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van Munster BC, Boot GG, Festen SF, de Rooij SE. Goals and outcomes of hospitalised older people: does the current hospital care match the needs of older people? Intern Med J 2021; 52:770-775. [PMID: 34490694 PMCID: PMC9314846 DOI: 10.1111/imj.15508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
Background Due to the rising number of acutely hospitalised older people in the coming years, there is increased interest in tailoring care to the individual goals and preferences of patients in order to reach patient‐centred care. Aims To investigate the goals of older hospitalised patients and the extent to which these goals were reached during hospitalisation. Methods A single‐centre prospective cohort study was performed in The Netherlands between December 2017 and January 2018. Participants aged 70 years or older were included. In the first 3 days of hospitalisation, a semi‐structured interview was conducted to assess the patient goals regarding the hospital admission. At 1−2 weeks after discharge, patients were asked to what extent the recent hospitalisation had contributed to reaching their goals. Results One hundred and four patients were included and follow up was completed for 86 patients. The main goals reported at hospital admission were ‘remaining alive’ (72.1%), ‘feeling better’ (71.2%) and ‘improving condition’ (65.4%). Hospitalisation seemed to have a positive contribution to reaching the goals ‘remaining alive’, ‘knowing what is wrong’, ‘feeling better’, ‘reducing pain’ and ‘controlling disease’. Hospitalisation seemed to contribute little to reaching the goals in the categories ‘enjoying life’, ‘independency and freedom’, ‘improving daily functioning’, ‘hobbies and work’ and ‘social functioning’. Conclusions It is important for healthcare professionals to know the goals of their patients. The majority of these goals were not achieved at hospital discharge. It is important to be aware of this, so sufficient aftercare can be arranged and patients can be prepared.
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Affiliation(s)
- Barbara C van Munster
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands.,Department of Internal Medicin, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerdine G Boot
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Suzanne F Festen
- Department of Internal Medicin, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sophia E de Rooij
- Department of Internal Medicin, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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2
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Gorecka M, Reddin C, Madders G, Monaghan L, Neylon A, Sharif F, Hynes B, Fennelly E, McHugh F, Martin N, Mohammed K, Bijjam VR, Veerasingam D, Soo A, DaCosta M, Wijns W, Mylotte D. Patient Disposition and Clinical Outcome After Referral to a Dedicated TAVI Clinic. Front Cardiovasc Med 2020; 6:188. [PMID: 31998755 PMCID: PMC6965013 DOI: 10.3389/fcvm.2019.00188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is the standard of care for the majority of patients with severe symptomatic aortic stenosis (AS) at excessive-, high- and intermediate-surgical risk. A proportion of patients referred for TAVI do not undergo the procedure and proceed with an alternate treatment strategy. There is scarce data describing the final treatment allocation of such patients. Hence, we sought to evaluate the final treatment allocation of patients referred for TAVI in contemporary practice. Methods: We performed a single center prospective observational study, including all patients referred to our institution for treatment of severe aortic stenosis between February 2014 and August 2017. Baseline demographic and clinical data were recorded. Patients were categorized according to treatment allocation: TAVI, surgical aortic valve replacement (SAVR) or optimal medical therapy (OMT). Clinical outcomes were adjudicated according to VARC-2 definitions. All patients were discussed at a dedicated Heart Team meeting. Results: Total of 245 patients were referred for assessment to a dedicated TAVI clinic during the study period. Patients with moderate (N = 32; 13.1%) and asymptomatic (N = 31; 13.1%) AS were excluded. Subsequently, 53.9% (N = 132) received TAVI, 12.7% (N =31) were managed with OMT, and 7.3% (N =18) had SAVR. Reasons for OMT included primarily: patient's preference (N = 12; 38.7%); excessive surgical risk (N = 4; 12.9%) and severe frailty (N = 5; 16.1%). Reasons for surgical referral included low surgical risk (N = 11; 61.1%), excessive annulus size (N = 5; 27.8%), and aortic root dilatation (N = 2; 11.1%). Patients proceeding to SAVR had lower surgical risk than those in either the OMT or TAVI cohorts (P < 0.001). Mean STS score in SAVR group was 2.2 ± 1.3 vs. 4.5 ± 2.4 in OMT cohort and 6.1 ± 4.9 in TAVI cohort. Six-month all-cause mortality was 16.7, 19.4, and 9.3% among those receiving SAVR, OMT, and TAVI, respectively. Conclusions: Almost half of all patients with severe AS referred to a dedicated TAVI clinic did not receive a TAVI. A considerable proportion of patients were reclassified as moderate AS (13%), were asymptomatic (13%), or intervention was determined to be futile (13%) due to advanced frailty. Early detection and increased awareness of valvular heart disease are required to increase the number of patients that can benefit from TAVI.
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Affiliation(s)
- Miroslawa Gorecka
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Catriona Reddin
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Gillian Madders
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Laura Monaghan
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Antoinette Neylon
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Ireland
| | - Brian Hynes
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Evelyn Fennelly
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Fiachra McHugh
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Niamh Martin
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Khalid Mohammed
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Venu Reddy Bijjam
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - David Veerasingam
- Department of Cardiothoracic Surgery, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Alan Soo
- Department of Cardiothoracic Surgery, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - Mark DaCosta
- Department of Cardiothoracic Surgery, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland
| | - William Wijns
- School of Medicine, National University of Ireland, Galway, Ireland.,The Lambe Institute for Translational Medicine and Curam, SAOLTA University Healthcare Group, National University of Ireland Galway, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, SAOLTA Healthcare Group, Galway, Ireland.,School of Medicine, National University of Ireland, Galway, Ireland
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Pel-Littel RE, Hofman CS, Yu L, Metzelthin SF, Leeuwis FH, Blom JW, Buurman BM, Minkman MM. Recommendations of older adults on how to use the PROM 'TOPICS-MDS' in healthcare conversations: A Delphi study. PLoS One 2019; 14:e0225344. [PMID: 31747443 PMCID: PMC6867646 DOI: 10.1371/journal.pone.0225344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/01/2019] [Indexed: 01/19/2023] Open
Abstract
In shared decision making, the exploration of preferred personal health outcomes is important. Patient-reported outcome measures (PROMs) provide input for discussions between patients and healthcare professionals. The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) PROM is a multidimensional questionnaire on the physical and mental health and wellbeing of older adults. This study investigates how the TOPICS-MDS could be used in individual healthcare conversations. We explored views of older adults regarding 1) whether the health domains they want to discuss are included in the TOPICS-MDS and 2) the comprehensibility of the TOPICS-MDS for healthcare conversations with older adults. A three-round Delphi study was conducted. A total of 57 older adults participated in the study, the mean (SD) age was 71.5 (8.5) years, and 78.9% of the participants were female. The participants were divided into four panels based on educational level and cultural background. We used online questionnaires and focus groups. Consensus was pre-defined to be the point when ≥75% of the participants agreed that a domain was important or very important (scored on a 5-point Likert scale). The inter-expert agreement was computed for Round 1 and 3 with Kendall's W. Round 2 was a focus-group. Qualitative data were analyzed by content analysis. Older adults considered 'functional limitations', 'emotional wellbeing', 'social functioning' and 'quality of life' to be important domains of the TOPICS-MDS to discuss in healthcare conversations. The participants added 'coping with stress', 'dealing with health conditions and the effects on life' as extra domains for healthcare conversations. Challenges regarding the comprehensibility of the TOPICS-MDS included difficult words and lengthy or sensitive questions. Questions that included multiple topics were difficult to understand. The TOPICS-MDS covers the domains of life that older adults value as important to discuss with healthcare professionals, and two additional domains were identified. For older adults with a low level of education or a culturally diverse background, the TOPICS-MDS needs to be adjusted for comprehensibility.
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Affiliation(s)
- Ruth E. Pel-Littel
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail: (RPL); (CH)
| | - Cynthia S. Hofman
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- * E-mail: (RPL); (CH)
| | - Liesje Yu
- Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Franca H. Leeuwis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - B. M. Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirella M. Minkman
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- University of Tilburg, TIAS school for Business and Society, Tilburg, the Netherlands
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Landman T, Schoon Y, Warlé M, De Leeuw FE, Thijssen D. The effect of repeated remote ischemic postconditioning on infarct size in patients with an ischemic stroke (REPOST): study protocol for a randomized clinical trial. Trials 2019; 20:167. [PMID: 30876432 PMCID: PMC6419836 DOI: 10.1186/s13063-019-3264-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 02/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background Remote ischemic postconditioning (rIPostC) refers to the observation that repeated, short periods of ischemia protect remote areas against tissue damage during and after prolonged ischemia. Based on previous observations of a potential neuroprotective effect of rIPostC, the aim of this study is to evaluate whether repeated rIPostC after an ischemic stroke can reduce infarct size, which could be translated to an improvement in clinical outcomes. Methods/design We will enroll 200 ischemic stroke patients to daily rIPostC or sham conditioning during hospitalization into a randomized single-blind placebo-controlled trial. The intervention consists of twice daily exposure to four cycles of 5-min cuff inflation around the upper arm to > 20 mmHg above systolic blood pressure (i.e., rIPostC) or 50 mmHg (i.e., control), followed by 5 minutes of deflation. The primary outcome is infarct size, measured using an MRI diffusion-weighted image at the end of hospitalization. Secondary outcomes include the Modified Rankin Scale, National Institutes of Health Stroke Scale, quality of life, and cardiovascular and cerebrovascular morbidity and mortality. To explore possible underlying mechanisms of rIPostC, venous blood will be sampled to assess biomarkers of inflammation and vascular health. Discussion Previous studies in animals and humans, using a single bout of remote ischemic conditioning, report a potential effect of rIPostC in attenuating neural damage. Although repeated rIPostC has been investigated for cardiovascular disease patients and preclinical stroke models, no previous study has explored the potential physiological and clinical effects of repeatedly applying rIPostC during the hospitalization phase after a stroke. Trial registration Netherlands Trial Register, NTR6880. Registered on 8 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3264-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thijs Landman
- Department of Physiology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands.
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
| | - Michiel Warlé
- Department of Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
| | - Frank-Erik De Leeuw
- Centre for Cognitive Neuroscience, Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
| | - Dick Thijssen
- Department of Physiology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, Gelderland, Netherlands
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van Munster B. [Not Available]. Tijdschr Gerontol Geriatr 2017; 48:261-262. [PMID: 29124552 DOI: 10.1007/s12439-017-0239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Barbara van Munster
- Gelre Ziekenhuizen, afdeling geriatrie, Apeldoorn, Nederland.
- Universitair Centrum Ouderengeneeskunde, Universitair Medisch Centrum Groningen, Groningen, Nederland.
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