Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Thesis (M.P.H.)--University of Michigan, 1963.

Thesis (M.P.H.)--University of Michigan, 1963.

Yes / Objectives The Cohen-Mansfield Agitation Inventory (CMAI; (Cohen-Mansfield and Kerin, 1986)) is a well-known tool for assessing agitated behaviours in people with dementia who reside in long-term care. No studies have evaluated the psychometric qualities and factor structure of the CMAI in acute general hospitals, a setting where people with demand may become agitated. Method Longitudinal study investigating pain, agitation and behavioural problems in 230 people with dementia admitted to acute general hospitals in 2011–2012. Cohen-Mansfield Agitation Inventory was completed as part of a battery of assessments including PAINAD to measure pain. Results A nine-item two-factor model of aggressive and nonaggressive behaviours proved to be the best-fitting measurement model in this sample, (χ2 = 96.3, df = 26, p<0.001; BIC [Bayesian Information Criterion] = 4593.06, CFI [Comparative Fit Index] = 0.884, TLI [Tucker Lewis Index] = 0.839, RMSEA [Root Mean Square Error of the Approximation] = 0.108). Although similar to the original factor structure, the new model resulted in the elimination of item 13 (screaming). Validity was confirmed with the shortened CMAI showing similar associations with pain as the original version of the CMAI, in particular the link between aggressive behaviours and pain. Conclusion The factor structure of the CMAI was broadly consistent with the original solution although a large number of items were removed. Scales reflecting physical and verbal aggression were combined to form an Aggressive factor, and physical and verbal nonaggressive behaviours were combined to form the Nonaggressive factor. A shorter, more concise version of the CMAI was developed for use in acute general hospital settings. Copyright © 2017 John Wiley & Sons, Ltd. / Alzheimer's Society and the BUPA Foundation. Grant Number: 131

Darbo tikslas: išanalizuoti personalo organizavimo ypatumus Lietuvos bendrojo pobūdžio ligoninėse. Tyrimo metodika: Vienmomentinė apklausa buvo vykdoma Lietuvos bendrojo pobūdžio ligoninėse nuo 2009 m. birželio 20 d. iki 2009 m. spalio 20 d. Tyrimo metu buvo apklausti asmenys atsakingi už personalo organizavimą Lietuvos bendrojo pobūdžio ligoninėse. Statistinėje analizėje buvo naudotos 58 teisingai užpildytos anketos (90,6 proc. visų išdalintų anketų). Rezultatai: Tyrimo rezultatai atskleidė, kad bendrojo pobūdžio ligoninėse vykdomi ne visi personalo organizavimo etapai. Rečiausiai vykdomi personalo organizavimo etapai yra darbuotojų karjeros planavimas (36,8 proc.) ir reguliaraus darbuotojų vertinimo atlikimas (40,4 proc.). Tyrimo metu nustatyta, kad dažniausiai (82,5 proc.) darbuotojų kaita ligoninėse yra nedidelė – iki 5 proc. darbuotojų per metus. Absoliuti dauguma bendrojo pobūdžio ligoninių turi parengtus darbo vietų aprašymus (pareigybines nuostatas), tačiau keturiose (7,0 proc.) bendrojo pobūdžio ligoninėse yra parengti ne visų darbuotojų darbo vietų aprašymai. Lietuvos bendrojo pobūdžio ligoninėms ieškant darbuotojų dažniau pritrūksta kvalifikuotų darbuotojų nei nekvalifikuotų. 71,9 proc. ligoninių vadovų ir asmenų, atsakingų už darbuotojų organizavimą, teigė, kad yra sunku surasti naujoms darbo vietoms tinkamos kvalifikacijos gydytojus. Didžioji dalis (79,3 proc.) tiriamųjų teigė, jog norėtų pagilinti savo žinias personalo organizavimo srityje. Labiausiai norėtų... [toliau žr. visą tekstą] / The aim of the work: to analyze the peculiarities of staff organization in general hospitals of Lithuania. Research methods: Cross-sectional survey was carried out in general hospitals of Lithuania from 20th June 2009 till 20th October 2009. Persons responsible for the staff organization in general hospitals of Lithuania were interviewed. The statistical analysis was performed using 58 correctly filled questionnaires (90.6 % of all distributed questionnaires). Results: The results revealed that not all stages of staff organization were implemented in general hospitals. The rarest implemented stages of staff organization are the planning of employees’ career (36.8 %) and the regular evaluation work performance (40.4 %). The study assessed that employee turnover in hospitals is low mostly (82.5 %) – up to 5 % employees during the year. The absolute majority of general hospitals have prepared job descriptions, meanwhile four (7.0 %) hospitals have had job descriptions not for all positions. General hospitals of Lithuania were lacking of skilled workers more often than unskilled workers. 71.9 % of hospital directors and persons, responsible for staff organization, stated that it is difficult to find appropriate and qualified physicians for new workplaces. The majority (79.3%) of respondents said they would like to increase their knowledge in the area of personnel organization. The most disrere topics were indentifies the analysis of workplaces, personnel training and evaluation... [to full text]

O propÃsito de mudanÃa na concepÃÃo de internaÃÃo hospitalar por uso de substÃncias psicoativas tem um novo direcionamento de assistÃncia, atuando numa lÃgica antimanicomial e interdisciplinar. Os objetivos do estudo foram: Analisar o perfil epidemiolÃgico dos pacientes usuÃrios de crack internados em leitos de um hospital geral de Sobral-CE, regulado pelo SUS, no ano de 2010; caracterizar o perfil sociodemogrÃfico e clÃnico de usuÃrios de crack, estimar a frequÃncia, por tipo de internaÃÃo psiquiÃtrica, devido ao uso de crack e descrever caracterÃsticas desse atendimento tais como: custos, profissionais envolvidos e assistÃncia. Estudo quantitativo, transversal, cuja coleta de dados foi realizada de novembro/2011 a fevereiro de 2012, tomando-se por base, dados de prontuÃrios de pacientes internados na enfermaria psiquiÃtrica no Hospital Geral, Dr. Estevam Ponte, na cidade de Sobral-CE. Selecionou-se usuÃrios de crack, internados no hospital, no ano de 2010, representando 31,5% das internaÃÃes por uso de substÃncias psicoativas neste ano, no total de 97 internamentos. Para coleta de dados foram extraÃdas variÃveis relevantes para o estudo relacionadas à internaÃÃo e ao paciente. A anÃlise foi realizada por meio dos software SPSS e R 2.10. Para identificar diferenÃa entre os tipos de desfecho e variÃveis sociodemogrÃficas e clÃnicas dos usuÃrios de crack, realizou-se testes de qui-quadrado de Pearson e Fisher, sendo utilizado valor de p menor que 0,05 e cÃlculo bruto das razÃes de chance e de prevalÃncia. Utilizou-se o teste de Mann- Whitney e com base nos resultados foram selecionadas variÃveis para anÃlise multivariadas segundo critÃrio de Hosmer-Lemeshow para regressÃo logÃstica e regressÃo de Cox. Para anÃlise da permanÃncia hospitalar adaptou-se as tÃcnicas de anÃlise de sobrevida e as curvas de Kaplan-Meier. O estudo foi aprovado pelo comità de Ãtica em pesquisa e financiado pelo CNPq. Quanto ao perfil dos usuÃrios de crack, eram em sua maioria do sexo masculino, na faixa etÃria de 25 a 34 anos, com baixa escolaridade, sem ocupaÃÃo no momento da admissÃ, com vÃnculo conjugal, com residÃncia fixa.Relativo a tipologia das internaÃÃes, mostrou-se estatisticamente significante ((p<0,05) o nÃmero de profissionais envolvidos, o valor da internaÃÃo e o uso de outras drogas associadas ao crack. Ao aplicarmos a regressÃo logÃstica concluÃmos que os fatores de risco para internaÃÃo involuntÃria foram o uso abusivo de substÃncias e a faixa etÃria de 25 a 34 anos. Relacionado ao tempo de internaÃÃo foi observado que a idade dos usuÃrios, o fato de estar desenvolvendo alguma ocupaÃÃo e o nÃmero de profissionais que o assistem tem diferenÃa significante (p < 0,05) na permanÃncia hospitalar dos mesmos, foram descritos aspectos importantes dos usuÃrios com tratamento anterior. A importÃncia do conhecimento do perfil destes pacientes e caracterÃsticas de internaÃÃes nos permite uma reflexÃo sobre os modelos de atenÃÃo e direcionamento de polÃticas voltadas para este cenÃrio. / The purpose of changing the conception of hospitalization for psychoactive substance use has a new direction for assistance, working in a logic antimanicomial and interdisciplinary. The study objectives were: To analyze the epidemiological profile of crack users hospitalized patients in beds of a general hospital in Sobral-CE, regulated by the UHS, in 2010; characterize the sociodemographic and clinical profile of crack users, estimate the frequency, type of psychiatric hospitalization due to crack use and describe characteristics of services such as: costs, professional envolvidosm, assistance. A quantitative study, a cross-sectional data collection was performed from November/2011 to February 2012, using as a base, data from medical records of patients admitted to the psychiatric ward at the General Hospital, Dr. Estevam Ponte in the city of Sobral-CE. Crack users hospitalized in the year 2010 were selected, representing 31.5% of admissions for psychoactive substance use this year, a total of 97 admissions. To collect data relevant variables were extracted for the study related to hospitalization and the patient. The analysis was performed using the SPSS and R 2.10. To identify differences between the types of outcome and the sociodemographic and clinical variables of crack users, Pearsonâs chi-square and Fisherâs were conducted, and used p value less than 0.05 and rough estimate of odds ratios and prevalence. It was used the Mann-Whitney and based on the outcome variables were selected for multivariate analysis according to the criteria of Hosmer-Lemeshow test for logistic regression and Cox regression. For analysis of length of hospital stay it was adapted to the techniques of survival analysis and Kaplan-Meier method. The study was approved by the research ethics committee and funded by CNPq. As the profile of crack users, mostly were male, aged 25-34 years with low education, no occupation at the time of admission, with marital bond, with fixed residence. On the type of admissions, the number of professionals involved was statistically significant (p <0.05), as the value of hospitalization and use of other drugs associated with the crack. By applying logistic regression it was concluded that the risk factors for involuntary hospitalization were substance abuse and the age group 25-34 years. Related to length of stay it was observed that the age of users, the fact that it is developing some occupation and the number of professionals who assist them have significant difference (p <0.05) in their length of hospital stay, important aspects were described of the users previously treated.The importance of understanding the profile of these patients and characteristics of these hospitalizations allows a reflection on the models of care and direction of policies for this scenario.

L'obligation faite aux gens de loi de conduire les mendiants dans les prisons de la ville la plus proche soulève la question de l'enfermement dans les grandes cités des provinces du nord. en france, l'etat royal croit remédier à ces difficultés par l'édit de juin 1662 ordonnant la création d'un hôpital général dans chaque ville du royaume. dès les années 1730, les administrateurs des principales villes des pays-Bas français appellent de leurs vœux une nouvelle forme de prise en charge du paupérisme : les hôpitaux généraux. ces établissements dans les provinces septentrionales n'ont fait l'objet d'aucune étude d'ensemble. il importe pourtant d'observer comment, dans un contexte de centralisation administrative, ces institutions se sont implantées dans des provinces où la tradition d'autonomie administrative était ardemment défendue. • la tutelle de l'intendant a-T-Elle été acceptée sans heurt dans la flandre maritime, pays d'administration directe, en flandre wallonne ou dans le hainaut, où les élites locales défendaient une co-Gestion du territoire ? • le financement de tels établissements doit également être étudié de près : selon les pays, là encore, le coût de l'hôpital général était supporté soit directement, soit indirectement par les contribuables, selon les modes d'administration locale. • l'expérience du renfermement des pauvres a par ailleurs suscité des critiques qu'il nous faudra analyser en tenant compte du contexte intellectuel du xviiie siècle. il convient aussi de s'interroger sur la réalité de l'autonomie de ces établissements hospitaliers, principalement au plan de la gestion financière et comptable.• pour administrer et gérer ces établissements, les magistrats font appel aux élites locales. les notables contribuent à la fois de leur temps et de leur argent à ces structures caritatives locales. ils collaborent souvent avec les représentants des élites des grandes villes• on ne négligera pas pour autant le caractère social du sujet : la large ouverture de ces hôpitaux généraux aux enfants permettra, semble-T-Il, d'établir un modèle particulier du traitement de l'enfance hôpitaux généraux ont joué un rôle prépondérant dans la genèse de l'enseignement élémentaire.c'est dunkerque qui ouvre la série des fondations grâce à des lettres patentes délivrées dès le 22 juillet 1737. lille suit à une courte distance en 1738, les années 1751-1752 correspondent à une accélération du mouvement avec la création des hôpitaux généraux de valenciennes et de douai. / The obligation (bond) made for people of law to lead (drive) the beggars in the prisons of the closest city raises the question of the confinement in the big cities (estates) of the provinces of the North. In France, the royal State believes to remedy these difficulties by the edict of June, 1662 ordering the creation of a general hospital in every city of the kingdom. The provinces of the North escape this movement up to the first third (third party) of the XVIIIth century. For the XVIth century, the assistance (audience) rests(bases) mostly on the Tables of the poor men there, charitable institutions were placed under the supervision (guardianship) of the Magistrates or people of law. After the wars of succession of Poland and Succession of Austria and under the influence of a new population growth, the northern provinces are confronted with an outbreak of the begging the scale of which questions brutally the efficiency of the model of assistance (audience) hispano - tridentin. The royal power strengthens just like that the repressive regulatory framework, arrests multiply and reveal the incapacity of the traditional structures of confinement. From the 1730s, the administrators (directors) of the main cities of the French Netherlands wish for a new shape of coverage (care) of the pauperism. The local authorities turn (shoot) then to the example of the general hospitals.

Yes / People with dementia occupy up to one quarter of acute hospital beds. However, the quality of care delivered to this patient group is of national concern. Staff working in acute hospitals report lack of knowledge, skills and confidence in caring for people with dementia. There is limited evidence about the most effective approaches to supporting acute hospital staff to deliver more person-centred care. This study aimed to evaluate the efficacy of a specialist training programme for acute hospital staff regarding improving attitudes, satisfaction and feelings of caring efficacy, in provision of care to people with dementia. A repeated measures design, with measures completed immediately prior to commencing training (T1), after completion of Foundation level training (T2: 4–6 weeks post-baseline), and following Intermediate level training (T3: 3–4 months post-baseline). All participants received the 3.5 day Person-centred Care Training for Acute Hospitals (PCTAH) programme, comprised of two levels, Foundation (0.5 day) and Intermediate (3 days), delivered over a 3–4 months period. Staff demographics and previous exposure to dementia training were collected via a questionnaire. Staff attitudes were measured using the Approaches to Dementia Questionnaire (ADQ), satisfaction in caring for people with dementia was captured using the Staff Experiences of Working with Demented Residents questionnaire (SEWDR) and perceived caring efficacy was measured using the Caring Efficacy Scale (CES). The training programme was effective in producing a significant positive change on all three outcome measures following intermediate training compared to baseline. A significant positive effect was found on the ADQ between baseline and after completion of Foundation level training, but not for either of the other measures. Training acute hospital staff in Intermediate level person-centred dementia care is effective in producing significant improvements in attitudes towards and satisfaction in caring for people with dementia and feelings of caring efficacy. Foundation level training is effective in changing attitudes but does not seem to be sufficient to bring about change in satisfaction or caring efficacy. Keywords