Results of the ADHERE upper airway stimulation registry and predictors of therapy efficacy.

OBJECTIVE/HYPOTHESIS: The ADHERE Registry is a multicenter prospective observational study following outcomes of upper airway stimulation (UAS) therapy in patients who have failed continuous positive airway pressure therapy for obstructive sleep apnea (OSA). The aim of this registry and purpose of this article were to examine the outcomes of patients receiving UAS for treatment of OSA. STUDY DESIGN: Cohort Study. METHODS: Demographic and sleep study data collection occurred at baseline, implantation visit, post-titration (6 months), and final visit (12 months). Patient and physician reported outcomes were also collected. Post hoc univariate and multivariate analysis was used to identify predictors of therapy response, defined as ≥50% decrease in Apnea-Hypopnea Index (AHI) and AHI ≤20 at the 12-month visit. RESULTS: The registry has enrolled 1,017 patients from October 2016 through February 2019. Thus far, 640 patients have completed their 6-month follow-up and 382 have completed the 12-month follow-up. After 12 months, median AHI was reduced from 32.8 (interquartile range [IQR], 23.6-45.0) to 9.5 (IQR, 4.0-18.5); mean, 35.8 ± 15.4 to 14.2 ± 15.0, P \u3c .0001. Epworth Sleepiness Scale was similarly improved from 11.0 (IQR, 7-16) to 7.0 (IQR, 4-11); mean, 11.4 ± 5.6 to 7.2 ± 4.8, P \u3c .0001. Therapy usage was 5.6 ± 2.1 hours per night after 12 months. In a multivariate model, only female sex and lower baseline body mass index remained as significant predictors of therapy response. CONCLUSIONS: Across a multi-institutional study, UAS therapy continues to show significant improvement in subjective and objective OSA outcomes. This analysis shows that the therapy effect is durable and adherence is high. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1333-1338, 2020

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Autonomy of nursing staff and the attractiveness of working in home care

In many Western European countries, the need for home care is rising. As this is often not accompanied by sufficient growth in the supply of home-care nursing staff, a number of countries are facing current and expected future shortages of home-care nursing staff. Therefore, it is pivotal to gain insight into working conditions that are related to the attractiveness of working in home care. This knowledge can help in retaining current nursing staff in home care and in recruiting new staff. The central idea studied in this thesis is that autonomy is important for the attractiveness of working in home care. Reasoning from some important contributions to the sociology of professions, it is assumed that home-care nursing staff value autonomy as it contributes to their professionalism. Three dimensions of autonomy were distinguished: autonomy over patient care; work autonomy; and organisational autonomy. This thesis also discusses whether the assumed positive association between autonomy and attractiveness of working in home care applies to nursing staff regardless of their level of education. The research findings described in this thesis show that autonomy is positively related to the attractiveness of working in home care. Home-care nursing staff who perceive more autonomy are more engaged in their work and less likely to consider leaving the healthcare sector. Nurses see the three dimensions of autonomy as attractive aspects of their work. In addition, home-care nursing staff who feel they have more autonomy over patient care are more satisfied with their job. Concerning the positive relationship between autonomy and the attractiveness of working in home care, no major overall differences were found between nursing staff with a higher educational level and nursing staff with a lower level of educational attainment. The study outcomes can help policymakers, home-care organisations, employers' organisations in home care and professional associations to develop strategies for tackling staff shortages in home care. It is recommended that the autonomy of nursing staff in home care is promoted in home-care policy and practice. This thesis also offers indications as to how nursing staff’s autonomy can be enhanced. For instance, it was found that working in a self-directed team, which probably contributes to nursing staff’s organisational autonomy, is positively related to job satisfaction, partly because nursing staff in self-directed teams feel they have more autonomy over patient care. Furthermore, delivering and organising people-centred and integrated home care is also likely to enhance nursing staff’s autonomy. This thesis revealed that nurses value the different aspects of people-centred, integrated home care. The downside of autonomy may be a higher risk of professional misconduct going unnoticed. If home-care nursing staff’s autonomy is enhanced, self-regulation by the professional community becomes more important. This thesis explores whether home-care nursing staff know how to deal with suspicions of misconduct by colleagues. It was shown that there is still some room for improvement here as a substantial number of nursing staff find it difficult to raise suspicions of professional misconduct within their organisation

Autonomy of nursing staff and the attractiveness of working in home care

In many Western European countries, the need for home care is rising. As this is often not accompanied by sufficient growth in the supply of home-care nursing staff, a number of countries are facing current and expected future shortages of home-care nursing staff. Therefore, it is pivotal to gain insight into working conditions that are related to the attractiveness of working in home care. This knowledge can help in retaining current nursing staff in home care and in recruiting new staff. The central idea studied in this thesis is that autonomy is important for the attractiveness of working in home care. Reasoning from some important contributions to the sociology of professions, it is assumed that home-care nursing staff value autonomy as it contributes to their professionalism. Three dimensions of autonomy were distinguished: autonomy over patient care; work autonomy; and organisational autonomy. This thesis also discusses whether the assumed positive association between autonomy and attractiveness of working in home care applies to nursing staff regardless of their level of education. The research findings described in this thesis show that autonomy is positively related to the attractiveness of working in home care. Home-care nursing staff who perceive more autonomy are more engaged in their work and less likely to consider leaving the healthcare sector. Nurses see the three dimensions of autonomy as attractive aspects of their work. In addition, home-care nursing staff who feel they have more autonomy over patient care are more satisfied with their job. Concerning the positive relationship between autonomy and the attractiveness of working in home care, no major overall differences were found between nursing staff with a higher educational level and nursing staff with a lower level of educational attainment. The study outcomes can help policymakers, home-care organisations, employers' organisations in home care and professional associations to develop strategies for tackling staff shortages in home care. It is recommended that the autonomy of nursing staff in home care is promoted in home-care policy and practice. This thesis also offers indications as to how nursing staff’s autonomy can be enhanced. For instance, it was found that working in a self-directed team, which probably contributes to nursing staff’s organisational autonomy, is positively related to job satisfaction, partly because nursing staff in self-directed teams feel they have more autonomy over patient care. Furthermore, delivering and organising people-centred and integrated home care is also likely to enhance nursing staff’s autonomy. This thesis revealed that nurses value the different aspects of people-centred, integrated home care. The downside of autonomy may be a higher risk of professional misconduct going unnoticed. If home-care nursing staff’s autonomy is enhanced, self-regulation by the professional community becomes more important. This thesis explores whether home-care nursing staff know how to deal with suspicions of misconduct by colleagues. It was shown that there is still some room for improvement here as a substantial number of nursing staff find it difficult to raise suspicions of professional misconduct within their organisation

Attractiveness of working in home care: An online focus group study among nurses

Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and retention of home-care nursing staff. The aims of this explorative, qualitative study were to gain in-depth knowledge about which aspects home-care nurses find attractive about their work and to explore whether these aspects vary for home-care nurses with different levels of education. Discussions were conducted with six online focus groups in 2016 with a total of 38 Dutch home-care nurses. The transcripts were analysed using the principles of thematic analysis. The findings showed that home-care nurses find it attractive that they are a “linchpin”, in the sense of being the leading professional and with the patient as the centre of care. Home-care nurses also find having autonomy attractive: autonomy over decision-making about care, freedom in work scheduling and working in a self-directed team. Variety in patient situations and activities also makes their work attractive. Home-care nurses with a bachelor's degree did not differ much in what they found attractive aspects from those with an associate degree (a nursing qualification after completing senior secondary vocational education). It is concluded that autonomy, variety and being a “linchpin” are the attractive aspects of working in home care. To help recruit and retain home-care nursing staff, these attractive aspects should be emphasised in nursing education and practice, in recruitment programmes and in publicity material

Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people‐centred and integrated health services. This includes providing integrated care around people′s needs that is effectively co‐ordinated across providers and co‐produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home‐care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people‐centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home‐care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people‐centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home‐care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people‐centred, integrated home care as attractive. Specific aspects that home‐care nurses find attractive are promoting the patient′s self‐reliance and having a network in the community. Hospital nurses are mainly attracted to health‐related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home‐care nurses and a minority of hospital nurses feel attracted to people‐centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home‐care organisations who aim to expand the home‐care nursing workforce