Modelling home care organisations from an operations management perspective

Home Care (HC) service consists of providing care to patients in their homes. During the last decade, the HC service industry experienced significant growth in many European countries. This growth stems from several factors, such as governmental pressure to reduce healthcare costs, demographic changes related to population ageing, social changes, an increase in the number of patients that suffer from chronic illnesses, and the development of new home-based services and technologies. This study proposes a framework that will enable HC service providers to better understand HC operations and their management. The study identifies the main processes and decisions that relate to the field of HC operations management. Hence, an IDEF0 (Integrated Definition for Function Modelling) activity-based model describes the most relevant clinical, logistical and organisational processes associated with HC operations. A hierarchical framework for operations management decisions is also proposed. This analysis is derived from data that was collected by nine HC service providers, which are located in France and Italy, and focuses on the manner in which operations are run, as well as associated constraints, inputs and outputs. The most challenging research areas in the field of HC operations management are also discussed

Psychological treatment of female sexual dysfunction: a critical review of the literature

AIM: Impairment of sexual functioning may have a significant impact on the person's quality of life. Despite the high prevalence of female sexual dysfunctions, it is still not clear what are the effective treatments for these disorders. The aim of this critical review is to provide an update on the efficacy of psychological treatments for female sexual dysfunctions.METHOD: A thorough literature search was performed, using electronic database (PubMed and PsychINFO) and manual searches, selecting articles in English and Italian language published in peer-reviewed journals. Only randomized controlled trials were included.RESULTS: Most of the studies investigated the efficacy of sex therapy using techniques developed by Masters and Johnson and behavioral/ cognitive-behavioral treatment programs. Both approaches were effective for dyspareunia and vaginismus. Cognitive-behavioral and mindfulness based therapy showed significant improvement in hypoactive sexual desire but more research is needed for this disorder. Studies on the efficacy of treatment for orgasmic disorder are scarce and dated and they investigated mainly behavioral programs.CONCLUSION: The low methodological quality of many studies and the paucity of data for the most prevalent female dysfunctions calls for further research on psychological interventions for these disorders, using randomized, controlled designs and larger samples

Salute e qualità delle relazioni familiari

Negli ultimi anni in psicosomatica si è assistito a un costante aumento di interesse nei confronti della famiglia del paziente con patologia medica. Gli sviluppi della medicina moderna hanno infatti ridotto i tassi di mortalità e prolungato la vita del paziente, spostando il contesto del trattamento dal setting ospedaliero a quello ambulatoriale e trasferendo la responsabilità delle cure quotidiane sulla famiglia (Given et al., 2001). In medicina è inoltre emerso un nuovo orientamento nella cura del paziente, il modello biopsicosociale di Engel (1978) che, sostituendo il modello medico-biologico dominante in passato, adotta una prospettiva ecologica e prende in considerazione l’ambiente sociale in cui avviene la gestione della malattia, quindi la famiglia. Nell’ambito della letteratura sui fattori familiari nelle malattie medico-internistiche, si individuano principalmente tre aree di ricerca che esaminano rispettivamente l’influenza dei fattori familiari sulla vulnerabilità alla malattia e sul trattamento, l’impatto e le conseguenze della malattia sulla famiglia e l’efficacia degli interventi familiari

Psicoterapia delle disfunzioni sessuali.

Nel capitolo vengono presi in considerazione gli studi sull'efficacia degli interventi psicologici per le disfunzioni sessuali femminili e maschili presenti in letteratura. Viene inoltre fornita una breve descrizione delle tecniche maggiormente usate nel trattamento di tali problematiche e l'esempio di un caso clinico

Le applicazioni cliniche del Family Assessment Device (FAD) nella popolazione adulta: una revisione della letteratura.

Obiettivi: La ricerca ha sottolineato l\u2019influenza della famiglia sulla vulnerabilit\ue0 individuale e sul decorso della malattia, evidenziando la necessit\ue0 di validi strumenti per l\u2019assessment del sistema familiare. Il Family Assessment Device (FAD) \ue8 un questionario self-report che valuta sei dimensioni di funzionamento familiare: Ruoli, Comunicazione, Coinvolgimento Emotivo, Risposta Affettiva, Controllo Comportamentale e Problem Solving. La settima scala, Funzionamento Generale, fornisce una valutazione complessiva. L\u2019obiettivo del lavoro \ue8 verificare l\u2019utilit\ue0 incrementale dell\u2019uso del FAD nel processo di valutazione di popolazioni cliniche medico-internistiche e psichiatriche. Metodi: Seguendo i criteri PRISMA, \ue8 stata effettuata una revisione sistematica della letteratura attraverso l\u2019uso dei database Pubmed, Web Of Science e PsychINFO, selezionando i lavori pubblicati in italiano e in inglese da Aprile 1983 a Maggio 2012. Risultati e Conclusioni: Sono stati inclusi nella revisione 120 studi: 60 inerenti popolazioni mediche, 52 riguardanti pazienti psichiatrici, 8 coinvolgenti disturbi sia medici che psichiatrici. Il FAD \ue8 stato in grado di discriminare tra popolazioni cliniche e controlli e tra diversi gruppi di pazienti, mostrando inoltre una buona attendibilit\ue0 test-retest e sensibilit\ue0 alla rilevazione del cambiamento in seguito a trattamento. Un buon funzionamento familiare, valutato tramite il FAD, \ue8 risultato predittivo di outcome clinici favorevoli. Gli studi supportano le ottime propriet\ue0 clinimetriche e l\u2019utilit\ue0 del FAD nell\u2019ambito della clinica e della ricerca in psicosomatica

Three-year outcome of family intervention versus dose increase in loss of efficacy during long-term antidepressant drug treatment.

The return of depressive symptoms during long-term maintenance treatment is a common phenomenon, but has attracted very limited research attention. Twenty outpatients with recurrent major depressive disorder who had at least 3 episodes with the immediately preceding one no more than 2.5 years before the onset of the episode which led to antidepressant treatment, who lived with a partner and relapsed while taking antidepressant drugs were randomly assigned to: (a) family intervention approach according to the McMaster model and maintenance of the antidepressant drug at the same dosage; (b) dose increase and clinical management. A 3-year follow-up was performed. Seven of 10 patients responded to an increased dosage but all relapsed again at follow-up (6 within one year). Seven of the 10 patients responded to family intervention, but only 2 relapsed during the 3-year follow-up. The findings of this preliminary extended outcome study suggest that application of a family intervention approach is feasible when there is a loss of clinical effect during long-term antidepressant treatment and this approach may carry long-term benefits

Psychological distress and family functioning in stroke patients and their caregivers: changes over time and associations with outcomes

Introduction: The aim of this longitudinal study was to explore change over time in psychological distress and family functioning of stroke patients and their caregivers and to verify if and which dimensions of family functioning were significantly associated with patients' functional recovery and caregivers' psychological distress. Methods: A sample of 40 Italian stroke survivors (age: 71.8 ± 12.5; 52.5% male) and 36 family caregivers (age: 58.8 ±9.0; 41.7% male) completed the Symptom Questionnaire (SQ) and the Family Assessment Device (FAD) at the admission to the rehabilitation hospital and 6 months after discharge. Stroke survivors' functional status was measured using the Functional Independence Measure (FIM) on admission to and discharge from rehabilitation. Results: Six months after hospital discharge, both patients and caregivers reported a significant decrease in SQ anxiety (p ≤ 0.05), with stroke patients showing a reduction in SQ somatic symptoms (p ≤ 0.05) as well. A significant deterioration over time in FAD general family functioning, roles, behavior control, and affective involvement was observed only in patients who reported also an association between FAD behavior control at hospital admission and recovery in the FIM cognitive domain at discharge (p ≤ 0.05). In caregivers, perception of family functioning at hospital admission significantly predicted caregivers' SQ hostility at 6 months after discharge (p ≤ 0.05), while FAD affective involvement was associated with SQ somatic symptoms (p ≤ 0.05). Conclusions: These data highlight the utility in the Italian setting of the adoption of a psychosocial assessment and a family-systems approach in stroke rehabilitation

L'approccio psicosomatico nella valutazione del caregiver di un paziente in stato vegetativo: un caso clinico.

Obiettivi: Recenti studi hanno valutato l\u2019impatto del Traumatic Brain Injury (TBI) sul sistema familiare, evidenziando, in particolare nei caregiver, elevati livelli di burden, ansia, depressione, compromissione della salute fisica e della qualit\ue0 di vita. Al fine di esaminare l\u2019associazione tra la presenza di disturbi di natura psicosomatica e specifiche caratteristiche psicologiche e relazionali, una donna di mezza et\ue0, moglie e caregiver di un paziente in Stato Vegetativo cronico ricoverato, \ue8 stata valutata attraverso una valutazione psicologico-clinica e psicosomatica. Metodi: La valutazione \ue8 stata effettuata attraverso strumenti auto ed etero valutativi. Risultati E Conclusioni: Dall\u2019intervista per i Criteri Diagnostici per la Ricerca in Psicosomatica (DCPR) si evidenzia la presenza di Conversione, Alessitimia, Umore Irritabile e Demoralizzazione, associati ad elevati sintomi depressivi (Beck Depression Inventory) e burden (Caregiver Burden Inventory). Emerge inoltre uno stile di attaccamento tendenzialmente evitante (Attachment Style Questionnaire), difese immature (Defense Style Questionnaire) e coping orientato all\u2019evitamento e alla mancanza di ricerca di sostegno sociale (Cope Coping Orientation to Problems Experienced ). Il funzionamento familiare (Family Assessment Device) \ue8 risultato nella norma. I risultati evidenziano interessanti relazioni fra le variabili misurate, fornendo utili indicazioni per un intervento psicologico mirato

Dally and Notum regulate the switch between low and high level Hedgehog pathway signalling.

International audienceDuring development, secreted morphogens, such as Hedgehog (Hh), control cell fate and proliferation. Precise sensing of morphogen levels and dynamic cellular responses are required for morphogen-directed morphogenesis, yet the molecular mechanisms responsible are poorly understood. Several recent studies have suggested the involvement of a multi-protein Hh reception complex, and have hinted at an understated complexity in Hh sensing at the cell surface. We show here that the expression of the proteoglycan Dally in Hh-receiving cells in Drosophila is necessary for high but not low level pathway activity, independent of its requirement in Hh-producing cells. We demonstrate that Dally is necessary to sequester Hh at the cell surface and to promote Hh internalisation with its receptor. This internalisation depends on both the activity of the hydrolase Notum and the glycosyl-phosphatidyl-inositol (GPI) moiety of Dally, and indicates a departure from the role of the second glypican Dally-like in Hh signalling. Our data suggest that hydrolysis of the Dally-GPI by Notum provides a switch from low to high level signalling by promoting internalisation of the Hh-Patched ligand-receptor complex