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  • 1
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This paper describes a pilot study that identifies the implications for resource use when ventilated patients are moved from hospital to the community, and pilots two generic health status survey instruments to measure quality of life experienced in the community for use in a future full evaluation. A group of 11 ventilated patients living in the community were interviewed to identify their resource use, and the SF-36 questionnaire, EuroQol questionnaire and Patient Generated Index were used to investigate implications on quality of life and whether these measures were suitable for use in this group of patients. The main results indicate that the cost of care varies considerably between hospital and community and across patients. The quality of life measures proved inadequate, and highlighted the problems of measuring quality of life for patients with deteriorating health status. All patients much preferred home care to hospital care. A full multi-disciplinary evaluation is required to determine an effective method of providing the care.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The ageing of the elderly population will mean an increase in the numbers of people with dementia and the thrust of the community care reforms suggest that many of these will continue to live in mainstream and sheltered housing. This article draws upon two different research projects to explore one implication of these trends, namely the ‘money handling’ issues (pension collection, bill payments, etc.) raised for social services and in particular for field level welfare professionals. The administrative framework for handling the social security benefits of others is shown to be inadequate with few safeguards over those who take on appointeeship roles. The article then goes on to draw upon focus group interviews with 37 field level staff to illustrate their anxieties and concerns over such issues as money left or lost in the house, their vulnerability to accusations of financial abuse and their need for guidance on when to challenge relatives who appear to perform appointeeship responsibilities not in the best interests of the elderly person. It is concluded that social services authorities need to improve radically the training, support and good practice guidance available to field level staff on personal finance issues.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The agenda of purchasers of health care in the National Health Service (NHS) is increasingly dominated by the issue of priority setting. This is a consequence of the interplay of limited budgets, increasing demands on health care services and a contracting process that makes explicit resource decisions that were previously implicit through clinical discretion. Purchasers are increasingly concerned to show that their decisions are rationally informed and embody a professional and public consensus. This paper examines literature that suggests variables, other than rational determinants, play a part in the process of priority setting at the purchaser and provider level. The interface of public, political and professional agendas in this process help explain the lack of national uniformity in both setting priorities and their translation into practice. Consequently, there is a need for more comprehensive exploration of the relationship between the setting of priorities and their effect on practice.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Many developments have taken place in home help services which have made further professionalization necessary. For this reason, a national study has been planned in the Netherlands to obtain a representative picture of the work of home helps and to examine overloading aspects of their workload. Five instruments were developed for this purpose and a pilot study was carried out to establish the reliability and content validity of the main instrument: a registration form to record the activities that home helps perform. Twenty-five home helps participated in the pilot study. An observer monitored them during their home visits for a period of 1 week. Both the observer and the home help recorded the activities that were carried out independently on the registration form. The reliability of the registration form was assessed by inter-rater-reliability. The validity of this instrument was estimated by the content validity. The results show that the registration form is, in general, a reliable instrument. There is a high level of agreement between home helps and observers in the four main categories: 94% for the household and the caring activities, 98% for the psycho-social or supporting activities and 96% for the reporting activities. The content validity of the form is adequate and only a few items will be added to the final version of the form.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Although work and employment are important elements in the lives of people recovering from psychiatric illness, their access to meaningful occupation and paid employment is limited. A number of state and voluntary vocational rehabilitation schemes provide training or retraining for open employment but whether this is a realistic aim in the current economic climate has been questioned. This study, using direct observation and informal interviewing, explored the interaction between the staff and trainees of one such rehabilitation workshop. It sought to elicit information about the role of the workshop from both the trainer and trainee perspectives.The results indicate a number of differences between the staff and trainee models and illustrate the problems faced by the workshop in balancing its smooth operation against the needs and expectations of its staff and trainees. In particular, its organization around a relaxed interpretation of the ‘through-put’ concept of rehabilitation did not meet the requirements of all the trainees. We consider how employment rehabilitation schemes can achieve the dual role of both helping service users move into employment or other forms of meaningful occupation, and providing work and work substitutes for long-term users.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Although considerable attention has been given to the abuse and neglect of older people by others, little attention has been given to self-neglect in later life. This paper reviews the research literature on self-neglect which comes primarily from the medical profession. It is argued that evidence that gross self-neglect constitutes a specific psychiatric syndrome (commonly referred to as Diogenes syndrome) is scant. Given current moves to make legal provision for the protection of ‘vulnerable’ older people, more rigorous research into self-neglect is required.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The progressive reduction in the numbers of hospital places available for people with mental health problems has led to an increasing demand on community support services. One response has been the development within social services departments of community mental health support teams, which employ largely unqualified staff who offer support to people with longer term mental health needs.The paper examines to what extent the practice of one authority's support teams reflects an appropriate ‘case management’ style of service, as developed in the USA to address the needs of long-term community patients. Key features of this approach are identified, and used as the basis of analysis of the support teams' practice in relation to 214 cases.It is concluded that a ‘case management’ model can be appropriate for work involving unqualified staff, provided that the service structure as a whole enables access to other skills as appropriate. Two specific risks are identified: firstly that the service is developed because of cost rather than appropriateness; and secondly that the service can rapidly become silted up with increasing numbers of people who need service of indefinite duration.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The paper considers how patients might be involved in medical audit. It argues that there are ethical, political and clinical justifications for widening the current ‘medical model’ to include patients' views of mainly sociopsychological matters, and that these are intrinsic to the delivery of health care and evaluations of its quality. The potential barriers to such involvement are doctor-patient relationships; the culture of general practice; the existing pattern of audit; and the lack of organization amongst patients. None of these barriers is seen as insurmountable and the paper concludes that audit could be extended to include practice-based initiatives within medically defined communities of interest.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A qualitative study was undertaken to determine the role that informal carers perform with respect to dependants' medication. The objectives of the study were to understand the nature of medication-related assistance provided by informal carers and to identify any problems they encounter with this role. Face-to-face interviews were conducted with 20 informal carers who were known to provide medication-related assistance. Three group discussions were held with informal carers attending a local selfhelp group.Results from the study indicate that informal carers often provide support with all aspects of medication management including obtaining supplies, administering medication and monitoring effects. Other informal carers keep an eye on their dependant's medication but are not involved in the day-to-day management. The amount of support provided is influenced by the carer's and dependant's physical and mental ability. Furthermore, carers' commitments, such as family and work, and their relationship with the dependant will also affect the level of support they provide. A lack of medication-related knowledge, and an inability to access some of the pharmaceutical and medical services available, result in carers experiencing additional difficulties in fulfilling their role. More attention should be paid to the practicalities of managing medication. Furthermore, the needs of carers should be considered alongside those of the patient when developing pharmaceutical services. Such a philosophy would be in line with the provision of Community Care which advocates the development of services which are sensitive to carers as well as to dependants.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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