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P O'Halloran

Publications and source records attributed to P O'Halloran.

8 recordsLinked to original sources
PubMed2000

Ambulance economics.

BACKGROUND: Ambulance services produce a large quantity of data, which can yield valuable summary statistics. For strategic planning purposes, an economic framework is proposed, and the following four resource allocation questions are answered, using data from the Surrey Ambulance Service: (1) To satisfy government response time targets, how many additional ambulances will be required, ceteris paribus? (2) To minimize average response time (r*) with given resources, how should ambulances be rostered temporally? (3) Which innovations are worth undertaking? (4) How would an increase in demand affect r*? METHODS: The 'Ambulance Response Curve' --the relation between response time and the number of available but not-in-use ambulances--is used to estimate how much r* will be reduced by deploying an additional ambulance. Estimating the marginal cost of an ambulance allows us to estimate the opportunity cost of each second of response time, and to compare the cost of three 'innovations' with that of increasing resources. The time savings of adding an extra ambulance at each of the 168 h of the week are examined. RESULTS: In 1997-1998, r* was 8 min 52 s. An additional ambulance reduces r* by 8.9 s. Each reduction of 1 s in r* costs 28,000 pounds per year. Fourteen additional ambulances are required to meet response time targets if the 8.9 s reduction per ambulance is maintained. r* reduces by 4.6 s when ambulances are shifted from early mornings to Saturday evenings. Activation time reduces by 38 s when crews sit in their ambulances. A 1 min decrease in overall call time decreases r* by 1.1 s. Answering only 10 per cent of all calls reduces r* by 63 s. An increase of demand of 10 per cent increases r* by 7.8 s. CONCLUSIONS: Ambulance services will be better able to determine which innovations are worth undertaking. Policy makers will be better placed to determine funding levels to achieve response time targets.

Ambulances↗
PubMed1999

Preliminary results from an Australian psychosocial rehabilitation program for people with serious mental illness.

Psychosocial rehabilitation, for those with a serious mental illness, is of significant importance due to both its frequency and cost to government. This paper describes the implementation and preliminary assessments of a new psychosocial rehabilitation program in New South Wales. Of particular urgency was the requirement to establish baseline measures for ongoing service evaluation at the unit. An extensive array of assessment tools (Brief Psychiatric Rating Scale, BPRS; Scale for the Assessment of Negative Symptoms, SANS; Quality Of Life Scale, QOLS) was applied to determine the functioning of clients prior to the program. Following the initial assessments, subsequent measures were undertaken on completion of the program and then at 1 year follow-up. It was hypothesized that the clients would demonstrate significant improvements on these measures with a reduction in their psychopathology as assessed by the BPRS, improvement in their quality-of-life as measured by the QOLS and improvement in their negative symptoms as measured by the SANS. The final outcome demonstrated improvement in the assessment scores by 34%. A positive correlation to the above results showed a 54% reduction in the re-admission rate of clients and length of stay in hospital. The paper describes further developments regarding this psychosocial rehabilitation unit and suggests other psychosocial rehabilitation initiatives.

Adolescent↗
PubMed1999

Shared governance.

Explore the source record for details and available documents.

Decision Making, Organizational↗
PubMed1997

The Family Attitude Scale: reliability and validity of a new scale for measuring the emotional climate of families.

Research on outcomes from psychiatric disorders has highlighted the importance of expressed emotion (EE), but its cost-effective measurement remains a challenge. This article describes development of the Family Attitude Scale (FAS), a 30-item instrument that can be completed by any informant. Its psychometric characteristics are reported in parents of undergraduate students and in 70 families with a schizophrenic member. The total FAS had high internal consistency in all samples, and reports of angry behaviour in FAS items showed acceptable inter-rater agreement. The FAS was associated with the reported anger, anger expression and anxiety of respondents. Substantial associations between the parents' FAS and the anger and anger expression of students was also observed. Parents of schizophrenic patients had higher FAS scores than parents of students, and the FAS was higher if disorder duration was longer or patient functioning was poorer. Hostility, high criticism and low warmth on the Camberwell Family Interview (CFI) were associated with a more negative FAS. The highest FAS in the family was a good predictor of a highly critical environment on the CFI. The FAS is a reliable and valid indicator of relationship stress and expressed anger that has wide applicability.

Adolescent↗
PubMed1997

Patient-controlled analgesia compared with nurse-controlled infusion analgesia after heart surgery.

A randomized, controlled clinical trial was conducted on 66 patients undergoing elective cardiac surgery to compare patient-controlled analgesia (PCA) to nurse-controlled analgesia (NCA) with continuous morphine infusion. Hourly assessment of pain (at rest and on movement) using a visual analogue scale (VAS), of respiratory rate, and level of sedation took place for the 24 h following extubation. The incidence of nausea was also recorded. Mean pain scores were calculated, and peak pain and sedation scores, together with lowest respiratory rates, were identified. Morphine consumption was measured at 24 h. No significant differences were found between the groups' scores for pain or sedation. The PCA group had significantly lower respiratory rates (P = 0.02) and a lower incidence of nausea (P = 0.008). The PCA group also consumed significantly more morphine (P = 0.0001). The study suggests a beneficial effect from PCA after cardiac surgery in reducing nausea, compared to NCA. It confirms nurse-controlled infusion analgesia as an effective form of pain relief in an intensive care and high-dependency setting.

Aged↗
PubMed1989

Psychodynamic formulation, consensual response method, and interpersonal problems.

We describe a new method for aggregating psychodynamic formulations of independent clinicians. 15 patients (10 female and 5 male, aged 23-41) were interviewed before they began brief dynamic psychotherapy. Different panels of 8 formulators (drawn from a pool of 72 psychodynamic clinicians with 10-38 years of clinical experience) observed each videotaped interview and wrote individual formulations. The text of each formulation was divided into thought-units, and thought-units that occurred 3 or more times were combined into a final consensual formulation. (One case was formulated twice to demonstrate the replicability of the method). Other clinical raters then read each consensual formulation and judged, for a list of interpersonal problems, whether each problem was apt to be distressing for that patient. The raters were very successful in predicting which problems were later discussed in treatment. Predictions were best for formulations with a high proportion of interpersonal content.

Adult↗
PubMedDate not supplied

Effect of health lifestyle pattern on dietary change.

PURPOSE: To examine the effect of lifestyle on the effectiveness of a low-intensity dietary intervention. DESIGN: A secondary data analysis was performed using data from the Eating Patterns Study, a randomized controlled trial that found that self-help materials with physician advice was effective in changing dietary intake and behavior. SETTING: Primary care clinics in a large health maintenance organization. SUBJECTS: A total of 2111 patients with a routine scheduled appointment with their primary care physicians. MEASURES: Participants were grouped into one of six health lifestyle patterns based on similarities in baseline measures of alcohol intake, smoking, diet quality, and exercise. Within each lifestyle pattern, changes from baseline in usual fat and fiber intake (based on a food frequency) and a fat and fiber behavior score were compared at 3 months and 12 months for intervention vs. control participants. INTERVENTION: Self-help materials delivered by a physician with advice to change diet. RESULTS: Intervention participants in the fitness lifestyle group made the largest changes relative to controls for each dietary outcome at 3 and 12 months. For intervention participants defined by their alcohol intake or current smoking, either no changes in diet were observed compared with controls, or early changes were not sustained over time. Intervention-control comparisons within the remaining lifestyle patterns showed smaller dietary changes compared with the fitness lifestyle. This finding was similar to previously published results. CONCLUSIONS: This randomized controlled trial had limited power to detect subgroup differences; however, these results suggest that lifestyle patterns may be useful in the development of effective, targeted interventions to change behavior.

Data Collection↗