Hospital and home : strange bedfellows or new partners?

This paper addresses the hospital/community interface as an emerging context of health care practice. As a consequence of industry reforms health service managers are looking to the community space as a location for delivery of acute health care. This focus on the community is sharpened by the promise of cost savings and enhanced by the seemingly limitless potential of biomedical technology. The paper argues that the interface of hospital and community is a conceptual space where two different types of health services meet, bringing with them different cultural practices and expectations. The ‘hospital in the home’ programs that structure health care at this interface provide the delivery of acute nursing and medical care and the accoutrements of this care in the community, the neighbourhood, the home. Consequently, the home is becoming the new site for high technology ‘hospital’ care. This domestication of illness technology is contrasted with the notion of home as a place of sanctuary, familiarity and belonging.

Outcomes following inpatient rehabilitation : a seven year perspective

Introduction: Improving physical and cognitive functioning is a key objective of multi-disciplinary inpatient geriatric rehabilitation. Outcomes relevant to minimum functional ability required for older adults to successfully participate in the community have been reported. However, there has been little investigation reporting outcomes of older inpatients receiving multi-disciplinary rehabilitation being discharged home from geriatric rehabilitation units. This study aims to investigate characteristics and physical and cognitive outcomes of this cohort. Method: The Princess Alexandra Hospital Geriatric and Rehabilitation Unit is the largest rehabilitation unit in Queensland. Multidisciplinary health professionals enter admission and discharge functional and clinical outcomes along with demographic information into a purpose designed database for all patients. Data collected between 2005 and 2011 was analysed using descriptive statistics. Results: During the seven-year period, 4120 patients were admitted for rehabilitation; 2126 (52%) were female, mean age of 74 years (Standard Deviation 14). Primary reasons for admission were for reconditioning post medical illness or surgical admission (n = 1285, 31%), and 30% (n = 1233) admitted for orthopaedic reasons. Of these orthopaedic admissions, 6.6% (n = 82) were for elective surgery, and 46% (n = 565) were for fractured neck-of-femurs. 76% (n = 3130) of patients were discharged home, 13% (n = 552) to residential care facilities and 10% (n = 430) were discharged to an alternative hospital setting or passed away during their admission. Mean length of stay was 44 days (SD 39) Preliminary analysis of FIM outcomes shows a mean motor score of 53 (SD = 19) on admission which significantly improved to 71 (SD = 18) by discharge. There was no change on FIM cognitive score (28 (SD7) vs 29 (SD 6). Conclusion: Geriatric patients have significant functional limitations even on discharge from inpatient rehabilitation; though overall cognition is relatively intact. Orthopaedic conditions and general deconditioning from medical/surgical admissions are the main reasons for admission. The majority of people receiving rehabilitation are discharged home.

Treating skin tears in nursing home residents : a pilot study comparing four types of dressings

A pilot study was conducted to compare four types of dressings used to treat skin tears in nursing home residents. Wounds treated with a non-occlusive dressing healed more quickly than those dressed with occlusive dressings. The results suggest that ease of use and product wastage are important considerations when treating skin tears. The pilot study also highlights the need for further research into skin tear management and the need for ongoing education for nurses regarding skin integrity risk assessment and product information.

Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010

Background & aims The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients. Methods Phase 1 recorded nutritional status (Subjective Global Assessment) and 24-h food intake (0, 25, 50, 75, 100% intake). Outcomes data (Phase 2) were collected 90-days post-Phase 1 and included length of hospital stay (LOS), readmissions and in-hospital mortality. Results Of 3122 participants (47% females, 65 ± 18 years) from 56 hospitals, 32% were malnourished and 23% consumed ≤ 25% of the offered food. Malnourished patients had greater median LOS (15 days vs. 10 days, p < 0.0001) and readmissions rates (36% vs. 30%, p = 0.001). Median LOS for patients consuming ≤ 25% of the food was higher than those consuming ≤ 50% (13 vs. 11 days, p < 0.0001). The odds of 90-day in-hospital mortality were twice greater for malnourished patients (CI: 1.09–3.34, p = 0.023) and those consuming ≤ 25% of the offered food (CI: 1.13–3.51, p = 0.017), respectively. Conclusion The ANCDS establishes that malnutrition and poor food intake are independently associated with in-hospital mortality in the Australian and New Zealand acute care setting.

The impact of malnutrition and decreased food intake on length of stay, readmission, and mortality in acute care patients

Rationale: The Australasian Nutrition Care Day Survey (ANCDS) evaluated if malnutrition and decreased food intake are independent risk factors for negative outcomes in hospitalised patients. Methods: A multicentre (56 hospitals) cross-sectional survey was conducted in two phases. Phase 1 evaluated nutritional status (defined by Subjective Global Assessment) and 24-hour food intake recorded as 0, 25, 50, 75, and 100% intake. Phase 2 data, which included length of stay (LOS), readmissions and mortality, were collected 90 days post-Phase 1. Logistic regression was used to control for confounders: age, gender, disease type and severity (using Patient Clinical Complexity Level scores). Results: Of 3122 participants (53% males, mean age: 65±18 years) 32% were malnourished and 23% consumed�25% of the offered food. Median LOS for malnourished (MN) patients was higher than well-nourished (WN) patients (15 vs. 10 days, p<0.0001). Median LOS for patients consuming �25% of the food was higher than those consuming �50% (13 vs. 11 days, p<0.0001). MN patients had higher readmission rates (36% vs. 30%, p = 0.001). The odds ratios of 90-day in-hospital mortality were 1.8 times greater for MN patients (CI: 1.03 3.22, p = 0.04) and 2.7 times greater for those consuming �25% of the offered food (CI: 1.54 4.68, p = 0.001). Conclusion: The ANCDS demonstrates that malnutrition and/or decreased food intake are associated with longer LOS and readmissions. The survey also establishes that malnutrition and decreased food intake are independent risk factors for in-hospital mortality in acute care patients; and highlights the need for appropriate nutritional screening and support during hospitalisation. Disclosure of Interest: None Declared.

The Botanist at his Mother's Grave

In this poem about processing human grief, I consciously drew on eco-critical theory – (Wilson 1992, Bate 2000) – and Darwinian literary theory (Carroll 2004) to explore the tension between ideas of the ‘natural’ apprehended through the senses, and poststructuralist ideas of the construction of reality through language.

Studying in Cuba, returning home to work : experiences of graduates from the English-speaking Caribbean

Cuba’s higher education scholarship program has received little attention in the literature on education and development. In this chapter, I discuss themes that emerge from my interviews with graduates from English-speaking Caribbean countries who studied in Cuba, as well as Cuban educators, on the nature of their academic programs and their subsequent careers. This facilitates exploration of a number of questions, including the following: 1. How, in the perceptions of scholarship students and graduates, have they experienced the philosophy of combing study, practical work, and research in the tertiary education curriculum in Cuban universities? 2. What impact does studying in Cuba appear to have on graduates after they return to their home countries? 3. How does the experience of the graduates throw light on the relationship between tertiary education and national development?

Supreme Court Act 1995 (Qld) s 253 – whether refusal to stay execution of costs is an order “as to costs only”

In Virgtel Ltd v Zabusky [2009] QCA 92 the Queensland Court of Appeal considered the scope of an order “as to costs only” within the meaning of s 253 of the Supreme Court Act 1995 (Qld) (‘the Act”). The Court also declined to accept submissions from one of the parties after oral hearing, and made some useful comments which serve as a reminder to practitioners of their obligations in that regard.

Reply - Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality

Dear Editor We thank Dr Klek for his interest in our article and giving us the opportunity to clarify our study and share our thoughts. Our study looks at the prevalence of malnutrition in an acute tertiary hospital and tracked the outcomes prospectively.1 There are a number of reasons why we chose Subjective Global Assessment (SGA) to determine the nutritional status of patients. Firstly, we took the view that nutrition assessment tools should be used to determine nutrition status and diagnose presence and severity of malnutrition; whereas the purpose of nutrition screening tools are to identify individuals who are at risk of malnutrition. Nutritional assessment rather than screening should be used as the basis for planning and evaluating nutrition interventions for those diagnosed with malnutrition. Secondly, Subjective Global Assessment (SGA) has been well accepted and validated as an assessment tool to diagnose the presence and severity of malnutrition in clinical practice.2, 3 It has been used in many studies as a valid prognostic indicator of a range of nutritional and clinical outcomes.4, 5, 6 On the other hand, Malnutrition Universal Screening Tool (MUST)7 and Nutrition Risk Screening 2002 (NRS 2002)8 have been established as screening rather than assessment tools.

Embedding graphic organisers in the teaching and learning of family and consumer sciences (home economics) in Kuwait

Educational reforms currently being enacted in Kuwaiti Family and Consumer Sciences (FCS) in response to contemporary demands for increased student-centred teaching and learning are challenging for FCS teachers due to their limited experience with student-centred learning tools such as Graphic Organisers (GOs). To adopt these reforms, Kuwaiti teachers require a better understanding of and competency in promoting cognitive learning processes that will maximise student-centred learning approaches. This study followed the experiences of four Grade 6 FCS Kuwaiti teachers as they undertook a Professional Development (PD) program specifically designed to advance their understanding of the use of GOs and then as they implemented what they had learned in their Grade 6 FCS classroom. The PD program developed for this study was informed by Nasseh.s competency PD model as well as Piaget and Ausubel.s cognitive theories. This model enabled an assessment and evaluation of the development of the teachers. competencies as an outcome of the PD program in terms of the adoption of GOs, in particular, and their capacity to use GOs to engage students in personalised, in-depth, learning through critical thinking and understanding. The research revealed that the PD program was influential in reforming the teachers. learning, understanding of and competency in, cognitive and visual theories of learning, so that they facilitated student-centred teaching and learning processes that enabled students to adopt and adapt GOs in constructivist learning. The implementation of five GOs - Flow Chart, Concept Maps, K-W-L Chart, Fishbone Diagram and Venn Diagram - as learning tools in classrooms was investigated to find if changes in pedagogical approach for supporting conceptual learning through cognitive information processing would reduce the cognitive work load of students and produce better learning approaches. The study as evidenced by the participant teachers. responses and classroom observations, showed a marked increase in student interest, participation, critical thought, problem solving skills, as a result of using GOs, compared to using traditional teaching and learning methods. A theoretical model was developed from the study based on the premise that teachers. knowledge of the subject, pedagogy and student learning precede the implementation of student-centred learning reform, that it plays an important role in the implementation of student-centred learning and that it brings about a change in teaching practice. The model affirmed that observed change in teaching-practice included aspects of teachers. beliefs, as well as confidence and effect on workplace and on student learning, including engagement, understanding, critical thinking and problem solving. The model assumed that change in teaching practice is inseparable from teachers. lifelong PD needs related to knowledge, understanding, skills and competency. These findings produced a set of preliminary guidelines for establishing student-centred constructivist strategies in Kuwaiti education while retaining Kuwait.s cultural uniqueness.

College, shared house, or home? The impact of living situation on university students’ drinking

University students are recognised as a heavy drinking group who are at risk of both short and long term harms from their alcohol consumption. This paper explores the social dynamics of drinking and the key differences between three core groups of university students – those who live at home, those living in college and those who live independently. We draw on a large scale survey of Australian university students on alcohol consumption and harm minimisation and extensive qualitative individual and focus group interviews with university students in Victoria, New South Wales and Queensland. Our data suggests that living at home supports safer drinking in comparison to the less regulated college context or living independently in shared households.

Does preoperative oral carbohydrate reduce hospital stay?

Background Carbohydrate-rich fluids are used to improve postoperative recovery but the effectiveness of the product for reducing length of hospital stay is uncertain. Objective To assess the effectiveness of preoperative loading with carbohydrates on postoperative outcomes. Participants Forty six patients booked for elective colorectal surgery. Methods Participants were allocated to a Carbohydrate-rich fluid group or Usual Care group during their pre-admission clinic visit. The primary outcome was ‘Time to readiness for discharge’. Results Patients in the control group spent on average 4.3 days (95% confidence interval 3.2 to 5.7) and the Carbohydrate-rich fluid group spent 4.1 days (95% confidence interval 3.2 to 5.4) until the primary outcome was met (p=0.824). Conclusion The safety of preoperative high carbohydrate fluids is supported but we were unable to confirm or refute the benefit of CHO for shorter hospital stay following elective colorectal surgery.

The most private private education : home education in Australia

In Australia, the decision to home educate is becoming increasingly popular (cf. Townsend, 2012). The popularity of home education is in spite of a large number of publically funded, financially affordable private and public schools that offer a range of educational alternatives to parents (cf. English, 2009). In spite of its increasing popularity, the reasons home education is chosen by Australian families is under-researched (cf. Jackson & Allan, 2010). This paper reports on a case study that set out to explore the reasons Australian parents choose to home educate and whether this decision is related to the choice of a private school in Australia. In-depth, qualitative interviews were conducted with a group of home education families in one of Australia’s most populated cities. Data were thematically analysed. The analysis revealed that there were similarities between the discourses of parents who privately educate and parents who home educate. In particular, it reveals the parents’ fears about schools, their negative experiences of schools and their hopes for their children’s futures.