Control of measles in a juvenile custodial setting in the wake of the recent US outbreak.

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

Diseño, planificación y organización de la Unidad de Custodia Hospitalaria del Hospital Universitario Fundación Alcorcón / Design, planning and management of the hospital custody unit at Hospital Universitario Fundación Alcorcón

Objetivo: Diseñar y organizar la Unidad de Custodia Hospitalaria (UCH) en el Hospital Universitario Fundación Alcorcón (HUFA), adecuada a los objetivos para la atención sanitaria especializada extrapenitenciaria de los internos que sufren una enfermedad, creando un entorno que facilita la vida diaria asistencial en el hospital y que responde a la doble función de lugar de custodia y espacio favorecedor de la rehabilitación de la salud. Material y método: Se realizó una búsqueda en la literatura científica en las bases de datos internacionales, así como nacionales sobre unidades de acceso restringido O unidades de custodia. Resultados: Diseño, planificación y organización de la Unidad de Custodia Hospitalaria del HUFA. Realización del Protocolo de Actuación de la Unidad de Custodia Hospitalaria del HUFA así como la Guía Rápida de Actuación para dicha Unidad. Discusión: La UCH va a permitir compatibilizar la actividad asistencial, la seguridad de los profesionales y la custodia de los pacientes privados de libertad. Para ello se requiere consensuar protocolos con los Cuerpos y Fuerzas de Seguridad del Estado y de asistencia entre los equipos sanitarios de los centros penitenciarios y del hospital de referencia, así como reforzar los cuidados especializados en salud mental e impulsar la telemedicina y las nuevas tecnologías para agilizar y acercar la prestación sanitaria y coordinar eficazmente el trabajo de los profesionales (AU)

Objective: The design and management of a Hospital Custody Unit at Hospital Universitario Fundación Alcorcón, to focus the aim of this study on specialized medical care for extra-penitentiary patients who have suffered from a disease. We are building a new space to facilitate their daily lives at hospital and we want to offer a double function to the patients that consists of a custody space and a health rehabilitation space. Material and methods: We carried out a scientific literature search on the international and national databases, about Hospital Custody Units or Restricted Access Units. The language of the reviews that we checked was English and Spanish. Results: We wrote the Action Guide of the Hospital Custody Unit for the design, planning and management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón. (We included complementary bibliographic material and the Quick Guide in the Unit). Discussion: The Hospital Custody Unit will be compatible with medical activity, occupational safety and the custody of patients that are in prison. We thus require consensus with police departments about custody protocols along with assistance from the clinicians’ teams at penitentiary centers and referral hospitals. Furthermore, it is important to step up special care for mental health and to promote telemedicine and new technologies to streamline medical care along with coordination with healthcare professionals (AU)

Hospitals in Hurricane Katrina: challenges facing custodial institutions in a disaster.

In the days after Hurricane Katrina struck and New Orleans's infrastructure failed, hospitals and other organizations that have custodial responsibility for human beings (such as nursing homes and jails) faced special difficulties. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage service, and many of these hospitals required external assistance, which was slow to arrive. Meanwhile, patients' needs for care continued unabated. Some hospitals evacuated all patients successfully, but by the end of that long week, some had become places of death. This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences. We conclude with lessons based on the Katrina experience.

The role of a rural sobering-up centre in managing alcohol-related harm to Aboriginal people in South Australia.

There is a paucity of literature on the topic of sobering-up centres (non-custodial safe overnight accommodation for the publicly intoxicated). This paper presents findings of a retrospective longitudinal case study of a sobering-up centre in regional South Australia over the ten years 1991 to 2000. There were 6,486 admissions during this period, 97.1% of which were of Aboriginal people. We collated and analysed primary data including demographic details of admissions and re-admissions, and qualitative and quantitative measures of intoxication. The findings from this case study, considered together with contextual understandings from a wider social study in this region by three of the authors, provide supporting evidence of the important role of sobering-up centres in averting the known harms of a custodial response to public drunkenness, as well as avoiding the potential harm of alcohol-related injury among vulnerable Aboriginal people.

Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations.

This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.

Senior assisted living: a hospital niche?

Nationwide demographic trends indicating a growing elderly population are creating interest in a number of senior related services, especially within the health care industry. A relatively new concept in senior care, assisted living, may well be the greatest area of growth in the senior housing industry today. Understanding assisted living, the factors which make it successful, and the role hospitals can play in development is critical to wise decision-making.

Custodial nursing home care. Setting realistic goals.

Despite concerted effort to rehabilitate and return patients to their homes, the majority of nursing home patients are destined to spend the remainder of their days in institutional settings. These custodial care patients are elderly, have many functional disabilities, and are often demented. The traditional medical approach to care, which emphasizes diagnosis and treatment of specific diseases, is often not appropriate for these patients. Instead, physicians should focus their attention on functional assessment and treatment, nontechnologic management of acute problems, humane terminal care, and the development of an efficient caregiving system within the nursing home.