Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

Unlicensed personnel administering medications to older persons living at home : a challenge for social and care services

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge. AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis. RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients. IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

Beyond the Threshold: Life in the New Russia

Amanda Sprang spent nine months, from September of 1995 to May of 1996, studying at Colby College's program in St. Petersburg, Russia. Through contacts made during previous trips to Russia in middle and high school, Amanda was able to quickly rekindle her old friendships and make new ones with many young Russians from different backgrounds. The following work is a collection of twelve essays about life in the New Russia. The essays are framed by a foreword and an epilogue that help place the entire work in a historical context. Although the theme of each essay emerges from a particular incident, within every story Amanda has addressed numerous topics relating to Russian life in today’s changing society. Her first essay, “Art Klinika," takes place in an avant-garde night club in St. Petersburg, and includes a brief yet impressionable, encounter with three young Russian men. “The Birthday Party” recalls a wild evening at the home of her close friend, showing how the Russians greet special occasions. Both the third and fourth essays take place in Moscow, where Amanda returns to visit old friends. These two essays portray the lives of the new economic elite in comparison with the average citizen, as well as show how young Russians face the new challenges that greet them. "Politics Russian Style" recalls a political rally in St. Petersburg, and attempts to shed light on the wacky political world of an infant democracy. Chapters Six through Ten take place away from the western cities of St. Petersburg and Moscow, as Amanda brings us to the cold, mysterious land of Siberia in the dead of winter. She recounts her five day train ride with a retired, high-powered, Communist party official, her experiences in the provincial city of Irkutsk, and a brief trip to a Buddhist monastery and, later, an excursion to Lake Baikal. Back in St. Petersburg, Chapter Eleven gives a humorous account of a ski trip with several Russian friends. Amanda finishes her work with her final chapter, “The Dacha," which describes a weekend spent at a Russian country home with her friend's family.