No description available.

Since deinstitutionalization many patients, instead of remaining in the community, revolve through the doors of psychiatric facilities resulting in the "Revolving Door Syndrome". Hence a biopsychosocial evaluation of readmissions was undertaken to see what processes came into play once a patient was discharged from a mental hospital and subsequently readmitted. Seventy Indian patients admitted to the Midlands hospital complex, Pietermaritzburg were interviewed and the data was collected. This comprised 40 readmissions and a control group of 30 first admissions. The diagnosis was made according to DSM-III-R. The results obtained were statistically analyzed and a chi square analysis was done to ascertain if there were any significant differences between the 2 groups. The following were the major findings 1. Most of the patients were in age group 20-29 years. 2. There was a preponderance of males in both groups. 3. Most of the patients in the readmitted group were unemployed and were receiving a disability grant. 4. The majority of patients was single or separated. 5. Most of the patients were discharged on a combination of drug and depot preparation. 6. A large percentage had two and more previous admissions. 7. Length of stay was less than 1 month in a large number of patients. 8. Community tenure was less than 1 year in most of the patients. 9. Even though the majority of patients reported regular attendance, a fair percentage reported attendance at the community clinic. 10. The reason for readmission was mainly aggressive behaviour and aggressive behaviour associated with substance abuse. 11. The discharge diagnosis was schizophrenia in a large number of patients. This study has several important implications for the community care of the patient and various recommendations are made to curtail the revolving door, as follows : 1. There is an urgent need for community based resources. eg. sheltered workshops, supervised housing, industrial and occupational therapy, halfway houses and day hospitals, which would help the chronically mentally ill patients lead more meaningful lives following discharge. 2. The family of the chronically mentally ill patient needs to be actively involved in the management of these patients and mental health workers must solicit the family's support, by educating them about schizophrenia, helping them to increase coping mechanisms and to decrease stress. It is recommended that support groups be held in the community for the families of patients. 3. The patient's family needs to be advised that when the patient show signs of decompensation, they should take the patient to the community clinic, rather than to the District Surgeon to avoid unnecessary rehospitalization. 4. The importance of maintenance medication cannot be overemphasised. There is a need to change the attitude of the patient and family with regard to their negative attitude about medication. 5. The high rate of readmission due to aggressive behaviour (which is aggravated by substance abuse) needs intervention. Substance abuse groups must be held in the community and the community needs to be educated about the consequences of substance abuse in the mentally ill. / Thesis (M.Med.)-University of Natal, 1993.

Die Zentrale Notaufnahme (ZNA) dient als Eintrittsstelle für alle ungeplanten Notfallpatienten eines Krankenhauses. Im Rahmen der Prozesssteuerung kommt der ZNA mit der Priorisierung der Behandlung (Ersteinschätzung), der zielgerichteten Diagnostik und Therapie sowie der Entscheidung über ambulanten Verbleib und stationäre Aufnahme der Patienten eine große Bedeutung zu. In Abhängigkeit von der Struktur und Organisationsform einer ZNA erfolgt bei bereits im ambulanten Bereich behandelten Patienten die Zuordnung zur weiterbehandelnden Fachdisziplin innerhalb des Krankenhauses auf Basis der Überweisungs- bzw. Einweisungsscheinen. Der auf dem Einweisungsschein dokumentierten Einweisungsdiagnose wird als Zuordnungskriterium bei der Prozesssteuerung im klinischen Alltag daher eine tragende Rolle zuteil. Die prospektive, monozentrische Untersuchung zeigt, dass Einweisungsdiagnosen durch niedergelassene Hausärzte und ambulante Versorgungeinrichtungen einer gewissen Unschärfe unterliegen: Nach Ende der Behandlung in der ZNA wurden bei 57,8% der Patienten die Einweisungsdiagnose als zutreffend, bei 23,6% als teilweise zutreffend und bei 18,6% als nicht-zutreffend dokumentiert. Bei Patienten mit teilweise bzw. nicht-zutreffender Einweisungsdiagnose fand sich eine 3-fach bzw. eine 6,5-fach höhere Konsilrate im Vergleich zu Patienten mit zutreffender Einweisungsdiagnose (p<0,05). Patienten mit zutreffender Einweisungsdiagnose wiesen eine signifikant kürzere Verweildauer im Vergleich zu denen mit teilweiser oder nicht-zutreffender Einweisungsdiagnose auf. Die Konsilrate in der ZNA stieg bei Nichtübereinstimmung der 3 Einweisungsdiagnose mit der in der ZNA gestellten Diagnose bis auf das 6,5-fache an [36 Konsile (7,9%) bei 453 Patienten mit zutreffender vs. 75 Konsile (51%) bei 146 Patienten mit nicht-zutreffender Einweisungsdiagnose] und auch die Verweildauer in der ZNA nahm signifikant zu (MW±SD: 192±108 min bei zutreffender vs. 258±138 min bei nicht-zutreffender Einweisungsdiagnose). Die vorliegenden Untersuchungsergebnisse zeigen, dass in der ZNA durch geeignete Maßnahmen (z. B. Ersteinschätzungssysteme, Behandlungspfade, „Standard Operation Procedure“) ein organisiertes und strukturiertes Vorgehen gewährleistet sein muss, um eine Fehlsteuerung mit Verlängerung der Patientenverweildauer und einer Erhöhung der Konsilrate mit höheren Kosten, einer höheren Personalbelastung und möglicherweise negativen Folgen für den Patienten bei nicht-zutreffender Einweisungsdiagnose zu vermeiden.

There is no abstract available for this thesis.

The purpose of the present study was to test the theoretical relationship of the concepts of informational support and threat appraisal with a sample of surgical cardiac patients twenty-four hours after discharge from the hospital. These discharged patients were adjusting to the transition of hospital to home environment while still recovering from a life threatening illness. They may need varying informational supports to reduce their threat perception of the magnitude of the illness. A convenience sample of thirty-six surgical cardiac patients was assigned to three groups. The groups received the standard discharge preparation as stated by the hospitals' policy and procedure manual. The experimental group received a supportive and informational telephone call approximately twenty-four hours after discharge. The second group was the placebo group, these participants were given a telephone call at the end of the twenty-four hours to remind them to return the questionnaire. The third group was the control group, received no telephone call and were instructed to complete the questionnaire at the specified time. All groups were instructed at the time of initial contact to complete the questionnaire at approximately the end of the first twenty-four hours after discharge. The placebo group and control group were then pooled for data analysis due to the low return rate of the two groups. The two groups were compared with a t-test. The demographic data compared age and educational level to the perceived level of threat. Reliability of the tool was determined using a Cronbach's Alpha. / School of Nursing

Syfte: Syftet med studien var att undersöka sjuksköterskors upplevelse av omvårdnaden av patienten vid förändrade inskrivningsrutiner inför en operation på kirurgavdelningen på Enköpings lasarett. Metod: Kvalitativ design med deskriptiv ansats. Åtta sjuksköterskor med erfarenhet av att arbeta innan och efter de nya inskrivningsrutinerna trädde i kraft intervjuades. En intervjuguide av semistrukturerad typ togs fram med en bred huvudfråga och olika teman för att besvara syftet. En innehållsanalys på manifest nivå med en induktiv ansats gjordes. Resultat: Upplevelsen av omvårdnaden vid de förändrade inskrivningsrutinerna var individuell hos de intervjuade sjuksköterskorna. Den generella upplevelsen var att omvårdnaden förändrats och resultatet visar positiva såväl som negativa aspekter av detta relaterat till de förändrade inskrivningsrutinerna. Slutsats: Då vården står inför en stor utmaning med en växande och åldrande befolkning är detta inskrivningssystem en del av den anpassning sjukvården går igenom för att bli mer effektiv. Fler liknande studier kan möjliggöra att denna typ av inskrivningsrutiners positiva aspekter kan uppmärksammas och förstärkas samt att de negativa aspekter som framkommit kan diskuteras och åtgärdas. / Purpose: The aim of this study was to investigate nurses' experience of nursing care of the patient with the new routine of same day admission before surgery in the surgical department at Enköpings hospital. Method: Qualitative design with descriptive approach. Eight nurses with experience working before and after the new routine of same day admission were interviewed. An interview guide of semi- structured type was developed with a broad main issue and different themes to answer the purpose. A content analysis of the data was made. Results: The experience of nursing after the introduction of same day admission was individual of the nurses who were interviewed. The general experience was that nursing care has changed and the result shows positive and negative aspects of this related to the changed admission routine. Conclusion: When care is facing a major challenge with a growing and aging population, this admission system is a part of the adaptation healthcare goes through to become more efficient. More similar studies may enable this type of admission so that positive aspects can be highlighted and strengthened and the negative aspects that emerged can be discussed and addressed.

Les xarxes WLANs possibiliten un accés de banda ampla a Internet des d'un terminal mòbil, essent una possible solució alternativa a les xarxes cel·lulars. Tanmateix, aquest tipus de tecnologia presenta certes limitacions, com és la difícil coexistència entre fluxos de tràfic rígids (VoIP) i fluxos de tràfic elàstic (TCP), degut al propi protocol d'accés al medi. En aquesta tesi es proposa la utilització d'un nou mecanisme de control d'admissió que utilitzant el nou estàndard de qualitat de servei en xarxes WLAN (EDCA). La utilització del mecanisme de control d'admissió millora notablement les prestacions que es poden obtenir de la xarxa, solucionant les diferents limitacions de la tecnologia. Per a l'avaluació i optimització del mecanisme de control d'admissió s'ha desenvolupat un conjunt d'eines matemàtiques que permeten capturar tant la dinàmica del protocol d'accés com el comportament dels diferents fluxos de tràfic multimèdia que s'han consideren (VoIP i tràfic elàstic, TCP). / WLANs provide a broadband access to Internet from a mobile terminal, which can be a possible alternative solution to cellular networks. However, this technology presents several limitations, as it is the difficult coexistence between rigid traffic flows (VoIP) and elastic traffic flows (TCP), due to the medium access protocol itself. In this thesis a new admission control mechanism is proposed. It uses the set of QoS mechanisms provided by the new EDCA standard. The use of the proposed admission control mechanism improves the overall WLAN performance, solving the different technology limitations. In order to be able to evaluate and optimize the admission control mechanism, several mathematical tools have been developed in order to capture the dynamics of both, the access protocol and of the different multimedia traffic flows that have been considered.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1958.

Thesis (M.H.A.)--University of Michigan, 1972.