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Day Hospital (day + hospital)
Selected AbstractsDon't seize the day hospital!INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005Recent research on the effectiveness of day hospitals for older people with mental health problems Abstract Background Day hospital (DH) care remains a core component of mental health services for older people. However, there has been an ongoing debate about the effectiveness and value for money of DHs in comparison to day centres (DC). Aim The aim was to review the recent research on the effectiveness of day hospitals for older people with mental health problems. Method A systematic search of relevant research literature over the last decade using the major electronic healthcare databases examining the quality and effectiveness of mental health DHs for older people. Results In the last decade the evidence for the effectiveness of DHs has continued to increase, but still lags behind research on DHs in general adult psychiatry and geriatric medicine. The review found that DHs appear effective at assessing and meeting needs and that a systematic approach to evaluating quality can be used to improve services. Conclusion Recent research supports the effectiveness of day hospitals, but further studies are needed in order to provide a more robust evidence base. Copyright © 2005 John Wiley & Sons, Ltd. [source] Day hospital versus inpatient management: An economic initiative of a pediatric center, examplified on uncomplicated vaso-occlusive crises of children with sickle cell diseasePEDIATRIC BLOOD & CANCER, Issue 3 2008Paul Imbach MD No abstract is available for this article. [source] Collaboration, facilities and communities in day care services for older peopleHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2001Sarah Burch BA Abstract Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome measures were the Barthel Index, Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two aspects of the trial are examined here. Firstly, we investigated whether trial patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre. Secondly, key staff from the different settings were interviewed to assess how well the day centre model had worked in practice. Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months of treatment. The day centre model had several problems, principally discharge policy, acceptability, facilities and attitudes of staff and regular attendees. Positive aspects of the day centre model, as well as successful rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of care. [source] Don't seize the day hospital!INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005Recent research on the effectiveness of day hospitals for older people with mental health problems Abstract Background Day hospital (DH) care remains a core component of mental health services for older people. However, there has been an ongoing debate about the effectiveness and value for money of DHs in comparison to day centres (DC). Aim The aim was to review the recent research on the effectiveness of day hospitals for older people with mental health problems. Method A systematic search of relevant research literature over the last decade using the major electronic healthcare databases examining the quality and effectiveness of mental health DHs for older people. Results In the last decade the evidence for the effectiveness of DHs has continued to increase, but still lags behind research on DHs in general adult psychiatry and geriatric medicine. The review found that DHs appear effective at assessing and meeting needs and that a systematic approach to evaluating quality can be used to improve services. Conclusion Recent research supports the effectiveness of day hospitals, but further studies are needed in order to provide a more robust evidence base. Copyright © 2005 John Wiley & Sons, Ltd. [source] Dementia Care Mapping reconsidered: exploring the reliability and validity of the observational toolINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2004A. Thornton Abstract Background Dementia Care Mapping (DCM) is a widely used observational method for evaluating the service quality provided to people with dementia. However, there is little evidence concerning its reliability and validity when used by routine care staff for whom it was designed. Method The study evaluated levels of inter-observer agreement; The ability of the five-minute time frame to reflect the ,actual passing of time'; And the nature of the relationship between individual Well/Ill-Being values (WIB) and dependency levels. Data collected using DCM and continuous time sampling (CTS) were compared. The methods were used in parallel where the CTS coder and the DCM mapper(s) observed the same participants. Observations were carried out with 64 people with dementia within a day hospital and a continuing care ward. Inter-observer agreement was calculated across 20 participants. Dependency levels were measured using the Clifton Assessment Procedure for the Elderly (CAPE) (Pattie and Gilleard, 1979). Results Low levels of inter-observer agreement were found where 11 of the 25 Behaviour Category codes and all six Well/Ill-being Codes produced unacceptable kappas (<0.6). The Behaviour coding frame provided a meaningful picture of activities participants engaged in, but significantly underestimated participant levels of inactivity. A strong relationship was demonstrated between participants' WIB score and levels of dependency, thus DCM was unable to measure well-/ill-being as a separate construct from participants' levels of dependency. Conclusions Questions were raised regarding the reliability and validity of DCM as used by routine care staff. Possible reasons for this, and suggestions for amendments are made. Copyright © 2004 John Wiley & Sons, Ltd. [source] B-Type Natriuretic Peptide Is Associated with Mortality in Older Functionally Impaired PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Miles D. Witham BM Objectives: To determine the predictive power of B-type natriuretic peptide (BNP) regarding death in older, functionally impaired patients with multiple comorbidity. Design: Prospective cohort study. Setting: Specialist geriatric assessment clinic and day hospital. Participants: Two hundred ninety-nine older, functionally impaired patients, mean age 79 at enrollment. Measurements: Full clinical history and examination, baseline BNP, and echocardiography. Date and cause of death were ascertained from Scottish death records. Kaplan-Meier survival curves were constructed for quartiles of log (BNP), and the contribution of BNP to prediction of death was investigated. Results: The follow-up period ranged from 3.9 to 5.2 years (mean 4.4 years). BNP was a powerful independent predictor of all-cause and cardiovascular mortality. BNP was a more powerful predictor than blood pressure, diabetes mellitus, smoking, echocardiographic left ventricular hypertrophy, left ventricular systolic dysfunction, or age. BNP predicted death in those with and without a previous cardiovascular event at baseline. Conclusion: BNP has significant predictive power for death in older, functionally impaired patients. [source] Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional AssessmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Olga H. Torres MD Objectives: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Design: Prospective observational study. Setting: Emergency department and geriatric medical day hospital of a university teaching hospital. Participants: Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Measurements: Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Results: Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94,0.98 and OR=0.97, 95% CI=0.95,0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01,1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16,2.57; P<.01). Conclusion: Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account. [source] Nursing the clinic vs. nursing the patient: nurses' experience of a day hospital chemotherapy serviceJOURNAL OF CLINICAL NURSING, Issue 9 2006Sonja Mcilfatrick PhD Aims and objectives., This study sought to explore the nurses' experience of a day hospital chemotherapy service in an acute general hospital in Northern Ireland and how this compared with their experience of working in an inpatient setting. Background., Despite the many changes taking place in cancer care delivery, little research has been conducted on nurses' experience of working in more acute cancer treatment settings. Research conducted to date has tended to focus on the role of nurses in wards, hospices and palliative care settings. Design., This Heideggerian hermeneutic phenomenological study explored nurses' lived experience of day hospital chemotherapy service. Method., Face-to-face focused in-depth interviews were conducted with the total population of nurses who worked in the day hospital at the time of data collection (n = 10). Data analysis involved a two-staged approach, the analysis of narratives and narrative analysis, based on the work of Polkinghorne (1995). Conclusions., The nurses' viewed their experience of the chemotherapy day hospital as having both positive and negative dimensions. The positive dimensions included an increased sense of autonomy and the challenge of developing new skills, while the negative dimension included a perceived decrease in their caring role: (i),The individual characteristics of the nurse were seen to have a key influence on caring experience; (ii),Role changes led to a perceived dichotomy between their actual and aspired role and their caring and clinical role. Relevance to clinical practice., There is a need to achieve a balance between delivering a clinical role (administering chemotherapy) while maintaining the centrality of the nurse,patient relationship. This can be likened to achieving a balance between ,nursing the clinic' alongside ,nursing the patient'. These findings have implications for the discourse on caring within other outpatient type clinics and discourse on cancer nursing as therapy and the culture of the cancer clinic. [source] A Role for Spiritual Change in the Benefits of 12-Step InvolvementALCOHOLISM, Issue 2007Sarah E. Zemore Background:, Emerging evidence implies a role for spirituality in recovery from substance abuse. The current study examines the hypothesis that spiritual change helps mediate (or explain) effects for involvement in 12-step groups on recovery outcomes among substance-abusing populations. Methods:, Participants (baseline N = 733) received treatment at 1 of 5 day hospital and 7 residential substance abuse treatment programs in California. Assessments included a baseline interview and 1-year follow-up; analyses incorporated regressions informed by Baron and Kenny (1986) and Sobel's (1982) test. To assess spirituality, measures included (1) the Religious Background and Behaviors scale and (2) an item assessing whether or not participants had had a spiritual awakening through their involvement with 12-step groups. Results:, Results confirmed the hypothesis. Increases in 12-step involvement from baseline to follow-up predicted higher odds of total abstinence at follow-up, and this relationship was partially explained by increases in spirituality. Results held in multivariate analyses and regardless of which spirituality measure was analyzed. Conclusions:, The present study provides further evidence that spiritual change contributes to recovery, at least within the context of 12-step involvement. The study also deepens our understanding of how 12-step involvement works. [source] Don't seize the day hospital!INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005Recent research on the effectiveness of day hospitals for older people with mental health problems Abstract Background Day hospital (DH) care remains a core component of mental health services for older people. However, there has been an ongoing debate about the effectiveness and value for money of DHs in comparison to day centres (DC). Aim The aim was to review the recent research on the effectiveness of day hospitals for older people with mental health problems. Method A systematic search of relevant research literature over the last decade using the major electronic healthcare databases examining the quality and effectiveness of mental health DHs for older people. Results In the last decade the evidence for the effectiveness of DHs has continued to increase, but still lags behind research on DHs in general adult psychiatry and geriatric medicine. The review found that DHs appear effective at assessing and meeting needs and that a systematic approach to evaluating quality can be used to improve services. Conclusion Recent research supports the effectiveness of day hospitals, but further studies are needed in order to provide a more robust evidence base. Copyright © 2005 John Wiley & Sons, Ltd. [source] Inter-rater reliability of the Brief Psychiatric Rating Scale and the Groningen Social Disabilities Schedule in a European multi-site randomized controlled trial on the effectiveness of acute psychiatric day hospitalsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2003Dr Matthias Schützwohl Abstract The objectives of this study were to report the inter-rater reliability of the Brief Psychiatric Rating Scale (BPRS 4.0) and the Groningen Social Disabilities Schedule (GSDS-II) as assessed in a randomized controlled trial on the effectiveness of psychiatric day hospitals spanning five sites in countries of Central and Western Europe. Following brief training sessions, videotaped BPRS-interviews and written GSDS-vignettes were rated by clinically experienced researchers from all participating sites. Inter-rater reliability often proved to be poor for items assessing the severity of both psychopathology and social dysfunction, but findings suggest that both instruments allow for the assessment of the presence or absence of specific psychopathological symptoms or social disabilities. Inter-rater reliability at subscale level proved to be good for both instruments. Results indicate that, with a brief training session and proper use of the instruments, psychopathology and social disabilities can be reliably assessed within cross-national research studies. The results are of particular interest given that the need to conduct cross-national multi-site studies including countries with different cultural backgrounds increases. Copyright © 2003 Whurr Publishers Ltd. [source] The cost of hospital-related care of patients with psoriasis in Italy based on the AISP studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2001AF Finzi Abstract The objective of this study was to assess the cost of caring for patients with psoriasis in Italy according to the AISP study (Associazione Italiana Studi Psoriasi or Italian Association for Studies on Psoriasis), involving 104 university and hospital centres and 7992 patients in 1994. The mean yearly cost of care for a single patient was calculated at 905 Euros. Hospitalization accounted for more than four-fifths of the costs, therapy for about one-eighth (systemic therapies were the most expensive) and office visits and day hospitals for the remainder. In our study series less than 20% of patients accounted for more than 90% of the total costs. [source] | ||||||||||