Patient and caregiver experience in the transition from hospital to home - brainstorming results from group concept mapping: a patient-oriented study

BACKGROUND

Improving the quality of care for patients who return home after a hospital stay is an international priority; however, few jurisdictions have engaged broadly with patients and caregivers to understand what most affects their experience transitioning home. We performed Ontario-wide group concept mapping, beginning with a brainstorming phase, to understand patient and caregiver priorities in the transition.

METHODS

We used group concept mapping to engage patients and caregivers who had lived experience transitioning from hospital to home in Ontario in the previous 3 years. We report on the first phase, brainstorming, conducted over 10 weeks beginning Jan. 11, 2018 via an online survey or facilitated group discussion. Participants responded to a single focal prompt: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." The study team identified recurrent concepts and overarching themes. Patients and caregivers informed the study design, recruitment and data interpretation.

RESULTS

In all, 665 people (263 patients [39.5%], 352 caregivers [52.9%] and 50 people who were both patient and caregiver [7.5%]) participated in brainstorming online, and 71 people participated in 1 of 8 group discussions. Participants identified 6 key areas affecting their experience of transition from hospital to home: home and community care, the discharge process, medical follow-up after discharge, medications, patient and caregiver education, and the kindness and caring of the health care team in hospital. Most notable were challenges with the timeliness, sufficiency, reliability and consistency of publicly funded home care services.

INTERPRETATION

Patients and caregivers from across Ontario noted a range of issues affecting their experience transitioning from hospital to home, particularly the quality and sufficiency of publicly funded home care. Our findings will be used to inform a provincial quality standard on the transition from hospital to home.

A clinical diagnostic algorithm for early onset cerebellar ataxia

Early onset cerebellar Ataxia (EOAc) comprises a large group of rare heterogeneous disorders. Determination of the underlying etiology can be difficult given the broad differential diagnosis and the complexity of the genotype-phenotype relationships. This may change the diagnostic work-up into a time-consuming, costly and not always rewarding task. In this overview, the Childhood Ataxia and Cerebellar Group of the European Pediatric Neurology Society (CACG-EPNS) presents a diagnostic algorithm for EOAc patients. In seven consecutive steps, the algorithm leads the clinician through the diagnostic process, including EOA identification, application of the Inventory of Non-Ataxic Signs (INAS), consideration of the family history, neuro-imaging, laboratory investigations, genetic testing by array CGH and Next Generation Sequencing (NGS). In children with EOAc, this algorithm is intended to contribute to the diagnostic process and to allow uniform data entry in EOAc databases.

A-12 Neuroticism and Extraversion are Related to Dual Task Postural Stability in Healthy Young Adults

Objective

The relation between personality and postural stability has received little attention. This study addressed whether neuroticism and extraversion are related to changes in postural stability and cognitive functioning during a standing balance task.

Method

Thirty-two healthy young adults completed a personality measure and two cognitive tasks, a 2-back task and a weather prediction task (WPT), both while seated and in tandem stance on a foam mat. Sway was quantified via normalized path lengths, and correlation coefficients were calculated between neuroticism, extraversion and dual task changes in postural stability and cognitive functioning.

Results

Consistent with predictions, higher neuroticism was related to increased dual task sway during the 2-back task, r = 0.40, p = 0.023, and lower extraversion was related to increased dual task sway during the WPT, r = -0.43, p = 0.013.

Conclusions

The results suggest that personality is related to postural stability in healthy young adults and that personality should be considered in the prediction of individuals at risk for falling or in the treatment of individuals with balance difficulties. The task-specific nature of the relation is discussed and may be due to differences in anxiety or underlying brain mechanisms between high neuroticism and low extraversion.

Patient engagement in the development of best practices for transitions from hospital to home: a scoping review

OBJECTIVES

To explore the extent of patient engagement in the development of best practice reports related to transitions from hospital to home.

DESIGN

Scoping review.

DATA SOURCES

Electronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Trip Database, DynaMed Plus and Public Health Plus) and multiple provincial regulatory agency and healthcare organisation websites.

ELIGIBILITY CRITERIA

We included best practice reports related to the transition from hospital to a long-term care facility, community dwelling or rehabilitation centre. We included documents disseminated in English between 1947 and 2019.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened for eligibility and one extracted and analysed data using a data extraction tool we developed based on established patient engagement frameworks. Only records actively engaging patients were analysed (n=11). The methodological quality of actively engaging patients was assessed using domain 2 (item 5) of stakeholder involvement from the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

RESULTS

The search yielded 1921 citations of which 23 met the inclusion criteria and were included for narrative synthesis. These were disseminated between 1995 and 2019, with 18 (78%) published after 2010. Most were conducted in North America (USA 43%, Canada 22%), Europe (UK 30%) and Australia (4%). Eleven (48%) actively involved patients, of which only two involved patients across all stages of development. Most involved patients through direct or indirect consultation. The mean AGREE II domain 2 item 5 score (of those that actively engaged patients) was 5.9 out of 7.

CONCLUSIONS

Only half of existing best practice reports related to the transition from hospital to home actively involved patients in report development. However, the extent of patient engagement has been increasing over time. More organisations should strive to engage patients throughout the best practice development process and provide patients with opportunities for shared leadership.

The role of hardpan formation on the reactivity of sulfidic mine tailings: A case study at Joutel mine (Québec)

The former Eagle and Telbel mine site (hereafter referred to as Joutel mine), located near the town of Joutel in the Nord-du-Québec (Canada) houses a tailings storage facility (TSF) that has been inactive since 1996. Fresh, unweathered tailings (beneath 10-30 cm of oxidized horizon) are characterized by an average sulfide content of 6-7 wt% and an average Fe-Mn-carbonate content of 20-40 wt%. The oxidation of Joutel's tailings under atmospheric conditions resulted in the precipitation of secondary phases such as ferric oxyhydroxides and gypsum. Accumulation of these secondary phases throughout the TSF caused cementation and agglomeration of grains, which decreased the porosity of the material in a horizon below the surface. This horizon, which is referred to as hardpan, is frequently encountered within fine, reactive tailings. Characterizations showed that hardpans have a highly compact texture. The formation of hardpans limits vertical water infiltration and oxygen diffusion and these layers greatly affect the global geochemical behavior of underlying tailings in the Joutel TSF by protecting the unweathered material from oxidation. As a result, the water quality of the TSF is largely controlled by the reactivity of the upper oxidized tailings horizon. Joutel's oxidized tailings showed an acidic behavior early during laboratory kinetic leaching tests despite the near absence of sulfides and neutralizing minerals. However, when unweathered tailings were added under oxidized tailings, the water became neutral and metal leaching rates were reduced. After over a year of laboratory leaching tests, hardpans formed within the columns and the natural phenomenon was reproduced under laboratory conditions.

Home haemodialysis in Ireland

BACKGROUND

Home haemodialysis (HHD) has the potential to impact positively on patient outcomes and health resource management. There has been rejuvenated international interest in HHD in recent years.

AIM

We aimed to review the activity and outcomes of the Irish HHD Programme since inception (2009-16).

DESIGN

Retrospective review.

METHODS

Patient data were collected using the national electronic Renal Patient database (eMEDRenal version 3.2.1) and individual centre records. All data were recorded in a coded fashion on a Microsoft Excel Spread-sheet and analysed with Stata SE software.

RESULTS

One hundred and one patients completed training and commenced HHD; a further fourty-five patients were assessed for HHD suitability but did not ultimately dialyse at home. Twenty patients switched to nocturnal HHD when this resource became available. The switch from conventional in-centre dialysis to HHD led to an increase in the mean weekly hours on haemodialysis (HD) and a reduction in medication burden for the majority of patients. The overall rate of arteriovenous fistula (AVF) as primary vascular access was 62%. Most HHD complications were related to access function or access-related infection. Over the 7-years, 29 HHD patients were transplanted and 9 patients died. No deaths resulted directly from a HHD complication or technical issue.

CONCLUSIONS

Patient and technique survival rates compared favourably to published international reports. However, we identified several aspects that require attention. A small number of patients were receiving inadequate dialysis and require targeted education. Ongoing efforts to increase AVF and self-needling rates in HD units must continue. Psychosocial support is critical during the transition between dialysis modalities.

Nitrate release from waste rock dumps in the Elk Valley, British Columbia, Canada

The origin, distribution and leaching of nitrate (NO₃^-) from coal waste rock dumps in the Elk Valley, British Columbia, Canada were defined using chemical and NO₃^- isotope analyses (δ¹⁵N- and δ¹⁸O-NO₃^-) of solids samples of pre- and post-blast waste rock and from thick (up to 180m) unsaturated waste rock dump profiles constructed between 1982 and 2012 as well as water samples collected from a rock drain located at the base of one dump and effluent from humidity cell (HC) and leach pad (LP) tests on waste rock. δ¹⁵N- and δ¹⁸O-NO₃^- values and NO₃^- concentrations of waste rock and rock drain waters confirmed the source of NO₃^- in the waste rock to be explosives and that limited to no denitrification occurs in the dump. The average mass of N released during blasting was estimated to be about 3-6% of the N in the explosives. NO₃^- concentrations in the fresh-blast waste rock and recently placed waste rock used for the HC and LP experiments were highly variable, ranging from below detection to 241mg/kg. The mean and median concentrations of these samples ranged from 10-30mg/kg. In this range of concentrations, the initial aqueous concentration of fresh-blasted waste rock could range from approximately 200-600mg NO₃^--N/L. Flushing of NO₃^- from the HCs, LPs and a deep field profile was simulated using a scale dependent leaching efficiency (f) where f ranged from 5-15% for HCs, to 35-80% for the LPs, to 80-90% for the field profile. Our findings show aqueous phase NO₃^- from blasting residuals is present at highly variable initial concentrations in waste rock and the majority of this NO₃^- (>75%) should be flushed by recharging water during displacement of the first stored water volume.