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Boarding out as an option for the care of elderly people.

There has been some experiment in Ireland in recent years with boarding out of elderly persons. This comprises the placement, usually with a non-relative in a private household, of an elderly person, with the carer receiving some reward. This study assesses the cost of care for a small group of elderly persons in boarding-out care compared with a similarly dependent group of elderly persons in welfare home institutional care. The cost of boarding out care is less than half the cost of care in the welfare home. This result is encouraging given the feeling that quality of care in boarding out is not below that of institutional care.

Aged↗

Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management.

AIMS: To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved. METHODS AND RESULTS: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991-01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991-93. Patients who survived cardiopulmonary arrest in 1997-01 were less likely to die from any cause (unadjusted HR 0.60, 95% CI 0.48-0.75, P<0.001) or cardiac disease (unadjusted HR 0.50, 95% CI 0.38-0.65, P<0.001). After adjustment for case-mix, there remained significant declines in all-cause (adjusted HR 0.62, 95% CI 0.50-0.78, P<0.001) and cardiac death (adjusted HR 0.52, 95% CI 0.39-0.68, P<0.001). Clinical management had improved, with increased use of thrombolysis (47-63%, chi2 trend, P<0.001), beta-blockers (28-53%, chi2 trend, P<0.001), ACE-inhibitors (48-69%, chi2 trend, P<0.001), and anti-thrombotics (79-88%, chi2 trend, P<001). Adjustment for recorded changes in management attenuated the decline in all-cause death (adjusted HR 0.77, 95% CI 0.60-0.98, P=0.03). CONCLUSION: Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.

Aged↗

The chronically mentally ill in nursing homes: issues in policy and practice.

The release of large numbers of patients from mental hospitals has resulted in the frequent placement of former mental patients in nursing homes. This study examines the integration of a sample of former patients into the residential facility itself and the community at large and concludes that the environment of the facility has a key impact on levels of residents' social integration.

Activities of Daily Living↗

Is case management effective for people with serious mental illness? A research review.

Recent literature on caring for people with serious mental illnesses reflects a growing belief in the effectiveness of case management services for this population. This article reviews recent outcome studies on case management to assess the extent to which prevailing claims that it is effective are supported empirically. Based on this review, the author concludes that the hypothesis that case management is effective remains plausible, but conclusive claims that its efficacy has been empirically demonstrated are premature. The outcome studies reflect diversity and ambiguity in the ways case management is conceptualized and implemented, problems in the research methodologies employed, and inconsistencies in outcomes. Consequently, implications for further research are drawn.

Deinstitutionalization↗

I am John.

"John's" story details the history of services provided to people with mental retardation in the United States from the 1720s to the present. Although "John" is fictitious, the facts relating to mental retardation, service, and treatment through the years are accurate. There are no social workers in John's life story mainly because mental retardation has not been a part of schools of social work curriculum. John's life might have been different if there had been social workers advocating for him.

Deinstitutionalization↗

Clinical decision making for discharge planning in a changing psychiatric environment.

This article reviews the clinical decision-making process involved in planning for continuity of care following discharge from inpatient psychiatric services. The decision-making frame of reference requires the identification of the players in the process, parameters of their roles, performance expectations, and boundaries of rights and obligations; clear definition of objectives; collection of data and analysis of its relevancy; and study of possible alternatives, with evaluations of their consequences. The authors present an approach to clinical decision making that includes an analysis of modalities and practice skills and a critical review of practice in a psychiatric setting that emphasizes the role of the family; the importance of continuity of care; and the need to engage the patient, family, and care systems within briefer time frames.

Adult↗

Assessing the impact of mental health programs upon community: the perspectives of primary caregivers and consumers.

Since 1985, there has been a significant movement in Spanish mental health services away from provision of care in psychiatric hospitals and toward a community mental health model (CMMH). This reform has ushered in changes not only for the patients but also for both their relatives and their primary caregivers. However, no survey has ever been carried out to obtain these parties' perceptions of the CMMH. Two studies have now been designed to describe the acceptability of the CMMH to these two key groups. The goals of the two projects were, firstly, to assess the opinions of primary care professionals about CMMH and, secondly, to sample the opinions of the patients' relatives regarding mental health care. In the first survey, 884 primary caregivers (general practitioners (GPs), pediatricians, nurses and social workers) filled out a 14-item questionnaire with a five-point response scale. Several aspects of care were evaluated: accessibility, referral facilities, therapeutic support, training or teaching activities, communication between primary care and mental health professionals for their mutual collaboration, and appropriateness of resources. Most of the primary caregivers reported that the community psychiatric model improved accessibility, treatment and communication between the different levels. Nurses and pediatricians reported dissatisfaction with the CMMH. In the second survey, the satisfaction of patients' relatives with the services provided by the therapists was assessed, using the Satisfaction with Therapist Questionnaire (STQ). The STQ consists of 15 items with a three-point response scale. Amount and adequacy of the information provided, accessibility, and style of conducting the appointment were assessed as measures of satisfaction. A sample of relatives of schizophrenic patients was surveyed by mail (76 relatives answered, a response rate of 31.13%). In summary, relatives were satisfied with therapists' competence but dissatisfied with their communication skills.

Adult↗

Model instructional program for mainstreaming handicapped children.

The purpose of this study was to implement and test the effectiveness of an instructional program designed to teach normal children about cerebral palsy. Presentation of the program to 17 first-grade children resulted in a significant increase in the students' knowledge of the disability, compared to that of a control group. Implications of these results for physical and occupational therapists involved in facilitating placement of handicapped children into the least restrictive environment were discussed.

Attitude↗

The enduring asylum.

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Attitude of Health Personnel↗