Suchergebnisse

Introduction: Heart failure (HF) is highly prevalent in nursing home residents. To diagnose HF properly, echocardiography is recommended by cardiology guidelines. In nursing homes, the nursing home physician (NHP) usually diagnoses HF based on history, clinical examination, electrocardiography (ECG) and levels of B-type natriuretic peptide only, which is in contrast to the cardiologist who probably always will apply for an echocardiogram. Therefore, we aimed (1) to investigate the agreement on the diagnosis of HF made by the NHP without echocardiography and (2) to determine the clinical characteristics that may contribute to the proper diagnosis of HF in nursing home residents. Materials and methods: The study followed a cross-sectional design. Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care, were included in the study. The NHP decided (stepwise) on the diagnosis of HF; first after anamnesis and physical examination, second after additional information on NTproBNP and ECG, and finally, on all available information, except echocardiography. An expert team consisting of two cardiologists and one hospital geriatrician decided on the final diagnosis, based on all available information. Results and conclusion: There was an overall agreement on both correctly identifying residents with HF and correctly excluding HF of 80.4% (kappa 0.57). Characteristics with a high contribution in predicting HF were a history of HF, a high NT-proBNP level, the presence of rales, arrhythmias and use of cardiac medication. NHPs are fairly capable of diagnosing HF in nursing home residents without echocardiography. (c) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Objectives: On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff. Design: Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes. Participants: Visitors and healthcare professionals. Intervention: Allowing visitors using local regulations based on national guidelines. Measurements: Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations. Results: National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects. Conclusion: The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.