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At least 19 recordsLinked to original sources
PubMed1993

A comparison of induced heat-shock protein in neurons destined to survive and those destined to die after transient ischemia in rats.

We examined the induction of heat-shock protein (HSP) in CA-1 pyramidal neurons compared with that in CA-3 pyramidal neurons, in rat brain following 20 min of ischemia. The time course of the changes of localization of HSP was investigated using immunohistochemical and Western blot analyses. The induction of HSP in the CA-1 subfield was the same as that in the surviving hippocampal CA-3 subfield.

Animals↗
PubMed1999

[Characteristics of the clients in a geriatric intermediate care facility located in the suburbs of an urban area and factors related to the discharge destinations desired by family caregivers].

Among the clients in a geriatric intermediate care facility located in the suburbs of Osaka and their family caregivers (72 subjects), the characteristics of the clients and their caregivers, and the discharge destination desired by their family caregivers were investigated, and the associated factors were evaluated. 1. Characteristics of the clients. The clients were elderly females with a low degree of independence, and dementia was observed in about 60% of them. The clients had a relatively large number of children, but many of them lived alone before admission. The rate of admission from hospitals was high (54%), and that of discharge to hospitals was also high (50%). Sixty-seven percent of the clients stayed for a long duration of over 6 months. 2. Conditions of the family caregivers. Most of the family caregivers were daughters or daughters-in-law, and considered themselves to be healthy. Sixty-three percent of the caregivers had jobs. However, most of the caregivers did not have sub-caregiver. 3. Factors related to the discharge destination desired by family caregivers. Not many family caregivers (19.4%) wanted them to go back to their homes after discharge, but their preferred discharge destinations were home (19.4%), hospitals (55.5%), and nursing homes (25.1%). The caregivers of single household clients often desired a nursing home as the discharge destination, and those of the clients from a 2- or 3-generation household often desired a hospital. The factors related to the discharge destination desired by client's family caregivers were that the client not show dementia, the job of the caregiver was a part-time job, there was a sub-caregiver, and the client had the experience of home public health nursing visits. This study showed, the percentage of the clients discharged from the geriatric intermediate care facility to their homes was low, and that of the family caregivers who desired their home as the discharge destination was also low. However, the results suggested that leading the discharge destination to the client's home is possible if social resources are provided such as the use of public health nursing services.

Aged↗
PubMed1991

Models of migration decision making reexamined: the destination search of older migrants to Cape Cod.

This paper explores variation in the scope of the destination search among a group of retirement migrants to Cape Cod, Massachusetts in terms of three factors: distance between origin and destination, previous place experience with the destination, and the presence of friends and family at the destination. The first two factors significantly restricted the search for potential destinations, but the third did not. These findings suggest the need to reevaluate accepted models of elderly migrants' decision making, which often distinguish between the decision to move and the selection of a destination.

Aged↗
PubMed1997

Discharge destination and repeat hospitalizations.

OBJECTIVES: Is discharge destination a determinant of readmission? Studies to date have been inconclusive. The primary purpose of this study was to identify the role of discharge destination in the occurrence of repeat hospitalizations for a national sample of patients discharged from Veterans Health Administration (VHA) hospitals. METHODS: The authors studied a 20% random sample of individual patients, 65 years of age or older, with either chronic obstructive pulmonary disease, stroke, or dementia who were discharged from a Veterans Health Administration hospital in 1988. All data for the study were obtained from secondary administrative sources. Multiple sources were used to determine discharge destination. The authors focused on personal home versus nursing home discharge destination. Both VHA and Medicare discharge data were used to track hospital readmissions. Proportional hazards regression models were used to examine the independent association of discharge destination with time to readmission within 30 days, 6 months, 1 year, and 2 years of discharge, adjusting for severity, other clinical and demographic characteristics, and censoring deaths. RESULTS: After adjustment and including out-of-system (Medicare) use, we found that patients with chronic obstructive pulmonary disease and patients with dementia who were discharged to nursing homes (community and Veterans Health Administration, respectively) were less likely to be readmitted within 30 days after discharge than patients discharged to personal homes. CONCLUSIONS: These findings have important implications for adjusting hospital performance profiles based on discharge destination and for focussing efforts to reduce the frequency and associated costs of hospital readmissions.

Aftercare↗
PubMed2003

Use of the Jarvik 2000 left ventricular assist system as a bridge to heart transplantation or as destination therapy for patients with chronic heart failure.

OBJECTIVE: To evaluate the Jarvik 2000 axial flow left ventricular assist system (LVAS) as a bridge to transplant and as destination therapy. SUMMARY BACKGROUND DATA: The Jarvik 2000 LVAS was implanted in 22 patients (16 men, 6 women; mean age 53 years) as a bridge to transplant (in the United States) and in 4 patients (all men; mean age 62.8 years) as destination therapy (in the United Kingdom). All patients in both of these initial feasibility studies were in NYHA class 4. METHODS: The pump was implanted through a thoracotomy or median sternotomy incision with the aid of partial cardiopulmonary bypass in bridge-to-transplant patients. A skull-mounted percutaneous power delivery was used for the patients who received the pump as destination therapy. RESULTS: Of the 22 bridge-to-transplant patients, 13 underwent transplant; 7 died during support; and 2 studies are ongoing. The surviving patients have an average follow-up of 15 months; one died at 2.6 months after transplant, and the remaining patients are all in NYHA class 1. Support averaged 67.1 days. Deaths were due to acute myocardial infarction in two patients and multiorgan failure in five patients. Hemodynamic function improved with LVAS support. The average cardiac index increased 70.6% by 48 hours after implant, pulmonary capillary wedge pressure decreased 44%, systemic vascular resistance decreased significantly, and inotropic support became unnecessary. Similar results have been seen in the patients who received the device as destination therapy. In that series, one patient died of subdural hematoma 380 days after implant. The other two patients are in NYHA class 1, 642 and 889 days after implant. The average cardiac index increased 89.5%, and pulmonary capillary wedge decreased 52.2%. CONCLUSIONS: The Jarvik 2000 axial-flow LVAS can be used safely in selected patients to provide support until transplant or as destination therapy. In this series, the patients who most benefited from this device were those who required true left ventricular assistance rather than total capture of left ventricular output. Current experience indicates that continuous offloading of the ventricle is most effective when there is enough residual myocardial function to maintain pulsatility and aortic root ejection and to maintain, with nonpulsatile pump support, a normal cardiac index as well as reinstitution of the Frank-Starling response to the native ventricle.

Adult↗
PubMed2002

[Relation between destination on discharge in the elderly patients and comprehensive geriatric assessment at admission in the ward of the Geriatric Department of University Hospital].

To determine the factors related to the destination on discharge from the geriatric ward of Nagoya University Hospital, we analyzed the relationship between the scores of comprehensive geriatric assessment at admission and the destination in patients who had dwelled in home. The scores of basic activity of daily living (Barthel index), instrumental activity of daily living (Lowton scale), and cognitive function (Mini-Mental State Examination) were significantly lower in the patients who moved to institutions than those in the patients who returned home. The proportion of disabilities in all items, except eating, in the Barthel index, and all items but washing in the Lowton scale were significantly higher in patients who moved to institutions than in patients who returned home. Space orientation, calculation, and drawing in the Mini-Mental State Examination were related to the destination. In items for social life communication and group behavior were related to the destination. In multiple logistic regression models, it was suggested that activity of daily living, specifically independence of excretion, and ability in communication were significantly related to the destination on discharge.

Activities of Daily Living↗
PubMed1992

The destination decision of political migrants: an economic approach.

"This paper deals with the destination decision of political migrants who, in spite of having strong cultural, ideological and religious ties to a particular potential destination, choose to emigrate elsewhere. The model presented characterizes the migrants, who have a choice of two possible destinations, by two properties, skill level and financial resources, and identifies those that move to each destination. The paper examines various immigration-encouraging policies and shows that although all of them will increase immigration, in some cases the economic quality of the new immigrants will rise and in some it will fall. This paper includes general evidence on the present immigration to Israel and some suggestions for empirical tests."

Asia↗
PubMed1990

The effect of base station contact on ambulance destination.

Concern has been raised that a single medical control base station serving a metropolitan area may preferentially divert ambulance patients to the base station hospital. Such concern may discourage the development of regional medical control systems. During the first six months of 1988, a retrospective cross-sectional analysis was made of all advanced life support (ALS) ambulance transports and all contacts to the single base station, known as Medical Resource Hospital (MRH). Destinations of all ALS ambulance calls dispatched through the county's 911 dispatch center were analyzed to determine whether the destinations were affected by MRH contact. There were 12,396 transports to 17 area hospitals with 1,272 (10.3%) of these requiring MRH contact. We hypothesized that if MRH contact did not affect destination, the proportion of all non-MRH ALS ambulance patients received by each hospital from the 911-dispatched group would equal the proportion of patients received by each hospital after MRH contact. Five hospitals received a statistically significant (P less than .003) different percentage of MRH contact patients than their proportion of 911-dispatched patients would have predicted. The three that received more were community hospitals in outlying areas. The remaining two were a large referral hospital and a smaller community hospital located in the urban area. The MRH hospital did not have a significantly different percentage of 911-dispatched patients after MRH contact. Similarly, destinations of specific ALS ambulances (two serving in the MRH ambulance catchment area and four in distant catchment areas) were evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed2000

Validity of an artificial neural network in predicting discharge destination from a postacute geriatric rehabilitation unit.

OBJECTIVE: To develop an artificial neural network (ANN) designed to predict discharge destination from postacute geriatric rehabilitation units. DESIGN: Nonconcurrent prospective study. SETTING: Postacute geriatric rehabilitation units: a 20-bed unit in a nonproprietary skilled nursing facility and a 40-bed unit in a suburban private facility. PATIENTS: Consecutive sample of 661 patients admitted between January 1995 and February 1999, including a derivation group of 452 patients and a validation group of 209 patients. INTERVENTIONS: A feed-forward, back-propagation neural network to predict discharge destination. MAIN OUTCOME MEASURE: Discharge destination from postacute geriatric rehabilitation. RESULTS: An ANN was trained on clinical pattern set derived from 452 patients and validated prospectively on 209 consecutive patients admitted to postacute geriatric rehabilitation units. The neural network achieved a sensitivity of 85.7% (95% confidence interval [CI], 83.7-89.4) and specificity of 94.1% (95% CI, 84.4-99.1) in identifying discharge destination with a corresponding area under the curve of 95.7% (95% CI, 92.1-98.3). CONCLUSION: An ANN can predict discharge to the community postacute rehabilitation with a high degree of accuracy. It could have particular value to predict return to the community for older adults with multiple comorbidities after an acute hospitalization.

Activities of Daily Living↗
PubMedDate not supplied

An emergency medical services program of alternate destination of patient care.

OBJECTIVE: The emergency department (ED) is ideally reserved for urgent health needs. The ED, however, is often the site of care for nonurgent conditions. The authors investigated whether emergency medical technicians could decrease ED use by patients with nonurgent concerns who use 911 by appropriately identifying and triaging them to alternate care destinations. METHODS: From August 2000 through January 2001, two King County fire-based emergency medical services (EMS) agencies participated in an alternate care destination program for patients with specific low-acuity diagnosis codes (intervention group). Eligible patients were offered care at a clinic-based destination as an alternate to the ED (n = 1,016). The frequency of the destination of care (ED, clinic, or home) for the intervention group was compared with a matched control group that was comprised of a preintervention historical cohort of EMS encounters from the same two fire-based agencies and with the same acuity and diagnosis criteria and seasonal interval (n = 2,617). RESULTS: Compared with the preintervention group, a smaller proportion of patients in the intervention group received care in the ED (44.6% vs. 51.8%, p = 0.001), while a greater proportion of patients in the intervention group received clinic care (8.0% vs. 4.5%, p = 0.001) or home care (no transport) (47.4 vs. 43.7%, p = 0.043). Results were comparable when adjusted for other patient characteristics. Similar relationships were not evident among nonparticipating King County EMS agencies. Based on physician review and patient interview, the alternate care intervention appeared to be safe and satisfactory. CONCLUSION: An EMS-based program may represent one approach to limiting nonurgent ED use.

Adult↗
PubMed1994

Discharge destinations of Medicare patients receiving discharge planning: who goes where?

This study aims to increase knowledge about factors affecting discharge destinations of Medicare patients leaving the hospital after receiving discharge planning services. Medical, social, financial, and demographic factors are tested in relation to three dispositions: home, nursing home, and rehabilitation unit. Polytomous logistic regression was used to assess the likelihood of going to one destination versus another. For both nursing home versus home and rehabilitation unit versus home, destination was a function of first medical and then financial factors, with social resources playing a lesser role in the models. The only demographic variable with a significant relationship to destination was race, with black patients less likely to enter nursing home settings.

Black or African American↗
PubMed1998

Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: postal questionnaire survey.

OBJECTIVE: To determine the career destinations, by 1995, of doctors who qualified in the United Kingdom in 1977; the relation between their destinations and early career choice; and their intentions regarding retirement age. DESIGN: Postal questionnaire. SETTING: United Kingdom. SUBJECTS: All (n=3135) medical qualifiers of 1977. MAIN OUTCOME MEASURES: Current employment; year by year trends in the percentage of doctors who worked in the NHS, in other medical posts in the United Kingdom, abroad, in non-medical posts, outside medicine, and in part time work; intentions regarding retirement age. RESULTS: After about 12 years the distribution of respondents by type of employment, and, for women, the percentage of doctors in part time rather than full time medical work, had stabilised. Of all 2997 qualifiers from medical schools in Great Britain, 2399 (80.0% (95% confidence interval 79.5% to 80.6%)) were working in medicine in the NHS in Great Britain 18 years after qualifying. Almost half the women (318/656) worked in the NHS part time. Of 1714 doctors in the NHS, 1125 intended to work in the NHS until normal retirement age, 392 did not, and 197 were undecided. Of the 1548 doctors for whom we had sufficient information, career destinations at 18 years matched the choices made at 1, 3, and 5 years in 58.9% (912), 78.2% (1211), and 86.6% (1341) of cases respectively. CONCLUSIONS: Planning for the medical workforce needs to be supported by information about doctors' career plans, destinations, and whole time equivalent years of work. Postgraduate training needs to take account of doctors' eventual choice of specialty (and the timing of this choice).

Adult↗
PubMed2001

Endovascular versus open surgical elective repair of infrarenal abdominal aortic aneurysm: predictors of patient discharge destination.

PURPOSE: To evaluate patient discharge destination after elective endovascular or open surgical repair of infrarenal abdominal aortic aneurysm and to determine predictors for discharge to home or to a rehabilitation center. MATERIALS AND METHODS: All patients electively treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and September 1999 were included. From the hospital database, information on discharge destination, patient characteristics, complications, and length of stay was retrieved. Multiple logistic regression analysis was performed to determine predictors for discharge to home or to a rehabilitation center. RESULTS: Patient characteristics did not differ significantly between the treatment groups, with the exception of age (mean age, 75.1 vs 72.9 years in the endovascular and open surgical group, respectively; P =.005). Patient discharge destinations differed significantly between the treatment groups (P =.001). After endovascular procedures, 156 (85.7%) of 182 patients went home and 19 (10.4%) of 182 patients went to a rehabilitation center. After open surgery, 187 (68.2%) of 274 patients went home and 64 (23.4%) of 274 patients went to a rehabilitation center. The odds ratio of discharge to a rehabilitation center, instead of home, following endovascular procedures versus open surgery was 0.23 (95% CI: 0.13, 0.43). CONCLUSION: Following elective repair of infrarenal abdominal aortic aneurysm, significantly more patients went home after an endovascular procedure than after open surgery. Procedure type was a significant predictor of discharge destination.

Aged↗
PubMed1978

The simultaneous examination of economic and social factors in destination selection: employing objective and subjective measures.

This research examines the role of social and economic factors in the past selection of destinations made by migrants living in Rhode Island. Results indicate that social ties play a more important role in the selection of destinations with low levels of opportunity than they do in the movement to high opportunity areas. An important aspect of the study was the simultaneous investigation of both objective and subjective measures of social and economic factors in the selection of low and high growth destinations. The analysis suggests that the simultaneous consideration of objective and subjective factors provides a more refined accounting of the potential influence of social and economic factors in the selection of destinations. The findings hold when age is introduced as a control.

Decision Making↗
PubMed1998

General practitioners' referral thresholds and choices of referral destination: an experimental study.

General practitioners (GPs) exert a major impact on NHS resource use, both as providers of primary care and as referrers to secondary care. Referral rates are subject to wide variations, leading to the conjecture that certain GPs may have different 'referral thresholds' from those of others. In this paper, the authors describe an experiment designed both to test the referral threshold hypothesis and to illuminate the GP's decision process with respect to choice over referral destination. Nottinghamshire GPs were provided with hypothetical case histories and a list of possible referral destinations, specifying a range of consultants, their specialist interests, plus the expected waiting times and costs for both out-patient investigation and in-patient treatment. For each case, respondents were requested to indicate whether or not they would refer the patient, and to whom. Respondents were also asked to indicate the extent to which their choices of consultants generally were governed by the specialist interest, the waiting time and the cost information. The responses of the sample support the referral threshold conjecture, with specialist interests and waiting time appearing to be far more important than cost in influencing choice of referral destination. The possibilities of influencing GPs' referral behaviour are discussed, in the light of recent initiatives with respect to prescribing.

Adult↗
PubMed1982

Destination choice of interstate family migrants to selected areas in California.

"In this study an attempt has been made to construct a destination choice model for those families who migrated to California from other states between the years 1965 and 1970. "The empirical work is based on a Public Use Sample of Basic Records from the 1970 Census; the technique of estimation used in this study is McFadden's maximum likelihood (multinomial logit technique which often is referred to as conditional logit). "[The] findings confirm the hypothesis that various groups of migrants respond somewhat differently to the geographic and economic stimuli in selecting their destinations in California. While white family migrants pay attention to the level of expected earnings in selecting their destinations, black family migrants are more concerned with the expansion of economic opportunities (i.e., growth rates of income and employment)."

Black or African American↗
PubMed2003

Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation.

OBJECTIVE: To validate the utility of the Berg Balance Scale (BBS) in predicting length of stay (LOS) and discharge destination for patients admitted to a stroke rehabilitation unit. DESIGN: Prospective study. SETTING: Provincial tertiary inpatient stroke unit for a primarily geriatric population. PARTICIPANTS: A total of 313 of the 325 patients admitted consecutively between April 1998 and August 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: LOS and discharge destination. RESULTS: Admission BBS scores correlated negatively with LOS (r=-.53, controlling for age). Logistic regression confirmed that the following were independent predictors of being discharged home rather than to an institution (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.06-1.12) and the presence of family supports (15.0, 7.2-31.3). These results generally concur with previously published results, obtained at a different stroke rehabilitation setting. CONCLUSIONS: This study validates the use of the BBS scores in assisting to estimate approximate LOS and eventual discharge destination. Age did not correlate significantly with the outcomes measured in this study, which was conducted in a geriatric population.

Activities of Daily Living↗
PubMed1999

The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting.

OBJECTIVE: To examine the utility of the Berg Balance Scale (BBS) in predicting length of stay and discharge destination for patients admitted to a stroke rehabilitation unit. DESIGN: Retrospective study. SETTING: Regional tertiary inpatient stroke rehabilitation unit. PATIENTS: One hundred twenty-eight of 141 patients admitted consecutively between January 1, 1995, and March 31, 1996. MAIN OUTCOME MEASURES: Length of stay and discharge destination. RESULTS: Admission BBS scores and Functional Independence Measure scores correlated with length of stay (r = -0.6 and -0.5, respectively, controlling for age). Logistic regression revealed that the following were independent predictors of being discharged home rather than to an institution (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.04-1.13), age (.89, .83-.95), and presence of family support (11.7, 3.1-44.3). CONCLUSIONS: Measuring the BBS scores of patients upon admission to an acute stroke rehabilitation unit may assist in approximating length of stay and predicting eventual discharge destination.

Acute Disease↗