.692. The surprise question (PS) was positive in 20.3% of the sample. The main conditions associated with the disease-specific severity item, were fragility (23.7%), chronic heart disease (21.2%) and chronic lung disease (12.7%). The demand group and specific severity indicators obtained a greater predictive capacity of PS+, with an area under the curve of 0.808 (95% CI: 0.697–0.918). Conclusions: NECPAL is feasible to be used in Chile, has adequate psychometric properties and will allow early detection of patients in need of palliative care.(AU)

Asunto(s)

RESUMEN

OBJECTIVE: Adapt and validate the NECPAL instrument in Chile. DESIGN: Prospective, longitudinal, analytical study for validation of the instrument in 5 stages: cultural adaptation, content validation, pilot test, application, and statistical analysis. PLACE: Four primary care centers of the South East Metropolitan Health Service, in Santiago, Chile. PARTICIPANTS: Primary health care physicians and nurses for cultural adaptation and application, and palliative care experts for content validation. MAIN MEASUREMENTS: Cultural adaptation was carried out through cognitive interviews. Content validity was measured using Delphi method and the Lawshe content validity ratio (CVR) was obtained. In the pilot test, we measured stability (test-retest), inter judge harmony and application time in 14 chronic advanced patients (CAP). The test was applied to this same group, calculating the sample according to Nunally's recommendation. RESULTS: A sample of 118 CAP was obtained. The CVR was 0.75 and the average testing time was 6.7 min (SD = 4.01). The test-retest obtained a Kappa test concordance index between 0.632 and 1.0; and the interjudge harmony agreement between 0.192 and 0.692. The surprise question (PS) was positive in 20.3% of the sample. The main conditions associated with the disease-specific severity item, were fragility (23.7%), chronic heart disease (21.2%) and chronic lung disease (12.7%). The demand group and specific severity indicators obtained a greater predictive capacity of PS+, with an area under the curve of 0.808 (95% CI: 0.697-0.918). CONCLUSIONS: NECPAL is feasible to be used in Chile, has adequate psychometric properties and will allow early detection of patients in need of palliative care.

Asunto(s)

RESUMEN

PURPOSE: People who are first-degree relatives of cancer patients are at an increased risk of developing cancer themselves. Despite this, relatives of cancer patients do not always make beneficial changes to their health behaviours. This study aimed to answer the following questions: (1) do the health behaviours of people who are first-degree relatives of cancer survivors change following cancer diagnosis, and if so, how, and why, (2) what motivations/barriers exist for first-degree relatives when seeking to engage with health promoting behaviours, and (3) what do first-degree relatives believe healthcare organisations can do to improve uptake of healthy lifestyle changes. METHOD: Nine biological first-degree relatives of cancer survivors living in Ireland (6 children, 2 siblings, 1 parent) participated in semi-structured interviews which were later thematically analysed. RESULTS: Findings revealed four superordinate themes: Being Conscious/Aware, Limited Lifestyle Changes, Psychosocial Consequences of Experience, and Unmet Needs, with each of these themes having two to three subordinate themes. Patient and public involvement emphasised Unmet Needs, including needs for information and family support, as the theme that was most reflective of participants' lived experience. CONCLUSIONS: Results suggest that while family members tend not to change their lifestyle behaviours following cancer diagnosis, they do seem to make changes to their medical behaviours. Additionally, they can be negatively impacted by the experience in several other ways. Identifying means of support will allow relatives to cope better post diagnosis.

Asunto(s)

RESUMEN

BACKGROUND: During the COVID-19 pandemic, the Lebanese government has taken the proactive anticipatory measure to minimize the infection rates. Despite the pivotal role of the pharmacists working in hospital settings, hospital pharmacists have not been engaged in the emergency preparedness for hospitals. The primary objective of this survey is to assess the knowledge, attitude, and practice of hospital pharmacists in Lebanon towards COVID-19 pandemic and explore the level of health emergency preparedness of Lebanese hospitals in response to this outbreak. METHODS: A standardized English-based, anonymous and online questionnaire was diffused via social media platforms to all Lebanese hospital pharmacists. The questionnaire consisted of 78 questions related to sociodemographic characteristics, knowledge-based, attitude-based, practice questions, and pandemic preparedness. Descriptive statistical analysis was used to summarize data. RESULTS: A total of 81 questionnaires were completed; the participants were able to know > 90% of the knowledge-based questions regarding COVID-19. Most of the respondents were concerned about getting infected and their families due to their professional exposure. Similarly, around 67% were following the safety recommendations. Most of the participants agreed that they are facing shortages, rising prices, and delays in supply of masks and sanitizers. In terms of COVID-19 readiness, about 50% of hospitals have taken practical steps. CONCLUSIONS: Our findings revealed an appropriate level of knowledge and good practice towards COVID-19, among the respondents from Lebanese hospitals. National organizations may benefit in utilizing the expertise of the hospital pharmacists to be able to minimize/avoid future waves of COVID-19 if it emerges.

RESUMEN

The purpose of this study was to examine the current utilization of healthcare services, exploring unmet healthcare needs and the associated factors among people living in rural Vietnam. This cross-sectional study was conducted with 233 participants in a rural area. The methods included face-to-face interviews using a structured questionnaire, and anthropometric and blood pressure measurements. We considered participants to have unmet health needs if they had any kind of health problem during the past 12 months for which they were unable to see a healthcare provider. Multivariate logistic regression analysis was performed to determine the factors associated with unmet healthcare needs. Of the participants, 18% (n = 43) had unmet healthcare needs, for reasons like transportation (30%), a lack of available doctors or medicine (47%), and communication issues with healthcare providers (16%). The multivariate logistic regression showed that living in a rural area, having stage 2 hypertension, and having insurance were associated with unmet healthcare needs. To better meet the healthcare needs in rural or suburban areas of Vietnam, allocation of adequate healthcare resources should be distributed in rural areas and insurance coverage for personalized healthcare needs might be required. Efforts should focus on availability of medicine, improvement of transportation systems, and communication skills of healthcare providers to improve access to healthcare services.

Asunto(s)

RESUMEN

In order to plan the right palliative care for patients and their families, it is essential to have detailed information about patients' needs. To gain insight into these needs, we analyzed five Italian local palliative care networks and assessed the clinical care conditions of patients facing the complexities of advanced and chronic disease. A longitudinal, observational, noninterventional study was carried out in five Italian regions from May 2017 to November 2018. Patients who accessed the palliative care networks were monitored for 12 months. Sociodemographic, clinical, and symptom information was collected with several tools, including the Necesidades Paliativas CCOMS-ICO (NECPAL) tool, the Edmonton Symptom Assessment System (ESAS), and interRAI Palliative Care (interRAI-PC). There were 1013 patients in the study. The majority (51.7%) were recruited at home palliative care units. Cancer was the most frequent diagnosis (85.4%), and most patients had at least one comorbidity (58.8%). Cancer patients reported emotional stress with severe symptoms (38.7% vs. 24.3% in noncancer patients; p = 0.001) and were less likely to have clinical frailty (13.3% vs. 43.9%; p < 0.001). Our study confirms that many patients face the last few months of life with comorbidities or extreme frailty. This study contributes to increasing the general knowledge on palliative care needs in a high-income country.

RESUMEN

BACKGROUND: Most seniors wish to live independently for as long as possible. Gerontechnologies such as personal alarms or remote control systems, have the potential to help them age in place. For seniors, assessing what is the most appropriate technology for their aging in place needs can be difficult. Professionals specifically tasked with matching seniors' needs with technology solutions can greatly help here. Yet not much is known about the challenges these professionals face or how they can optimize their matchmaking service. METHODS: Participatory action research was conducted in the Netherlands, in two phases. In phase one, ten matchmaking dialogues between municipal technology consultants and seniors were observed, followed by interviews with both technology consultants and seniors to understand the current matchmaking service. In phase two, a new matchmaking tool was co-created with technology consultants and other professionals over the course of four co-creation session. Variants of the tool were tested out in nine additional matchmaking dialogues. The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS) model, which can be used to understand both origins and consequences of technology acquirement by independent-living seniors, was used as a theoretical lens. RESULTS: Important challenges for municipal technology consultants in their current matchmaking practice are: making the matchmaking service more demand oriented and creating an accurate and complete overview of relevant factors within the seniors' individual situation so that an optimal match can be made. Together with technology consultants and other professionals, a new Gerontechnologies Matchmaking (GTM) tool was created to help overcome these challenges. Evaluation of the tool showed that it better includes each senior's personal, social, physical and technological context, within the matchmaking service. CONCLUSION: Professionals who help seniors match gerontechnology to their aging in place needs experience a variety of challenges in the delivery of their service. Currently, few tools are available for them to overcome these challenges. The newly developed GTM tool can help overcome challenges and optimize matchmaking services. Further testing of the tool in different contexts is needed to determine its generalizability.

Asunto(s)

RESUMEN

BACKGROUND: South Korea has the fastest growing aging population in the world, and older people require more healthcare services. Unmet healthcare needs still exist in Korea due to several complex reasons. This study aimed to evaluate the factors associated with unmet healthcare needs of the older Korean population. METHODS: This cross-sectional study included 1,194 older adults, aged 65 years and older, who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2017. Sociodemographic factors, lifestyle and health status, comorbidity, and unmet healthcare needs were included in this study's analysis. Multiple logistic regression analysis was used to evaluate the association between unmet healthcare needs and other factors. RESULTS: The prevalence of unmet healthcare needs in this study population was 7.8%. After adjusting for age, sex, education level, household income, living alone, private health insurance, regular walking, body mass index, unintended weight loss, and osteoarthritis, women (adjusted odds ratio [aOR], 1.921; 95% confidence interval [CI], 1.061–3.479) and unintended weight loss (aOR, 2.218; 95% CI, 1.105–4.453) were more likely to have unmet healthcare needs than their counterparts. The group with general obesity (aOR, 1.691; 95% CI, 1.015–2.816) was more likely to have unmet healthcare needs than the group with normal body mass index. CONCLUSIONS: Among the older Korean population, being a woman, general obesity, and unintended weight loss may be risk factors for unmet healthcare needs.

Asunto(s)

RESUMEN

OBJECTIVE: Predictive statistical models used in population stratification programmes are complex and usually difficult to interpret for primary care professionals. We designed FINGER (Forming and Identifying New Groups of Expected Risks), a new model based on clinical criteria, easy to understand and implement by physicians. Our aim was to assess the ability of FINGER to predict costs and correctly identify patients with high resource use in the following year. DESIGN: Cross-sectional study with a 2-year follow-up. SETTING: The Basque National Health System. PARTICIPANTS: All the residents in the Basque Country (Spain) ≥14 years of age covered by the public healthcare service (n=1 946 884). METHODS: We developed an algorithm classifying diagnoses of long-term health problems into 27 chronic disease groups. The database was randomly divided into two data sets. With the calibration sample, we calculated a score for each chronic disease group and other variables (age, sex, inpatient admissions, emergency department visits and chronic dialysis). Each individual obtained a FINGER score for the year by summing their characteristics' scores. With the validation sample, we constructed regression models with the FINGER score for the first 12 months as the only explanatory variable. RESULTS: The annual FINGER scores obtained by patients ranged from 0 to 57 points, with a mean of 2.06. The coefficient of determination for healthcare costs was 0.188 and the area under the receiver operating characteristic curve was 0.838 for identifying patients with high costs (>95th percentile); 0.875 for extremely high costs (>99th percentile); 0.802 for unscheduled admissions; 0.861 for prolonged hospitalisation (>15 days); and 0.896 for death. CONCLUSION: FINGER presents a predictive power for high risks fairly close to other classification systems. Its simple and transparent architecture allows for immediate calculation by clinicians. Being easy to interpret, it might be considered for implementation in regions involved in population stratification programmes.

Asunto(s)

RESUMEN

AIM: To raise awareness on nocturia disease burden and to provide simplified aetiologic evaluation and related treatment pathways. METHODS: A multidisciplinary group of nocturia experts developed practical advice and recommendations based on the best available evidence supplemented by their own experiences. RESULTS: Nocturia is defined as the need to void ≥1 time during the sleeping period of the night. Clinically relevant nocturia (≥2 voids per night) affects 2%-18% of those aged 20-40 years, rising to 28%-62% for those aged 70-80 years. Consequences include the following: lowered quality of life; falls and fractures; reduced work productivity; depression; and increased mortality. Nocturia-related hip fractures alone cost approximately €1 billion in the EU and $1.5 billion in the USA in 2014. The pathophysiology of nocturia is multifactorial and typically related to polyuria (either global or nocturnal), reduced bladder capacity or increased fluid intake. Accurate assessment is predicated on frequency-volume charts combined with a detailed patient history, medicine review and physical examination. Optimal treatment should focus on the underlying cause(s), with lifestyle modifications (eg, reducing evening fluid intake) being the first intervention. For patients with sustained bother, medical therapies should be introduced; low-dose, gender-specific desmopressin has proven effective in nocturia due to idiopathic nocturnal polyuria. The timing of diuretics is an important consideration, and they should be taken mid-late afternoon, dependent on the specific serum half-life. Patients not responding to these basic treatments should be referred for specialist management. CONCLUSIONS: The cause(s) of nocturia should be first evaluated in all patients. Afterwards, the underlying pathophysiology should be treated specifically, alone with lifestyle interventions or in combination with drugs or (prostate) surgery.

Asunto(s)