Évaluation d'une structure gériatrique entre l'ambulatoire et l'hospitalier [Geriatric institutions, between ambulatory and hospital care: patients' description and performance assessment].

Introduction : Décrire les patients d'une structure gériatrique offrant des hospitalisations de courte durée, dans un contexte ambulatoire, pour des situations gériatriques courantes dans le canton de Genève (Suisse). Mesurer les performances de cette structure en termes de qualité des soins et de coûts. Méthodes : Des données relatives au profil des 100 premiers patients ont été collectées (huit mois), ainsi qu'aux prestations, aux ressources et aux effets (réadmissions, décès, satisfaction, complications) de manière à mesurer différents indicateurs de qualité et de coûts. Les valeurs observées ont été systématiquement comparées aux valeurs attendues, calculées à partir du profil des patients. Résultats : Des critères d'admission ont été fixés pour exclure les situations dans lesquelles d'autres structures offrent des soins mieux adaptés. La spécificité de cette structure intermédiaire a été d'assurer une continuité des soins et d'organiser d'emblée le retour à domicile par des prestations de liaison ambulatoire. La faible occurrence des réadmissions potentiellement évitables, une bonne satisfaction des patients, l'absence de décès prématurés et le faible nombre de complications suggèrent que les soins médicaux et infirmiers ont été délivrés avec une bonne qualité. Le coût s'est révélé nettement plus économique que des séjours hospitaliers après ajustement pour la lourdeur des cas. Conclusion : L'expérience-pilote a démontré la faisabilité et l'utilité d'une unité d'hébergement et d'hospitalisation de court séjour en toute sécurité. Le suivi du patient par le médecin traitant assure une continuité des soins et évite la perte d'information lors des transitions ainsi que les examens non pertinents. INTRODUCTION: To describe patients admitted to a geriatric institution, providing short-term hospitalizations in the context of ambulatory care in the canton of Geneva. To measure the performances of this structure in terms of quality ofcare and costs. METHOD: Data related to the clinical,functioning and participation profiles of the first 100 patients were collected. Data related to effects (readmission, deaths, satisfaction, complications), services and resources were also documented over an 8-month period to measure various quality and costindicators. Observed values were systematically compared to expected values, adjusted for case mix. RESULTS: Explicit criteria were proposed to focus on the suitable patients, excluding situations in which other structures were considered to be more appropriate. The specificity of this intermediate structure was to immediately organize, upon discharge, outpatient services at home. The low rate of potentially avoidable readmissions, the high patient satisfaction scores, the absence of premature death and the low number of iatrogenic complications suggest that medical and nursing care delivered reflect a good quality of services. The cost was significantly lower than expected, after adjusting for case mix. CONCLUSION: The pilot experience showed that a short-stay hospitalization unit was feasible with acceptable security conditions. The attending physician's knowledge of the patients allowed this system tofocus on essential issues without proposing inappropriate services.

The book of Niagara Falls /

On cover : Steele's book of Niagara Falls.

Four days at Niagara Falls, in North America /

Inscription in ink, t.p. verso: James Ainsworth Esq With the respectful com'ts of the author.

Picturesque Niagara /

Cover title.

Steele's book of Niagara Falls /

"Illustrated by maps of the Falls and immediate vicinity, and of the Niagara River, from Lake Erie to Lake Ontario, and six new views."

City of Niagara Falls Plans, 1846, 1877, 1884, 1886, 1889-1890, 1892-1894, 1903-1905, 1910, 1914, 1919, 1925, 1927-1928, n.d.

The collection consists of 37 plans, surveys or maps of the City of Niagara Falls beginning in 1846 until 1928. Some of the plans were created for the Falls Company, a group of land speculators that included Buchanan, Murray, Street, Allen, Robinson and others. Other plans relate to the building of the suspension bridge and the railway. Some plans and drawing may refer to estate documents in RG 167 Niagara South estate and legal documents collection. Item 22 has been scanned for preservation purposes.

Clifton House Ladies’ and Gentlemens’ Ordinary menu, 1865

The menu, with wine list from the Ladies’ and Gentlemens’ Ordinary of the Clifton House hotel in Niagara Falls, Ont. Also includes handwritten additions or alterations to the printed menu. The proprietors of the hotel were D.H. Bromley & Co. The Clifton House hotel was built in 1833 and destroyed by fire in 1896. It was known as the finest hotel on the Canadian side of the falls. Oakes Garden Theatre marks its location today.

Canadian Niagara Power Company fonds

Power at the Falls: The first recorded harnessing of Niagara Falls power was in 1759 by Daniel Joncairs. On the American side of the Falls he dug a small ditch and drew water to turn a wheel which powered a sawmill. In 1805 brothers Augustus and Peter Porter expanded on Joncairs idea. They bought the American Falls from New York State at public auction. Using Joncairs old site they built a gristmill and tannery which stayed in business for twenty years. The next attempt at using the Falls came in 1860 when construction of the hydraulic canal began by the Niagara Falls Hydraulic Power and Manufacturing Co. The canal was complete in 1861 and brought water from the Niagara river, above the falls, to the mills below. By 1881 the Niagara Falls Hydraulic Power and Manufacturing Co. had a small generating station which provided some electricity to the village of Niagara Falls and the Mills. This lasted only four years and then the company sold its assets at public auction due to bankruptcy. Jacob Schoellkopf arrived at the Falls in 1877 with the purchase of the hydraulic canal land and water and power rights. In 1879 Schoellkopf teamed up with Charles Brush (of Euclid Ohio) and powered Brush’s generator and carbon arc lights with the power from his water turbines, to illuminate the Falls electrically for the first time. The year 1895 marked the opening of the Adam No. 1 generating station on the American side. The station was the beginnings of modern electrical utility operations. The design and operations of the generating station came from worldwide competitions held by panels of experts. Some who were involved in the project include; George Westinghouse, J. Pierpont Morgan, Lord Kelvin and Nikoli Tesla. The plants were operated by the Niagara Falls Power Company until 1961, when the Robert Moses Plant began operation in Lewiston, NY. The Adams plants were demolished that same year and the site used as a sewage treatment plant. The Canadian side of the Falls began generating their own power on January 1, 1905. This power came from the William Birch Rankine Power Station located 500 yards above the Horseshoe Falls. This power station provided the village of Fort Erie with its first electricity in 1907, using its two 10,000 electrical horsepower generators. Today 11 generators produce 100,000 horsepower (75 megawatts) and operate as part of the Niagara Mohawk and Fortis Incorporated Power Group.

Niagara Region Hospital fonds, 1941-2003, n.d. (non-inclusive)

The fonds contains materials relating to The St. Catharines General Hospital, from 1941-2003 (non-inclusive). The materials included are meeting minutes, reports, media releases and correspondence media packages and some photographs. There are also a few short books put together on the history of the Mack Training School for Nurses and the Shaver Hospital. Material within folders has retained its original order. Many of the folders contain more than one type of material, for example media releases, clippings, correspondence etc. The most prominent form of material within the folder is what dictates the folder title. Sub-series within a series have been arranged alphabetically. Folders within a sub-series have been arranged chronologically.

A Geographical view of the Province of Upper Canada

Full Title: A geographical view of the province of Upper Canada : and promiscuous remarks on the government, in two parts, with an appendix, containing a complete description of the Niagara Falls, and remarks relative to the situation of the inhabitants respecting the war, and a concise history of its progress, to the present date. William and David Robinson, Printers

Niagara Falls Suspension Bridge Company fonds, 1875-1876, 1878, 1884

In 1846, the governments of Upper Canada and the State of New York initiated the creation of two companies that would be authorized to build a bridge over the Niagara River. The bridge was to be owned by both companies, respectively known as the Niagara Falls Suspension Bridge Company (Canadian) and the International Bridge Company (American). A suspension bridge was completed in 1848. This bridge was later replaced by a second suspension bridge that accommodated railways, built in 1853-54. However, the increasing weight of trains made it necessary for the bridge to be redesigned, and a third bridge was completed in 1886. Eventually, this bridge was replaced by a steel arch bridge, which was completed in 1897.

Image of Niagara Falls n.d.

In 1818 Parkhurst Whitney built stairs leading to the river’s edge at Prospect Point. In 1825 Porter Brother replaced that staircase with a spiral one. In 1844 Whitney started a water powered incline railway there although the staircase was also used until 1890. In 1906 the water wheel was replaced by an electric power plant. There were lower buildings which included Shadow of the Rock which was a concession stand and also rented raincoats to the tourists. This was destroyed by fire and ice in 1892 and replaced by a chalet-style building in 1894-95. On July 6th, 1907 a cable on the incline railway broke. One person was killed and several sustained injuries. An elevator was constructed and it opened in January of 1910. It was condemned in 1954 when water entered the shaft, this was at the time of the collapse of Prospect Point which occurred at 4:50 pm. on July 28, 1954. This photograph was taken prior to 1954. Today the New York State Observation Tower stands at Prospect Point and The Maid of the Mist boat ride is available from the base of the tower. with information from: Niagara Falls Canada: a History by the Kiwanis Club of Stamford, Ontario

Niagara Falls Bridge Commission Scrapbooks, 1941-1948, 1953-1963, 1965-1974

The Niagara Falls Bridge Commission was created by a joint resolution of the 1938 U.S. Congressional Third Session. The Extra Provincial Corporations Act of Ontario, Canada licenses the Niagara Falls Bridge Commission. Canada and the United States are equally represented on the Commission by an 8 member Board of Commissioners. Canadian commissioners are appointed by the Premier of Ontario. The three Niagara bridges are the Whirlpool Bridge, the Lewiston-Queenston Bridge and the Rainbow Bridge. Source:http://niagarafallsbridges.com/index.php3