Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

__Abstract__ __Background__: Hospital-at-home is an accepted alternative for usual hospital treatment for patients with a Chronic Obstructive Pulmonary Disease (COPD) exacerbation. The introduction of hospital-at-home may lead to changes in health care providers’ roles and responsibilit

Why supervisors should promote feedback-seeking behaviour in medical residency

Background: Individual disposition of goal orientation and situational factors of the working context, both generate and modulate motives to seek feedback. Aim: We looked for correlations between feedback-seeking and individual goal orientation, motives or concerns of feedback-seeking, working context of medical residents. We focussed on how promotion of feedback-seeking by supervisors and educational environment influenced motives and behaviours of feedback-seeking in residents. Methods: Web-based administration of a Likert-type composite questionnaire to residents of a tertiary care teaching hospital in Switzerland and mini-interviews. Results: Fifty-six (45%) of 125 residents completed the questionnaire. After multiple regression analysis promotion of feedback-seeking through supervisors remained the sole predictor correlating with feedback-seeking through inquiry (R 2 16) and the motive of self-improvement (R-2 = 0.30). This predictor was also associated with reduced concerns of ego-protection (R-2 = 0.14) and impression-defence (R-2 = 0.18). Performance-avoid goal orientation was associated with concerns of impression-defence (R-2 = 0.36) and ego-protection (R-2 = 0.48). Women had significantly more concerns of ego-protection, residents with more than three years of experience more concerns of impression-defence. Disillusion that PG-training would ever improve, seemed the main reason to refuse participation Conclusions: Promotion of feedback-seeking through supervisors combined with delivery of high quality feedback may guide residents towards seeking feedback for professional self-improvement

Psychosocial risk factors for hospital readmission in COPD patients on early discharge services: a cohort study

<p>Abstract</p> <p>Background</p> <p>Hospital readmission for acute exacerbation of COPD (AECOPD) occurs in up to 30% of patients, leading to excess morbidity and poor survival. Physiological risk factors predict readmission, but the impact of modifiable psychosocial risk factors remains uncertain. We aimed to evaluate whether psychosocial risk factors independently predict readmission for AECOPD in patients referred to early discharge services (EDS).</p> <p>Methods</p> <p>This prospective cohort study included 79 patients with AECOPD cared for by nurse led EDS in the UK, and followed up for 12 months. Data on lung function, medical comorbidities, previous hospital admissions, medications, and sociodemographics were collected at baseline; St George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS), and social support were measured at baseline, 3 and 12-months. Exploratory multivariate models were fitted to identify psychosocial factors associated with readmission adjusted for known confounders.</p> <p>Results</p> <p>26 patients were readmitted within 90 days and 60 patients were readmitted at least once during follow-up. Depression at baseline predicted readmission adjusted for sociodemographics and forced expiratory volume in 1 second (odds ratio 1.30, 95% CI 1.06 to 1.60, p = 0.013). Perceived social support was not significantly associated with risk of readmission. Home ownership was associated with the total number of readmissions (<it>B </it>= 0.46, 95% CI -0.86 to -0.06, p = 0.024). Compared with those not readmitted, readmitted patients had worse SGRQ and HADS scores at 12 months.</p> <p>Conclusion</p> <p>Depressive symptoms and socioeconomic status, but not perceived social support, predict risk of readmission and readmission frequency for AECOPD in patients cared for by nurse-led EDS. Future work on reducing demand for unscheduled hospital admissions could include the design and evaluation of interventions aimed at optimising the psychosocial care of AECOPD patients managed at home.</p