315 research outputs found
Mortality reduction for fever, hyperglycemia, and swallowing nurse-initiated stroke intervention: QASC trial (Quality in Acute Stroke Care) follow-up
No full textAbstract not availableSandy Middleton, Kelly Coughlan, George Mnatzaganian, Nancy Low Choy, Simeon Dale, Asmara Jammali-Blasi, Chris Levi, Jeremy M. Grimshaw, Jeanette Ward, Dominique A. Cadilhac, Patrick McElduff, Janet E. Hiller, Catherine D’Est
Gap in funding for specialist hospitals treating patients with traumatic spinal cord injury under an activity-based funding model in New South Wales, Australia
No full textObjective: The aim of this study was to estimate the difference between treatment costs in acute care settings and the level of funding public hospitals would receive under the activity-based funding model. Methods: Patients aged ≥16 years who had sustained an incident traumatic spinal cord injury (TSCI) between June 2013 and June 2016 in New South Wales were included in the study. Patients were identified from record-linked health data. Costs were estimated using two approaches: (1) using District Network Return (DNR) data; and (2) based on national weighted activity units (NWAU) assigned to activity-based funding activity. The funding gap in acute care treatment costs for TSCI patients was determined as the difference in cost estimates between the two approaches. Results: Over the study period, 534 patients sustained an acute incident TSCI, accounting for 811 acute care hospital separations within index episodes. The total acute care treatment cost was estimated at A29.9 million using the DNR- and NWAU-based methods respectively. The funding gap in total costs was greatest for the specialist spinal cord injury unit (SCIU) colocated with a major trauma service (MTS), at A$4.4 million over the study period. Conclusions: The findings of this study suggest a substantial gap in funding for resource-intensive patients with TSCI in specialist hospitals under current DRG-based funding methods. What is known about the topic?: DRG-based funding methods underestimate the treatment costs at the hospital level for patients with complex resource-intensive needs. This underestimation of true direct costs can lead to under-resourcing of those hospitals providing specialist services. What does this paper add?: This study provides evidence of a difference between true direct costs in acute care settings and the level of funding hospitals would receive if funded according to the National Efficient Price and NWAU for patients with TSCI. The findings provide evidence of a shortfall in the casemix funding to public hospitals under the activity-based funding for resource-intensive care, such as patients with TSCI. Specifically, depending on the classification system, the principal referral hospitals, the SCIU colocated with an MTS and stand-alone SCIU were underfunded, whereas other non-specialist hospitals were overfunded for the acute care treatment of patients with TSCI. What are the implications for practitioners?: Although health care financing mechanisms may vary internationally, the results of this study are applicable to other hospital payment systems based on diagnosis-related groups that describe patients of similar clinical characteristics and resource use. Such evidence is believed to be useful in understanding the adequacy of hospital payments and informing payment reform efforts. These findings may have service redesign policy implications and provide evidence for additional loadings for specialist hospitals treating low-volume, resource-intensive patients
The influence of parental emotional neglect on assault victims seeking treatment for depressed mood and alcohol misuse: A pilot study
No full textThis study explores the relationship between reported parental emotional neglect when a child, assault type experienced, posttraumatic stress symptoms (PTSS), depression, and alcohol consumption in treatment seekers for comorbid depressive symptoms and alcohol misuse. Participants (n = 220) with concurrent depression and alcohol misuse were recruited from the DAISI (Depression and Alcohol Integrated and Single-focussed Interventions) project. Assault type and PTSS were retrospectively assessed by the Posttraumatic Stress Diagnostic Scale. The Measure of Parenting Style is a self-report measure that retrospectively assessed emotional neglect experienced as a child. An exploratory factor analysis using the tetrachoric correlation matrix (applying principal factor extraction with a varimax rotation) identified the two assault factors of sexual assault (SA) and physical assault (PA). A path analysis revealed that Maternal Emotional Neglect increased the impact of PTSS and depression. Paternal Emotional Neglect increased the impact of PA on PTSS and alcohol dependence symptoms. There appears to be differential effects of assault type and Maternal/Paternal emotional neglect on depression and alcohol misuse, suggesting that parenting roles serve distinct protective functions
Dietary pattern transitions, and the associations with BMI, waist circumference, weight and hypertension in a 7-year follow-up among the older Chinese population: a longitudinal study
No full textBackground: Few studies explored the effects of nutritional changes on body mass index (BMI), weight (Wt), waist
circumference (WC) and hypertension, especially for the older Chinese population. Methods: By using China Health and Nutrition Survey 2004-2011 waves, a total of 6348 observations aged ≥ 60
were involved in the study. The number of participants dropped from 2197 in 2004, to 1763 in 2006, 1303 in 2009, and 1085 in 2011. Dietary information was obtained from participants using 24 hour-recall over three consecutive days. Height, Wt, WC, systolic and diastolic blood pressure were also measured in each survey year. The dietary pattern was derived by exploratory factor analysis using principal component analysis methods. Linear Mixed Models were used to investigate associations of dietary patterns with BMI, Wt and WC. Generalized Estimating
Equation models were used to assess the associations between dietary patterns and hypertension. Results: Over time, older people’s diets were shifting towards a modern dietary pattern (high intake of dairy, fruit,
cakes and fast food). Traditional and modern dietary patterns had distinct associations with BMI, Wt and WC. Participants with a diet in the highest quartile for traditional composition had a β (difference in mean) of −0.23 (95 % CI: −0.44; −0. 02) for BMI decrease, β of −0.90 (95 % CI: −1.42; −0.37) for Wt decrease; and β of −1.57 (95 % CI: −2.32; −0.83) for WC
decrease. However, participants with a diet in the highest quartile for modern diet had a β of 0.29 (95 % CI: 0.12; 0.47) for BMI increase; β of 1.02 (95 % CI: 0.58; 1.46) for Wt increase; and β of 1.44 (95 % CI: 0.78; 2.10) for Wt increase. No significant associations were found between dietary patterns and hypertension. Conclusions: We elucidate the associations between dietary pattern and change in BMI, Wt, WC and hypertension in a 7-year follow-up study. The strong association between favourable body composition and traditional diet, compared with an increase in BMI, WC and Wt with modern diet suggests that there is an urgent need to develop age-specific dietary guideline for older Chinese people.Xiaoyue Xu, Julie Byles, Zumin Shi, Patrick McElduff and John Hal
Diagnosis and disclosure of a memory problem is associated with quality of life in community based older Australians with dementia
No full textBACKGROUND: Identification of factors associated with quality of life (QoL) in people having dementia will help develop strategies for maintenance and improvement of patient QoL. This study examined the predictors of QoL in a community-dwelling population aged 75 years and over, with or without dementia. METHODS: This was a cross-sectional study involving 169 GPs and 2,028 patients. Patients were interviewed to collect information on personal circumstances. Several instruments were administered including the WHOQOL-BREF (quality of life outcome measure), Geriatric Depression Scale, GPAQ (satisfaction with GP care), and the CAMCOG-R (cognitive function). Patients with a CAMCOG-R score < 80 were allocated to the dementia group. GPs provided an independent clinical judgment of cognitive function for each of their participating patients. RESULTS: The dementia group had significantly lower QoL scores in all four domains of the WHOQOL-BREF (all p ≤ 0.002). The GDS score was negatively correlated with all four domains in the non-dementia group and with physical, psychological, and environmental QoL in the dementia group (all p < 0.001). Satisfaction with GP communication was positively associated with psychological QoL in the dementia group and all domains in the non-dementia group. Participants in the dementia group who had been given a diagnosis of a memory problem had significantly higher physical (2.05, 95% CI 0.36 to 3.74) and environmental (2.18, 95% CI 0.72 to 3.64) QoL. CONCLUSIONS: Satisfaction with GP communication is associated with a higher QoL in their older patients. Diagnosis and disclosure of memory problems is associated with better QoL in people with dementia. Clinicians should not be deterred from discussing a memory diagnosis and plans for the future with patients.Karen E. Mate, Constance D. Pond, Parker J. Magin, Susan M. Goode, Patrick McElduff and Nigel P. Stock
Self-blood-pressure monitoring - A questionnaire study: Response, requirement, training, support-group popularity and recommendations
No full textThe objective of this study was to survey hypertensive patients' response to, requirement for and training in self-blood pressure monitoring (SBPM). A total of 222 hypertensive were invited to complete a questionnaire even when not participating in the project. Questions supplied information on demographics, monitoring frequency, convenience of attending the surgery, monitor ownership and preference for and ease of self-monitoring. Comments supplied qualitative data. Training group questionnaires supplied similar data as well as SBPM data before and after training. Of 133 respondents, a higher educated, younger, wider age range wanted to participate (76; 57.2%) and tended to self-monitor. However, only an increase in further education (FE) was associated with an increased probability of participation and inclination to self-monitor in the multivariate analyses. A positive relationship exists between age and frequency in both groups. About a sixth of respondents own monitors and ownership is correlated to FE. Although most patients found it convenient to visit the surgery, the percentage finding it convenient was lower in patients attending training sessions than in the original survey, possibly indicating that independence is important for SBPM. Younger, higher-educated patients tended to self-monitor although FE was again the significant factor. Training increased preference for the idea of SBPM, prospective monitor ownership (64.8% of non-owners) and self-monitoring intention (76.1%). Patients found recording card listed cardiovascular disease (CVD) risks valuable and 69.6% (32) wanted to establish a support group. Comments and interviews indicated haphazard knowledge, routines and uncertainty about SBPM. A standardised procedure including patient assessment, SBPM protocol and lifestyle education is needed for SBPM to be successful
Case fatality after an acute cardiac event: the effect of smoking and alcohol consumption
No full textThe objective of this study was to use a population-based register of acute cardiac events to investigate the association between survival after an acute event and history of smoking and alcohol consumption. The population was all residents of the Lower Hunter Region of Australia aged 25 to 69 years who suffered myocardial infarction or sudden cardiac death between 1986 and 1994. Among 10,170 events, 2504 resulted in death within 28 days. After adjusting for sex, age and medical history, current smokers had a similar risk of dying after an acute cardiac event to never-smokers [odds ratio (OR)=1.10, 95% confidence interval (CI) 0.94-1.29]. People who consumed more than 8 alcoholic drinks per day on more than 2 days per week (OR=1.93, 95% CI 1.39-2.69) and former moderate to heavy drinkers (OR=4.59, 95% CI 3.65-5.76) were more likely to die than people who were nondrinkers. The results of this large community study, suggesting no effect of smoking on case fatality and an increased risk of death after an acute cardiac event for heavy drinkers and former moderate to heavy drinkers, highlight the importance of a population view of case fatality. These results can also shed some light on reasons for the paradoxical results from clinical trials. (C) 2001 Elsevier Science Inc. All rights reserved
Brill's companion to the reception of Senecan tragedy scholarly, theatrical and literary receptions
No full text"In Brill's Companion to the Reception of Senecan Tragedy, Eric Dodson-Robinson incorporates essays by specialists working across disciplines and national literatures into a subtle narrative tracing the diverse scholarly, literary and theatrical receptions of Seneca's tragedies. The tragedies, influential throughout the Roman world well beyond Seneca's time, plunge into obscurity in Late Antiquity and nearly disappear during the Middle Ages. Profound consequences follow from the rediscovery of a dusty manuscript containing nine plays attributed to Seneca: it is seminal to both the renaissance of tragedy and the birth of Humanism. Canonical Western writers from Antiquity to the present have revisited, transformed, and eviscerated Senecan precedents to develop, in Dodson-Robinson's words, "competing tragic visions of agency and the human place in the universe." Contributors are: Florence de Caigny, Francesco Citti, Peter J. Davis, Eric Dodson-Robinson, Patrick Gray, Joachim Harst, Siobhán McElduff, Tomàs Martínez Romero, Ralf Remshardt, Helen Slaney, Christopher Star, Christopher Trinacty, and Jessica Winston"-
The Views of Carers of Adults with Intellectual Disabilities on Annual Health Checks - Final Report
No full textThis report presents data from a survey of carers about Annual Health Checks for people with learning/intellectual disabilities.
The main aims of this study were to discover what factors cause the low uptake of Annual Health Checks (AHCs) by people with learning disabilities. For those who have had AHCs they explored the level of carers' satisfaction with these.
This report presents data from a survey of carers. There is quantitative data from answers to standardized survey questions and qualitative data was also collected about carers' opinions and experiences.
Findings identify, people with ID were more likely to have an AHC if cared for by a paid carer rather than by the family. The number of people with ID attending and being invited for an AHC needs to be increased. Increased training, awareness, advertising, correspondence and
coordination of and between healthcare professionals, carer organisations and social services is necessary. A transformation from reactive responses to health change and health decline to a proactive approach with health checking and health protection and promotion needs to happen
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