Outcomes following intensive day rehabilitation for young people in Western Australia.

OBJECTIVE: Intensive rehabilitation aims to improve and maintain functioning in young people who experience disability due to illness or injury. Day rehabilitation may have advantages for families and healthcare systems over inpatient models of rehabilitation. METHODS: This study evaluated the goals and outcomes of a cohort of young people in Western Australia who attended a specialist intensive day rehabilitation programme ("iRehab") at Perth Children's Hospital. Analysis of the iRehab service database was performed. Rehabilitation goals and outcomes were recorded as per the Canadian Occupational Performance Measure (COPM), Children's Functional Independence Measure (WeeFIM), and Goal Attainment Scale (GAS). RESULTS: There were 586 iRehab admissions between August 11, 2011, and December 31, 2018. Admissions were divided by diagnosis: Cerebral Palsy (228, 38.5%), Acquired Brain Injury (125, 21.3%), Spinal Cord Disorders (91, 15.5%), and Other (141, 24.2%). Mean COPM Performance increased by 2.78 points from admission to discharge (95% CI 2.58 to 2.98, p < 0.001). Mean COPM Satisfaction was 3.29 points higher at discharge than admission (95% CI 3.07 to 3.51, p < 0.001). Mean total WeeFIM score improved by 6.51 points between admission and discharge (95% CI 5.56 to 7.45, p < 0.001), and by 3.33 additional points by six months post discharge (95% CI 2.14 to 4.53, p < 0.001). Mean GAS T-scores increased by 27.85 (95% CI 26.73 to 28.97, p < 0.001) from admission to discharge, and by 29.64 (95% CI 28.26 to 31.02, p < 0.001) from admission to six months post discharge, representing improvement consistent with team expectations. CONCLUSION: This study describes a model by which intensive rehabilitation can be delivered in a day rehabilitation setting. A diverse population of young people who experienced disability achieved significant improvements in occupational performance, independence, and goal attainment after accessing intensive day rehabilitation. Improvements were measured in all diagnostic subgroups and were maintained six months after discharge.

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)

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

¿Existe una creciente dificultad en el manejo de los pacientes hospitalizados en servicios médicos? / Is there increasing difficulty in managing patients hospitalized in medical services?

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

Resumo 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).

Abstract 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).

Impacto de los determinantes sociales en la psicopatología de adolescentes ingresados en un hospital de día comunitario / Impact of social determinants in the psychopathology of adolescents in a community day care hospital

En la actualidad asistimos con cada vez mayor frecuencia a una población clínica con situaciones socio-familiares muy deterioradas que complican notablemente su valoración y tratamiento. Mediante la aplicación del cuestionario HoNOSCA hemos cuantificado el impacto de estos determinantes sociales de la salud mental en un hospital de día de adolescentes. Se discuten los resultados

The mental health of adolescents is influenced by socioeconomic determinants, which leads to greater complexity in their therapeutic approach. In order to study its impact on mental health, we collected data on adolescents admitted to partial hospitalization. We analyzed two groups of cases, which were differentiated by the preponderance of social factors, and it was seen that social cases were more numerous, more complex and required more multidisciplinary work. It is concluded that a more communitarian view of mental health would improve the approach of complex cases

Variabilidad en los hospitales de día de Reumatología en España: proyecto VALORA / Variability in Rheumatology day care hospitals in Spain: VALORA study

Objetivos. Describir la variabilidad de las unidades de hospitalización de día (UHdD) de Reumatología en España, en términos de recursos estructurales y procesos de funcionamiento. Material y métodos. Estudio descriptivo, multicéntrico, con evaluación de las UHdD mediante cuestionario autocumplimentado a partir de estándares de calidad de la Sociedad Española de Reumatología. Se analizaron recursos estructurales y procesos de las UHdD estratificados por complejidad del hospital (comarcal, general, mayor y complejo), y se determinó la variabilidad mediante el coeficiente de variación (CV) de la variable con relevancia clínica que presentara diferencias estadísticamente significativas al comparar por centros. Resultados. Un total de 89 centros (16 comunidades autónomas y Melilla) se incluyeron en el análisis. El 11,2% de los hospitales son comarcales; el 22,5%, generales; el 27%, mayores, y el 39,3%, complejos. El 92% de las UHdD son polivalentes. El número de tratamientos aplicados, la coordinación entre las UHdD y farmacia hospitalaria y la presencia de formación posgrado fueron las variables de proceso que presentaron diferencias estadísticamente significativas en función del nivel de complejidad del hospital. La tasa de tratamientos más alta se halló en hospitales complejos (2,97 por 1.000 habitantes), y la más baja, en hospitales generales (2,01 por 1.000 habitantes). El CV fue de 0,88 en hospitales mayores, de 0,86 en comarcales, de 0,76 en generales y de 0,72 en los complejos. Conclusiones. Existe una mayor variabilidad en el número de tratamientos de UHdD en los hospitales mayores, seguido de los comarcales. Sin embargo, la variabilidad en estructura y funcionamiento no parece deberse a diferencias de complejidad de los centros (AU)

Objective. To describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes. Material and methods. Multicenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers. Results. A total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22,5% general, 27%, major and 39,3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1,000 population), and the lowest in general hospitals (2.01 per 1,000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex. Conclusions. there was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity (AU)

Apple and bananas when comparing recovery and patients satisfaction following day surgery

There is still no consensus around how to assess performance, recovery and patient satisfaction following day care anaesthesia and surgery. This review considers metrics that might be used to assess these phases of day surgery care (AU)

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Ocular diseases at geriatric clinics in Rio de Janeiro: social and epidemiological considerations among patients with motor locomotion deficit / Morbidades oculares em clínicas geriátricas do Rio de Janeiro: considerações sociais e epidemiológicas associados a indivíduos com déficit de locomoção

Objective: To identify the causes of low visual acuity and systemic morbidities that limit ambulation and access to eye care in geriatric clinics in Rio de Janeiro. Methods: This cross-sectional study evaluated 187 patients from three geriatric clinics in Rio de Janeiro between January 2010 and January 2011. The inclusion criteria were individuals with a visual acuity of less than of equal to 20/200 in either eye (118 individuals), without optical correction. The exclusion criteria were individuals who refused to participate and those unable to undergo screening because of mental disabilities (6 individuals). Of the 187 individuals evaluated, 63 had visual acuity above 20/200. Results: A total of 118 individuals with a visual acuity of ≤20/200 effectively participated in the study after meeting the inclusion and exclusion criteria. In addition, 57 participants (48.3%) presented systemic disabling morbidities. Of the 118 individuals with low visual acuity, 27.96% had cataract and 26.27% had refractive errors. Conclusion: Most of the patients from geriatric clinics experienced ocular morbidities, but their proper treatment resulted in improved visual acuity. A more socially oriented problem associated with eye care involved the difficulty of access to ophthalmologic consultations. .

Objetivo: Identificar causas de baixa acuidade visual e morbidades sistêmicas que dificultem a deambulação e o acesso à tratamento oftalmológico em clínicas geriátricas do Rio de Janeiro. Métodos: Estudo transversal com 187 indivíduos de 3 clínicas geriátricas do Rio de Janeiro, no período de janeiro de 2010 à janeiro de 2011. O critério de inclusão foi todos os indivíduos com acuidade visual menor ou igual a 20/200 em qualquer olho (118 indivíduos) e sem atualização da correção óptica. O critério de exclusão foi indivíduos que se recusaram à participar do estudo e indivíduos incapazes de realizarem os exames por déficit mental (6 indivíduos). Dos 187 indivíduos avaliados, 63 indivíduos tinham acuidade visual melhor que 20/200. Resultados: Participaram do estudo efetivamente, após os critérios de inclusão e exclusão, 118 indivíduos com variadas causas de acuidade visual menor ou igual 20/200. Foram encontrados no estudo 57 (48,3%) indivíduos com a presença de morbidades sistêmicas incapacitantes. Dos 118 indivíduos com baixa acuidade visual, que participaram do estudo, 27,96% apresentaram catarata e 26,27% ametropias. Conclusão: A maioria dos indivíduos destas clínicas geriátricas apresentou morbidades oculares que com tratamento adequado permitem a melhora da acuidade visual. Foi encontrado um problema mais de cunho social pela dificuldade de acesso à consulta oftalmológica. .

Hospital de día médico como alternativa a la hospitalización convencional en un servicio de medicina interna de un hospital comarcal / No disponible

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¿El Hospital de Día Psiquiátrico de Adultos evita ingresos posteriores? / Does day hospital avoid readmissions?

Objetivo: Pretendemos estudiar el perfil del paciente de Hospital de Día (HD), observar si un ingreso en HD disminuye los reingresos en cualquier unidad hospitalaria, qué variables están relacionadas con menos reingresos y si existe relación entre la duración del ingreso en HD y los reingresos. Método: Estudio retrospectivo y comparativo de cada uno de los pacientes. Duración: 28 meses (167 pacientes). Resultados analizados en función del tipo de ingreso: I y II. El tipo I es de más de 10 días de duración y tiene una finalidad terapéutica. Resultados: Encontramos una disminución de los reingresos en los tipo I, a expensas de pacientes con diagnóstico de esquizofrenia/otros T. psicóticos y T. afectivos. Disminución de los reingresos en pacientes con mayor número de hospitalizaciones previas y en aquellos que realizaron un ingreso de mayor duración. Conclusiones: Se deduce que el HD es eficaz, sobre todo para aquellos pacientes con diagnósticos de trastorno psicótico y del estado de ánimo

Objective: The aim of our trial is to study the type of patient who is in partial hospitalisation, to assess if an admission in DH would reduce readmission to other hospitalisation units, to study predictors related to less readmissions and the relationship between the duration of a DH admission and readmissions. Method: Retrospective, comparative study with every patient. Duration: 28 months (167 patients). Results analysed according to the type of admission: I and II. Type I is longer than 10 days hospitalised and it has a therapeutic purpose. Results: Reduction in readmissions rates in type I admissions. Reduction in readmissions for those patients diagnosed with schizophrenia/other psychotic disorders and affective disorders. Reduction in readmissions in those patients with less hospitalisations before a DH admission. Finally, patients who spend a longer period in day car have lower readmission rates significantly. Conclusions: We deduce that DH is effective, especially in those patients with psychotic and affective disorders

Day-care management of sickle cell painful crisis in Jamaica: a model applicable elsewhere?

In the U.K. and the U.S.A., painful crises account for 80-90 percent of sickle-related hospital admissions, with average durations of 5-11 d. In Jamaica, many severe painful crises are managed in a day-care centre. Patients (n = 1160) with homozygous sickle cell (SS) disease aged 18 years and over were registered with the clinic during a 1-year study period. Of these, 216 patients with 476 painful crises attended the day-care facility for a total of 688 d. Most patients (119 or 55.1 percent) had single crises and for most crises (338 or 71 percent), patients attended for only 1 d, when they were given bed rest, assurance, rehydration and analgesia. Patients with complicated painful crises were usually referred for admission after initial pain relief and the rest were monitored during the day. In the evening they were given the option of hospital admission or allowed home with oral analgesia. Hospital admission for complicated painful crises or inadequate pain relief occurred in 42 (8.8 percent) crises and home management in 434 (91.2 percent) crises. Of 186 patients initially selecting home management, 20 percent returned for further day-care and five (2.7 percent) died during subsequent admission for that painful crisis, one without other known complications, two with acute chest syndrome (one associated with Salmonella septicaemia), another with Salmonella septicaemia, and one with dengue haemorrhagic fever. With suitable oral analgesia, adequate education and support, the majority of severe painful crises in SS disease in Jamaica have been managed on an outpatient basis. This model of patient care may merit assessment in other communities where painful crises are a common clinical problem.(Au)

Hospitalización parcial en la clínica psiquiátrica universitaria ¿un recurso subutilizado? / Partial hospitalization in the university psychiatric clinic ¿an under used asset?

La hospitalización parcial ofrece una serie de ventajas sobre la internación total y la atención ambulatoria. Sin embargo, esta modalidad asistencial no se ha expandido como habría sido de esperar. En este trabajo se estudió retrospectivamente la utilización de la hospitalización diurna en la Clínica Psiquiátrica de la Universidad de Chile entre 1982 y 1989. Se revisaron las historias clínicas de los pacientes del Hospital Diurno y los registros de egreso de los enfermos internados a tiempo completo durante esos años. Se analizó la relación en el período estudiado, en ambos tipos de hospitalización. La internación parcial representó el 8%del total de hospitalizaciones, porcentaje que fluctuó, descendiendo entre 1982 y 1986 y ascendiendo paulatinamente entre 1987 y 1989. En comparación con la interacción completa siempre hubo una mayor proporción de esquizofrenias y en los últimos años hubo un leve aumento de los trastornos afectivos, orgánicos y de personalidad. Se concluye que, en la Clínica Psiquiátrica Universitaria, la hospitalización parcial es un recurso subutilizado y que se la considera sólo como alternativa útil para los pacientes esquizofrénicos. Se discuten las posibles razones de esta subutilización, algunas atribuibles a la organización misma y otras a la actitud de los familiares y de los médicos de la institución