Effectiveness of a geriatric day hospital.

OBJECTIVE: To determine whether there is a difference in the quality of life between elderly patients managed in a day hospital and those receiving conventional care. DESIGN: Randomized controlled trial; assessment upon entry to study and at 3, 6 and 12 months afterward. SETTING: Geriatrician referral-based secondary care. PATIENTS: A total of 113 consecutively referred elderly patients with deteriorating functional status believed to have rehabilitation potential; 55 were assessed and treated by an interdisciplinary team in a day hospital (treatment group), and 58 were assessed in an inpatient unit or an outpatient clinic or were discharged early with appropriate community services (control group). OUTCOME MEASURES: Barthel Index, Rand Questionnaire, Global Health Question and Geriatric Quality of Life Questionnaire (GQLQ). MAIN RESULTS: Eight study subjects and four control subjects died; the difference was insignificant. Functional status deteriorated over time in the two groups; although the difference was not significant there was less deterioration in the control group. The GQLQ scores indicated no significant difference between the two groups in the ability to perform daily living activities and in the alleviation of symptoms over time but did show a trend favouring the control group. The GQLQ scores did indicate a significant difference in favour of the control group in the effect of treatment on emotions (p = 0.009). CONCLUSION: The care received at the day hospital did not improve functional status or quality of life of elderly patients as compared with the otherwise excellent geriatric outpatient care.     

Increase in acute admissions and deaths after closing a geriatric day hospital

In 1978 the normal function of a large geriatric day hospital was halted by 16 weeks of industrial action. Comparing affected patients with a matched control population for the years 1974-80 showed an appreciable increase in acute hospital admissions and deaths of those affected by the stoppage, which suggests an obvious benefit for those who are selected for attendance at a geriatric day hospital. Neither the number of acute admissions nor the number of deaths during the two months after normal services were resumed differed appreciably from those in the control years. No single cause predominates among those reported for acute admission or death during the affected year. These findings are relevant given the recent closure of several day hospitals by health authorities to cut costs. There are no published figures showing unequivocal benefits for attendance at day hospitals, and many clinicians remain unaware of their function. Yet adequate provision for day hospitals may ease the pressure on more costly acute hospital beds.     

Evolution of an active psychogeriatric day hospital.

A geriatric day hospital was established as part of the psychogeriatric unit of the Royal Ottawa Hospital. While initially this day hospital was integrated with day hospital programs of other units, it became apparent that a separate facility was desirable. The activities and programs of the psychogeriatric day hospital, run by one registered nurse, were integrated with those of the geriatric inpatient unit. It was found to be advantageous for inpatients and day hospital patients to share the same physical facilities. The majority of day hospital patients came from the inpatient unit; almost all had affective disorders. The emphasis was on reintegration into the community. During the 1st year of operation there were 75 patients in the program; only 3 needed admission to the inpatient unit and 1 was readmitted after discharge.     

The efficiency and effectiveness of geriatric day hospitals

One hundred patients who were referred consecutively to two geriatric day hospitals were followed for 3 months, to determine the efficiency and effectiveness of day hospital management. Transport was highly efficient; only one in every 40 attendances failed because of transport. Selection of patients may have been less efficient, in that only half completed planned treatment. In most cases this was because of progression of the illness. Time at the day hospital was on the whole efficiently used, in that three-quarters of the time was devoted to programmed activities. The effectiveness of the day hospital was limited. In only about one-third of referred patients were the objectives set by the doctor attained. Likewise only one-third of patients felt that they had improved, and one-third of carers experienced relief of strain.     

Learning by experience. A student residential workshop in hospital.

A four-day residential workshop was conducted for students beginning their clinical studies at the St George Hospital in 1974. The aim of the workshop was that the students should understand the functioning of the hospital and feel comfortable as students in the hospital, so that they would learn their clinical skills more effectively in their subsequent years at the hospital. Each student lived in a hospital bed with an "illness" for two days, and spent another two days helping care for these "student patients" and exploring the hospital. Evaluation at the end of the workshop suggested that the objectives had been achieved.     

Methadyl acetate versus methadone: the experience of one hospital.

Sixty subjects participated in a double-blind study comparing methadyl acetate (80 mg) with two dosages of methadone (50 mg and 100 mg) in the maintenance of opiate addicts. The safety of all three regimens was supported and methadyl acetate was as effective as methadone in the retention of subjects.     

A memory clinic at a geriatric hospital: rationale, routine and results from the first 100 patients.

OBJECTIVE: To describe the operation of a memory clinic with reference to the referral pattern, patient characteristics and psychiatric diagnoses, frequency of reversible dementias and utility of brief cognitive screening tools in the detection of dementia. DESIGN: All patients underwent cognitive screening tests (Mini Mental Status Examination, Abbreviated Mental Test Score, Organic Brain Syndrome Scale of the Brief Assessment Scale) and two activities of daily living instruments. Psychiatric diagnoses were made according to criteria of the Diagnostic and statistical manual, third edition revised, of the American Psychiatric Association (DSM-III-R). SETTING: A large geriatric hospital. SUBJECTS: First 100 patients referred. RESULTS: The mean age of the patients was 75.5 years and 75 were women. Seventy-four met DSM-III-R criteria for dementia and a further 13 had other organic brain syndromes. No case of reversible dementia which recovered was encountered. The cognitive screening tools had a high correlation (r = 0.85-0.89) with one another but a much lower correlation with the activities of daily living instruments (r = 0.27-0.37). CONCLUSION: Reversible dementias are unlikely to be detected in a memory clinic at a geriatric hospital, but the assessment process may have other benefits which will need to be assessed in prospective research. The clinic population represents a unique resource for further research on dementia.     

Laparoscopic cholecystectomy: experience in a district general hospital.

In many centres laparoscopic cholecystectomy has become the procedure of choice for symptomatic gallbladder stones. By comparison with conventional cholecystectomy it appears to be associated with minimal morbidity, shorter hospital stay, earlier return to work and a better cosmetic result. The present study reviews the results of the first 50 laparoscopic cholecystectomies performed at Altnagelvin Area Hospital.     

Cervical cytology screening: experience of a general hospital.

At Henderson General Hospital, Hamilton, a program was introduced whereby cervical smears were taken routinely for cytologic study from all women admitted aged 17 years or older. The procedure was performed by a specially trained nurse. In a 5-year period 53% of eligible patients were screened. Of these, 32% had not had a cervical smear taken before. In 7681 smears nine instances of invasive disease were discovered: three of the cervix, three of the endometrium and three metastatic. There were 20 cases of carcinoma in situ and 2 of severe dysplasia. Evidence of infection was present in a high percentage of the smears. Hospital admission affords an excellent opportunity of applying this valuable screening procedure.     

Non-attendance at a psychiatric day hospital new patient clinic.

People who do not attend for treatment present problems in the efficient running of any service. This is particularly the case with new patients referred to a psychiatric clinic where an hour may be set aside for the initial assessment. High non-attendance rates cause administrative problems and loss of valuable time. The referring doctor may be left with his patient unassessed, the patient may miss valuable treatment or advice, and an incorrect assessment of the true prevalence of some disorders may be made.