A comparison of the home‐care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home‐care service

Restorative home‐care services, or re‐ablement home‐care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home‐care services had only been investigated in terms of singular outcomes such as length of home‐care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home‐care and healthcare services received over the 2‐year period following service commencement. Seven hundred and fifty older individuals referred for government‐funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home‐care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home‐care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow‐up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home‐care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2‐year follow‐up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost‐effective option than providing conventional home care.     

Gender Differences in the Relationship between Depressive Symptoms and Cravings in Alcoholism

This study examines the clinical correlates of alcohol craving in men and women self‐referred for addiction treatment. Admission clinical data from patients participating in the Mayo Clinic 1‐month Intensive Addictions Program were evaluated. Women had higher BDI and PACS scores compared with men in both the entire cohort and Dual Diagnoses group. Alcohol‐dependent females had the most marked correlation between BDI and PACS (ρ= .78). Further prospective study is encouraged to evaluate whether depressive symptoms and concomitant alcohol cravings in women are a marker for relief cravings and, as such, a target symptom for treatment intervention. (Am J Addict 2010;00:1–5)     

The relationship between structural empowerment and psychological empowerment for nurses: a systematic review

wagner j.i.j., cummings g., smith d.l., olson j., anderson l. & warren s. (2010) Journal of Nursing Management 18 , 448–462
The relationship between structural empowerment and psychological empowerment for nurses: a systematic review Aim To describe the findings of a systematic review examining the relationship between structural empowerment and psychological empowerment for registered nurses (RNs). Background Workplace empowerment research reveals a link between empowerment and positive work behaviours and attitudes. Research demonstrating the essential relationship between structural empowerment and psychological empowerment will provide direction for future interventions aimed at the development of a strong and effective health care sector. Methods Published research articles examining structural empowerment and psychological empowerment for nurses were selected from computerized databases and selected websites. Data extraction and methodological quality assessment were completed for the included research articles. Results Ten papers representing six studies reveal significant associations between structural empowerment and psychological empowerment for RNs. Implications for nursing management Creation of an environment that provides structural empowerment is an important organizational strategy that contributes to RNs’ psychological empowerment and ultimately leads to positive work behaviours and attitudes. Critical structural components of an empowered workplace can contribute to a healthy, productive and innovative RN workforce with increased job satisfaction and retention.     

Gut vernetzt oder aus dem Netz gefallen?

The article presents a practice-oriented instrument for the perception and analysis of complex situations, in which individuals, groups and organisations may find themselves. Findings from the economy, sociometry, and networking research have been gathered and made suitable for supervision and management consultation. The socio-dramatic network analysis presents a method for active diagnostics??in order to understand people within their social context, in their professional and social field, as colleagues, clients and customers. It may serve as a tool for a complex and effective understanding of problems and may offer insights to new coping strategies for individuals, groups, teams, departments and organisations. The theory and practice of the method are explicated and demonstrated through case studies from various professional contexts.     

Medikamentöse Prophylaxe der Migräne

With the introduction of the highly effective triptans in the treatment of acute migraine attacks, the significance of migraine prevention temporarily lost ground in the awareness of doctors and, even more so, patients. This was unjustified, as the increasing numbers of patients with triptan-overuse headache clearly demonstrated. Recent years have seen this trend reversed with a resurgence of migraine prevention. In daily practice the first question is whether migraine prevention is indeed indicated for the patient. If answered affirmatively, the next step is the intricate selection of the most promising agent for the patient. Treatment guidelines regularly updated by the relevant medical societies provide a general overview of the agents principally available according to the principles of evidence-based medicine. Yet, low compliance rates suggest that in practice implementation of these guidelines may have to be tailored to the patient in question. The treatment algorithm presented here tries to bridge the gulf between general treatment guidelines and the actual needs of the patient. From this, feasible clinical pathways are derived for individualized treatment.     

Perceived professional support and the use of blocking behaviours by hospice nurses

A prospective study of the impact of training 41 hospice nurses in assessment skills was used to test hypotheses that blocking behaviours would be used more when patients disclosed feelings and used less when nurses perceived that they had satisfactory professional support Each nurse was asked to assess a patient's current problems before and after feedback training and 8 months later Audiotape recordings of these interviews were rated by trained raters They determined the frequency of nurses' responses which had the function of blocking patient disclosure and the emotional level of patient disclosure Before each patient assessment each nurse was interviewed and questionnaires administered to measure her perceptions of the support she received Blocking behaviours were most evident when patients disclosed their feelings (Kendalls r=0 36, P < 0 001) In interviews containing most patient disclosure of feeling, blocking was significantly less (r= - 0 24, P < 0 5) when the nurse felt that practical help would be available if needed and when the nurse felt that her direct supervisor was concerned about the nurse's own welfare (r= -0 37, P < 0 005)