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Prevention and management of delayed transfer of older people from hospital to community settings is an enduring issue in industrialised societies and is the subject of many recent policies in the United Kingdom. A deeper, evidence-based understanding of the complex organizational and interprofessional issues which contribute to delays in transfer has emerged in recent years. Despite this, and the relative success of recent policies, two recent reviews of the area highlight the lack of studies on patients' perspectives. We sought to address this deficit by using conversational interviews and a phenomenological approach to explore and interpret participants' perceptions of delayed transfer from hospital into the community. A purposive sampling strategy was employed to incorporate participants from different categories of delay identified on weekly Situation Reports. Participants aged 65 years and over (mean age 82 +/- 5.4 years) and with a mean delay of 32 days (+/- 26) were recruited from three hospitals based in two NHS Trusts in the South of England. This paper focuses on their perceptions of the effects of delayed transfer into the community, their involvement in discharge planning and future community care needs. Our findings show that participants actively or passively relinquished their involvement in the processes of discharge planning because of the perceived expertise of others and also feelings of disempowerment secondary to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex community care needs. Participants expressed a longing for continuity, emphasised the importance of social contact and sometimes appeared unrealistic about their future care needs. While current policies may have helped reduce overall numbers of delayed patients in the UK, our study suggests that there is scope for improvement in the involvement of delayed patients in planning their discharge into the community. 相似文献
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The impact of the frequency of short contact dithranol treatment 总被引:3,自引:0,他引:3
Prins M Swinkels OQ Van de Kerkhof PC Van der Valk PG 《European journal of dermatology : EJD》2001,11(3):214-218
Dithranol short contact treatment is usually applied once a day. For some patients this does not fit their possibilities or needs. Therefore we investigated the efficacy of two other treatment strategies in two small groups of patients. In the attempt to shorten the treatment time, one group of patients was treated twice daily. In order to not withhold short contact dithranol treatment from patients who are unable to perform the treatment daily or at home, a thrice-weekly treatment regimen was studied. 8 patients were treated twice daily and all achieved at least a 90% reduction of the area of involved skin (clearance) within 12.3 (+/- 1.6) weeks. In the thrice weekly group six out of eight patients achieved a clearance of their psoriasis within 13.1 (+/- 4.2) weeks. The aim of shortening the treatment period was not achieved by twice daily treatment in a day-care centre. However, the thrice-weekly treatment regimen certainly appeared to be an effective one. Further studies are needed on larger populations of patients to find out the optimal regimen for intermittent dithranol short contact treatment. 相似文献
77.
Prins M Swinkels OQ Bouwhuis S de Gast MJ Bouwman-Boer Y van der Valk PG van de Kerkhof PC 《Skin pharmacology and applied skin physiology》2000,13(5):273-279
In the search for the ideal dithranol cream preparation for short-contact treatment of psoriasis, we investigated the clinical efficacy, side effects and patient appreciation of two dithranol cream preparations (cream A and B) in a double-blind left-right comparing study. Dithranol was dissolved at preparation in cream A and dispersed in cream B. Cream A is known to have a shelf life of 1 year, while cream B has a much shorter shelf life (several months). Ten patients with chronic plaque-type psoriasis were treated during 7 weeks in a short-contact regimen. The clinical efficacy was monitored by scoring of erythema, induration, scaling and involved area (PASI); skin irritation was scored visually, and patient appreciation was evaluated by means of a multiple-choice questionnaire. Dispersion of dithranol in a cream was associated with less irritation and less discoloration of the skin, and its efficacy was comparable with that of the cream in which the dithranol was dissolved. As the dispersed dithranol formulation is easier to be manufactured, its quality will be less depending on the pharmacist's experience and equipment, and so more reliable. Besides, it will be less expensive to prepare. We advise to use this formulation for short-contact treatment. 相似文献
78.
目的探讨肠球菌属细菌分布及耐药性特征,为指导临床合理用药及控制医院感染提供依据。方法对该院2011年1月至2013年12月年临床送检标本进行细菌分离培养、鉴定和药敏试验。结果共检出肠球菌属细菌140株,屎肠球菌71株(50.7%),粪肠球菌60株(42.9%),其他肠球菌9株(6.4%),其中尿液99株(70.7%);粪肠球菌对青霉素、氨苄西林、红霉素的耐药率为15.0%、12.5%和75.0%,屎肠球菌对青霉素、氨苄西林、左氧氟沙星、环丙沙星、红霉素耐药率大于80.0%,粪肠球菌和屎肠球菌对万古霉素(5.0%、4.2%)、利奈唑胺(8.4%、1.4%)极度敏感,喹奴普丁/达福普丁对粪肠球菌耐药率(100.0%)高于屎肠球菌(26.7%),达托霉素无耐药菌株。结论肠球菌属以泌尿系统感染为主,屎肠球菌检出率略大于粪肠球菌,屎肠球菌对大多数抗菌药物耐药率高于粪肠球菌,喹奴普丁/达福普丁仅对屎肠球菌有较高敏感性,万古霉素、利奈唑胺、达托霉素对肠球菌属细菌保持极高敏感性。 相似文献
79.
纤维粘连蛋白基因多态性与尘肺易感性的研究 总被引:1,自引:0,他引:1
目的 探讨纤维粘连蛋白(FN)4个基因位点多态性与尘肺发病的关系.方法 以确诊的128例汉族男性Ⅰ期尘肺患者作为病例组,选择与病例组年龄相差不超过5岁、同性别、同民族、开始接尘时间及累积接尘工龄相差不超过2年、在同一车间或同一采掘工作面工作的非尘肺接尘工人为对照.采Ⅲ聚合酶链反应-限制性片断长度多态件分析(PCR-RLFP)的方法 检测FN基因HaeⅢb、Msp Ⅰ、HindⅢ、Taq Ⅰ b位点的基因型.结果 病例组携带Msp Ⅰ野牛基因型(CC)频率和等位基C的分布频率分别为10.9%和41.8%,明显高于对照组(分别为3.9%和31.2%),差异有统计学意义(P<0.05).病例组携带HaeⅢb野生基因型(AA)的频率为24.2%,明显高于对照组(17.9%),差异行统计学意义(P<0.05);病例组HaeⅢbA等位基因频率为51.9%,明显高于对照组(42.2%),差异有统计学意义(P<0.05).病例组和对照组Taq Ⅰb位点基因型和Hind Ⅲ位点基因型的分布频率比较,筹异均无统计学意义(P>0.05).病例组同时携带Msp Ⅰ cc和HaeⅢbAA基因型的频率明显高于对照组,差异行统计学意义(P<0.05).结论 携带FN Msp Ⅰ cc和Hae Ⅲ b AA基冈型的接尘工人患尘肺的危险性增加,同时携带这2种基因型的接尘工人更易患尘肺.未发现FN Taq Ⅰ b和HindⅢ位点基因多态性与尘肺易感性有关. 相似文献
80.
Dietz C Swinkels SH van Daalen E van Engeland H Buitelaar JK 《Archives of pediatrics & adolescent medicine》2007,161(4):363-368
OBJECTIVES: To examine the prevalence of parents' compliance with follow-up measurements after their child tested positive at a screening to assess problems in social development, as well as to find demographic, screening-related, and child-specific factors associated with parental compliance. DESIGN: Two-stage screening design. SETTING: Utrecht, the Netherlands. PARTICIPANTS: A random population of 31,724 children were screened at well-baby clinics at age 14 to 15 months (screen 1). Three hundred sixty-four children underwent screen 2 (255 children who scored positive at screen 1 [population screening] and 109 children younger than 36 months who were identified by surveillance because of suspected problems in their social development). Main Exposure A 2-stage screening was applied. MAIN OUTCOME MEASURES: Compliance with recommendations of having either a second screening (after screen 1) or clinical evaluation (after screen 2). RESULTS: Of 370 children who tested positive at screen 1, parents of 255 children (69%) complied with screen 2. Three groups were distinguished after screen 2 (n = 173): early compliance (clinical evaluation within 6 months) (68%), late compliance (clinical evaluation after 6 months) (14%), and noncompliance (no clinical evaluation) (18%). Late compliance and noncompliance were more common in parents of younger children and children who were identified via population screening. Parents of children with either relatively high cognitive skills and/or low scores on screening measures were less inclined to comply. CONCLUSIONS: Study results suggest higher effectiveness of surveillance over population screening. Screening may well be applied as a second step after surveillance to identify children who need further clinical evaluation. 相似文献