Home treatment for chronic respiratory failure in children: a prospective study

Home treatment for children with chronic respiratory failure (CRF) is increasing. However, the causes of CRF in children and the details of their home treatment are not well-known. The aim of this study was to describe the causes of CRF in the paediatric population and the treatments that the patients received at home. We surveyed all children (aged < or = 18 yrs) entering the Association Nationale pour le Traitement à Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) for home treatment of CRF between March 1992 and March 1993. Two hundred and eighty seven children (178 boys, 62%) started home treatment for CRF during the year. One hundred and eleven patients had obstructive respiratory disease: cystic fibrosis (CF) (n = 24); bronchopulmonary dysplasia (BPD) (n = 79); other obstructive respiratory disease (n = 8). One hundred and seventy six patients had restrictive lung disease: neuromuscular disease (n = 87); kyphoscoliosis (n = 21); pulmonary fibrosis (n = 6); cardiac disease (n = 14); stomatological disease (n = 10); other restrictive respiratory disease (n = 9); and 29 miscellaneous causes. One hundred and thirteen patients received oxygen therapy, with a mean daily use of 17.7 h (20 h.day-1 for BPD patients and 12.3 h.day-1 for CF patients). Oxygen was delivered by a concentrator in 88% of cases. One hundred and fifty eight children received mechanical ventilation (MV). Five children received nasal continuous positive airway pressure ventilation for sleep apnoea, four had pneumatic belt ventilation, and 12 had a tracheostomy without MV. Treatment was stopped in 21 children, because of death in nine and improvement in the other 12. Home treatment for children with CRF is well developed in France via the ANTADIR network. Causes of CRF in children are heterogeneous, with a relatively good prognosis.     

Home parenteral nutrition in children: the Polish experience

BACKGROUND: Home parenteral nutrition has become routine for management of intestinal failure in patients. In Poland the main obstacle to widespread use of home parenteral nutrition is the lack of interest of commercial companies in delivering feedings and ancillaries to patients. METHODS: Twenty-five home parenteral nutrition patients aged from 4 months to more than 13 years were reviewed. The mother or both parents were trained in home parenteral nutrition techniques for 4 to 6 weeks and compounded the nutrients themselves at home. RESULTS: The mean duration of home parenteral nutrition was 10,117 patient days. Hospital stays of patients receiving parenteral feedings were significantly shorter than the duration of administration of home parenteral nutrition (p < 0.001). Eleven children are continuing the home parenteral nutrition program. Eighty-three catheters were used in these patients. The rate of catheter occlusion decreased within the observation period, and in 1997 not one case of occlusion was observed. In 1997 only three catheters were removed during 7.8 patient years, and the overall incidence of catheter-related complications was 0.38 per patient year. The overall occurrence of septicemia was one case in 516 days and of catheter infection was one in 459 days. In 1997 a catheter was infected on average of once every 1419 days. There was significant improvement in the z score for weight during therapy. The average monthly cost of nutrients and ancillary items was approximately $1200 (4200 Polish zlotys [PLN]). These costs are 1.6 to 3 times lower than those recorded in other studies. CONCLUSION: Home parenteral nutrition in children with nutrients mixed by caregivers in the home setting is a safe and appropriate method of treatment that can be used in countries where home parenteral nutrition solutions are not manufactured or where commercial home parenteral nutrition is not economically feasible.     

Home health reimbursement and the 1997 Budget Act

The Balanced Budget Act of 1997, which was passed by Congress on July 28, was signed into law by President Clinton on August 5. The legislation contains a 5-year plan to balance the federal budget and reduces Medicare expenditures by $115 billion during that period. Home health cuts total $16.2 billion; hospice accounts for $200 million in additional reductions. In addition, the agreement contains significant cuts for home medical equipment (HME) and oxygen.     

Home monitoring of pulmonary function

The use of healthcare technology in homes is increasing. This article details an electronic home spirometry unit used by lung transplant patients. The unit can also be used with other populations including persons with asthma or cystic fibrosis, or persons awaiting transplants. Home health nurses are in a prime position to assist patients in using technology that provides direction for the treatment regimen.     

Home health care

Home health care is the fastest-growing expense in the Medicare program because of the aging population, the increasing prevalence of chronic disease and increasing hospital costs. Patients and families are choosing the option of home care more frequently. Medicare's regulations are often considered the standard of care for all home health agency interactions, even when a patient does not have Medicare insurance. These regulations require patients who receive home health care services to be under the care of a physician and to be homebound. The patient must have a documented need for skilled nursing care or physical, occupational or speech therapy. The care must be part time (28 hours or less per week, eight hours or less per day) and occur at least every 60 days except in special cases. A detailed referral and specific care plan maximize the care to the patient and the reimbursement received by the physician.     

Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology

OBJECTIVE: To compare patterns of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality in 11 selected industrialized countries with highly developed death registration systems and a broad range of cumulative AIDS incidence rates. METHODS: Data on HIV/AIDS mortality were obtained from the World Health Organization (WHO) and Statistics Canada for the years 1987-1991. We obtained data for Australia, Canada, Denmark, France, the former Federal Republic of Germany, Italy, the Netherlands, New Zealand, Spain, Switzerland, and the US, stratified by sex and 5-year age groups. Population figures were obtained from national censal, post-censal or interpolated annual estimates compiled by WHO and from Statistics Canada. RESULTS: A total of 141534 deaths were attributed to HIV/AIDS (126224 in men and 15310 in women) in the 11 countries from 1987 to 1991. The majority of deaths (73.7%) occurred in the US. Other countries contributing substantially to the number of deaths were France (7.1%), Italy (4.9%), Spain (4.9%), former West Germany (3.5%), and Canada (3.0%). Age-specific death rates for men aged 25-44 years in 1991 were highest in the USA at 47.1 per 100000 population and highest for women in Switzerland at 7.7 per 100000 population. Potential years of life lost (PYLL) before age 75 years were highest for males in the US (2388 per 100000 population) and for females in Switzerland (373 per 100000 population). The lowest rates were in New Zealand (339 per 100000 population in men and 6.5 per 100000 population in women). CONCLUSIONS: This historical demographic analysis indicates that mortality resulting from HIV infection and AIDS among men and women varies considerable by country. Rates of death were highest in the US and lowest in Australia, the Netherlands, and New Zealand.     

Developing AIDS care in Zimbabwe: a case for residential community centres?

New support services are needed as the AIDS epidemic escalates. Home care has been the cornerstone of new developments in Zimbabwe and the southern African region, essentially resource-strapped countries. However, while home care has many benefits, levels of coverage are often low and many patients at some phase of their disease need more than their home can provide, even with access to support services. Hospital admission is often not a viable option and the need may arise for some form of respite or hospice community centre to provide residential care. This option is debated and potential benefits and pitfalls are explored.     

Current status of pediatric home mechanical ventilation in Japan]

The first nationwide survey of pediatric home mechanical ventilation (HMV) was conducted. From 35 out of 149 medical centers investigated, 49 cases of HVM were reported. The patients ranged in age from 1 to 20 years, and the causes of respiratory failure were neuromuscular diseases (51%), central hypoventilation (33%), respiratory disorders (10%) and cervical cord injury (6%). Since 1983 when 2 patients were discharged home on mechanical ventilation, more and more ventilator-dependent children have been sent home every year. However, home mechanical ventilation is not yet well recognized in Japan as an option for pediatric patients with chronic respiratory failure, and there are many problems to be solved. Firstly, very few, if any, hospitals have a designated home care team composed of physicians and other specialists. Secondly, the current health insurance system scarcely covers the cost of home ventilation. Thirdly, development of home use equipment, in particular, portable ventilators and monitors is imperative. There are 107 hospitalized patients in 56 institutions who are reportedly able to go home if a support system is established. A program for pediatric home mechanical ventilation should be urgently developed on a national basis.     

Health for the Hopeful: A Study of Attachment Behavior in Home Health Care Nurses.

Home health nursing is a growth industry in Western industrialized countries and is a stressful occupation. The current study builds on a line of research that examined the positive effects of attachment behavior at work on health for executives, managers, military officer candidates, and basic military trainees. The present study of 175 home health nurses from the U.S. Southwest included the new construct of hope in its design. Hope was found to mediate, rather than moderate, the relationships between attachment styles and health. Interdependence had positive associations, whereas counterdependence had negative associations, with hope and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the AFDC program. Aid to Families with Dependent Children

The NADYA Group, integrated in the Spanish Society of Parenteral and Enteral Nutrition (SENPE), and made up of professionals dedicated to Artificial Nutrition, and specifically, to Artificial Nutrition in the home, annually undertakes the task of collecting data on diagnosis, type of support, follow up characteristics, complications, and quality of life, of patients included in programs of at home artificial nutrition in Spain. In the Annual Register corresponding to 1994, 17 hospitality groups have participated, providing 369 patients with Home Enteral Nutrition, and 30 with Home Parenteral Nutrition. Home Enteral Nutrition is mainly applied in patients with neoplasias (36%) or neurological alterations (35%). The most commonly used access route in the nasogastric tube, although there is an observed increase in the application of Percutaneous Gastrostomies (21%) in relation to previous data of the Spanish population. There is an observed complications index of 0.07 episodes/patient-year, a mortality of 30% (neoplasias) and 20% (neurological alterations), and low rehabilitation indexes in this group. In Home Parenteral Nutrition, post-radiation enteritis, neoplasias, and mesenteric ischemia, are the main diagnostic groups. The majority of the patients have a tunneled tube (63%), with 37% using an implanted tube. With an index of hospitalizations of 0.83 hospitalizations/ patient-year, catheter septicemia justifies the majority of the re-hospitalizations derived from nutritional treatment (0.56 hospitalizations/patient-year), note the mortality of 37%. There are complete rehabilitations, continuing the previously normal activity in 80% of the cases.     

Home parenteral nutrition in the management of patients with chronic idiopathic intestinal pseudo-obstruction

Home parenteral nutrition is indicated in all those patients who are unable to cover all their needs orally or enterally during prolonged periods of time, and who do not require any other general care other than the parenteral nutrition. Our objective is to prove the use of home parenteral nutrition as a nutritional support in patients with severe forms of chronic idiopathic intestinal pseudo-obstruction. In our unit, three patients with this disease, have received home parenteral nutrition between 1993 and the present date. One patient received it during four months, with the catheter being removed due to a fungemia. At present she is being maintained with oral and enteral nutrition. The other two patients continue in the program: one since October 93 and the other since July 94. The hydroelectric alterations caused during the episodes of sub-occlusion make more frequent changes in the composition of the parenteral nutrition necessary, compared to other types of patients. The low incidence of complications and the degree of acceptance by the patient makes this technique an ideal method for the long term nutritional support.     

Home dampness and respiratory health status in european children

BACKGROUND: Living in a damp home has been associated with impaired respiratory health in previous studies, but objective data on lung function variability and atopy have been lacking from most studies. OBJECTIVES: Data collected in the winter of 1993-1994 in the framework of the PEACE study (Pollution Effects on Asthmatic Children in Europe) were used to study the association between home dampness and Peak Flow (PEF) variability, frequency of respiratory symptoms and relief medication use during the period of observation. METHODS: Children were selected with a screening questionnaire on the basis of positive answers to questions on symptoms of asthma and chronic cough. Children were instructed to perform PEF measurements with Miniwright PEF meters twice daily over a period of 2 months. Parents kept diaries on respiratory symptoms and medication use of their children. Data on demographic and housing characteristics were derived from a parent-administered questionnaire. As indicators for home dampness reported moisture stains and moulds were used. Children were tested for atopy with skin-prick tests. Data from 1614 children from 13 centres in 10 different countries were available for analysis. Linear regression models and prevalence rate ratios were used to investigate the association between home dampness and PEF variability and the period prevalence of cough, phlegm, lower and upper respiratory symptoms and bronchodilator use. RESULTS: In atopic children, PEF variability was positively related to self-reported moulds but not to moisture stains. The period prevalence of cough and upper respiratory symptoms was significantly higher in children living in houses with reported moulds, compared with 'dry' homes. CONCLUSIONS: These results show that self-reported moulds in homes are associated with objective as well as subjective markers of airway lability in European children with chronic respiratory symptoms.     

Home vaccination for children behind in their immunisation schedule: a randomised controlled trial

OBJECTIVE: To ascertain the effectiveness of a home vaccination service for children behind in their vaccination schedule. DESIGN: Randomised controlled trial of nurse-administered vaccination at home. Children were allocated at random to the intervention or the control group before any contact with the parents was made. SETTING: 10 council areas in north-west metropolitan Melbourne defined by 56 postcode zones. Six-week intervention period from November 1996. PARTICIPANTS: 405 children--all those in the study area (n = 2610) 90 days late (age 9 months) for their third diphtheria-tetanus-pertussis/poliomyelitis/Haemophilus influenzae type B (DTP/OPV/Hib) vaccination, or 120 days late (age 16 months) for their measles-mumps-rubella (MMR) vaccination, according to the Australia Childhood Immunisation Register. MAIN OUTCOME MEASURES: Number of children completing DTP/OPV/Hib or MMR during the intervention period, and number up to date before intervention. RESULTS: Verification of vaccination status with the parents revealed that 123 (60%) of the children in the intervention group and 113 (56%) of those in the control group were up to date with their vaccinations, leaving a study population of 81 (intervention group) and 88 (control group). Vaccination was achieved in 46 (57%) intervention children and 24 (27%) control children (risk ratio [RR], 2.08; 95% CI, 1.4-3.1; P < 0.001). For DTP/OPV/Hib, 18/32 (56%) intervention children and 12/36 (33%) control children were vaccinated, (P = 0.06). For MMR, 28/49 (57%) and 12/52 (23%) children were vaccinated, respectively (P < 0.001). Home vaccinations were completed with 26 families (including five siblings). The average cost per child vaccinated as a result of the home program was $92.52. CONCLUSION: Home vaccination for children behind in their immunisation schedule is an effective, acceptable and relatively cheap method of completing recommended vaccinations. We recommend that a home vaccination program be widely implemented and made available, particularly for disadvantaged families.     

The detection of the sleep apnea syndrome in a population of professional drivers

The aim of this study was to reduce the risk of traffic accidents related to obstructive sleep apnea syndrome (OSAS) by means its detection and treatment in a group of 100 commercial drivers from Seville. Besides, to analyze which clinical findings could suggest OSAS. By means a questionnaire we selected subjects without (questionnaire score < 10 points) and with (questionnaire score > or = 10) clinical history of OSAS. In cases with score > or = 10, an overnight home polygraphy was carried out (Apnoescreen II, Jaeger), with measurement of oronasal airflow, chest and abdominal movements, oxygen saturation, electrocardiogram, body position and actimetry. We performed a manual analysis of recordings, and polygraphy was considered to be positive for OSAS if both AHI (respiratory events Index) or DI (desaturation Index) were > or = 10. In these positive cases, overnight conventional polysomnography was carried out (SleepLab, Jaeger), with therapeutic tests with CPAP if OSAS was diagnosed (AHI > or = 10). Average age and BMI (Body Mass Index) were 41.5 +/- 0.9 years and 28.2 +/- 0.4 kg/m2. Questionnaire was positive in 59 subjects, in 35 of whom home polysomnography was done. We did not find differences in age, BMI, neck circumference or symptomatology among these 35 drivers and the 24 remaining subjects in whom home polygraphy was not performed. Home polygraphy was positive in 10 subjects and negative In 25. Drivers in first group were older, heavier and complaint more frequently about snoring, sleep apnea and daytime sleepiness. We did not find differences in neck circumference, waist/hip ratio nor alcohol consumption between both groups. From the group with positive polygraphy, we performed conventional polysomnography in 8 cases and OSAS was diagnosed in 5 (in all cases, treatment with CPAP was started). This study does not provide data about prevalence, but it seems that the percentage of our drivers with OSAS could be lightly higher than the prevalence in general population. These subjects seem to be older, heavier and complaint more frequently about snoring, sleep apnea and daytime sleepiness.     

我国中厚板生产现状与发展

本文从我国中厚板的生产装备与生产规模、生产工艺技术及其经济技术指标和产品品种质量三个方面,分析了中厚板生产的现状及与国外的差距,针对如何提高中厚板产品质量、围绕提高总体装备水平进行技术改造以及适应市场需求不断优化品种结构等方面,就我国中厚板生产与技术的发展提出了建议。     

Home versus intensive care pressure support devices. Experimental and clinical comparison

A bench study using an artificial lung model and a clinical study in patients were performed to evaluate six commercially available home pressure support devices. Six devices were tested in the in vitro study, including five designed for home use and one designed for use in intensive care units. Minimal positive end-expiratory pressure (PEEP) varied across home devices, from 0.5 cm H2O to 4.3 cm H2O. Work imposed during exhalation varied up to six-fold across devices. A substantial rebreathing volume has present for the three home devices with a common inspiratory and expiratory line. This rebreathing volume decreased with increasing PEEP level, as expected, but remained substantial at the widely used PEEP level of 5 cm H2O. Use of a non-rebreathing valve increased both the work imposed by the circuit during the exhalation phase and the time required to attain the relaxation equilibrium. Except for two home devices and a bilevel positive airway pressure (BiPAP) device equipped with a non-rebreathing valve, differences in inspiratory trigger sensitivities were small between home and intensive care devices. During pressure support, the total work performed by the machines did not differ by more than 15% between devices, whereas differences of more than 300% were observed in flow acceleration. Only one home device gave a flow acceleration similar to or better than that obtained with the intensive care device. In a randomized, crossover clinical study, we compared a home device to a device specially designed for intensive care use in seven intubated patients during weaning from mechanical ventilation. The main differences between the two devices were trigger sensitivity and initial flow acceleration. For the same level of pressure support, there were no significant differences in arterial PCO2, tidal volume, respiratory rate, or minute ventilation between these two devices. However, the esophageal pressure-time product was 30% higher with the home device (165 +/- 93 versus 119 +/- 80 cm H2O/min, p < 0.05). In conclusion, differences exist between devices in terms of occurrence of rebreathing, speed of attainment of stable pressure support level, and expiratory resistance. These differences characterizing the delivery of pressure support may have clinical impact on the inspiratory effort of patients.     

Respiratory failure based on pulmonary tuberculosis sequelae and its management

According to the complexity of pathological change of pulmonary tuberculosis sequelae (TB seq), on which respiratory failure based shows the higher incidence of marked degree of hypoxemia and hypercapnia than that based on chronic pulmonary emphysema (CPE). In TB seq, pulmonary artery mean pressure is higher, nocturnal oxyhemoglobin desaturation is much lower than in CPE. Also hypoxemia on exercise is lower, and oxygen inhalation for this hypoxemia is more effective than in CPE. The most effective therapy is continuous oxygen therapy. Home oxygen therapy has improved the prognosis and quality of life (QOL) of patients with respiratory failure based on TB seq. Artificial positive pressure ventilation (TIPPV) with intubation or tracheotomy is carried out for patients with severe hypercapnia and respiratory acidosis. Recently, early application of nasal mask ventilation (NPPV) on patients with TB seq has prohibited acute exacerbation of chronic respiratory failure. And also for patients with severe hypercapnia, NPPV with BIPAP method is effective for their QOL. Comprehensive respiratory rehabilitation is also successfully applied for their management.     

Where do cancer patients die? Ten-year trends in the place of death of cancer patients in England

Although studies have found that 50-70% of cancer patients would prefer to die at home, there has been a trend towards the hospitalization of the dying in many countries. No study has attempted to analyse the changes in place of death in detail. The aim was to analyse the 10-year trends in place of death of cancer patients, by region and by diagnosis, within England. To do this, data on the place of death and patients' characteristics were derived from death registrations for all cancer deaths between the years 1985-94. We examined trends in the place of death for the whole of England, for each region separately and for the main cancer diagnoses. The results show that there were over 1.3 million death registrations from cancer during the 10 years. The mean age increased over the period from 69.9 years in 1985, to 71.3 years in 1994. The percentage who died in a UK National Health Service (NHS) hospital or nursing home fell gradually from 58% (1985) to 47.3% (1994), while the percentage who died in non-NHS hospitals, nursing homes, hospices and communal establishments increased. The percentage who died at home fell slightly but steadily between 1985 and 1992 from 27% to 25.5% and since then increased slightly to 26.5% in 1994. The percentage of home deaths was lowest in the two Thames regions (less than 25%) and highest in the West Midlands, Anglia and Oxford (over 29%). These differentials were maintained across age groups and diagnoses. Older people and women were less likely to die at home than younger people and men. Significant trends showing an increase in home deaths were found in two regions: North Thames and South Thames. Patients with cancers of the lung, colorectum, respiratory organs, bone or connective tissue and lip, oral cavity and pharynx were more likely to die at home (over 29% in 1994) than patients with cancers of the (breast (women, 25% in 1994) or the lymphatic or haematological system 16% in 1994). It can be concluded that the trend towards a reducing home death rate from cancer in England appears to have halted, although this varies between regions. This has implications for primary care services. Although hospital is still the most common place of death from cancer, the percentage of cancer patients who die in hospital is reducing. The largest rise is in the increasing use of hospices and communal establishments, including residential and nursing homes. Given the ageing population, this trend is likely to continue.     

Home management of bronchopulmonary dysplasia

Home oxygen was utilized in six infants with BPD with no complications. This program allowed for early discharge of the infants, resulting in a mean financial savings of $18,000 per infant and a more normal family environment for the babies.     

Home care in Canada

OBJECTIVES: This article describes the social, socioeconomic and other health-related characteristics of people receiving formal, publicly funded home care services. DATA SOURCE: The data are from the household component of the 1994/95 National Population Health Survey. The analysis covers 16,291 respondents aged 18 or older. ANALYTICAL TECHNIQUES: Recipients of publicly funded home care services were profiled using weighted univariate frequencies and multivariate logistic regression. MAIN RESULTS: Recipients of publicly funded home care services in 1994/95 numbered over half a million. People who were elderly, female, had two or more chronic conditions or were living with others accounted for large proportions of these recipients. Characteristics significantly associated with receiving home care included old age, poor or fair general health, abstinence from alcohol (compared with regular use), low income, living alone, needing help with some activity of daily living, and having cancer or the effects of a stroke.