Sarcopenia en pacientes de hospital de día geriátrico / Sarcopenia in a geriatric day hospital

Introducción: La sarcopenia es una enfermedad muscular progresiva y generalizada asociada con un aumento de los resultados adversos para la salud (caídas, fracturas, discapacidad y mortalidad). Multiplica por 4 el riesgo de muerte por cualquier causa y tiene un gran impacto en otros resultados de salud y pérdida de calidad de vida. Objetivo: El objetivo principal de esta investigación es establecer la prevalencia y las variables relacionadas con la sarcopenia en pacientes de un hospital de día geriátrico. Metodología: Muestra de 55 pacientes: 40 mujeres (73%) y 15 hombres (27%), con una edad media de 73,25 años (desviación estándar de 13,4). Resultados: El 87% de los pacientes sobreviven al año de seguimiento. El coeficiente de correlación (positivo) (p < 0,01) para SARC-F y SPPB, SARC-F e índice de Barthel, y dinamómetro e índice de Barthel. El coeficiente de correlación de Pearson (negativo) (p < 0,05) para edad y medicación, índice de fragilidad e índice de Barthel, índice de fragilidad y GDS, e índice de Barthel y SPPB. Conclusiones: se puede concluir que el principal factor de riesgo para sarcopenia es la edad. Cuanto mayor es la edad, mayor es el riesgo de sarcopenia. En los mayores de 80 años se obtiene una alta prevalencia en comparación con otros estudios. La sarcopenia y la fragilidad se consideran fuertes predictores de morbilidad, discapacidad y mortalidad en las personas mayores (AU)

Introduction: Sarcopenia is a progressive and generalized muscledisease associated with an increase in adverse health outcomes (falls, fractures, disability and mortality). It is a disease that multiplies by 4 the risk of death from any cause and has a great impact on other health outcomes and loss of quality of life. Objective: The main objective of this research is to establish the prevalence and variables related to sarcopenia in patients from the geriatric day hospital. Methodology: Sample of 55 patients: 40 women (73%) and 15 men (27%), with a mean age of 73.25 years (standard deviation of 13.4). Results: The 87% of patients survive at one-year follow-up. The Pearson correlation coefficient (positive) (p < 0.01) for SARC-F and SPPB, SARC-F and Barthel index, and dynamometer and Barthel index. The Pearson correlation coefficient (negative) (p < 0.05) for age and medication, frailty index and Barthel index, frailty index (IFVIG) and GDS, and Barthel index and SPPB. Conclusions: it can be concluded that the main factor for sarcopenia is age. The older the age is, the greater the risk for sarcopenia. In those over 80 years of age, we obtain a high prevalence compared to other studies. Sarcopenia and frailty are considered strong predictors of morbidity, disability, and mortality in older people (AU)

Cigarette Smoking in an Acute Partial Hospital Program.

ABSTRACT: This study explored demographic and clinical features, plus clinical outcomes, in a smoke-free acute partial hospital (PH) among current smokers, former smokers, and those who had never smoked (nonsmokers). Compared with nonsmokers, current smokers were younger and more likely to be unmarried and unpartnered, unemployed, or receiving disability benefits. They had more prior inpatient (IP) and PH episodes. They also had more problems with interpersonal relationships, mood lability, psychosis, and substance use. Compared with nonsmokers, current smokers were more likely to miss PH treatment days and drop out. They also had longer time to readmission to PH or IP. Former smokers resembled nonsmokers, except that former smokers also had a high rate of dropout. Changes in symptoms and functioning for patients who completed PH were the same among all groups. In an acute PH setting, smoking is a marker for psychiatric and psychosocial impairment plus treatment interruption.

Advance Directives State Requirements, Center Practices, and Participant Prevalence in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.

OBJECTIVES: Adult day services centers (ADSCs) may serve as an entrée to advance care planning. This study examined state requirements for ADSCs to provide advance directives (ADs) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs. METHODS: Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted. RESULTS: Nine states had a requirement to provide AD information. About 80.8% of ADSCs provided AD information and 41.3% of participants had documented ADs. There were significant associations between state requirements, awareness, and providing information with AD prevalence. State requirement was mediated by awareness. DISCUSSION: This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements.

The French Cochlear Implant Registry (EPIIC): Cochlear implantation complications.

OBJECTIVES: The aim of this study was to evaluate peri- and post-operative complications related to cochlear implantations. We searched for risk factors predicting these complications and analyzed the complications in the youngest and most elderly. STUDY DESIGN: Retrospective analysis of cochlear implant patients. MATERIALS AND METHODS: All patients who underwent cochlear implantation in France between January 2012 and December 2016 were anonymized and registered in the EPIIC database. This population included 3483 adults and 2245 children. Their demographic and surgical data and their incidence of peri- or post-operative complications, including their severity, whether major or minor, were all indicated. RESULTS: The global complication rate was 6.84%. The risk of complication was higher in initial implantation versus reimplantation (P<0.0001). The risk was also higher for bilateral implantation versus unilateral (P<0.0001). Complications were more frequent for patients with cochlear malformation (P=0.002). There was no difference in complication rates across age groups; babies under 1 year old, and the elderly over 80 and even over 90, did not have more complications than the rest of the population. Patients treated in the daily care unit had no more complications than those who were hospitalized for one night or more (P=0.64). CONCLUSION: Cochlear implantation is a safe technique with a low incidence of complications. The absence of increased risk in patients at the extremes of the age spectrum justifies offering this solution to all, without age limitation.

Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study.

BACKGROUND: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. METHODS: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). RESULTS: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121-£190 (excluding volunteer contribution) to £172-£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: - 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: - 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: - 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. CONCLUSIONS: This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS.

Impact of anxiety on dropping out of treatment for major depressive disorder at an intensive partial hospitalization program.

BACKGROUND: Premature treatment discontinuation (dropout) is a common problem among patients seeking treatment for major depressive disorder (MDD). To prevent treatment dropout, it is important to identify its associated risk factors. The impact anxiety has on treatment dropout for MDD is especially critical to investigate due to the high rates of comorbidity between anxiety and depressive disorders. Evidence for the degree to which anxiety reliably predicts treatment dropout for MDD remains inconclusive and has yet to be investigated at an adult partial hospitalization program. Examining this can help elucidate which factors predict dropout among patients who need intensive treatment for their depression. METHODS: Participants were patients seeking treatment for MDD at an adult partial hospitalization program (N = 461). A series of Chi-square tests and t tests were conducted to assess for any differences in frequencies of anxiety disorder comorbidities or mean scores of dimensional anxiety among patients who dropped out of treatment and those who did not. RESULTS: No significant associations between high baseline anxiety and early dropout were found (all P > .05). CONCLUSIONS: Findings suggest that no specific actions need to be taken to prevent individuals with high baseline levels of anxiety from prematurely dropping out of a partial hospitalization program.

Recall of consent information by day care prostate biopsy patients: An assessment of the role of a third-party check.

BACKGROUND: To evaluate the extent of recall of consent information by daycare prostate biopsy patients in our low-literacy setting. And to evaluate the role of a 3rd party check on patient's recall of consent information. SUBJECTS AND METHODS: As part of our standard of care, a formal informed consent session for day care prostate biopsy takes place 3 days prior to the procedure. For this study, before leaving the outpatient clinic the same day, the patient acknowledged before a third-party that his concerns were or were not satisfactorily addressed. The extent of recall of consent information was assessed on the morning of the procedure using a researcher-administered questionnaire. Consecutive patients participated in this cross-sectional study for day care prostate biopsy at a tertiary hospital in southeast Nigeria from February to November 2015 after obtaining due consent. RESULTS: The recall of the risks associated with the planned procedure was poorer than the recall of the nature of the disease condition or the nature of the planned procedure. However, it was observed that aggregate recall was significantly poorer among patients who negatively attested to a satisfying consent session (OR 0.125; P < 0.0005). CONCLUSION: The use of a third-party in determining patient satisfaction after a consent session may be a better indicator of patient comprehension and subsequent recall of consent information, especially in low-literacy settings. Using a third-party, in this manner, may assist in checking paternalism inherent in the patient-doctor relationship.

Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment.

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with Anorexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alternative to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates transition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP program for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs. 17.9, p<0.001) and at 12 months follow- up (17.9 vs. 19.3, p<0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less intensive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p<0.043). CONCLUSION: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moderate to severe AN. This new model has cost-effectiveness implications as it is a safe resource and is less costly than IT.

Comparison of Patient Satisfaction on a Day-case Mastectomy Pathway for Breast Cancer Versus a Traditional Inpatient Delivery Model, Using a Validated Questionnaire.

BACKGROUND: In 2011, a guidance was issued by the National Health Service (NHS) Improvement a model on how mastectomy could be offered in the day-case setting. The goal of this guidance was to reduce inpatient bed days and cost to the NHS, and demonstrate that it can be performed within an acceptable safety profile. The aim of this study was to assess whether patients find the day-case pathway for mastectomy an acceptable management model. We compared complication rates between the day-case and inpatient delivery model. PATIENTS AND METHODS: This study was a retrospective analysis of patients' experience undergoing day-case (n=26) and inpatient mastectomy (n=60). The primary outcome measure was based on a telephone interview using a validated, standardised questionnaire. RESULTS: No statistically significant difference in the satisfaction levels between the two groups (raw scores 6.76 day-case vs. 6.15 inpatient, p=0.37) was demonstrated. We found no statistically significant difference between the two groups when specifically analysing whether patients found the first night harder as a day-case or inpatient (3.192 vs. 2.80, p=0.59, range 0-10). Our overall complications were 11.4% (day-case) and 18.3% (inpatients). Rates were comparable between the two groups and equivalent to published rates in the literature. CONCLUSION: There was no statistically significant difference in satisfaction scores between patients who had a mastectomy as an inpatient versus those who had their operation as a day-case procedure. In addition, there were no significant differences in the complication rates between the two groups. We conclude then that it is feasible and safe to offer day-case mastectomy, with no loss in patient satisfaction.

Cost-effectiveness of a non-pharmacological treatment vs. "care as usual" in day care centers for community-dwelling older people with cognitive impairment: results from the German randomized controlled DeTaMAKS-trial.

BACKGROUND: Cognitive impairment in older adults causes a high economic and societal burden. This study assesses the cost-effectiveness of the multicomponent, non-pharmacological MAKS treatment vs. "care as usual" in German day care centers (DCCs) for community-dwelling people with mild cognitive impairment (MCI) or mild to moderate dementia over 6 months. METHODS: The analysis was conducted from the societal perspective alongside the cluster-randomized controlled, multicenter, prospective DeTaMAKS-trial with waitlist group design. Outcomes were Mini-Mental Status Examination (MMSE) and Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) of 433 individuals in 32 DCCs. Incremental differences in MMSE and ETAM were calculated via a Gaussian-distributed and incremental cost difference via a Gamma-distributed Generalized Linear Model. Cost-effectiveness was assessed via cost-effectiveness planes and cost-effectiveness acceptability curves (CEAC). RESULTS: At 6 months, MMSE (adjusted mean difference = 0.92; 95% confidence interval (CI): 0.17 to 1.67; p = 0.02) and ETAM (adjusted mean difference = 1.00; CI: 0.14 to 1.85; p = 0.02) were significantly better in the intervention group. The adjusted cost difference was - €938.50 (CI: - 2733.65 to 763.13; p = 0.31). Given the CEAC, MAKS was cost-effective for 78.0% of MMSE and 77.4% for ETAM without a need for additional costs to payers. CONCLUSIONS: MAKS is a cost-effective treatment to stabilize the ability to perform activities of daily living and cognitive abilities of people with MCI or mild to moderate dementia in German DCCs. Thus, MAKS should be implemented in DCCs.

[Supportive day care at a cancer center: A comparative study of 2008 versus 2016 activity]. / Hôpital de jour de soins de support dans un Centre de Lutte contre le cancer : étude comparative de l'activité entre 2008 et 2016.

The Paul Strauss Center day-care accompaniment department ("SSAJ") is an oncologic supportive day-care, also an alternative to conventional hospitalization. In order to follow the SSAJ department's activity, in the "ambulatory turnover" context, we compared the 2008 and 2016 four first months activity. In 2016, there was an average of 4.96 patients per day versus 5.62 in 2008 (P<0.001); average day incoming of 653€ per stay in 2016 versus 775€ in 2008 (P<0.001). In 2016, there was an average 63.9 % of imagery done versus 27.7 % in 2008 (P<0.001). The 2016 average patient following period was of 84.7 days versus 67.6 days in 2008 (P=0.019). Average time between first day-care visit and death was 161.7 days in 2016 versus 133.5 days in 2008 (P=0.0033). Average day activity is lower in 2016 than 2008, nonetheless number of total stays and inpatients has increased on the four months period. The SSAJ intervenes more precociously in 2016 than 2008. Hospital technical platform is better used, but average per-stay incoming has statistically lowered. The SSAJ limits and prepares complete hospitalizations. Inpatient close reevaluation after a "shorter-willing" stay, home issues anticipation and identification with the home-care team, and worsening prevention gives this activity all its meaning.

[Day care/inpatient psychiatric treatment of minors and adults with hyperkinetic disorder in German psychiatric hospitals : Basic conditions, diagnoses and comorbidities]. / (Teil-)stationäre Therapie von Voll- und Minderjährigen mit einer hyperkinetischen Störung in der deutschen Psychiatrie : Rahmenbedingungen, Diagnosevergabe und Komorbiditäten.

BACKGROUND: Hyperkinetic disorders (HKD, ICD-10 F90.­) have increasingly been the focus of research literature in recent years. Empirical studies analyzing the care situation in psychiatric clinics are so far primarily available for a few health insurances. This study analyzed a German sample from 2015 consisting of inpatient as well as day care psychiatric treatment cases from all statutory health insurances focusing on the care situation and differentiating between minor vs. adult patients with the main diagnosis HKD. MATERIAL AND METHODS: The study was based on the treatment relevant indicators in psychiatry and psychosomatics (VIPP) database, which contains data according to §21 of the Hospital Remuneration Act (KHEntgG). A total of 896 treatment cases with the diagnosis of HKD from the year 2015, based on anonymized routine records from 41 psychiatric clinics, were analyzed. RESULTS: The basic conditions for inpatient/day care psychiatric treatment significantly differed between minor vs. adult patients. Minors travelled greater distances to the treatment site, received more therapy units and stayed longer in the psychiatric clinic than adults. Significant differences were also found between the subgroups concerning the main diagnoses according to ICD-10 coding as well as comorbid mental disorders. CONCLUSION: Due to greater distances from their residence to a psychiatric hospital for minors, extension of capacities with a focus on child and youth psychiatry seems to be a reasonable conclusion. Simultaneously, the intensity of treatment seems to be lower for adult patients, despite a greatly increased number of secondary diagnoses and thus anticipated psychological stress. Transition difficulties from child and youth psychiatry to adult psychiatry may be a possible explanation for this discrepancy.

Reliability, validity and minimal detectable change of 2-min walk test and 10-m walk test in frail older adults receiving day care and residential care.

BACKGROUND: The psychometric properties of the 2-min walk test (2MWT) and 10-m walk test (10MeWT) for frail older adults are unclear. AIMS: To determine the test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC95) of these walk tests in frail older adults receiving day care and residential care services. METHODS: A cross-sectional study with repeated measures was conducted on frail older adults who could walk independently for at least 15 m. The participants completed the 2MWT and 10MeWT on three separate occasions over a 2-week period under two independent assessors. RESULTS: Forty-four frail older adults were examined. Excellent test-rest (ICC = 0.95-0.99) and inter-rater reliability (ICC = 0.95-0.97) were shown in both walk tests. Good to strong correlations were found between the walk tests and 6-min walk test (r = 0.89-0.92), Elderly Mobility Scale (r = 0.56-0.57), Berg Balance Scale (r = 0.66-0.66) and Modified Barthel Index (r = 0.55-0.59). The MDC95 were 7.7 m in the 2MWT and 0.13 m/s in the 10MeWT. DISCUSSION: Although the walking performances of the day care and residential care participants were similar, the validity of the walk tests was different between these two subgroups. CONCLUSIONS: The 2MWT and 10MeWT are reliable and valid measures in evaluating the walking performances of frail older adults. The MDC95 of the walk tests has been recommended.

Employment and attendance in day care centres for people with mild intellectual disabilities - do age, gender, functional level or hospital admissions matter?

BACKGROUND: Workforce inclusion is an important political goal in many countries. However, nearly 70% of Norwegians registered with mild intellectual disabilities (IDs) are not registered employed or attending in day care centres. This study investigates the association between age, gender, functional level and hospital admissions with employment or attendance in public financed, community-based day care centres for adults with mild IDs in Norway. METHOD: This study is based on data from a linkage of the national population-based registries from 2013 to 2015: Statistics Norway (SSB), the Norwegian Information System for the Nursing and Care Sector (IPLOS) and the Norwegian Patient Registry (NPR). The sample consisted of 2370 adults registered with a mild ID, receiving disability pension in Norway, aged 18-67 years. Binary and multinomial logistic analyses, adjusted for age, gender, functional level and hospital admissions, were performed. RESULTS: In 2015, 45.7% and 19.6% of the samples aged 20-31 and 52-63 years, respectively, were registered as employed or in day care centres. Participation in day care is a public service registered in IPLOS, which requires registration of functional level, while attendance in employment support is registered in SSB, where functional level is not registered. Compared with people registered with a high functional level, the probability of being employed or in day care centres was lower for people without registration of functional level. People with hospital admissions were less likely to be employed, especially if they had both psychiatric and somatic hospital admissions. People were less likely to attend day care and open employment only if they had a combination of both types of hospital admissions. Attendance in day care centres was less likely for men than women. CONCLUSIONS: Older people with mild ID, without registered functional level (meaning not receiving public community-based services) and with a history of hospital admissions were significantly less likely to be employed or participate in day care centres. The clear association between not being employed or attending day care centres and not having one's functional level registered implies there is a need for increased focus on how to enhance work participation among people with mild IDs who are not within the system of receiving public services.

Diferencias sobre variables de salud mental y físico-funcionales entre hombres y mujeres del primer centro de día referencial del adulto mayor de Chile / Differences on mental and physical-functional health variables between men and women of the first referential day center of the older adult of Chile

INTRODUCCIÓN: El proceso de envejecimiento afecta de distinta manera a hombres y mujeres, ya que existen factores biológicos, genéticos y fisiológicos que los diferencian. OBJETIVO: Determinar diferencias en memoria, fluidez fonética, orientación temporo-espacial, percepción de la calidad de vida y condición física entre hombres y mujeres que asisten al primer centro de día referencial del adulto mayor de Chile. MÉTODOS: Estudio no experimental, descriptivo-comparativo con enfoque cuantitativo y corte transversal que evaluó 30 adultos mayores (n=15 hombres: edad 76,5 años, peso corporal 72,6 kg, estatura bípeda 1,63 m e IMC 27,0 kg/m2; y n=15 mujeres: edad 76,2 años, peso corporal 72,1 kg, estatura bípeda 1,52 m e IMC 31,1 kg/m2). Las variables dependientes fueron obtenidas a través de la encuesta de memoria, fluidez fonética y orientación temporo-espacial (MEFO); la encuesta de percepción de la calidad de vida relacionada con la salud SF-36v.2; la batería Senior Fitness Test (condición física) y fuerza de prensión manual. Se realizaron comparaciones a través de las pruebas t de Student y U de Mann Whitney considerando un p < 0,05. RESULTADOS: Se aprecian diferencias estadísticamente significativas (p = 0,018) entre hombres y mujeres sólo en el puntaje total del MEFO, siendo las mujeres quienes presentan mayor deterioro cognitivo. No se reportaron diferencias significativas en el resto de las variables estudiadas. CONCLUSIONES: Las mujeres que asisten al primer centro de día referencial del adulto mayor de Chile presentan mayor deterioro cognitivo respecto a los hombres. Mientras que la percepción de la calidad de vida y condición física de hombres y mujeres es más baja que la señalada para su edad y sexo

INTRODUCTION: The aging process affects men and women differently, since there are biological, genetic and physiological factors that differentiate them. OBJECTIVE: To determine differences in memory, phonetic fluency, temporo-spatial orientation, perception of quality of life and physical fitness between men and women attending the first referential day center of the older adults of Chile. METHODS: Non-experimental, descriptive-comparative study with quantitative approach and cross-sectional cut that evaluated 30 older adults (n = 15 men: age 76.5 years, body weight 72.6 kg, bipedal height 1.63 m and BMI 27.0 kg/m2; and n = 15 women: age 76.2 years, body weight 72.1 kg, bipedal height 1.52 m and BMI 31.1 kg/m2). The dependent variables were obtained through the survey of memory, phonetic fluency and temporo-spatial orientation (MEFO); the health-related perception of quality of life SF-36v.2; the Senior Fitness Test (physical fitness) and grip strength. Comparisons were made through the Student t-test and Mann Whitney U test considering a p <0.05. RESULTS: Statistically significant differences (p = 0.018) can be seen between men and women only in the total MEFO score, with women having the greatest cognitive impairment. No significant differences were reported in the rest of the variables studied. CONCLUSIONS: Women who attend the first referential day center of the older adults of Chile have greater cognitive impairment compared to men. While the perception of quality of life and physical fitness of men and women is lower than that indicated for their age and sex

Adult mental health provision in England: a national survey of acute day units.

BACKGROUND: Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England. METHODS: English NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions. RESULTS: Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services. CONCLUSIONS: The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.

[Waiting Times For Admission Into A Psychotherapeutic Inpatient Treatment - Results of A Prospective Study In South-Württemberg]. / Wartezeiten auf die Aufnahme in eine Psychosomatische Klinik ­ Ergebnisse einer prospektiven Studie in Südwürttemberg.

INTRODUCTION: Waiting times for the admission into a so called psychosomatic hospital in Germany prevent the necessary immediate treatment. They lead to further incapacity for work and chronic manifestation of the disease. It is reported that most psychosomatic hospitals have waiting times, but there are no studies on data on that. Therefore, it was the aim of this study to access prospectively in a defined region, how long it takes for the patients to get an outpatient preliminary talk and thereafter, how long they have to wait for their admission. METHODS: 7 hospitals out of the region of South-Württemberg took part on this study, 2 of them had bigger day hospitals. Data were assessed prospectively in 2015 over 9 months, in total 916 admissions were assessed. RESULTS: The waiting time until a preliminary talk, in which the indication for inpatient treatment was secured, was in the mean 25 days (SD=31). The waiting time after this talk until admission was 56 days (SD=47). Patients who waited for a day treatment had to wait even longer. An urgency remark, given by the therapist of the preliminary talk, as well as a private illness insurance led to shorter waiting times. The diagnosis had no influence on the waiting time. CONCLUSIONS: The waiting times are substantial and imply a burden for the patient and also for the health care system. It is recommended to assess and publish these waiting times on a regularly basis. Politics, but also the actors in the health care system should discuss if and how this deficit can be changed.

Comparative study of quality of life of elderly nursing home residents and those attneding a day Center. / Estudo comparativo da qualidade de vida de idosos asilados e frequentadores do centro dia.

The aim of this study was to compare the QOL of the elderly living in nursing homes and those who attend the Day Center (Centro Dia) at the the Asilo Vila Vicentina in the city of Bauru/SP. The sample consisted of 48 subjects, 21 men, 5 from the Day Center and 16 nursing home residents, and 27 women, 16 from the Day Center and 11 nursing homes residents, who answered the following questionnaires: socio-demographic characteristics, WHOQOL-Old, and WHOQOL-Bref. The responses were submitted to descriptive and inferential statistics to compare the QOL scores of the nursing home residents with the elderly who attend the Day Center using the Mann Whitney test. The results showed better QOL scores for the elderly who attend the Day Center, in which women stood out. Among the institutionalized elderly, women presented the worst QOL values, particularly in the Physical and Psychological domains. The domains with the lowest scores were Environment (42.6 ± 10.7 for women in nursing homes and 44.4 ± 9.7 for men at the Day Center) and Intimacy (13.1 ± 17.3 for women in nursing homes and 9.4 ± 22.7 for men in nursing homes). The domains with the highest scores were Social Affairs (74.0 ± 13.6 for women at the Day Center and 68.3 ± 10.9 for men at the Day Center) and Death/Dying (83.6 ± 22.0 for women at the Day Center and 80.0 ± 32.6 for men at the Day Center).

Objetivou-se comparar a QV de idosos asilados e frequentadores do Centro Dia do Asilo Vila Vicentina, no município de Bauru/SP. A amostra contou com 48 sujeitos, sendo 21 homens, 5 do Centro Dia e 16 asilados, e 27 mulheres, 16 do Centro Dia e 11 asiladas, que responderaim aos questionários: caracterização sociodemográfica, WHOQOL-Old e WHOQOL-Bref. As respostas, submetidas à estatística descritiva e inferencial, permitiram comparar os escores de QV dos asilados aos dos frequentadores do Centro Dia, por meio do Teste de Mann Whitney. Os resultados apontaram melhores escores de QV para os idosos do Centro Dia, destacando-se as mulheres. As institucionalizadas tiveram os piores valores de QV, sobressaindo-se os domínios Físico e Psicológico. Os domínios com escores mais baixos foram: Meio Ambiente (42,6 ± 10,7 para as asiladas e 44,4 ± 9,7 para os homens do Centro Dia) e Intimidade (13,1 ± 17,3 para as asiladas e 9,4 ± 22,7 para os asilados). Os mais altos foram: Relações Sociais (74,0 ± 13,6 para as mulheres do Centro Dia e 68,3 ± 10,9 para os homens do Centro Dia) e Morte/Morrer (83,6 ± 22,0 para as mulheres do Centro Dia e 80,0 ± 32,6 para os homens do Centro Dia).

The impact of attending day care designed for home-dwelling people with dementia on nursing home admission: a 24-month controlled study.

BACKGROUND: Day care services offer meaningful activities, a safe environment for attendees and respite for family caregivers while being expected to delay the need for nursing home (NH) admission. However, previous research has shown inconsistent results regarding postponement of NH admission. The objective of the study was to explore the influence of a day care programme designed for home-dwelling people with dementia on NH admission. METHOD: A quasi-experimental trial explored the proportion of patients permanently admitted to nursing homes after 24 months as the main outcome by comparing a group of day care attendees (DG) and a group of participants without day care (CG). In all, 257 participants were included (181 in DG and 76 in CG). A logistic regression model was developed with NH admission as the outcome. Participant group (DG or CG) was the main predictor, baseline patient and family caregiver characteristics and interactions were used as covariates. RESULTS: The mean age of participants was 81.5 (SD 6.4), 65% were women and 53% lived alone. The mean MMSE score was 20.4 (SD 3.5). In all, 128 (50%) of the participants were admitted to a nursing home by the 24-month follow-up, 63 participants (25%) completed the follow-up assessment and 66 (26%) dropped out due to death (8%) and other reasons (18%). In the logistic unadjusted regression model for NH admission after 24 months, participant group (DG or CG) was not found to be a significant predictor of NH admission. The results from the adjusted model revealed that the participant group was associated with NH admission through the interactions with age, living conditions, affective symptoms, sleep symptoms and practical functioning, showing a higher probability for NH admission in DG compared to CG. CONCLUSION: The study reveals no evidence to confirm that day care services designed for people with dementia postpone the need for NH admission. Admission to nursing homes seems to be based on a complex mix of personal and functional characteristics both in the person with dementia and the family caregivers. The findings should be considered in accordance with the limitation of inadequate power and the high drop-out rate. TRIAL REGISTRATION: The study is registered in Clinical Trials ( NCT01943071 ).

A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision.

BACKGROUND: An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%-3% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (<2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors. METHODS: A prospective audit was undertaken over a 3-month period. Our practice was compared with evidence-based analgesic and antiemetic interventions in accordance the Association of Paediatric Anaesthetists of Great Britain and Ireland. Perioperative strong opiate administration rates occurred in 44% of cases. Four strategic interventions were selected based on quality of evidence, ease of implementation, and low cost: selection of higher concentration local anesthetic use for penile blocks, intravenous dexamethasone, and preoperative paracetamol combined with maximum dose nonsteroidal anti-inflammatory. RESULTS: The audit was duplicated a year later demonstrating a significant increase in application of these interventions with a parallel fall in strong opiate use from 44% to 9% and an unprecedented zero unplanned admission rate in our unit for 10 months in a row after implementation. CONCLUSION: Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention.