A psychogeriatric community outreach service: Description and evaluation

The structure and function of a small psychogeriatric community outreach team is outlined, together with the results of intervention in 100 consecutive cases. Patients in residential or nursing home care were rated for level of behavioural disturbance at entry to the study and after three months. Patients with dementia and psychotic disorders showed clinically and statistically significant improvement, whereas the improvement of patients with major depression was not statistically significant. The usefulness of the outreach service was evaluated independently by carers and by referring agents. Eighty per cent of carers and 87% of referring agents rated the service as useful or very useful. It was concluded that a small outreach team (comprising the equivalent of only six full-time staff) is an effective and acceptable supplement to the overall care of psychogeriatric patients.     

Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study

Background There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services. Method In a randomized controlled trial we compared assertive outreach with ‘standard’ community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. Results We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. Conclusions Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.     

From the Grey Nuns to the streets: a critical history of outreach nursing in Canada

This article traces the historic antecedents of outreach nursing in Canada, going as far back as the Grey Nuns in what is now Quebec. It attempts to place modern-day street nursing in a historical context, which includes Nightingale, Wald, the early Victorian Order of Nurses, and the social reform movements of the early 20th century. The article critiques the involvement of nursing in less than virtuous aspects of social control with respect to impoverished and otherwise marginalized groups. The article goes on to trace the origins of modern Canadian street nursing in three cities: Vancouver, Toronto, and Montreal. It uses both a search of the nursing literature and, because much of this history is undocumented, oral history and anecdotal information as well. It critiques nursing's traditional avoidance of political action and calls upon modern-day nurses to support and educate one another to engage in this work.     

Determinants of children's participation in California's Medicaid and SCHIP programs

OBJECTIVE: To develop a comprehensive predictive model of eligible children's enrollment in California's Medicaid (Medi-Cal [MC]) and State Children's Health Insurance Program (SCHIP; Healthy Families [HF]) programs. DATA SOURCES/STUDY SETTING: 2001 California Health Interview Survey data, data on outstationed eligibility workers (OEWs), and administrative data from state agencies and local health insurance expansion programs for fiscal year 2000-2001. STUDY DESIGN: The study examined the effects of multiple family-level factors and contextual county-level factors on children's enrollment in Medicaid and SCHIP. DATA COLLECTION/EXTRACTION METHODS: Simple logistical regression analyses were conducted with sampling weights. Hierarchical logistic regressions were run to control for clustering. PRINCIPAL FINDINGS: Participation in MC and HF programs is determined by a combination of family-level predisposing, perceived need, and enabling/disabling factors, and county-level enabling/disabling factors. The strongest predictors of MC enrollment were family-level immigration status, ethnicity, and income, and the presence of a county-level "expansion program"; and the county-level ratio of OEWs to eligible children. Important HF enrollment predictors included family-level ethnicity, age, number of hours a parent worked, and urban residence; and county-level population size and outreach and media expenditure. CONCLUSIONS: MC and HF outreach/enrollment efforts should target poorer and immigrant families (especially Latinos), older children, and children living in larger and urban counties. To reach uninsured eligible children, it is important to further simplify the application process and fund selected outreach efforts. Local health insurance expansion programs increase children's enrollment in MC.     

Living Donor Kidney Transplantation: Improving Education Outside of Transplant Centers about Live Donor Transplantation—Recommendations from a Consensus Conference

Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation’s Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates.     

Criteria for intensive care unit admission and severity of illness

This article explores the provision and organisation of critical care services in the UK and examines the issues surrounding admission to, discharge from and the withholding of critical care.