The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.

Aggressive hospital discharge policies adopted in the 1990s led to an influx of patients recovering from acute illness accessing post-acute home care services. Performance of the post-acute home care program in the Saskatoon Health Region was examined using formative program evaluation methods. Brief surveys of clients and nurse providers captured: care objectives and service outcomes; patient-centeredness; trust in providers; health improvement/decline; emotional/social functioning; functional status; injury avoidance; and overall quality. For clients, perceptions of quality were significantly affected by patient centeredness and experiencing unexpected health complications, which accounted for 83.0% of the variation. For nurse providers, overall quality of care was significantly related to patient centeredness, service outcomes, team communication and injury avoidance. Analysis revealed for clients with complex needs, the service period could be extended from 60 to 97 days which would cover 50.0% of clients. The research examining administrative data predicted the dependent variable Log of Total Care Hours (TCH) to enable analysis using General Linear Modelling. The results showed post-acute home care clients referred from Emergency Departments received approximately 84.2 % more TCH; post-acute home care clients referred from Surgical wards received approximately 42.1% more TCH; and post-acute home care clients referred from Cardiology received approximately 66.3% more TCH than clients referred from the community. Furthermore, single clients received more TCH than married clients. Nursing chart reviews of post-acute home care clients with wound care also predicted the Log of TCH to enable analysis using General Linear Modelling. Post-admission, 11.3% of post-acute home care clients receiving wound care displayed clinical signs and symptoms of emerging infection, while 19.7% displayed clinical signs and symptoms of acquired infection. Post-acute home care clients receiving wound care experiencing injury, trauma or harm while admitted to home care received approximately 53.3% TCH; and post-acute home care clients who acquired an infection after admission received approximately 70.2% TCH. The implications of this research suggest there is room to improve post-acute home care services to address client re-hospitalisation, unexpected health symptoms/complications, and wound care.

Independent from initial severity, many patients develop persistent symptoms after infection with SARS-CoV-2, described as long COVID syndrome. Most of these patients are treated by general practitioners (GPs). As evidence-based treatment recommendations are still sparse, GPs must make their therapy decisions under uncertainty. We investigated (1) the most frequently observed long COVID symptoms in general practices and (2) GPs' applied treatment and rehabilitation plans for these symptoms. In total, 143 German GPs participated in an online-based survey between 05/2021 and 07/2021. We found that each GP practice was treating on average 12 patients with long COVID symptoms. Most frequently seen symptoms were fatigue and reduced performance. Current therapy options were rated as poor and loss of smell and taste, fatigue, or lack of concentration were perceived to be especially difficult to treat. The use of drug and non-drug therapies and specialist referrals focused primarily on physiological and less on psychosomatic/psychological rehabilitation and followed guidelines of similar conditions. Our results provide first insights into how GPs approach a newly emerging condition in the absence of guidelines, evidence-based recommendations, or approved therapies, and might inform about GP preparedness in future pandemics. Our results also emphasize a gap between the current knowledge of the long COVID manifestation and knowledge about effective rehabilitation.

Background: Post COVID-19 Condition (PCC, also known as long COVID and post-acute sequelae of COVID-19) is a major public health concern with severe and pervasive impacts on physical and mental health. PCC is highly heterogeneous and may manifest as different clusters of symptoms of varying intensity and duration. The etiology of PCC remains uncertain, though several underlying pathophysiological mechanisms, such as cellular damage, inflammatory cytokines, and a hypercoagulable state, are thought to contribute to PCC inception and trajectory. Examination of potential serological markers of PCC, accounting for clinical covariates, may yield emergent pathophysiological insights. Objectives: Primary objectives of this thesis are to 1) Identify key clinical and potential serological predictors of PCC; 2) Acquire clinical and serological data in a large-scale prospective observational study; 3) Assess relationships between PCC and serological markers, accounting for clinical covariates; 4) Systematically review evidence to date on primary observational studies comparing serological response between people with and without persistent symptoms post COVID-19 recovery; 5) Discuss persisting gaps in knowledge and data quality, and propose strategies for resolve. Methods: This thesis is framed around three core efforts: 1) The design of survey questions and study materials, recruitment of participants, and data collection in a large-scale prospective cohort study launched in 2020; 2) The assessment of relationships between pre-defined serological predictors and PCC, accounting for clinical covariates; and 3) A robust rapid review of PCC onset and phenotype as functions of serological markers. Expert opinion was sought to define serological predictors. Clinical predictors were defined a priori based on systematic reviews meeting AMSTAR 2 guidelines. Conclusions: To address objectives, we described efforts to collect clinical and serological data from a large-scale prospective cohort study; identify PCC-cases and infected-controls; assess associations between pre-defined serological predictors (IgG titres targeting SARS-CoV-2 spike (S), nucleocapsid (N), and receiver binding domain (RBD) antigens, and efficient neutralization) and PCC; and synthesized findings from an extensive rapid review on PCC as a function of serological markers. Our multivariate analysis using Stop the Spread Ottawa data is, to our knowledge, the first Canadian study to report the direction and magnitude of association between selected serological predictors (anti-IgG response to S, N, and RBD SARS-CoV-2 antigens, and neutralizing efficiency) and PCC status and impact on quality of life. Finally, we described five potential strategies which may improve the accessibility, quality, and amalgamation of data pertaining to PCC: 1) Fostering comparability between studies to enable synthesis of multiple datasets; 2) Advancing the characterization and consensus on PCC phenotypes; 3) Employing innovative modelling strategies that could potentially yield novel insights; 4) Promoting robust collaboration and knowledge sharing among research teams; and 5) Engaging people with lived experience at all stages of research.

Annotation: The purpose of this Master's thesis is to describe objectively topic of medical social workers' communication in centers of post-acute care, to highlight importance and difficulty of social work with senior citizens and to propose eventual changes leading to eventual communication improvement. Social work here is complicated because senior citizens are often lonely or may have problematic family relationships or may suffer from dementia and quite often are polymorbid patients. For the thesis were used statistics from The Centre of Postacute Care - Motol University Hospital, then method of questionnaire realized with medical social workers from centers of post-acute care in Czech Republic, and method of structured interview with patients in Center of Postacute Care - Motol University Hospital.

Le traumatisme craniocérébral léger (TCCL) s'accompagne d'une constellation de symptômes de nature variée, appelés symptômes post-commotionnels (SPC). La majorité des patients se rétablissent complètement et rapidement, à savoir dans le mois qui suit l'accident. Cependant, 10 à 20 % d'entre eux présentent un rétablissement prolongé avec des SPC persistants (SPCP), lesquels entravent la qualité de vie, l'intégration à la communauté et le retour aux activités. Pour la minorité de patients présentant des SPCP, il est donc nécessaire d'intervenir au-delà de la psychoéducation préventive aiguë recommandée par les guides de pratique. Or, il existe très peu d'interventions visant spécifiquement à outiller ces patients afin de diminuer les SPC et ainsi, accélérer le rétablissement. En effet, à l’heure actuelle, les interventions psychologiques et psychoéducatives développées spécifiquement pour la phase post-aiguë, qui prend place entre les phases aiguë (0-1 mois après le TCCL) et chronique (> 6 mois post-accident), sont particulièrement rares. Les quelques études existantes plaident en faveur d'une approche brève de quelques séances de psychoéducation et/ou de soutien. Cependant, il s'agit de données préliminaires et de nombreuses inconnues subsistent encore quant au format idéal (ex. : en personne vs par téléphone, individuel vs en groupe, nombre de séances, contenu précis). En outre, la pauvre qualité méthodologique des études complique significativement les interprétations possibles à ce sujet (ex. : absence de groupe contrôle, groupes non randomisés). L'objectif principal de cette thèse était donc de développer une nouvelle intervention de psychoéducation et de soutien destinée aux personnes en phase post-aiguë du rétablissement post-TCCL, et d’explorer sa faisabilité ainsi que son efficacité. L'objectif du premier article de la thèse (Chapitre 2) était de remédier à la pauvreté de la littérature en ce qui a trait, d'une part, à la description des protocoles d'intervention de psychoéducation et, d'autre part, relativement à leurs assises théoriques. Il avait donc pour objectif de présenter la démarche théorique et méthodologique associée au développement de l'intervention SAAM, un programme de quatre séances d'intervention individuelles d’une heure, données en personne, et visant chacune un type de SPC fréquent en phase post-aiguë : Sommeil/fatigue, Attention, Anxiété/humeur, Mémoire/organisation. Le programme offre de l'information au patient, le rassure sur son rétablissement et l'accompagne vers un retour graduel aux activités, en l'outillant à cet effet. Cette approche est ancrée dans un modèle théorique intégratif de persistance des symptômes (Hou et al., 2012), dont les composantes sont expliquées dans l'article. Celui-ci permet non seulement de mieux saisir les fondements théoriques associés à la création du nouvel outil d'intervention, mais en dévoile également son contenu. Il met donc en lumière une démarche qui s'inscrit parfaitement dans un effort de clarification et de transparence, essentiel au progrès de la recherche interventionnelle. Plus largement, ce travail permettra de faciliter la réplication scientifique et de soutenir le transfert de connaissances vers les milieux cliniques. Le deuxième article de la thèse (Chapitre 3) avait pour objectif d'estimer la faisabilité et d’explorer l'effet de l'intervention SAAM auprès de patients symptomatiques en phase post-aiguë de leur rétablissement. Une étude pilote d’essai contrôlé randomisé à deux groupes parallèles (expérimental, n = 13 et liste d'attente, n = 12) a permis de démontrer la faisabilité et la tolérance à l’intervention SAAM. Les données préliminaires suggèrent un effet de l’intervention sur la diminution des SPC en général. En ce qui a trait plus directement aux SPC visés par l'intervention SAAM, une amélioration des plaintes reliées aux symptômes dépressifs, à la fatigue et à la perception de la qualité du sommeil a été mise en évidence à la suite de l'intervention. Cependant, l’étude n'a pas montré d’effet bénéfique du programme SAAM en termes de plaintes somatiques ni de performance cognitive (attention, mémoire). De plus, aucun effet n'a été observé sur le plan de l'intégration à la communauté. Des analyses supplémentaires (Chapitre 4) suggèrent que l'intervention SAAM pourrait restaurer le besoin de compétence, un besoin psychologique fondamental intimement relié au bien-être des individus. Enfin, des analyses supplémentaires portant sur un questionnaire de satisfaction face à l'intervention confirment un haut taux de satisfaction des participants face à l'intervention, ce qui est de bon augure pour l'implémentation en milieux cliniques. Par son aspect novateur, son format standardisé bref et facilement accessible, ainsi que ses effets objectivés sur plusieurs SPCP particulièrement invalidants à la suite du TCCL, le programme d'intervention SAAM est prometteur. La portée clinique de cette thèse est donc particulièrement importante et est discutée, avec ses limites et les avenues de recherche futures, dans le dernier chapitre. Ces résultats soulignent l'importance de poursuivre la recherche dans le champ des interventions post-TCCL, afin d’outiller les cliniciens et d’offrir les meilleurs soins possibles aux patients ayant subi un TCCL. / Mild traumatic brain injury (mTBI) is accompanied by a constellation of manifestations known as post-concussive symptoms (PCS). The majority of patients recover completely and promptly, i.e. within one month of injury. However, 10-20 % experience prolonged recovery with persistent PCS (PPCS), which impact quality of life, community integration and resumption of activities. For the minority of patients who present PPCS, it is necessary to provide them with resources beyond the acute preventive psychoeducation recommended by practice guidelines. However, there are very few interventions available to reduce PCS and thus enhance recovery. To date, psychological and psychoeducational interventions developed specifically for the post-acute phase, which takes place between the acute (0-1 month after mTBI) and the chronic phase (> 6 months post-injury), are particularly rare. The scarce existing evidence suggests that the optimal intervention should be brief, including a few sessions of psychoeducation and/or counseling. Nevertheless, these are preliminary data and many open questions remain regarding the optimal format (e.g., in person vs. on the phone, individual vs. group, number of sessions, specific content). Moreover, the poor methodological quality of previous intervention studies significantly complicate interpretations (e.g., absence of control groups, non-randomized groups). The main objective of this thesis was therefore to develop and explore the feasibility and treatment effect of a novel psychoeducational and counseling intervention program for the post-acute phase after mTBI. The objective of the first article of the thesis (Chapter 2) was to overcome the paucity of work describing psychoeducational intervention protocols and their theoretical underpinnings. The article therefore aimed to present the theoretical and methodological approach associated with the development of the SAAM intervention. SAAM is a program including four 1-hour individual intervention sessions given in person, each targeting a type of common PCS in the post-acute phase: Sleep/fatigue, Attention, Anxiety/mood, Memory/organization. It informs the patient, provides reassurance about recovery, and supports the gradual resumption of activities by giving the patient the tools to do so. This approach is anchored in an integrative theoretical model of symptom persistence (Hou et al., 2012), the components of which are explained in the article. The latter provides a better understanding of the theoretical rationale behind the development of the SAAM intervention, and includes a detailed description of the protocol. The article is meant to align with efforts to clarify the theoretical underpinnings of the intervention program and enhance transparency in scientific reporting, an essential step in the advancement of interventional research. More broadly, this work will facilitate scientific replication and knowledge transfer in clinical settings. The second article (Chapter 3) aimed to estimate feasibility and explore the treatment effect of the SAAM intervention in symptomatic patients during the post-acute phase. A pilot randomized controlled trial with two parallel groups (experimental, n = 13 and wait list, n = 12) demonstrated the feasibility and tolerability of the intervention. Preliminary data suggest an effect of the intervention in reducing overall PCS. More specifically, regarding the PCS targeted by the SAAM intervention, an improvement in complaints related to depressive symptoms, fatigue, and sleep quality perception was observed post-intervention. However, the intervention failed to show a positive effect in addressing anxiety or somatic complaints, nor was it significantly impactful in improving cognitive performance (attention, memory). No effect was observed in terms of community integration either. Nonetheless, additional analyses (Chapter 4) suggest that SAAM intervention might restore the need for competence, a basic psychological need closely related to the individual's well-being. Finally, additional analyses pertaining to an intervention satisfaction questionnaire confirm that participants report a high level of satisfaction with the intervention, which bodes well for clinical implementation. The SAAM intervention holds promise because of its innovative aspect, its brief and easily accessible standardized format, and its demonstrated effects on several disabling PCS. The clinical significance of this thesis is notable and is discussed, along with study limitations and future avenues of research, in the final chapter. This work emphasizes the importance of pursuing research efforts in the field of post-mTBI interventions, in order to provide clinicians with the tools they need to offer the best possible care to patients who have sustained mTBI.

[pt] Prejuízos cognitivos persistentes foram descritos em pacientes pós-COVID-19 independentemente da severidade da infecção, indicando que mesmo pacientes com infecção de grau leve ou moderado podem apresentar complicações cognitivas contínuas. Estratégias não-farmacológicas para reabilitação cognitiva ainda não foram revisadas de maneira sistemática neste grupo de pacientes. Dessa forma, o objetivo do presente estudo foi sistematicamente identificar, resumir e avaliar estudos de intervenção não-farmacológica avaliando desfechos cognitivos em pacientes com prejuízos neuropsicológicos persistentes após casos de COVID-19. Uma busca sistemática por artigos foi conduzida no dia primeiro de Julho de 2022. No total, 833 artigos foram identificados, dos quais 13 estudos foram incluídos na revisão final. Dentre esses, 7 eram estudos de grupo e 6 estudos de caso de sujeito único. Os estudos de grupo incluíram entre 12 e 50 participantes, e 2 destes também incluíram grupos controle. A maior parte dos estudos (11/13) testou a efetividade de intervenções multimodais de reabilitação, em geral combinando exercícios físicos com estimulação cognitiva. Dentre outros protocolos, reabilitação respiratória, ocupacional, psicossocial e fonoaudiológica também foram investigados. Com exceção de dois artigos, todos estudos descreveram resultados positivos após os processos de intervenção, incluindo aumento em escores de testes neuropsicológicos, redução em percepção de fadiga cognitiva e aumento de funcionalidade em atividades da vida diária. No entanto, as diversas limitações da presente literatura indicam que tais resultados devem ser interpretados com cautela. / [en] Persistent cognitive impairment has been described in people after COVID-19 irrespective of infection severity, indicating that patients with mild to moderate infection may also experience persevering cognitive problems. Non-pharmacological strategies for cognitive rehabilitation and their outcomes in this group have so far not been systematically summarized. Therefore, the aim of this study was to systematically identify, summarize, and appraise non-pharmacological rehabilitation intervention studies assessing neuropsychological outcomes in people with cognitive impairment after COVID-19. On July 1st, 2022, a systematic search was conducted using PubMed, Web of Science, PsycNET, and CENTRAL. In total, 833 papers were retrieved, of which 13 were included. Among those, 7 were group studies and 6 were single-subject case reports. The group studies included between 12 and 50 participants, of which two studies also included a control group. Most of the studies (11/13) tested multimodal interventions, mainly combining physical exercise with cognitive stimulation. Respiratory rehabilitation, occupational and speech-language therapy, EEG neurofeedback, tDCS, and psychosocial interventions were also investigated. With the exception of two, all studies described positive post-intervention results, including increased cognitive performance, reduced cognitive fatigue, and improved physical functionality. However, limitations of the current literature suggest that results should be considered carefully.

Two years after the first recorded outbreak of Covid-19 its long-term effects are still not completely understood. An unknown proportion of all covid patients go on to develop post-acute covid syndrome and suffer long-term symptoms and health effects long after the initial infection subsides. Project Crowdsourcing Långtidscovid-Sverige sent out in summer of 2021 an open online survey and gathered respondents through crowdsourcing to gather info about people in Sweden with prolonged health effects lasting at least three months after confirmed or suspected Covid-19 infection. In this thesis an explorative analysis of the aforementioned survey is conducted with its initial focus placed onthe progression of symptoms. Descriptive statistics are provided for the survey sample; hierarchical clusteringon principal components is performed; and association rule mining as well as sequence rule mining is used toextract frequently co-occurring symptoms. Women stand for 85.2% of all respondents, possibly indicating a skewed gender distribution in the sample. The average age of a respondent is 50 years old, but ranges between 18 and 80 years of age. The number of reported symptoms tend to diminish over time and symptoms within the 'air passages' category diminish on average quicker than other categories. Hierarchical clustering with Ward’s criterion revealed 4 clusters with an average silhouette coefficient of 0.246. The resulting clusters are not well-separated from each other and have some overlap in their bordering regions, and should therefore be interpreted with caution. Broadly speaking, individuals from cluster 1, 3 and 4 are distinguished primarily by their total number of symptoms reported, meanwhile cluster 2 is characterized by individuals that experience many symptoms early on and fewer symptoms later on. The most prevalent symptom over the entire period is fatigue (90.2%), closely followed by worsening symptomsafter physical activity (87.1%), problems with concentration (82.3%), headaches (79.5%), and brain fog (77.9%). There are several strong associations between various symptoms, especially for symptoms within the same category. Most symptoms have a sequential correlation with themselves and have an increased tendency to occur several times.

No description available.