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A Qualitative Study Exploring Professional Perspectives of a Challenging Rehabilitation Environment for Geriatric Rehabilitation. J Clin Med 2023; 12:jcm12031231. [PMID: 36769879 PMCID: PMC9918066 DOI: 10.3390/jcm12031231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
There is a trend towards the formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment on rehabilitation wards. So far, literature on the principles of the CRE is scarce. This study aims to explore the perspectives regarding the CRE of healthcare professionals through a qualitative study. Therefore, between 2018 and 2020, six international and 69 Dutch professionals were interviewed in focus groups, and 180 professionals attended workshops on two Dutch congresses. Data were thematically analyzed using ATLAS.ti. Seven themes emerged regarding the rehabilitation processes: (1) rehabilitant (attention for cognitive functioning and resilience); (2) goals (setting personal goals); (3) exercise (increasing exercise intensity); (4) daily schedule (following the daily rhythm); (5) involving the client system (involving informal caregivers); (6) nutrition (influences rehabilitation capability); and (7) technology (makes rehabilitation more safe and challenging). Regarding organizational aspects, four main themes were identified: (1) environmental aspects (encourages exercises); (2) staff aspects (interdisciplinary team); (3) organizational aspects (implementing CRE requires a shared vision); and (4) factors outside the ward (a well-prepared discharge process). To offer effective rehabilitation, all elements of the CRE should be applied. To improve the CRE, specific interventions need to be developed and implemented. Consequently, the effectiveness and efficiency of the CRE need to be measured with validated tools.
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Tijsen LMJ, Derksen EWC, Achterberg WP, Buijck BI. A Qualitative Study Exploring Rehabilitant and Informal Caregiver Perspectives of a Challenging Rehabilitation Environment for Geriatric Rehabilitation. J Patient Exp 2023; 10:23743735231151532. [PMID: 36687166 PMCID: PMC9850128 DOI: 10.1177/23743735231151532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
There is a trend toward formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment in rehabilitation wards. So far, literature about the principles of CRE is scarce. This study aims to explore the opinions of rehabilitants and informal caregivers regarding CRE, through a qualitative study between 2019 and 2020. Three telephone interviews were conducted with informal caregivers, and also 3 focus groups with 15 rehabilitants and 3 informal caregivers, all with recent experience in rehabilitation. Nine themes emerged regarding the rehabilitation process: (1) rehabilitant (attention for resilience, motivation, cognitive and emotional aspects), (2) rehabilitant centered (goal setting, physical and cognitive functioning and coping), (3) informal caregivers (involving and attention for resilience and relation), (4) communication (aligning the rehabilitation process), (5) exercise (increasing intensity by using task-oriented exercise, patient-regulated exercise, and group training), (6) peer support (learning experiences and recognition), (7) daily schedule (influence on the planning and activities outside therapy), (8) nutrition (energy for rehabilitation), and (9) eHealth (makes rehabilitation more challenging and fun). Regarding organizational processes, 4 themes were identified: (1) environmental aspects (single bedrooms, shared room for activities and therapy options on the ward), (2) staff aspects (small team with an emphatic supportive and motivating attitude), (3) organizational aspects (organized in an efficient way), and (4) return home (the discharge process should be well prepared for instance with home visits). Organizing excellent rehabilitation care requires a thorough understanding of the concept of CRE, as it is a complex and comprehensive concept that concerns the whole rehabilitation process. Its effectiveness and efficiency should be researched in prospective studies.
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Affiliation(s)
- Lian M J Tijsen
- Department of Public Health and Primary Care, Leiden University
Medical Center, Leiden, The Netherlands,Oktober, Bladel, The Netherlands,De Zorgboog, Bakel, The Netherlands,Lian M J Tijsen, LUMC, Department Public
Health and Primary Care, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The
Netherlands.
| | - Els W C Derksen
- Department of Primary and Community Care, Radboud University Medical
Center, Nijmegen, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University
Medical Center, Leiden, The Netherlands
| | - Bianca I Buijck
- Oktober, Bladel, The Netherlands,De Zorgboog, Bakel, The Netherlands
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Bachmann N, Zumbrunn A, Bayer-Oglesby L. Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland. Front Public Health 2022; 10:871778. [PMID: 35615032 PMCID: PMC9126315 DOI: 10.3389/fpubh.2022.871778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022] Open
Abstract
If hospitalization becomes inevitable in the course of a chronic disease, discharge from acute hospital care in older persons is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalization represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalization after acute hospital discharge in Switzerland. The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included 60,209 patients 75 years old and older living still at a private home and being hospitalized due to a chronic health condition in 199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level (compulsory vs. tertiary education OR = 1.16 (95% CI: 1.03-1.30), insurance class (compulsory vs. private insurance OR = 1.24 (95% CI: 1.09-1.41), living alone vs. living with others (OR = 1.64; 95% CI: 1.53-1.76) and language regions (French vs. German speaking part: OR = 0.54; 95% CI: 0.37-0.80) on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalization and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone. This study shows that acute hospital discharge in older age is a critical moment of transient dependency especially for socially disadvantaged patients. Social and health care should work coordinated together to avoid unnecessary institutionalizations.
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Affiliation(s)
- Nicole Bachmann
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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Riviere M, Duprez V, Dufoort H, Van Hecke A, Beeckman D, Verhaeghe S, Deschodt M. The interpersonal care relationship between nurses and older patients: A cross-sectional study in three hospitals. J Adv Nurs 2022; 78:2408-2425. [PMID: 35170094 DOI: 10.1111/jan.15182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/09/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
AIM To gain insight into which elements of the interpersonal care relationship (IPCR) are perceived as occurring (less) frequently and as (not) disturbing from the perspective of hospitalized older patients. DESIGN A cross-sectional study in three Belgian hospitals. METHODS A convenience sample of patients aged 75 years or older admitted to a non-geriatric ward were recruited between May 2017 and April 2019. The Interpersonal Geriatric care relationship (InteGer) tool was used to identify elements of the IPCR and was completed by the researchers through structured patient interviews. RESULTS The mean total scale score for frequency was 3.74 (SD 1.51) [range 0-12]. On subscale level, the highest mean score was in the accessibility and the lowest mean score in the humanization subscale. Statistically significant differences between the hypothesized and experienced disturbance were observed in 18 of the 30 items. Ten items score in the category 'no action needed' (not occurring, not disturbing), nine items in the category 'remain attentive for patient experiences' (occurring, not disturbing), 10 items in the category 'further analyses or monitoring needed' (not occurring, disturbing) and one item in the category 'urgent action needed' (occurring and disturbing). CONCLUSION Participants report mostly positive experiences related to the four subscales of the InteGer, that is, humanization, attentiveness, interest and accessibility. Insights from this study provide important opportunities in the context of care optimization for each category with the main focus on items with high experienced disturbance. IMPACT The InteGer can be used for monitoring IPCR and formulating action points at ward and hospital level to further improve the IPCR and quality of care.
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Affiliation(s)
- Melissa Riviere
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium.,AZ Delta, General Hospital, Roeselare, Belgium
| | - Veerle Duprez
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | | | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium.,Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Public Health, Nursing Science, University of Basel, Basel, Switzerland
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Takahashi PY, Chandra A, McCoy RG, Borkenhagen LS, Larson ME, Thorsteinsdottir B, Hickman JA, Swanson KM, Hanson GJ, Naessens JM. Outcomes of a Nursing Home-to-Community Care Transition Program. J Am Med Dir Assoc 2021; 22:2440-2446.e2. [PMID: 33984293 DOI: 10.1016/j.jamda.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Most transitional care initiatives to reduce rehospitalization have focused on the transition that occurs between a patient's hospital discharge and return home. However, many patients are discharged from a skilled nursing facility (SNF) to their homes. The goal was to evaluate the effectiveness of the Mayo Clinic Care Transitions (MCCT) program (hereafter called program) among patients discharged from SNFs to their homes. DESIGN Propensity-matched control-intervention trial. INTERVENTION Patients in the intervention group received care management following nursing stay (a home visit and nursing phone calls). SETTING AND PARTICIPANTS Patients enrolled after discharge from an SNF to home were matched to patients who did not receive intervention because of refusal, program capacity, or distance. Patients were aged ≥60 years, at high risk for hospitalization, and discharged from an SNF. METHODS Program enrollees were matched through propensity score to nonenrollees on the basis of age, sex, comorbid health burden, and mortality risk score. Conditional logistic regression analysis examined 30-day hospitalization and emergency department (ED) use; Cox proportional hazards analyses examined 180-day hospital stay and ED use. RESULTS Each group comprised 160 patients [mean (standard deviation) age, 85.4 (7.4) years]. Thirty-day hospitalization and ED rates were 4.4% and 10.0% in the program group and 3.8% and 10.0% in the group with usual care (P = .76 for hospitalization; P > .99 for ED). At 180 days, hospitalization and ED rates were 30.6% and 46.3% for program patients compared with 11.3% and 25.0% in the comparison group (P < .001). CONCLUSIONS AND IMPLICATIONS We found no evidence of reduced hospitalization or ED visits by program patients vs the comparison group. Such findings are crucial because they illustrate how aggressive stabilization care within the SNF may mitigate the program role. Furthermore, we found higher ED and hospitalization rates at 180 days in program patients than the comparison group.
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Affiliation(s)
- Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA.
| | - Anupam Chandra
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lynn S Borkenhagen
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mary E Larson
- Employee and Community Health, Mayo Clinic, Rochester, MN, USA
| | | | - Joel A Hickman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kristi M Swanson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Hanson
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN, USA; Division of Community Palliative Medicine, Mayo Clinic, Rochester, MN, USA
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Riviere M, Duprez V, Dufoort H, Beeckman D, Van Hecke A, Verhaeghe S. The development and psychometric validation of the interpersonal geriatric care relationship (InteGer) tool. J Adv Nurs 2021; 77:3571-3583. [PMID: 33951224 DOI: 10.1111/jan.14882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/22/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Abstract
AIM To develop and psychometrically test the Interpersonal Geriatric care relationship tool. BACKGROUND The quality of nursing care is highly influenced by the quality of the interpersonal care relationship, yet there are no tools available that capture the conceptual breadth of the interpersonal care relationship. DESIGN Instrument development and psychometric testing of the content and construct validity, factor structure and reliability. METHODS A four-phased validation procedure was conducted (January 2016-April 2019): defining the construct measured by the tool, tool development, content validation and psychometric evaluation. RESULTS The 30-item Interpersonal Geriatric care relationship tool was subjected to exploratory factor analysis. Four components (humanization, attentiveness, interest and accessibility) were extracted. The tool demonstrated discriminating power and good internal consistency. Cronbach's alphas for the components ranged between 0.69 and 0.84. CONCLUSION The Interpersonal Geriatric care relationship tool is a valuable measure that can be used by scientists, educators and healthcare professionals to benchmark the interpersonal care relationship culture in hospitals and optimize the quality of care.
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Affiliation(s)
- Melissa Riviere
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium.,AZ Delta, General Hospital, Roeselare, Belgium
| | - Veerle Duprez
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | | | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Skin Integrity Research Group (SKINT), Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI, Dublin, Ireland
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
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Reynish E, Hapca S, Walesby R, Pusram A, Bu F, Burton JK, Cvoro V, Galloway J, Ebbesen Laidlaw H, Latimer M, McDermott S, Rutherford AC, Wilcock G, Donnan P, Guthrie B. Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions.
Objective
This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013.
Design
For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost.
Data sources
Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set.
Results
In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower.
Limitations
A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders.
Conclusions
Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways.
Future work
Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital.
Study registration
This study is registered as PROSPERO CRD42015024492.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma Reynish
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Simona Hapca
- School of Medicine, University of Dundee, Dundee, UK
| | - Rebecca Walesby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Angela Pusram
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Feifei Bu
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Jennifer K Burton
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Vera Cvoro
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - James Galloway
- Health Informatics Centre, University of Dundee, Dundee, UK
| | | | - Marion Latimer
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | | | - Gordon Wilcock
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Peter Donnan
- School of Medicine, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- School of Medicine, University of Dundee, Dundee, UK
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Tijsen LM, Derksen EW, Achterberg WP, Buijck BI. Challenging rehabilitation environment for older patients. Clin Interv Aging 2019; 14:1451-1460. [PMID: 31496672 PMCID: PMC6697645 DOI: 10.2147/cia.s207863] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/07/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE. Methods A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized. Results After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation. Discussion This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups. Conclusion Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.
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Affiliation(s)
- Lian Mj Tijsen
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Oktober , Bladel, The Netherlands.,De Zorgboog , Bakel, The Netherlands
| | - Els Wc Derksen
- Department Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilco P Achterberg
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Bianca I Buijck
- Oktober , Bladel, The Netherlands.,De Zorgboog , Bakel, The Netherlands
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Riviere M, Dufoort H, Van Hecke A, Vandecasteele T, Beeckman D, Verhaeghe S. Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital: A mixed-methods systematic review. Int J Nurs Stud 2019; 92:154-172. [PMID: 30826498 DOI: 10.1016/j.ijnurstu.2019.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The fundamental importance of establishing an interpersonal care relationship for quality nursing care has been highlighted. However specific elements of the interpersonal care relationship of importance to older patients in the hospital have not been identified. OBJECTIVES The aim of this review was to explore and synthesise research findings regarding the elements of the interpersonal care relationship concept from the perspectives of older patients. DESIGN A systematic mixed-methods review. DATA SOURCES An extensive search was conducted up until October 2018 for articles without any publication date time limit in PubMed, Web of Science, Cochrane Database of Systematic Reviews and CINAHL. REVIEW METHODS Primary studies were included if they concerned patients aged 65 years or older and their perspectives on the elements of the interpersonal care relationship with nurses. Inclusion was limited to patients without cognitive impairment who were admitted to an acute hospital setting. The methodological quality of each study was assessed using the Critical Appraisal Skills Programme for qualitative studies, the Quality Assessment Tool for Quantitative Studies and the Mixed-Methods Appraisal Tool. Thematic analysis was used to structure the results of the included studies. RESULTS Of the 7596 studies found, 24 were included in this review. Twenty articles had a qualitative, three a quantitative and one a mixed methods design. Older patients consider dignity and respect as core values that need to be met in the interpersonal care relationship. Five core elements of the interpersonal care relationship were identified to meet these core values: elements related to caring behaviour and attitude, person-centred care, patient participation, communication and situational aspects. These core elements were structured according to three categories, identified in the literature, that determine the quality of the interpersonal care relationship: nurse-, older-patient-related elements and situational aspects. CONCLUSIONS The elements identified in this review can guide efforts to define the interpersonal care relationship between older patients and nurses. Nurses should be supported and motivated by education and practice to adapt their behaviour, attitudes and communication to meet older patients' expectations. Hospital management can also encourage nurses to communicate well. Investment in the current organisation of care is needed to improve nurses' work overload and presence. Further research is needed to clarify the underlying processes influencing the experience of the interpersonal care relationship from the perspectives of older patients, nurses, informal caregivers and hospital management.
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Affiliation(s)
- M Riviere
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department Health Care, VIVES University College, Roeselare, Belgium; AZ Delta, General Hospital, Roeselare, Belgium.
| | - H Dufoort
- AZ Delta, General Hospital, Roeselare, Belgium.
| | - A Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - T Vandecasteele
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department Health Care, VIVES University College, Roeselare, Belgium.
| | - D Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; School of Health Sciences, Örebro University, Sweden; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| | - S Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department Health Care, VIVES University College, Roeselare, Belgium.
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10
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The Impact of Being a Migrant from a Non-English-Speaking Country on Healthcare Outcomes in Frail Older Inpatients: an Australian Study. J Cross Cult Gerontol 2018; 32:447-460. [PMID: 28808814 DOI: 10.1007/s10823-017-9333-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this prospective study of 2180 consecutive index admissions to an acute geriatric service was to compare in-hospital outcomes of frail older inpatients born in non-English-speaking counties, referred to as culturally and linguistically diverse (CALD) countries in Australia, with those born in English-speaking countries. Multivariate logistic regression was used to model in-hospital mortality and new nursing home placement. Multivariate Cox proportional hazards regression was used to model length of stay. The mean age of all patients was 83 years and 93% were admitted through the emergency department. In multivariate analyses, patients from CALD and non-CALD backgrounds were equally likely to die (CALD odds ratio [OR] 0.69, 95% confidence interval [95% CI] 0.44-1.10) and be newly placed in a nursing home (OR 0.75, 95% CI 0.51-1.12). Patients from CALD backgrounds unable to speak English were more likely to die (11.5% vs. 7.2%, p = 0.02). While patients from CALD backgrounds had significantly shorter lengths of stay in univariate analysis (median 9 days vs. 10 days, p = 0.02), this was not apparent in multivariate analysis (hazard ratio 1.02, 95% CI 0.91-1.14), where the ability to speak English proved to be a strong confounder. While most of the literature shows poorer outcomes of people from minority ethnic groups, our findings indicate that this is not necessarily the case. Developing culturally appropriate services may mitigate some of the adverse outcomes commonly associated with ethnicity. Our findings are particularly relevant to countries populated by multiple ethnic groups.
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Abstract
Objective: To evaluate the impact of frailty, measured using the Canadian Study of Health and Aging Clinical Frailty Scale, on outcomes of older people hospitalized with acute illness. Method: Consecutive patients were randomly allocated to a model development sample or a model validation sample. Multivariate analyses were used to model in-hospital mortality, new nursing home placement, and length of stay. Variables selected in the development samples were tested in the validation samples. Results: The mean age of all 2,125 patients was 82.9 years. Most (93.6%) were admitted through the emergency department. Frailty predicted in-hospital mortality (odds ratio [OR] = 2.97 [2.11, 4.17]), new nursing home placement (OR = 1.60 [1.14, 2.24]), and length of hospital stay (hazard ratio = 0.87 [0.81, 0.93]). Discussion: Frailty is a strong predictor of adverse outcomes in older people hospitalized with acute illness. An increased awareness of its impact may alert clinicians to screen for frailty.
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Lopes MJ, Escoval A, Pereira DG, Pereira CS, Carvalho C, Fonseca C. Evaluation of elderly persons' functionality and care needs. Rev Lat Am Enfermagem 2014; 21 Spec No:52-60. [PMID: 23459891 DOI: 10.1590/s0104-11692013000700008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/15/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the elderly persons' functionality, based on the International Classification of Functionality. METHODS a cross-sectional, descriptive study; a stratified random sample of 903 elderly persons; a confidence level of 95%; and a margin of error of 2.5%. Questionnaire based on the International Classification of Functionality; data was collected based on structured interviews undertaken by health professionals in the health centers in the Alentejo region of Portugal. RESULTS 30.7% of the elderly persons stated that they were illiterate, and 22.9% lived alone. Feeding/dietary (18.7%), housing (19.2%) and health needs (26.0%) were not met. Orientation functions were maintained in 83.4%; 58% of the elderly persons referred to pain so intense that it required care; 73.3% of the elderly persons did not have functional dentition. Levels of performance were superior to 80% in the participation activities: washing oneself (82.6%), toileting (92.2%), dressing, eating, and drinking (89%). CONCLUSION although a progressive decline in functionality is observed as age advances, the majority of dimensions are preserved until around 75 years of age.
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Affiliation(s)
- Manuel José Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, Portugal.
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Lakhan P, Jones M, Wilson A, Gray LC. The Higher Care At Discharge Index (HCDI): Identifying older patients at risk of requiring a higher level of care at discharge. Arch Gerontol Geriatr 2013; 57:184-91. [DOI: 10.1016/j.archger.2013.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/25/2022]
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Portegijs E, Buurman BM, Essink-Bot ML, Zwinderman AH, de Rooij SE. Failure to regain function at 3 months after acute hospital admission predicts institutionalization within 12 months in older patients. J Am Med Dir Assoc 2012; 13:569.e1-7. [PMID: 22572555 DOI: 10.1016/j.jamda.2012.04.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/30/2012] [Accepted: 04/03/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the effects of functional decline on admission to long-term institutionalized care within 12 months from acute hospital admission. DESIGN Pooled analyses of 3 longitudinal cohorts. SETTING Tertiary and secondary hospital. PARTICIPANTS A total of 1085 community-dwelling patients older than 65 years acutely admitted to an internal medicine or orthopedic ward. MEASUREMENTS Demographic data and medical data were collected within 2 days from hospital admission. Functional status (activities of daily living [ADL]) was assessed at baseline (reflecting preadmission status 2 weeks before admission) and 3 months after admission, and function loss (change between preadmission and 3 months) was calculated. Living situation was assessed 3 and 12 months after hospitalization. Cox regression analysis was used to predict institutionalization (living in a long-term assisted care or nursing home facility) within 12 months. RESULTS ADL function loss in the 3 months following hospital admission increased the risk of institutionalization also in patients without preadmission impairment (loss of function in 1 item HR = 5.3, 95% CI 2.2-12.6, p < .001; ≥2 items HR = 7.3, 95% CI 3.4-15.7, p < .001) compared with patients without impairment and function loss. The risk progressively increased with higher preadmission impairment. Patients with preadmission ADL impairment in 2 or more items without additional loss of function had an increased risk (HR = 6.4, 95% CI 3.1-13.3, p < .001) for institutionalization. This model was adjusted for age, gender, cognitive impairment, social situation, use of health care services, length of hospital stay, and comorbidity. CONCLUSION Loss of function in ADL tasks following hospitalization increased the risk for institutionalization, irrespective of preadmission ADL impairment. Potentially, counteracting loss of function in ADLs after acute hospital admission by more intensive rehabilitation may partly reduce the need for institutionalization.
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Affiliation(s)
- Erja Portegijs
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Foss C, Hofoss D. Elderly persons' experiences of participation in hospital discharge process. PATIENT EDUCATION AND COUNSELING 2011; 85:68-73. [PMID: 20884160 DOI: 10.1016/j.pec.2010.08.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 08/16/2010] [Accepted: 08/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to describe older hospital patients' discharge experiences on participation in the discharge planning. METHODS A sample of 254 patients aged 80+ was interviewed using a questionnaire developed by the research team. Data were collected by face-to-face interviewing during the first two weeks following patients discharge from hospital. RESULTS In spite of their advanced age the patients in this study did express a clear preference for participation. However, there were no significant correlation between patients' wish for participation and experienced opportunity to share decisions. Hearing ability was the only significant factor affecting the chance to participate, whereas sociodemographic factors did not significantly affect on the likelihood participation the discharge process. CONCLUSION The actual practice of involving old people in the discharge process is not well developed as experienced by old patients themselves. The fact that factors like gender and education have little influence on participation in the oldest patients might be related to age; when you get old enough, old is all that is 'visible'. PRACTICE IMPLICATIONS To determine the extent of elderly patients' desire to participate, one must actively look for it both through research and in the hands-on process of discharge.
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Affiliation(s)
- Christina Foss
- Institute of Health and Society, Department of Nursing and Health Sciences, Blindern, Oslo, Norway.
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Poynter L, Kwan J, Sayer AA, Vassallo M. Does cognitive impairment affect rehabilitation outcome? J Am Geriatr Soc 2011; 59:2108-11. [PMID: 22092047 DOI: 10.1111/j.1532-5415.2011.03658.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess how cognitive impairment affects rehabilitation outcomes and to determine whether individual benefit regardless of cognition. DESIGN Prospective open observational study. SETTING Two rehabilitation wards admitting older adults after admissions with medical or surgical problems. PARTICIPANTS Two hundred forty-one individuals admitted to two rehabilitation wards, 144 female, mean age 84.4 ± 7.3 (range: 59-103). MEASUREMENTS The Mini-Mental State Examination (MMSE) was administered, and participants were categorized into four groups: cognitively intact (MMSE score: 27-30), mildly impaired (MMSE score: 21-26), moderately impaired (MMSE score: 11-20), and severely impaired (MMSE score: 0-10). Barthel activity of daily living score was calculated on admission, at 2 and 6 weeks (if appropriate), and at discharge to assess level of independence and improvement or deterioration in function. Information relating to mortality, discharge destination, and length of stay was also collected. RESULTS After adjusting for comorbidities and age, all four groups showed improvement in Barthel score from admission to discharge. This improvement was highly significant (P = .005) in participants with normal cognition and mild to moderate impairment. Severely impaired participants also made significant improvement (P = .01). Length of stay was significantly longer for participants with lower cognitive scores. Discharge of 50% of participants occurred by 26, 28, 38, and 47 days for Groups 1 to 4, respectively (P = .001). Higher rates of institutionalization and mortality (P = .02) were associated with lower MMSE score. CONCLUSION All participants improved functionally regardless of cognition. Likelihood of institutionalization, mortality, length of stay, and adverse incidents was higher with lower MMSE scores.
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Brown SHM, Abdelhafiz AH. Institutionalization of older people: prediction and prevention. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.10.88] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Expenditure on long-term care is likely to increase with the aging of the population and the increased need for institutionalization. Identifying risk factors for nursing home admission is of particular interest to develop predictive tools and intervention programs to reduce entry into nursing homes. Most of the patient-related risk factors leading to nursing home admission are based on an underlying decline in physical and/or cognitive functions. Interaction between caregiver and care recipient characteristics is also an important contributing factor. Structured preventive programs are more effective than individual counseling. Tailoring intervention programs to individual needs and preferences, continuous and comprehensive support of patients and their caregivers with access to a geriatrician is an important factor in the success of an intervention. Further research is still required to explore whether interventions at early stages of chronic diseases would delay physical and cognitive dysfunction and reduce the institutionalization of older people.
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Affiliation(s)
- Siobhan HM Brown
- Department of Elderly Medicine, Rotherham General Hospital, Moorgate Road, Rotherham,S60 2UD, UK
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Landi F, Liperoti R, Bernabei R. Postacute rehabilitation in cognitively impaired patients: comprehensive assessment and tailored interventions. J Am Med Dir Assoc 2011; 12:395-7. [PMID: 21708350 DOI: 10.1016/j.jamda.2011.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
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Fusco D, Bochicchio GB, Onder G, Barillaro C, Bernabei R, Landi F. Predictors of rehabilitation outcome among frail elderly patients living in the community. J Am Med Dir Assoc 2009; 10:335-41. [PMID: 19497546 DOI: 10.1016/j.jamda.2009.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 01/21/2009] [Accepted: 02/11/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Physical therapy is frequently offered to community-dwelling frail elderly as part of home care rehabilitation programs. A better knowledge of predictors of rehabilitative success could allow a better targeting of limited resources. The purpose of this study is to evaluate the association of medical indicators of health status on functional recovery during rehabilitation of frail elderly living in the community. SUBJECTS Subjects included 598 patients aged 70 years or more admitted consecutively to a home care rehabilitation program from January 2004 to December 2004. METHODS A comprehensive geriatric multidisciplinary evaluation was offered to all patients, based on the Minimum Data Set for Home Care (MDS-HC) assessment form. Predictors of functional recovery were identified by a multiple logistic regression model. Data analyses were based on the items contained in the MDS-HC form. RESULTS An improvement in ADL score was seen in 33% of patients, while the others remained unchanged or worsened. In multivariate analysis the negative predictors of functional improvement were as follows: cognitive impairment (OR 0.67; CI 0.60-0.74), depression (OR 0.89, CI 0.82-0.96), visual (OR 0.32, CI 0.21-0.50) and hearing impairment (OR 0.42, CI 0.27-0.67), and urinary (OR 0.21, CI 0.14-0.33) and bowel incontinence (OR 0.16, CI 0.10-0.26). CONCLUSIONS Cognitive impairment, depressed mood, sensory impairment, and incontinence are key factors that need to be assessed in order to individuate patients at risk of failure in rehabilitation. A targeted intervention in these areas could offer the opportunity of improving rehabilitation outcome.
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Affiliation(s)
- Domenico Fusco
- Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
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Abstract
Rehabilitation in broad terms is a process aimed at restoring a person's functional capacity particularly in relation to activities of daily living. Studies have shown that hospitalization of older patients is a major risk factor for an often irreversible decline in function, and that functional decline from baseline occurs as early as day two of admission. Rehabilitation is therefore often required for older patients following an admission to an acute hospital. Older patients admitted for rehabilitation are more likely to be functionally impaired and are more medically complex than younger patients.
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