A new intelligent bed care system for hospital and home patients

An intelligent bed-care system has been developed for monitoring patient movements and behavior in the hospital and at home in order to prevent injuries from falls, a major problem in health care facilities. Falls, as well as patient activity immediately preceding falls (i.e. exiting the bed), are especially dangerous when infusion extubation also occurs. This new system detects in-bed infusion fluid leaks, bleeding due to infusion-tube pullout, and urine resulting from incontinence. It employs stainless steel tape and wire noncontacting electrodes, several linear integrated circuits, and a low-power, 8-bit single-chip microcomputer The electrodes are installed between the bed mattress and sheet to record changes in an always-present alternating current (AC) voltage, which is induced on the patient's body by electrostatic coupling from a 100-V, 60-Hz alternating current power line around the bed. The microcomputer uses changes in the induced alternating current voltage to detect the patient's movements before and after leaving the bed, as well as any fluid leakage. The microcomputer alerts the nursing station, via the nurse call system or personal handy phone (PHS), that the patient is in an active state; has a dangerous posture on the bed; is contaminating the sheet due to leaking, bleeding or incontinence; or is out of bed.     

The health and cost effects of substituting home care for inpatient acute care: a review of the evidence

BACKGROUND: There is much interest in reducing hospital stays by providing some health care services in patients'' homes. The authors review the evidence regarding the effects of this acute care at home (acute home care) on the health of patients and caregivers and on the social costs (public and private costs) of managing the patients'' health conditions. METHODS: MEDLINE and HEALTHSTAR databases were searched for articles using the key term "home care." Bibliographies of articles read were checked for additional references. Fourteen studies met the selection criteria (publication between 1975 and early 1998, evaluation of an acute home care program for adults, and use of a control group to evaluate the program). Of the 14, only 4 also satisfied 6 internal validity criteria (patients were eligible for home care, comparable patients in home care group and hospital care group, adequate patient sample size, appropriate analytical techniques, appropriate health measures and appropriate costing methods). RESULTS: The 4 studies with internal validity evaluated home care for 5 specific health conditions (hip fracture, hip replacement, chronic obstructive pulmonary disease [COPD], hysterectomy and knee replacement); 2 of the studies also evaluated home care for various medical and surgical conditions combined. Compared with hospital care, home care had no notable effects on patients'' or caregivers'' health. Social costs were not reported for hip fracture. They were unaffected for hip and knee replacement, and higher for COPD and hysterectomy; in the 2 studies of various conditions combined, social costs were higher in one and lower in the other. Effects on health system costs were mixed, with overall cost savings for hip fracture and higher costs for hip and knee replacement. INTERPRETATION: The limited existing evidence indicates that, compared with hospital care, acute home care produces no notable difference in health outcomes. The effects on social and health system costs appear to vary with condition. More well-designed evaluations are needed to determine the appropriate use of acute home care.     

The multidisciplinary guidelines on nutrition for patients indicated for nursing home care, 2001

This article describes the most important aspects of these guidelines. The guidelines are composed of two complementary lines of care. The first line focusses on the basic nutritional care in nursing homes and the second specifically on the patient with nutritional problems. The purpose is to help nursing homes in formulating a sensible and patient-centred nutritional policy; and to realize alertness on nutritional problems in patients, so that necessary interventions can be undertaken in time. Attention is also paid to the importance of an adequate implementation of the guidelines.     

The patient assignment problem in home health care: using a data-driven method to estimate the travel times of care givers

Home health care is one of the recent service systems where human resource planning has a great importance. The assignment of patients to care givers is a relevant issue that the home health care service provider must address before generating the daily routes. The assignment decision is typically made without knowing the visiting sequence, which creates some uncertainties and disparities regarding the effective workload of care givers. However, taking into account travel times in the care giver workload while solving the assignment problem is not straightforward, because travel times can also be affected by clinical conditions of patients and their homes. Providing good travel time estimates that would be used in the assignment decision is the specific topic this paper focuses on. In particular, we propose a data-driven method to estimate the travel times of care givers in the assignment problem when their routes are not available yet. The method, based on the Kernel regression technique, uses the travel times observed from previous periods to estimate the time necessary for visiting a set of patients located in specific geographical locations. The main advantage offered by this technique is the empirical modelling of the travel routes generated by care givers. Numerical results based on realistic problem instances indicate that the proposed estimation method performs better than the average value and k-nearest neighbor search methods and can be successfully used in a two-stage approach that first assigns patients to care givers and then defines their routes.     

Myocardial infarction: a comparison between home and hospital care for patients.

To compare the results of home and hospital treatment in men aged under 70 years who had suffered acute myocardial infarction within 48 hours 1895 patients were considered for study in four centres in south-west England. Four-hundred-and-fifty patients were randomly allocated to receive care either at home by their family doctor or in hospital, initially in an intensive care unit. The randomised treatment groups were similar in age, history of cardiovascular disease, and incidence of hypotension when first examined. They were followed up for up to a year after onset. The mortality rate at 28 days was 12% for the random home group and 14% for the random hospital group; the corresponding figures at 330 days were 20% and 27%. On average, older patients and those without initial hypotension fared rather better under home care. The patients who underwent randomisation were similar to those whose place of care was not randomised, except that the non-randomised group contained a higher proportion of initially hypotensive patients, whose prognosis was poor wherever treated. These results confirm and extend our preliminary findings. Home care is a proper form of treatment for many patients with acute myocardial infarction, particularly those over 60 years and those with an uncomplicated attack seen by general practitioners.     

Possible home care in poliomyelitis

THREE MAIN PROBLEMS IN PROVIDING ADEQUATE HOME CARE MUST BE SOLVED: (1) the obtaining of necessary equipment for the patient such as bed, chair, hot pack materials, appliances and exercising apparatus; (2) the training of some responsible member of the family in the care that is required for the patient; and (3) the provision of adequate supervision by the physical therapist and the physician. The provision of these needs requires proper organization of all the persons and agencies in the community that have a contribution to make toward this care.