Are family physician visits and continuity of care associated with acute care use at end-of-life? A population-based cohort study of homecare cancer patients

Background: Previous end-of-life cancer research has shown an association between increased family physician continuity of care and reduced use of acute care services; however, it did not focus on a homecare population or control for homecare nursing.

Aim: Among end-of-life homecare cancer patients, to investigate the association of family physician continuity with location of death and hospital and emergency department visits in the last 2 weeks of life while controlling for nursing hours.

Design: Retrospective population-based cohort study.

Setting/participants: Cancer patients with ≥1 family physician visit in 2006 from Ontario, Canada. Family physician continuity of care was assessed using two measures: Modified Usual Provider of Care score and visits/week. Its association with location of death and hospital and emergency department visits in the last 2 weeks of life was examined using logistic regression.

Results: Of 9467 patients identified, the Modified Usual Provider of Care score demonstrated a dose-response relationship with increasing continuity associated with decreased odds of hospital death and visiting the hospital and emergency department in the last 2 weeks of life. More family physician visits/week were associated with lower odds of an emergency department visit in the last 2 weeks of life and hospital death, except for patients with greater than 4 visits/week, where they had increased odds of hospitalizations and hospital deaths.

Conclusions: These results demonstrate an association between increased family physician continuity of care and decreased odds of several acute care outcomes in late life, controlling for homecare nursing and other covariates.©The Author(s) 2013 Reprints and permissions sagepub.co.uk/journalsPermissions.nav.

'Back into the american continuity of crust and mantle'': da cidade inscrita à cidade em escrita

No contexto norte-americano, falar da noção de cidade implica olhar para além das complexas redes sociais, económicas, políticas e culturais que se interligam em espaços mais ou menos urbanizados. É necessário considerar o facto de que na América a cidade assenta no princípio da Cidade erguida na Colina e esta dimensão mítica e simbólica que inspira os colonos recém-chegados a Nova Inglaterra é perpetuada nas gerações seguintes, refletindo-se igualmente no panorama literário norte-americano.

Continuity of care for people with psychotic illness: its relationship to clinical and social functioning.

Background: The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims: To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. Methods: The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Results: Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Conclusion: Continuity is a dynamic process, influenced significantly by care structures and organizational change.

Continuity of care for carers of people with severe mental illness: results of a longitudinal study

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer’s assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer’s assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user’s immediate family, lived with them and had had a carer’s assessment. Conclusion: The vast majority of the carers had not had a carer’s assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers’ reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.

A non-autonomous strongly damped wave equation: Existence and continuity of the pullback attractor

In this paper we consider the strongly damped wave equation with time-dependent terms u(tt) - Delta u - gamma(t)Delta u(t) + beta(epsilon)(t)u(t) = f(u), in a bounded domain Omega subset of R(n), under some restrictions on beta(epsilon)(t), gamma(t) and growth restrictions on the nonlinear term f. The function beta(epsilon)(t) depends on a parameter epsilon, beta(epsilon)(t) -> 0. We will prove, under suitable assumptions, local and global well-posedness (using the uniform sectorial operators theory), the existence and regularity of pullback attractors {A(epsilon)(t) : t is an element of R}, uniform bounds for these pullback attractors, characterization of these pullback attractors and their upper and lower semicontinuity at epsilon = 0. (C) 2010 Elsevier Ltd. All rights reserved.

On the continuity of pullback attractors for evolution processes

In this paper we give general results on the continuity of pullback attractors for nonlinear evolution processes. We then revisit results of [D. Li, P.E. Kloeden, Equi-attraction and the continuous dependence of pullback attractors on parameters, Stoch. Dyn. 4 (3) (2004) 373-384] which show that, under certain conditions, continuity is equivalent to uniformity of attraction over a range of parameters (""equi-attraction""): we are able to simplify their proofs and weaken the conditions required for this equivalence to hold. Generalizing a classical autonomous result [A.V. Babin, M.I. Vishik, Attractors of Evolution Equations, North Holland, Amsterdam, 1992] we give bounds on the rate of convergence of attractors when the family is uniformly exponentially attracting. To apply these results in a more concrete situation we show that a non-autonomous regular perturbation of a gradient-like system produces a family of pullback attractors that are uniformly exponentially attracting: these attractors are therefore continuous, and we can give an explicit bound on the distance between members of this family. (C) 2009 Elsevier Ltd. All rights reserved.

Continuity of the dynamics in a localized large diffusion problem with nonlinear boundary conditions

This paper is concerned with singular perturbations in parabolic problems subjected to nonlinear Neumann boundary conditions. We consider the case for which the diffusion coefficient blows up in a subregion Omega(0) which is interior to the physical domain Omega subset of R(n). We prove, under natural assumptions, that the associated attractors behave continuously as the diffusion coefficient blows up locally uniformly in Omega(0) and converges uniformly to a continuous and positive function in Omega(1) = (Omega) over bar\Omega(0). (C) 2009 Elsevier Inc. All rights reserved.

Dynamics in dumbbell domains III. Continuity of attractors

In this paper we conclude the analysis started in [J.M. Arrieta, AN Carvalho, G. Lozada-Cruz, Dynamics in dumbbell domains I. Continuity of the set of equilibria, J. Differential Equations 231 (2006) 551-597] and continued in [J.M. Arrieta, AN Carvalho, G. Lozada-Cruz, Dynamics in dumbbell domains II. The limiting problem, J. Differential Equations 247 (1) (2009) 174-202 (this issue)] concerning the behavior of the asymptotic dynamics of a dissipative reaction-diffusion equation in a dumbbell domain as the channel shrinks to a line segment. In [J.M. Arrieta, AN Carvalho. G. Lozada-Cruz, Dynamics in dumbbell domains I. Continuity of the set of equilibria, J. Differential Equations 231 (2006) 551-597], we have established an appropriate functional analytic framework to address this problem and we have shown the continuity of the set of equilibria. In [J.M. Arrieta, AN Carvalho, G. Lozada-Cruz. Dynamics in dumbbell domains II. The limiting problem, J. Differential Equations 247 (1) (2009) 174-202 (this issue)], we have analyzed the behavior of the limiting problem. In this paper we show that the attractors are Upper semicontinuous and, moreover, if all equilibria of the limiting problem are hyperbolic, then they are lower semicontinuous and therefore, continuous. The continuity is obtained in L(p) and H(1) norms. (C) 2008 Elsevier Inc. All rights reserved.

Continuity of attractors for parabolic problems with localized large diffusion

In this paper we study the continuity of asymptotics of semilinear parabolic problems of the form u(t) - div(p(x)del u) + lambda u =f(u) in a bounded smooth domain ohm subset of R `` with Dirichlet boundary conditions when the diffusion coefficient p becomes large in a subregion ohm(0) which is interior to the physical domain ohm. We prove, under suitable assumptions, that the family of attractors behave upper and lower semicontinuously as the diffusion blows up in ohm(0). (c) 2006 Elsevier Ltd. All rights reserved.

The CATH Hierarchy Revisited-Structural Divergence in Domain Superfamilies and the Continuity of Fold Space

This paper explores the structural continuum in CATH and the extent to which superfamilies adopt distinct folds. Although most superfamilies are structurally conserved, in some of the most highly populated superfamilies (4% of all superfamilies) there is considerable structural divergence. While relatives share a similar fold in the evolutionary conserved core, diverse elaborations to this core can result in significant differences in the global structures. Applying similar protocols to examine the extent to which structural overlaps occur between different fold groups, it appears this effect is confined to just a few architectures and is largely due to small, recurring super-secondary motifs (e.g., alpha beta-motifs, alpha-hairpins). Although 24% of superfamilies overlap with superfamilies having different folds, only 14% of nonredundant structures in CATH are involved in overlaps. Nevertheless, the existence of these overlaps suggests that, in some regions of structure space, the fold universe should be seen as more continuous.

CONTINUITY OF GLOBAL ATTRACTORS FOR A CLASS OF NON LOCAL EVOLUTION EQUATIONS

In this work we prove that the global attractors for the flow of the equation partial derivative m(r, t)/partial derivative t = -m(r, t) + g(beta J * m(r, t) + beta h), h, beta >= 0, are continuous with respect to the parameters h and beta if one assumes a property implying normal hyperbolicity for its (families of) equilibria.

Uniform exponential dichotomy and continuity of attractors for singularly perturbed damped wave equations

For eta >= 0, we consider a family of damped wave equations u(u) + eta Lambda 1/2u(t) + au(t) + Lambda u = f(u), t > 0, x is an element of Omega subset of R-N, where -Lambda denotes the Laplacian with zero Dirichlet boundary condition in L-2(Omega). For a dissipative nonlinearity f satisfying a suitable growth restrictions these equations define on the phase space H-0(1)(Omega) x L-2(Omega) semigroups {T-eta(t) : t >= 0} which have global attractors A(eta) eta >= 0. We show that the family {A(eta)}(eta >= 0), behaves upper and lower semi-continuously as the parameter eta tends to 0(+).

Dynamics in dumbbell domains I. Continuity of the set of equilibria

We analyze the dynamics of a reaction-diffusion equation with homogeneous Neumann boundary conditions in a dumbbell domain. We provide an appropriate functional setting to treat this problem and, as a first step, we show in this paper the continuity of the set of equilibria and of its linear unstable manifolds. (c) 2006 Elsevier B.V. All rights reserved.