Systemic side effects from topical imiquimod.
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Administration, Topical↗
Biomedical subjects
Carl Hanger
Publications and source records attributed to Carl Hanger.
Dinner Bed and Breakfast for Older People: early experiences of a short-term service to manage acute hospital demand.
AIMS: The paper describes a service (Dinner Bed and Breakfast [DBB]) to provide short-term rest home care to acutely unwell elderly people as an alternative to acute hospital admission. This was part of a larger project to manage acute general hospital demand. Service changes were introduced after an initial audit cycle and key outcomes monitored. METHOD: Retrospective audit of patient data for three audit periods. RESULTS: The interim outcomes (at conclusion of DBB funding) in the initial audit were 46% of patients able to return home, 32% remained in the rest home, and 22% were admitted to hospital. The proportion of patients returning home from DBB increased to 68% over the study period. At final outcome (at end of index illness), the return home rate increased from 73% to 85% and the number requiring permanent rest home care decreased from 22% to 14%. CONCLUSIONS: Short-term rest home care may be a viable alternative to acute hospital care, but the service needs to include appropriate patient selection, multidisciplinary care, and ongoing monitoring of patient outcomes. One of the risks of this service is patients staying on in rest home care. Short-term enhanced home care may be preferable to rest home care to avoid this risk. The shift of care (from acute hospital to community) caused strain on specialist geriatric services, which was not planned or funded.
Aged↗
Norovirus outbreaks in a hospital setting: the role of infection control.
AIMS: Noroviruses (NV) (until recently known as Norwalk-like viruses) are a common cause of outbreaks of viral gastroenteritis and can result in significant hospital disruption. We report our experience of two outbreaks that occurred in a geriatric rehabilitation hospital and the role of infection control in limiting their spread. METHODS: The outbreaks occurred in two separate rehabilitation wards for older people. A case definition was developed and a register kept to record patient and staff sickness. The NV was identified from faecal specimens by reverse transcriptase polymerase chain reaction. RESULTS: There were 41 cases in the first outbreak, with an attack rate of 57.1% for patients and 41% for staff. The outbreak lasted 14 days and closed the ward for 11 days. During this outbreak one patient died, with gastroenteritis the precipitating event of his final illness. There were 24 cases in the second outbreak, with an attack rate of 56.5% for patients and 18% for staff. The outbreak lasted 16 days with the ward closed for six days. The mean duration of staff sickness was 3.5 days in the second outbreak compared with only 1.2 days in the first outbreak. In both outbreaks infection was contained within a single ward. CONCLUSIONS: NV infections can significantly disrupt hospitals through their rapid spread to patients and staff as well as the associated high attack rate. Early recognition of an outbreak and prompt implementation of infection control measures, staffing restrictions and ward closure can limit the spread of infection.
Aged↗
Stroke rehabilitation services in New Zealand.
AIMS: To obtain an overall picture of the organisation of stroke rehabilitation services throughout New Zealand and to see if this is consistent with recommendations in evidence-based guidelines. METHODS: A questionnaire was sent to all hospitals in New Zealand. This included questions about access to organised stroke rehabilitation, guidelines for the management of common problems after stroke, and the use of audit. RESULTS: All 48 hospitals surveyed responded, with 37 providing inpatient stroke rehabilitation services. Only one hospital (serving 9% of the population) provided a dedicated, inpatient stroke rehabilitation facility. In the other 36 hospitals, stroke rehabilitation was performed in assessment, treatment and rehabilitation units (25 hospitals, 84%) or general medical wards (8 hospitals, 7%). Only 57% of the population had access to hospitals with a nominated lead clinician for stroke rehabilitation services. Thirty per cent were served by hospitals without a multidisciplinary therapy team expert in stroke care. Guidelines for the management of common problems following stroke were used in most hospitals. Only 8 hospitals (28%) had audited their stroke rehabilitation services. CONCLUSIONS: The organisation and type of rehabilitation services available for people with stroke are not consistent with best practice or accepted guidelines. The development of an organised approach to stroke rehabilitation services in New Zealand must be seen as a priority.
Age Factors↗