Development and outcomes of a therapeutic group for women with postnatal depression.

Postnatal depression is a significant problem affecting approximately 14.5% of mothers and has the potential for negative long-term consequences for mothers and their children. Previous research suggests that group interventions using cognitive behavioural techniques can be helpful, providing mothers with strategies to address their problems as well as professional and peer support. This paper describes how a therapeutic group was developed by Health Visitors for mothers with postnatal depression in Oxfordshire. It was hypothesised that women who attended the group would feel better able to manage their mood, that their mood would improve and that attending the group would be a positive and supportive experience for them. Formal outcome measures as well as feedback questionnaires were used to evaluate the group and test these hypotheses as well as provide information to improve the service. An overview of the effectiveness of the group is given here, with the majority of women who attended showing improvement in their mood as well as high satisfaction with the content and processes of the course. The findings are discussed and plans for the future are presented.

Patient characteristics, treatment outcomes and rehabilitation practices for patients admitted with hip fractures using multiple data set analysis.

AIMS: For older patients with hip fracture, we explored patient characteristics, outcomes and osteoporosis treatments for those admitted to rehabilitation compared to those discharged directly from hospital, using data set analysis. METHODS: Retrospective cohort study including all consecutive patients (65 years and over) admitted to Christchurch Hospital over one year. Outcomes were compared for patients in four groups: 1) aged residential care (ARC) residents and 2) not ARC residents discharge from acute orthopaedics, and those discharged from 3) orthogeriatric or 4) general geriatric rehabilitation. Clinical data was extracted from hospital data warehouse using signals from noise. RESULTS: Over 12 months, 415 patients were admitted with hip fracture. Over half (n=282) were transferred for inpatient rehabilitation. Thirty-day mortality was 10%. Mortality at 180 days was 7% in orthogeriatric rehabilitation group and 8% in general rehabilitation group. Length of stay was shorter in orthogeriatric compared with general rehabilitation (median 12.9 vs 20.4 days). Osteoporosis treatment was addressed in 88% of patients in the orthogeriatric group compared with 62% in general rehabilitation group. More patients in orthogeriatric group discharged home compared with general rehabilitation group (70% vs 43%), but functional improvements were similar. For ARC residents discharged following acute admission, length of stay was short (median 6.5 day), but overall 180-day mortality was 7%. The not-ARC resident group discharged directly from hospital was less comorbid than the other groups with lower 180-day mortality (4%). Osteoporosis treatment rates were lower in patients discharged from acute admission (15-42%). CONCLUSION: Mortality was highest in ARC residents discharged from acute orthopaedics. Patients admitted for orthogeriatric rehabilitation had shorter length of stay, lower 30-day mortality, were more likely to return home and most likely to be offered osteoporosis treatment (88%), noting less underlying comorbidity and better baseline functional status in this group. This paper supports further study (eg, randomised trials) to examine the effects of targeted post-surgical rehabilitation for patients with hip fracture and explore measures to increase uptake of osteoporosis treatment.