SosCaregivers: piloting of a psycho-social service for family caregiver in a hard-to-reach setting

Background

”Ageing-in-place” may improve elderly citizens' quality of life and the sustainability of welfare systems. In this process engaging family caregivers is crucial.

Methods

A community-based participatory research in the remote area of Vallecamonica was enacted. First, we surveyed unmet needs of family caregivers. Then, a scoping literature review on existing interventions for engaging family caregivers was performed. Third, 4 co-design workshops were conducted to co-generate a new service. Finally, the service was piloted for a period of 6 months and evaluated.

Results

51 caregivers participated in the survey: they were mainly females, mean 60 y.o and with medium-low level of education. The scoping review resulted in only 14 interventions targeted to elderly's caregivers in remote areas. The workshops involved 27 caregivers and co-designed a new psycho-social service (SOSCargivers) articulated into: 1) a structured informative platform to facilitate health literacy and information seeking; 2) a tailored educational program focused on medical and practical aspects related to elderly care; 3) a set of peer-to-peer meetings for experience sharing and mutual support; 4) a “caregivers board” was created to lead the service. In the piloting 5 training sessions, 5 peer-to-peer meetings, 3 meeting with the “citizens board” were enabled.

Conclusions

The service was positively received by caregivers, although participation wasn't high. Co-designing the service with its expected users facilitates the depth understanding of local people's needs and expectations. SOSCaregivers may support family caregivers of elderly citizens in hard to reach areas by both delivering more value and giving them an active role in the social-care network.

Key messages

Family caregivers’ engagement is crucial for integrated and sustainable services in hard to reach communities. Co-designing the service with its expected users facilitates the Department understanding of local people’s needs and expectations.

[Health-care costs and health technology assessment]

This paper is made up of four sections: a) an overview of the relationship between health-care costs and health technology assessment; b) the state of art of the research into health technology assessment with details on the main fields of research, the results obtained, and the gaps to be bridged; c) an analysis of the techniques for assessing health-care technology (cost-minimization analysis [CMA]; cost-effectiveness analysis [CEA]; cost-utility analysis [CUA]; cost-benefit analysis [CBA]); and d) an overview of the use of the four assessment techniques between 1980 to 2006 in nephrology, with special emphasis on dialysis.

[Videolaparoscopic adrenalectomy in an unusual case of adrenal mycetoma]

The authors report a rare case of mycetoma of the adrenal gland. Mycetoma is a chronic, localized, non-contagious infection of cutaneous and subcutaneous tissue characterized by tumefaction, aggregates of aetiological agents (Actinomyces or true fungi). Sometimes an unusual site (other tissues or organs) is described in the literature, but to date no cases of adrenal gland mycetoma have been reported. The treatment of choice is surgical with associated penicillin and/or antifungal drugs. In the case reported surgical treatment is performed with a laparoscopic approach. This technique constitutes the gold standard in cases of benign neoplasms of the adrenal gland and incidentalomas. This therapeutic choice is open to criticism if a malignant neoplasm is suspected.

[Laparoscopic surgical treatment of cholecysto-choledochal calculi. A single step solution]

The laparoscopic era has created a new basis for the management of choledocholithiasis. Many surgeons now regard laparoscopic cholecystectomy and exploration of the common bile duct as the "gold standard". The main advantages of single-stage treatment consist in a significantly shorter hospital stay, very low complication rates and a reduction of average hospital costs. Among 601 cases of cholelithiasis treated over the period from 1994 to 1999, we report 73 cases of common-bile-duct stones. Surgical sphincterotomy was performed in 20 cases and endoscopic sphincterotomy in 24; only in 7 cases was choledochotomy and/or hepaticojejunostomy (3 cases) performed for critical situations. Twenty-two cases of cholelithiasis were treated by laparoscopic cholecystectomy and exploration of the common bile duct. Stone extraction was obtained with a balloon catheter or Dormia basket via a choledochotomy. Surgery was completed by suturing, cholangiography and the placement of sub-hepatic drainages. No mortality or long-term complications were recorded with the laparoscopic procedure; only two immediate complications were reported, both of which were biliary leakages (9%) that resolved spontaneously. With the other procedures, high rates of mortality, morbidity, hospital admissions and technical failure were registered. We regard laparoscopic exploration of the common bile duct as the treatment of choice for bile-duct stones when combined with cholecystectomy. We reserve ERCP plus endoscopic sphincterotomy only for common-bile-duct stones alone, without a gallbladder or gallstones. Open surgery is performed in particular situations such as Mirizzi's syndrome or when other procedures have failed to yield satisfactory results.

[The epiphrenic esophageal diverticulum. Its transhiatal laparoscopic treatment]

A new laparoscopic surgical approach to treat an esophageal epiphrenic diverticulum is described. This is a rare disease. Today only 4 cases of laparoscopic transhiatal treatment with good results are reported in the literature. The present case report is an 80 years-old male with medium size epiphrenic diverticulum (10 cm) and very symptomatic dysphagia. Preoperative investigations include barium swallow, upper gastrointestinal endoscopy and esophageal manometry. The laparoscopic transhiatal treatment was carried out without difficulty. Diverticulectomy esophageal myotomy and partial gastric fundoplication (Dor) were performed. No postoperative complication was recorded and optimal result was achieved. In conclusion, the efficacy of laparoscopic approach is underlined and the short and medium-term results are satisfactory.

[The laparoscopic treatment of esophageal achalasia. Our experience]

BACKGROUND

Laparoscopic Heller myotomy combined with a Dor fundoplication is considered the procedure of choice to treat esophageal achalasia. The aim of this study is to report a personal experience and to analyse the controversial aspect of this procedure.

METHODS

From January 1997 to March 1998 six patients with esophageal achalasia were treated by Heller laparoscopic myotomy with anterior fundoplication.

RESULTS

There was one intraoperative perforation of esophageal mucosa, sutured laparoscopically with non postoperative sequelae. There were no surgical mortality and no postoperative morbidity. Complete relief of dysphagia in five of six patients, the good clinical and instrumental results and the satisfaction of these patients, lead to a prudent optimism.

CONCLUSIONS

Personal initial experience, although the little number of patients and the short follow-up, confirms that laparoscopic cardiomyotomy is a safe and effective procedure for the treatment of esophageal achalasia.

[Laparoscopic incidental diagnosis: treatment during laparoscopic surgery]

BACKGROUND

The authors consider the importance of laparoscopic exploration of the abdominal cavity for the diagnosis of mistaken preoperative pathologies, during laparoscopic surgery.

RESULTS

In our series the incidental diagnosis is 5.3%.

CONCLUSIONS

The additional treatment diagnosis is realized when there is no great surgical engagement or when there are risks for the patient's life (i.e.: hemorrhagic ovarian cyst). In case of incidental neoplasia diagnosis it would been more appropriate to do a biopsy only, for typing. The realization of demanding or non-programmed surgical operations must be consequent on written consent.

Describing and interpreting 24-hour blood pressure patterns in physiologic pregnancy

The time course of blood pressure in clinically healthy (pregnant and nonpregnant) women was followed by automatic ambulatory monitoring. Chronobiologic methods revealed the time course of dynamic rhythm characteristics as a function of gestational age. Differences were found between nonpregnant and pregnant women with an overall lowering during pregnancy of the rhythm-adjusted midline estimating statistic of rhythm (mesor).