Appropriateness of acute admissions and last in-patient day for patients with long term neurological conditions

<p>Abstract</p> <p>Background</p> <p>To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives.</p> <p>Methods</p> <p>Adults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed.</p> <p>Results</p> <p>A total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives.</p> <p>Conclusion</p> <p>Patients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.</p

Optimising the use of caesarean section: a generic formative research protocol for implementation preparation

BACKGROUND: Caesarean section rates are rising across all geographical regions. Very high rates for some groups of women co-occur with very low rates for others. Both extremes are associated with short and longer term harms. This is a major public health concern. Making the most effective use of caesarean section is a critical component of good quality, sustainable maternity care. In 2018, the World Health Organization published evidence-based recommendations on non-clinical interventions to reduce unnecessary caesarean section. The guideline identified critical research gaps and called for formative research to be conducted ahead of any interventional research to define locally relevant determinants of caesarean birth and factors that may affect implementation of multifaceted optimisation strategies. This generic formative research protocol is designed as a guide for contextual assessment and understanding for anyone planning to take action to optimise the use of caesarean section. METHODS: This formative protocol has three main components: (1) document review; (2) readiness assessment; and (3) primary qualitative research with women, healthcare providers and administrators. The document review and readiness assessment include tools for local mapping of policies, protocols, practices and organisation of care to describe and assess the service context ahead of implementation. The qualitative research is organized according to twelve identified interventions that may optimise use of caesarean section. Each intervention is designed as a "module" and includes a description of the intervention, supporting evidence, theory of change, and in-depth interview/focus group discussion guides. All study instruments are included in this protocol. DISCUSSION: This generic protocol is designed to underpin the formative stage of implementation research relating to optimal use of caesarean section. We encourage researchers, policy-makers and ministries of health to adapt and adopt this design to their context, and share their findings as a catalyst for rapid uptake of what works

Elektrochemische Untersuchungen an 2,3-Dihydro-1,3-Diborolyl- und 2,3,5-Tricarbahexaboranyl-Metallkomplexen Darstellung und Struktur von 2,3,5-Tricarbahexaboranyl-Nickelkomplexen

SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Gallerie zur Cotta-Göschen'schen Volks-Bibliothek der Deutschen Klassiker : Göthe, Schiller, Klopstock, Lessing, Wieland, Platen, Thümmel, Pyrker und Lenau ; 144 Stahlstiche nach Original-Zeichnungen / von J. Buchner, J. Köckert, G. Osterwald ...

GALLERIE ZUR COTTA-GÖSCHEN'SCHEN VOLKS-BIBLIOTHEK DER DEUTSCHEN KLASSIKER : GÖTHE, SCHILLER, KLOPSTOCK, LESSING, WIELAND, PLATEN, THÜMMEL, PYRKER UND LENAU ; 144 STAHLSTICHE NACH ORIGINAL-ZEICHNUNGEN / VON J. BUCHNER, J. KÖCKERT, G. OSTERWALD ... Gallerie zur Cotta-Göschen'schen Volks-Bibliothek der Deutschen Klassiker : Göthe, Schiller, Klopstock, Lessing, Wieland, Platen, Thümmel, Pyrker und Lenau ; 144 Stahlstiche nach Original-Zeichnungen / von J. Buchner, J. Köckert, G. Osterwald ... (1) Einband (1) Titelseite (3) Göthe. (5) Schiller. (47) Wieland. (78) Lessing. (111) Klopstock. (117) Platen. (122) Thümmel. (131) Pyrker. (136) Lenau. (140