scholarly journals The NHS and Community Care Act 1990

2000 ◽  
Vol 24 (5) ◽  
pp. 177-178 ◽  
Author(s):  
Indra I. Angunawela ◽  
Andrew Barker ◽  
Simon D. Nicholson
Keyword(s):  
Hospital Stay ◽  
Social Services ◽  
Care Management ◽  
Community Care ◽  
Patient Costs ◽  
Duration Of Hospital Stay ◽  
People With Dementia ◽  
The Difference ◽  
Delayed Discharges ◽  
Discharge Profile

Aims and MethodThe Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia inpatients, prospective studies of inpatient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted.ResultsThe proportion of patients discharged to their own homes and to residential/nursing homecare remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 (P=O.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes.Clinical ImplicationsThe new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and hig her in-patient costs.

scholarly journals Social services departments: success or failure?

Social Work ◽  
2020 ◽  
pp. 21-36
Author(s):  
Terry Bamford
Keyword(s):  
Social Work ◽  
Financial Crisis ◽  
Local Government ◽  
Social Security ◽  
Social Services ◽  
Care Management ◽  
Community Care ◽  
Service Users ◽  
Child Deaths ◽  
Security Funds

Social Services departments, created after the 1970 Local Authority Social Services Act, survived for nearly half a century. Their ability to meet the vision set out in the Seebohm Report was compromised by curtailment of expansion after the financial crisis in 1975. Their reputation was damaged by a number of widely reported child deaths in which social work was seen as passive and ineffective. Severe criticism followed when they were viewed as over active as in Cleveland and Orkney. As a result social services were seen as toxic in deprived communities. Despite winning responsibility for community care in the 1990 NHS and Community Care Act, departments suffered, first, from the requirement to spend the bulk of transferred social security funds in the independent sector and secondly from the prolonged squeeze on local government spending. The potential of care management for innovation and empowering service users was never fully realised.

The Cardinal Needs Schedule – a modified version of the MRC Needs for Care Assessment Schedule

1995 ◽  
Vol 25 (3) ◽  
pp. 605-617 ◽  
Author(s):  
M. Marshall ◽  
L. I. Hogg ◽  
D. H. Gath ◽  
A. Lockwood
Keyword(s):  
Social Services ◽  
Care Management ◽  
Social Care ◽  
Community Care ◽  
Reliability And Validity ◽  
Systematic Account ◽  
Needs For Care ◽  
Care Assessment ◽  
Modified Schedule ◽  
Assessment Of Need

SYNOPSISThis paper describes a modified version of the MRC Needs for Care Schedule (the Cardinal Needs Schedule), for measuring needs for psychiatric and social care amongst patients with severe psychiatric disorders. The modified schedule has three new features: (i) it is quick and easy to use; (ii) it takes systematic account of the views of patients and their carers; (iii) it defines and identifies need in a way that is concise and easy to interpret. The paper describes why the three new features were considered necessary, and then gives an overview of the structure of the Cardinal Needs Schedule, together with a description of how the three new features were developed. During a study of social services care management the practicality of the modified schedule was investigated and further data were obtained on the reliability and validity of the standardized approach to measuring need, in domains not previously investigated. Because of its speed and simplicity, the Cardinal Needs Schedule offers a new choice to researchers who wish to use a standardized and practical assessment of need in evaluative studies of community care. Examples of the usage of the modified schedule are given in an Appendix.

scholarly journals Peritoneal closure or non-closure in open appendectomy: a reality or a myth

2018 ◽  
Vol 5 (9) ◽  
pp. 3102
Author(s):  
T. R. V. Wilkinson ◽  
Mahendra K. Chauhan ◽  
Isha Trivedi
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Open Appendectomy ◽  
Daily Basis ◽  
Wound Infections ◽  
Open Appendicectomy ◽  
Duration Of Hospital Stay ◽  
Peritoneal Closure ◽  
The Difference ◽  
Group B

Background: The objective of this study is to analyze the difference of outcome and complications in peritoneal closure versus non-closure in open appendicectomy.Methods: This was the prospective comparative study. 126 patients with the diagnosis of acute appendicitis undergoing open appendicectomy divided in two groups non-randomly. Group A: Open appendicectomy with closure of peritoneum (n=59) and Group B: Open appendicectomy with non-closure of peritoneum (n=67). Intra operative time and post-operative period for pain and complications like wound infections, hernia and duration of hospital stay were analyzed. Patients were shown ‘visual analogue scale’ on a daily basis and those who reported unbearable pain given additional analgesia.Results: Operative time, number of doses of analgesic required, wound infections and duration of hospital stay in both groups were compared. Difference in operative time between both the groups was found to be statistically significant (p< 0.0001).Conclusions: Non-closure of peritoneum in open appendicectomy is associated with lesser operative time, and shorter duration of hospital stay. Hence, it can be safely recommended.

scholarly journals The consultant psychiatrist and community care

1993 ◽  
Vol 17 (9) ◽  
pp. 513-516 ◽  
Author(s):  
Matt Muijen
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Community Mental Health ◽  
Social Services ◽  
Care Management ◽  
Community Care ◽  
Care Programme ◽  
Lead Agency ◽  
Consultant Psychiatrist ◽  
Health Centres

It cannot be ignored that community care is now a fact, and not merely an issue. Some mental hospitals have closed and the number of mental illness beds have been reduced overall by about 40% over the last decade and a range of hostels, multidisciplinary rehabilitation teams and community mental health centres have been launched. The move towards well integrated and well coordinated community care has been urged by a large number of reports, white papers and policies including the second Griffiths report, Working for Patients, Caring for People, The Health of the Nation, the Care Programme Approach and care management, with social services becoming the lead agency in community care.

scholarly journals Comparative study of the need for re-intervention after chest tube remove in two groups with and without chest x-ray in Patients Admitted into Razi and Poursina hospital in Rasht city

2021 ◽  
Vol 2 (1) ◽  
pp. 157-163
Author(s):  
Manouchehr Aghajanzadeh ◽  
Ali Alasvand Lahbar ◽  
Mohammad Reza Asgari ◽  
Ramin Ebrahimian ◽  
Ali Alavi Fomani ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chest Tube ◽  
Clinical Signs ◽  
Pleural Space ◽  
P Value ◽  
Duration Of Hospital Stay ◽  
Asymptomatic Patients ◽  
Standard Guideline ◽  
Significant Difference ◽  
The Difference

Introduction: The most common types of injuries following blunt or sharp trauma of lungs and the pleural space are pneumothorax, hemothorax and hemopneumothorax, which in most cases are resolved through supportive care and thoracostomy (use of chest tubes). Removal of the CT (chest tube) can result in complication such as pneumothorax and accumulation of fluid in the pleural space. Despite the lack of a standard guideline regarding the management of patients post CT removal, it is advised to procure a CXR as a means of a conservative approach. However, most of the findings acquired from the post CT removal CXR are not clinically significant and in the case of patients requiring intervention, there are almost always clinical signs and symptoms present. Considering the prior statements, the lack of a standard guideline even in the general and thoracic surgery references, show cases the importance of this study. This study is set upon proving that, the omission of post CT removal CXR in asymptomatic patients will not have an impact on the clinical outcome of the case and will reduce the costs as well as the patients' exposure to radiation and hospital stay. Methods: This study is designed as cross-sectional study with a sample size of 200 patients who were hospitalized for CT insertion in the Surgery clinic of Razi and Poursina Hospitals in Rasht between 21/4/2019 and 20/4/2020 and matched our entry criteria. The patients were divided into 2 groups of 100, with one group being monitored without CXR and the other with the use of CXR. Some forms were designed as checklists for the task of data collection. The data analysis was done through Fisher's exact test, Chi square test and Mann Whitney U test. In addition, the Significance level was set at 0.05 (p value ≤ 0.05). Result: Out of the 200 patients included in our study, 120 were male (60%) and the rest (40%) were female. The most common underlying disease in both groups (with and without CXR) of our study was Hip fracture. In both groups, The most frequent reason for CT insertion was pleural effusion (36% and 43% in with CXR and without CXR groups respectively), but the difference between the 2 groups was not statistically significant (p = 0.597). In most of the cases, 1 CT was inserted and there was no statistically significant difference between the 2 groups. The difference between the 2 groups regarding the need for intervention (11 cases in the CXR group and 6 cases in the Non CXR group) was also statistically insignificant. The duration of hospital stay did not show a statistically significant difference between the 2 groups (p = 0.644). Conclusion: Our study suggests that whether a post CT removal CXR is obtained or not, will not make a statistically significant difference in the number of interventions, the cause of intervention, and the number of inserted CTs and the duration of hospital stay. Therefore, it can be suggested that the need for reintervention in post CT removal patients can be determined through clinical signs, symptoms and the surgeon's judgment, without the need for a routine CXR.

scholarly journals A comparative study of single layer extra mucosal versus conventional double layer anastomosis of intestines in elective and emergency laparotomy

2019 ◽  
Vol 7 (1) ◽  
pp. 184
Author(s):  
K. Lohit Sai ◽  
C. Sugumar
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Double Layer ◽  
Single Layer ◽  
Duration Of Hospital Stay ◽  
Key Skills ◽  
Group A ◽  
The Difference ◽  
Group B

Background: Gastrointestinal anastomosis has been a part of research since decades and is one of the key skills in surgeon’s armamentarium. This study compared the outcome of single layer anastomosis with double layer anastomosis.Methods: The study was designed as a prospective comparative study and 29 cases were included in the study during December 2016 to September 2017, who consented for being part of the study. Patients were alternatively allotted into the either group. Group A underwent single layer anastomosis and Group B underwent double layer anastomosis. Outcome parameters were analysed in the form of ‘duration required to perform anastomoses, ‘duration of hospital stay’ and ‘dnastomotic leak.Results: Mean duration required to perform anastomosis in Group A is 21.64±1.60 minutes and in Group B is 29.6±2.02 minutes. The difference between the mean duration required for anastomosis between the two groups were statistically significant (p<0.005). Mean duration of hospital stay in Group A was 12.35±1.72 days and Group B was 12±2.44 days (difference was statistically insignificant), 3 (10%) cases in Group A and 2 (6.8 %) cases in Group B developed anastomotic leak and the difference was statistically insignificant.Conclusions: Our study concluded that there is statistically significant difference between the single layer anastomosis and double layer anastomosis in terms of time taken to perform anastomosis, however there is no difference in postoperative anastomotic leak and duration of hospital stay.

BLUNT ABDOMINAL TRAUMA WITH HAEMOPERITONEUM TREATED BY EXPLORATORY LAPAROTOMY VERSUS ONLY ABDOMINAL DRAINAGE: A PROSPECTIVE AND COMPARATIVE STUDY.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Dhawal Panchal ◽  
Firdaus Dekhaiya ◽  
Harin Tailor
Keyword(s):  
Hospital Stay ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Exploratory Laparotomy ◽  
Blunt Injury ◽  
Abdominal Drainage ◽  
Duration Of Hospital Stay ◽  
Considerable Morbidity ◽  
Injured Patients

In today’s mechanized world, Blunt Abdominal Trauma (BAT) is a common emergency which is associated with considerable morbidity and mortality. More than 75% of abdominal traumas are blunt in nature and liver and spleen are the commonest organs to be injured as a result of BAT. The aim is to analyse and compare two groups of patient of blunt abdominal trauma managed conservatively with drainage and one by exploratory laparotomy. 50 cases of blunt abdominal trauma were taken. The patient were studied  which includes age ,sex, mode of injury, initial vitals on presentation, Mortality in each group, duration of hospital stay, pre interventions and post interventions state and requirements, complications and follow up. It was observed 48% of patients were in between age group ranging from 10 to 30. Overall in terms of sex ratio, males dominated the no. of cases. RTA was most common mode of trauma. Liver and spleen was most common organ to be injured. Patients managed by laparotomy had higher mortality rate, duration of hospital stay was more, and complication were more. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients. Keywords:  Blunt Abdominal Trauma, Haemoperitoneum , laparotomy , Abdominal Drainage.

EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

2012 ◽  
pp. 79-85
Author(s):  
Van Lieu Nguyen ◽  
Doan Van Phu Nguyen ◽  
Thanh Phuc Nguyen
Keyword(s):  
Hospital Stay ◽  
Perioperative Complications ◽  
University Hospital ◽  
Anal Pain ◽  
Stapled Hemorrhoidectomy ◽  
Fourth Degree ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

Propensity-adjusted cost analysis of radial versus femoral access for neuroendovascular procedures

2020 ◽  
pp. neurintsurg-2020-016728
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Stefan W Koester ◽  
Tyler S Cole ◽  
Jacob F Baranoski ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Diagnostic Procedures ◽  
Femoral Access ◽  
Catheter Size ◽  
The Mean ◽  
The Difference ◽  
Procedure Type ◽  
Angiographic Findings

BackgroundTransradial artery (TRA) access for neuroendovascular procedures is associated with fewer complications than transfemoral artery (TFA) access. This study compares hospital costs associated with TRA access to those associated with TFA access for neurointerventions.MethodsElective neuroendovascular procedures at a single center were retrospectively analyzed from October 1, 2018 to May 31, 2019. Hospital costs for each procedure were obtained from the hospital financial department. The primary outcome was the difference in the mean hospital costs after propensity adjustment between patients who underwent TRA compared with TFA access.ResultsOf the 338 elective procedures included, 63 (19%) were performed through TRA versus 275 (81%) through TFA access. Diagnostic procedures were more common in the TRA cohort (51 of 63, 81%) compared with the TFA cohort (197 of 275, 72%), but the difference was not significant (p=0.48). The TRA cohort had a shorter length of hospital stay (mean (SD) 0.3 (0.5) days) compared with the TFA cohort (mean 0.7 (1.3) days; p=0.02) and lower hospital costs (mean $12 968 ($6518) compared with the TFA cohort (mean $17 150 ($10 946); p=0.004). After propensity adjustment for age, sex, symptoms, angiographic findings, procedure type, sheath size, and catheter size, TRA access was associated with a mean hospital cost of $2514 less than that for TFA access (95% CI −$4931 to −$97; p=0.04).ConclusionNeuroendovascular procedures performed through TRA access are associated with lower hospital costs than TFA procedures. The lower cost is likely due to a decreased length of hospital stay for TRA.

scholarly journals Generational Differences in Support and Care of Individuals Diagnosed With Severe Mental Illness

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Deborah Finkel ◽  
Per Bulöw ◽  
Pia Bulöw ◽  
Monika Wilińska ◽  
Cristina Joy Torgé ◽  
...  
Keyword(s):  
Social Support ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Social Services ◽  
Generational Differences ◽  
System A ◽  
Care Systems ◽  
The Difference ◽  
Changes Over Time ◽  
Age Range

Abstract As part of the process of de-institutionalizing the Swedish mental health care system, a reform was implemented in 1995 moving responsibility for social support for people with severe mental illness (SMI) from the county to social services in the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. To investigate possible generational differences in support experiences, two nonoverlapping cohorts were created from surveys conducted every fifth year between 1996 and 2011 in one middle-sized municipality in the south of Sweden, aiming to detect the needs for social support. Cohort 1 includes everyone detected at the 1996 survey aged 65 and 79 years (N = 92). Cohort 2 includes individuals first detected at the 2011 survey who were aged 65 to 79 (N = 104). Results indicates significant differences between the two cohorts in diagnosis, reflecting changes over time in diagnostic tendencies. Cohort 1 was on average 10 years older than Cohort 2, even within the restricted age range. After correcting for age, there were no differences between the two cohorts in education, functioning (CAN and GAF), or marital status. Although Cohort 1 experienced more days of institutionalization than Cohort 2 (median = 424.5 days vs. 382 days), the difference was not statistically significant. Cohort 2 had significantly higher additional subsidies and disposable income, as well as significantly higher income from other sources after retirement. Results indicate the changing demands that older adults with SMI will place on care systems.

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