Emergency department-based home care

STUDY OBJECTIVE: To assess the feasibility of coordinating home care services from an inner-city emergency department. INTERVENTION: In a preintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who arranged and managed rapidly deployed home care services then was assigned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status. SETTING: Teaching hospital serving a large indigent population. PARTICIPANTS: Adult patients about to be discharged home from the ED. MAIN RESULTS: Forty-five of 650 (7%) surveyed patients were not receiving home care services for which they were eligible. In the subsequent eight-month period, 670 patients were referred for home care on discharge from the ED (2% of all discharges). Seventy-six percent of these patients were women, and the average age was 73.5 years. Four hundred fifty patients (67%) received visits from home care providers managed by the ED coordinator. For 99 of these patients (22%), the availability of rapidly deployed home care services obviated the need for emergency admission to the hospital. Net billings to third-party payers exceeded the costs of the program. CONCLUSION: A significant proportion of elderly patients being discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admission for a select group of debilitated patients. The provision of home care services from the ED is economically feasible.     

Emergency admissions to a general hospital. Why emergency admission? Is there an alternative?

A study was conducted where the GPs in a district answered a questionnaire on reasons for hospital admission, divided into the categories: needed hospital investigation, hospital treatment, or needed care and nursing. They judged whether the admission could have been prevented. Finally, a multidisciplinary panel discussed ways to obtain better courses of admission. Of 266 admissions, 40 (15%) were due to a need for care and nursing. Ninety-seven (37%) of the admissions could be replaced by a short one-day stay, and 52 (20%) could have been postponed until the next day if that was possible. The panel discussion showed that municipalities can do more to strengthen the local professional support. It is concluded that the interface between primary care and the hospital should offer better opportunities for one-day admissions or sub-acute admissions, and that municipalities must be more aware of their responsibility for the care of fragile and ill people.     

Release on trust in social service as an alternative to imprisonment: criminological problems

The Authors, after synthetic outline of the new regulations concerning "the release on trust in social service", an alternative measure to that of imprisonment according to law no. 354 of 26 July 1975, take into consideration some of the problems and difficulties which have emerged in the first months of application of this law. This examination is followed by a review of the results of criminological research on the period of probation and of the present aims emerging with regard to this measure, in the countries where it has been tested for some time. The Authors conclude with a critical evaluation of the present regulations and a series of proposals aimed at improving the application of the probation system in social service.     

The home as a framework for health care

A 6-month-old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment for bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.     

Age as a factor in critical care unit admissions

BACKGROUND: Although the aged occupy a high proportion of critical care beds nationwide, few multicenter studies have been undertaken to specifically determine physician attitudes toward the elderly in a critical care setting. We attempt to determine the importance of patient age as a factor in the admission of acutely ill medical patients to critical care units. METHODS: In response to a hypothetical case scenario, physicians were asked to admit one of two patients to a last available critical care unit bed. An accompanying questionnaire was used to gain a ranking of several admission factors as compared with age, and to gain demographic data regarding the study population. Data were subjected to nonparametric statistical analysis. RESULTS: When age was the only difference between two patients in a hypothetical case scenario, 80.7% of respondents chose the younger patient (age 56 years) for admission, 13.2% chose the older patient (age 82 years), and 6.2% abstained. Following the provision of more detailed medical and social information, however, only 53.5% chose the younger patient, 41.2% chose the older patient, and 5.3% continued to abstain. In a ranking of several admission factors, age was found to be of less importance than severity of presenting illness, previous medical history, and do not resuscitate status, but of more importance than patient motivation, ability to contribute to society, family support, and ability to pay for care. When asked if they supported a definitive age criterion that would restrict all patients over a certain age from access to critical care units, 95.1% responded that they did not. CONCLUSIONS: Age is a factor considered by physicians in the admission of acutely ill medical patients to critical care units. Other medical and social factors, however, can affect the impact of patient age on treatment decisions. Further study and discussion are needed to clarify the appropriate role of age and other factors in critical care unit admissions.     

Association of social relationships with depressive symptoms: Testing an alternative to social support.

Low social support and expressed emotion have been associated with depression, but no studies examined their relative contributions. A self-report questionnaire was developed to measure family emotional involvement and perceived criticism to assess the main components of family expressed emotion. 83 family practice patients older than 40 yrs responded to a survey assessing depressive symptoms, social support, life events, and expressed emotion. Perceived criticism, intense emotional involvement, and negative life events were all independently associated with depressive symptoms. After controlling for expressed emotion, the association of low social support with depressive symptoms was no longer statistically significant. Results support the primacy of family interactions (with high perceived criticism and emotional involvement) over low social support in explaining the association between social relationships and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-control techniques as an alternative to pain medication.

A 65-yr-old retired army officer with a productive work history was admitted to a psychiatric ward with symptoms of chronic abdominal pain and social withdrawal. For several years his pain had been managed with Talwin (pentazocine), which was self-administered intramuscularly 6 times/day. The patient was taught self-control of his pain through a program of relaxation, covert imagery, and cognitive relabeling. He was then withdrawn from medication by diluting the Talwin with increasing proportions of normal saline. Follow-up showed the patient to be socially active, without medication, and more successfully controlling his pain. Results are discussed in terms of punishment, self-attribution of change, the nature of pain, and the ethical issues involved in instituting a treatment procedure without the completely informed consent of the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A conceptual model for the mobility patterns of nursing home admissions

This article draws from the literature in long-term care, demography, and geography to develop an initial conceptual framework to explain variations in the patterns of nursing home moves. The conceptual framework is bolstered by preliminary data from state censuses of nursing homes that asked about the origins of current nursing home residents. The data suggest that a relatively high proportion of nursing home residents move to a different county in the process of admission to a nursing home. The research and applied implications of the framework are discussed.     

Admission to hospital versus home care for stroke]

The incidence and prevalence of cerebrovascular disease is very high. This is a major sanitary problem. There are no studies comparing the management of acute stroke as inpatient or outpatient, publications about each of these items are analyzed. General Practitioners may play a very important role, not only at the first step in the attention of stroke patients. Admission criteria for stroke and hospitalization span for its different ethiopathogenic types are revised.     

Emergency hospital admissions for respiratory disorders attributable to summer time ozone episodes in Great Britain

BACKGROUND: There is accumulating evidence from various countries, including the UK, that ground level ozone concentrations are associated with increased daily hospital admissions for respiratory diseases. This paper estimates the impact of ozone episodes on daily hospital admissions for respiratory disease in Great Britain by combining locally based exposure-response relationships with mapped estimates of ozone exposure for the population in the summers of 1993 and 1995. METHODS: For the given years the available ozone measurements were used to construct maps of ozone concentrations for each day. The population exposed to a given concentration of ozone on a particular day was calculated from census data using a geographical information system. The additional hospital admissions for respiratory disease were then estimated using a regression coefficient for London. RESULTS: It is estimated that 0.10% (a total of 184) and 0.35% (a total of 643) of hospital admissions for respiratory disorders during the summers of 1993 and 1995, respectively, can be attributed to levels of ozone above 50 ppb (the recommended air quality standard for the UK). A sensitivity analysis for 1995 found that, if no threshold is assumed, the estimate is increased by about twenty fold (6% of admissions attributable). CONCLUSIONS: The additional hospital admissions for respiratory disease attributable to ozone are very small in both absolute and relative terms if a threshold of 50 ppb is assumed, but this estimate is very sensitive to threshold assumptions.     

Transitional care: hospital to home

Contemporary acute hospital care of older adults must include special attention to the transitional, or peridischarge, phase of hospitalization. This article reviews the evidence from outcomes data and economic factors that demonstrate that precise transitional planning is a critical element in the care of older hospitalized adults. Some of the promising initiatives being explored around the country are reviewed.     

Particle concentration fluorescence as an alternative to radioactivity for cytokine receptor binding assays

OBJECTIVE: To determine the in vitro and in vivo effects of lidocaine on preimplantation mouse embryo development during prolonged exposure. STUDY DESIGN: In vitro experiments: Two-cell mouse embryos were exposed to lidocaine doses of 0, 10, 100, and 1000 micrograms/mL for 72 h. In vivo experiments, female mice were exposed to lidocaine doses of 0, 0.3, 1.7, and 3.3 mg/kg body weight on days 1, 2, 3, and 4 of pregnancy. Early development, cell number, mitotic index, and micronuclei frequency were examined. RESULTS: Development to the blastocyst stage was inhibited by all the doses tested in vitro and in vivo. Most of the affected embryos showed arrest and degeneration. The cell number was decreased, but not the mitotic index. Furthermore, clastogenic damage was observed in vitro. CONCLUSIONS: Lidocaine adversely affects preimplantation mouse embryo development in vitro and in vivo.     

Temporary gastrostomy as an alternative procedure for nasogastric suction

Based on personal experience with 70 cases of temporary tube gastrostomy - used as an alternative procedure to nasogastric suction in 50 cases and as a double-purpose tube in 20 cases of radical esophagectomy - pertinent problems concerning indication, technique, advantages, and possible complications are presented. The results indicate that temporary gastrostomy is a safe procedure, reduces cardiopulmonary disorders, and increases the patient's comfort. The procedure is therefore strongly recommended for patients with poor cardiopulmonary reserve and for the age group above 60 years. Temporary gastrostomy is also indicated in younger patients, if prolonged gastric distension with the necessity of decompression is anticipated.