The Best primary care practice for the 1990s.

Mode of access: Internet.

Effect of conditional release from hospitalization on mortality risk

Objectives: This study considered the protective value provided by conditional release. It assessed the contribution of conditional release to mortality risk among patients with mental disorders severe enough to require psychiatric hospitalization during a mental health treatment span of 13.5 years in Victoria, Australia. Methods: Death records were obtained from the Australian National Death Index for a sample of 24,973 Victorian Psychiatric Case Register patients with a history of psychiatric hospitalizations: 8,879 had experienced at least one conditional release during community care intervals and 16,094 had not. Risk of death was assessed with standardized mortality ratios of the general population of Victoria. Relative risk of death among patients with and without past experience of conditional release was computed with risk and odds ratios. The contribution of conditional release to mortality, taking into account use of community care services, age, gender, inpatient experience, and diagnosis, as well as other controls, was assessed with logistic regression. Results: Patients who had been hospitalized showed higher mortality risk than the general population. Sixteen percent ( 4,034) died. Patients exposed to conditional release, however, had a 14 percent reduction in probability of noninjury-related death and a 24 percent reduction per day on orders in the probability of death from injury compared with those not offered such oversight throughout their mental health treatment, all other factors taken into account. Conclusions: Conditional release can offer protective oversight for those considered dangerous to self or others and appears to reduce mortality risk among those with disorders severe enough to require psychiatric hospitalization.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

Character education in a Muslim school: A case study of a comprehensive Muslim school's curricula

Deteriorating social behavior, negative media influence and violence among adolescents have given cause to pause and assess character development for the youth of this country. The purpose of this case study was to examine how a Muslim school’s curricula implemented character education. This study used a qualitative single-case methodology to examine character education as it was experienced by the participants in a private Muslim school. Data were collected from participant interviews, document analysis, and observations of classrooms, daily activities and special events. Data were analyzed to determine how character education was defined by the school, the method of delivery for the character education initiatives and the implementation of character education in this Muslim school. Analysis was based on Character Education Partnership’s (CEP) Eleven Principles of Effective Character Education (2007). The results of the study revealed: (a) participants defined character education using varied traits, processes, and expected behaviors. (b) The school delivers its character education curriculum primarily through the Islamic studies division; an add-on delivery method. Still, there was evidence of partial integration of character education in the core courses and (c) based on CEP’s Eleven Principles four were present and five were partially present in the school’s character education initiatives. Findings also revealed that the school’s emphasis on values, morality and spirituality was instrumental in their teaching character. Findings suggest that if participants in the school community work together they might formulate a definition of character education based on common process and expected behavior and create a collaborative working relationship to implement a character education program. Finally, addressing the absent and partially absent elements of the eleven principles could enhance the school’s character education initiatives. The study provides a process by which religious schools could examine their character education programs. The criteria used to measure the use of character education elements are transferable to other settings; however, this method of study does not allow generalization of findings.

What is best for Esther? Building improvement coaching capacity with and for users in health and social Care-A case study

While coaching and customer involvement can enhance the improvement of health and social care, many organizations struggle to develop their improvement capability; it is unclear how best to accomplish this. We examined one attempt at training improvement coaches. The program, set in the Esther Network for integrated care in rural Jonkoping County, Sweden, included eight 1-day sessions spanning 7 months in 2011. A senior citizen joined the faculty in all training sessions. Aiming to discern which elements in the program were essential for assuming the role of improvement coach, we used a case-study design with a qualitative approach. Our focus group interviews included 17 informants: 11 coaches, 3 faculty members, and 3 senior citizens. We performed manifest content analysis of the interview data. Creating will, ideas, execution, and sustainability emerged as crucial elements. These elements were promoted by customer focusembodied by the senior citizen trainershared values and a solution-focused approach, by the supportive coach network and by participants' expanded systems understanding. These elements emerged as more important than specific improvement tools and are worth considering also elsewhere when seeking to develop improvement capability in health and social care organizations.

Know Your Rights, June 24, 2016

In Iowa, the Managed Care Ombudsman Program was established to advocate for the rights and wishes of Medicaid managed care members who receive care in a health care facility, assisted living program or elder group home, as well as members enrolled in one of the following seven home and community-based services (HCBS) waiver programs.

What is the Medicaid Elderly Waiver Program, 2015

Medicaid Home and Community Based Services (HCBS) Elderly Waiver Program. The Elderly Waiver Program provides services and supports to older Iowans who are medically qualified for the level of care provided at a nursing facility (but do not wish to live in a nursing home); are 65 years of age or older; and eligible for Medicaid.

Factors contributing to defaulting scheduled therapy sessions by caregivers of children with congenital disabilities

Background Defaulting scheduled rehabilitation therapy may result in increased adverse outcomes such as permanent disability and increased healthcare costs. Concomitantly, there is evidence to suggest that early and continued rehabilitation of children with congenital disabilities can improve outcomes significantly. This study was conducted to determine factors contributing to caregivers’ defaulting scheduled rehabilitation therapy sessions. Methods A descriptive cross sectional study was carried out at Chitungwiza Central Hospital, a tertiary facility offering in and outpatient rehabilitation services in Zimbabwe. Caregivers of children who had congenital disabilities (N=40) and who had a history of defaulting treatment but were available during the data collection period responded to an interviewer administered questionnaire. Data were analysed for means and frequencies using STATA 13. Results Factors that contributed to caregivers defaulting scheduled therapy included economic constraints (52%), child related factors (43%), caregiver related factors (42%), service centred factors (30%) and psychosocial factors (58%). Majority of the caregivers (98%) were motivated to attend therapy by observable improvements in their children. Other motivators were incentives given in the rehabilitation department (45%), availability of rehabilitation personnel to provide the required services (48%) and psychosocial support from fellow caregivers, families and the rehabilitation staff (68%). Although all the caregivers could not distinguish occupational therapy from physiotherapy services they all reported that therapy was important. Conclusions A combination of psychosocial, economic, child centred and service centred factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for caregivers.

Análise do trabalho em agentes de contatopaciente: Investigação das táticas utilizadas

A análise do trabalho a que nos propusemos transforma as operações da ação analisada não em instrumento de referência para reproduzilas ou corrigilas, mas sim em instrumento de descoberta de alternativas diversas a partir das quais a ação se constrói. Nesse sentido, o objetivo deste trabalho é verificar as táticas utilizadas pelos agentes de contatopaciente no atendimento de internação em um hospital, no intuito de avaliar o distanciamento entre o trabalho prescrito e o trabalho efetivamente real. Para tanto, utilizouse a entrevista de explicitação como metodologia qualitativa. Também foi analisado o processo de atendimento ao paciente, identificandose tarefas, ações e recursos para obterse melhoria nos resultados com vistas na satisfação do cliente. As táticas específicas de contatocliente foram classificadas em três categorias, baseadas numa tipologia de cliente. A primeira consiste em alterar as demandas que recaem sobre o agente de contatopaciente; a segunda, em tentar impedir os remetentes de dirigir demandas ao agente de contatopaciente; e a terceira em evitar e incluir táticas que permitem ao agente manipular e alterar as demandas recebidas. Nesse sentido, nove táticas foram identificadas.

LAGUNA HULE: EXPERIENCIA DE UN MODELO ECOTURISTICO COMUNITARIO

El principal atractivo turístico de Costa Rica lo constituyen sus recursos naturales; de ahí que en los últimos años se ha presentado el acelerado desarrollo de una serie de proyectos llamados “ecoturísticos”, ejecutados por grandes consorcios, en la mayoría de los casos con el aporte de capital extranjero. El proyecto que se describe en el presente artículo lo ejecutan las comunidades de Cariblanco, Ujarrás y Los Angeles, ubicadas en las zonas aledañas al Refugio Nacional de Vida Silvestre Bosque Alegre. Esta experiencia representa un modelo de desarrollo turístico, que se puede llevar a cabo en otras poblaciones rurales, que cuenten COfl los componentes necesarios para la protección y la conservación de sus recursos naturales, asimismo posibilita la utilización de estos desde una perspectiva de sostenibilidad. El trabajo comunitario se realizó con niños de edad escolar, jóvenes, docentes, líderes comunales y amas de casa. Estos grupos mcta constituyen los verdaderos núcleos de apoyo por medio de los cuales se realizan los diversos subproyectos que se ejecutan en el ámbito del turismo ecológico en el Refugio Nacional de Vida Silvestre Bosque Alegre. Abstract:The main touristic altractive of Costa Rica is its natural resources. For this reason, during the last years there are an accelerate development of ecotouristic project by transnational. The project thai is described in ihis article is carrying out by the Cariblanco, Ujarras and Los Angeles Communities located next to the Wildlife National Refugee of Bosque Alegre. This experiene is a model of tourism development thai can be carrying out in others rural communities thai has the difference component of conservation and preservation of the natural resources. For other hand, it gives the opportunity Lo use and management the natural resources basing in the sustainable approach. The community work was realized with school children, young people, teachers, community leader and housekeepers. Those target groups are (he real people thai support the different activities of the projects that are carry out in to the Wildlife National Refugee of Bosque Alegre.

Report of the Community Integrated Living Arrangement Nursing Services Reimbursement Work Group to the Secretary of the Department of Human Services, the Illinois General Assembly, and the Honorable Rod R. Blagojevich, Governor : in response to Senate Resolution 514 /

This report presents the findings and recommendations of the Work Group; it evaluates the Division of Developmental Disabilities' CILA rate model in terms of the sufficiency of nursing services included in the model, as well as the competitiveness of the wage levels assumed by the model for nurses working in the CILAs. In accordance with Resolution 514, the report is the product of the Working Group's discussions and requests for information and has been facilitated by the Department of Human Services, Division of Developmental Disabilities. As such, the report does not represent the recommendations of the Department of Human Services, nor can the Department of Human Services make any commitment to implement any of the report recommendations or commit funding without executive and legislative direction and a funding appropriation. However, the recommendations of the Work Group are consistent with the nursing services structures of the CILA rate-model and would enhance nursing services reimbursement in CILA, if adopted.

Work activities of occupational therapists in Australian mental health services

The aim of this study was to obtain a profile of occupational therapists’ work activities in contemporary Australian mental health services so as to better understand the specific contribution of this profession. The study also aimed to determine whether or not actual work activity was congruent with the preferred roles of occupational therapists. A cross-sectional survey of 196 occupational therapists working in mental health was conducted. For the purposes of the study, a new instrument was developed that evaluated both actual and preferred work roles in four broad categories: administrative, general clinical skills, specialist clinical skills and community development. Respondents were engaged in a greater proportion of generic than discipline-specific work activities. They reported a preference for higher levels of activity in each of the work categories. These findings suggest that, contrary to some previous reports, not only are occupational therapists in Australia engaged in a broad spectrum of non-specialist mental health work activities, but these activities are mostly congruent with their expectations and wishes.

A community nurse referral system for HMRs: Can it work?

The HMR model contains a mechanism whereby anyone who is concerned about the risk of medication misadventure can request a HMR from the patient's GP. Since nurses are widely involved in a range of triage and gatekeeping roles, utilising their primary care skills to identify patients for a HMR is a logical extension of this role. Furthermore, community nurses visit their clients in the home situation and see many difficulties the client may be experiencing at first hand. They are therefore well placed to request specialist assistance for the client. Blue Care in Brisbane, a community nursing service, approached its local Division of General practice to determine how best to request HMRs for its clients. The Division contacted The University of Queensland which initiated this study to engage the health care team to tailor the established HMR request process to the needs of community nurses and test the system developed. (non-author abstract)