ABSTRACT
This paper presents the conceptual framework, activities and outcomes of the Allied Health BONE (Best Orthopaedic New Enterprise) Team, an early discharge incentive at the Gold Coast Hospital. The clinical team of a physiotherapist, occupational therapist and social worker provided services within an interdisciplinary model of care with the aim of reducing the length of stay of acute adult orthopaedic patients. The team provided intervention in the community, the accident and emergency department, pre-admission clinic and orthopaedic wards to patients with hip and knee replacements, back pain and upper femoral fractures. This paper reports data from the first six months of the project, demonstrating success in improving the continuity of care provided to orthopaedic patients and reducing the length of stay in target groups by 24%.
Subject(s)
Arthroplasty, Replacement, Hip/rehabilitation , Arthroplasty, Replacement, Knee/rehabilitation , Patient Care Team , Patient Discharge , Adult , Aftercare , Aged , Continuity of Patient Care/organization & administration , Continuity of Patient Care/standards , Hospital Bed Capacity, 500 and over , House Calls , Humans , Length of Stay , Middle Aged , Outcome Assessment, Health Care , Patient Readmission , Program Evaluation , Queensland , Referral and ConsultationABSTRACT
Peripheral blood mononuclear cell fractions from 15 patients in continuous clinical remission from follicular lymphoma for longer than 10 years were examined for cells carrying the t(14;18) translocation using the polymerase chain reaction (PCR). The assay used was able to detect one positive cell in approximately 5 x 10(5) cells (a single 14q+ molecule in 2.5 micrograms DNA). Cells positive for t(14;18) were found in six of eight patients initially presenting with stage III or IV disease, compared with zero of seven of those with stage I or II disease (P less than .05). In two cases 14q+ junction regions were also successfully amplified from formalin-fixed biopsy material obtained at presentation 12 and 17 years previously. In both, sequence analysis demonstrated that the cells circulating in remission belonged to the original clone. These results indicate that cells bearing t(14;18) frequently persist in the peripheral blood in long remission of advanced follicular lymphoma and question the value of their presence as a predictor of relapse.
Subject(s)
Chromosomes, Human, Pair 14/physiology , Chromosomes, Human, Pair 18/physiology , Leukocytes, Mononuclear/physiology , Lymphoma, Follicular/genetics , Translocation, Genetic/genetics , Adult , Aged , Base Sequence , DNA, Neoplasm/genetics , Female , Humans , Lymphoma, Follicular/blood , Lymphoma, Follicular/therapy , Male , Middle Aged , Molecular Sequence Data , Polymerase Chain Reaction , Predictive Value of Tests , Remission InductionABSTRACT
A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.
