Tesis sobre el tema "Hospitalisation"
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1
Wilson-Barnett, Jenifer. "Patients' emotional reactions to hospitalisation". Thesis, King's College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343472.
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Colin, Jessica. "Psychological aspects of psychiatric hospitalisation". Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/2935/.
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This thesis contains a literature review and a qualitative research project. The purpose of the literature review was to examine recent literature on service user perspectives on seclusion, to explore the psychological impact of being secluded. Thirteen studies were identified, and their methodological quality was evaluated. The findings of the studies were examined and common themes were identified. Although some service users reported some positive aspects of seclusion, the overall consensus is that seclusion is distressing. This review suggests additional recommendations to those in the NICE guidelines, which may reduce the negative psychological impact of seclusion on service users. The research project investigated the experiential impact on inpatient nursing staff of caring for individuals with early psychosis, using Interpretative Phenomenological Analysis. Five main themes were identified: 1) Working with uncertainty, 2) Feeling restricted, 3) The ward as a threatening environment, 4) “You’re like my bloody mother” - Working with younger patients, and 5) “Shut the doors and go home” - Coping and self-preservation. Working in the acute inpatient environment can be distressing for staff, however, participants in the study associated working with younger patients experiencing their first admission with closer emotional attachments and increased hope for recovery.
3
Boumaza, Assia. "Hospitalisation psychiatrique et droits de l'homme /". Paris : Éd. du CTNERHI : diff. PUF, 2002. http://catalogue.bnf.fr/ark:/12148/cb389244920.
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Evano, Didier. "Devenir des personnes âgées après hospitalisation". Bordeaux 2, 1990. http://www.theses.fr/1990BOR25108.
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Carlot, Anne. "L'hospitalisation a domicile en 1991". Lille 2, 1992. http://www.theses.fr/1992LIL2P025.
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Homet, Alexandrine. "Hospitalisation pour suspicion de grossesse extra-utérine". Bordeaux 2, 1989. http://www.theses.fr/1989BOR25247.
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7
Luven, Erwan. "Première admission psychiatrique en hospitalisation sous contrainte". Brest, 2009. http://www.theses.fr/2009BRES3021.
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L'auteur souhaite évaluer le vécu des patients lorsque leur première admission en hôpital psychiatrique se déroule sans consentement, ainsi que l'incidence de cette contrainte initiale sur l'alliance thérapeutique et le suivi médical. Après avoir retracé les aspects historiques des hospitalisations psychiatriques puis exposé le cadre législatif actuel des hospitalisations sans consentement et des droits des patients, il tente de préciser les notions de consentement et d 'alliance thérapeutique à partir des données de la littérature. Il présente ensuite une enquêt eréalisée sous forme d'un questionnaire anonyme adressé aux 84 patients de l'établissement public de santé mentale de Quimper (29) admis en hospitalisation pour la première fois et sous la contrainte en 2006. Ces données sont complétées par une analyse des dossiers médicaux des patients. Les résultats font l'objet d'une réflexion sur l'incidence d'une telle expérience sur la suite de la prise en charge du patient.
8
Gautier, Jean-Louis. "Hospitalisation psychiatrique sous contrainte et droits fondamentaux". Thesis, Aix-Marseille 3, 2011. http://www.theses.fr/2011AIX32034.
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Malgré les reproches qui lui ont souvent été adressés, les nombreuses tentatives de réforme qui ont émaillé son histoire, la vieille loi sur les aliénés n’a pas empêché une évolution remarquable des soins vers plus de liberté, notamment par le biais de la sectorisation. L’inadaptation de la loi monarchiste a justifié l’intervention du législateur en 1990, mais elle était toute relative car la loi n°90-527 n’a fait que reprendre, certes en les rénovant, les moyens de contraindre aux soins fondés sur les exigences de l’ordre public. Or, l’application de la loi nouvelle, destinée à l’amélioration des droits et de la protection des personnes hospitalisées en raison de troubles mentaux, a eu un résultat paradoxal : une extension et un renforcement de la contrainte psychiatrique, qui ont fait ressurgir les critiques du dualisme juridictionnel auquel est soumis le contentieux de l’hospitalisation psychiatrique. Le Tribunal des conflits n’a jamais cessé de réaffirmer le principe de séparation des autorités administratives et judiciaires, écartant l’idée d’une unification du contentieux de l’hospitalisation sans consentement au profit du juge judiciaire. Mais par une décision du 17 février 1997, le Haut tribunal a opéré une rationalisation des compétences contentieuses qui a permis au dispositif juridictionnel de révéler son efficacité : l’administration, aujourd’hui, est contrainte de veiller au respect des procédures d’hospitalisation, la certitude d’une sanction lui est acquise en cas de manquement (Première partie). Toutefois le haut niveau de garantie des droits de la personne hospitalisée sans consentement est menacé. Depuis 1997, une réforme de la loi est annoncée comme imminente. Les propositions avancées par de nombreux rapports et études, qu’elles soient d’inspiration sanitaire ou sécuritaire, suscitaient des inquiétudes. Les dispositions relatives à la déclaration d’irresponsabilité pénale pour cause de trouble mental dans la loi n°2008-174 ne pouvaient que les entretenir, préfigurant une aggravation de la situation des personnes contraintes à des soins psychiatriques. Le projet de loi déposé sur le bureau de la Présidence de l’Assemblée nationale le 5 mai 2010 en apporte la confirmation. Le texte en instance devant les institutions parlementaires révèle une finalité sanitaire, mais le droit individuel à la protection de la santé parviendrait à justifier une contrainte que les motifs d’ordre public ne pourraient fonder ; l’obligation de soins psychiatriques ne serait plus uniquement fondée sur les manifestations extérieures de la maladie du point de vue de la vie civile. En outre, si les exigences récemment dégagées par le Conseil constitutionnel à l’occasion d’une question prioritaire de constitutionnalité portant sur le maintien de la personne en hospitalisation contrainte constituent une amélioration, la présence accrue du juge judiciaire dans les procédures n’apporterait aucun supplément de garantie dès lors que les dispositions nouvelles opèreraient une profonde transformation de la fonction du juge des libertés en la matière, notamment en l’associant à la décision d’obligation de soins. Contre toute attente, l’objet sanitaire de la mesure, lorsqu’il devient une fin en soi et n’est plus subordonné à l’ordre public, se révèle liberticide (Deuxième partie)The old law on insane people has often been criticized but none of the numerous attempts of reform, that it has met throughout its history, has prevented the outstanding move of cares towards more liberty, notably through sectorization. The lack of adaptation of the monarchist law made the legislator act in 1990, but the action was very relative as 90-527 law only rephrased, with some updates, the means to constrain to a treatment abiding by public policy. But, the new law, intended for the improvement of liberty and the protection of hospitalized insane persons, had paradoxical results: an extension and a reinforcement of psychiatric constraint, which made reappear the criticisms of jurisdictional dualism, which psychiatric hospitalization is subjected to. The court relentlessly reaffirmed its attachment to the principle of separation of administrative and judiciary authorities, while it was rejecting the legal argument’s unification of the psychiatric hospitalization without agreement in favor of the judicial judge. The High Court, with an adjudication dated from February 17th, 1997, made a rationalization of disagreement’s skills which allowed the jurisdictional plan to reveal its efficiency : administration, nowadays, has to make sure the hospitalization is respectful of procedures, it would be compulsorily sanctioned in case of a breach of the rules (First part). Nevertheless, hospitalized persons without acceptance should worry about the high-level of guarantee of their rights. Since 1997, an imminent reform of this law has been expected. Numerous reports and studies have led to sanitarian or security order proposals, which sparked concern. The measures about the statement of penal irresponsibility due to mental disorder, and tackled in 2008-174 law, kept feeding these concerns making the situation of persons forced to psychiatric cares worse. The bill submitted to the President of the national assembly on May 5th, 2010, confirmed this evolution. The text pending the parliamentary institution has a sanitarian aim, but the individual right to health protection would justify a constraint that public order can not establish ; the necessity of psychiatric cares would not only be based on the external manifestation of the disease as an aspect of civilian life. Moreover, even if the constitutional Council’s requirements, defined during a major questioning of the constitutionality of the maintenance of constrained hospitalization, are an enhancement, the increased presence of a judicial judge during the procedure would not ensure better guarantee as long as the new disposals operate a deep transformation of judges' duties, notably if they are associated with the decision of constrained cares. Against all expectations, the sanitarian aspect of the measure, when it turns to be an end in itself and is not dependent on public order, is dwindling liberties (Second part)
9
MEKDISSI, GILLES. "Orientation des malades apres un episode d'asthme aigu grave : hospitalisation classique ou hospitalisation de courte duree au service d'urgence". Lyon 1, 1990. http://www.theses.fr/1990LYO1M415.
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Fassier, Thomas. "Réanimation et personnes âgées en France : étude descriptive des hospitalisations dans la base nationale médico-administrative & étude qualitative des décisions médicales de triage et de réanimation". Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10160.
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Fenton, Kelly. "The experiential impact of hospitalisation in early psychosis". Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/2939/.
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Background: We know that psychiatric hospitalisation can be distressing (Morrison et al, 1999), and can have a negative impact on self-esteem (Bers et al 1993). Early Intervention in Psychosis services aim to keep young people out of hospital by providing community based services. Nevertheless people with an early psychosis may require hospitalisation. Little is known about the impact of hospitalisation on people where they are likely to have been hospitalised in a crisis and may have had the expectation that hospitalisation was unlikely given the ethos of the services supporting them. Aims: The research aimed to gain an understanding of what it was like for young people to be hospitalised. Method: The research made use of Interpretative Phenomenological Analysis (Smith et al, 1999), which is a qualitative approach concerned with the opinions, experiences and feelings of individuals. Results: Findings showed participants’ had a variety of experiences of hospitalisation. The themes which emerged were: ‘So, where are you taking me?’, which explored the meaning of having no explanations, the ‘Mixed perceptions of the hospital’, which sought to understand what it was like when on the ward and ‘The challenge of making meaning,’ which explored the participants’ attempts to work out where they fitted in terms of the hospital and wider society.
12
Albano, Thierry. "Analyse rétrospective de l'influence du motif d'hospitalisation sur la durée des séjours dans un service de médecine générale de la région alésienne en 1996". Montpellier 1, 1998. http://www.theses.fr/1998MON11062.
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Royer, Papazoglou Emmanuelle. "Hospitalisation mere-enfant en psychiatrie : etude retrospective au chru de lille". Lille 2, 1994. http://www.theses.fr/1994LIL2M209.
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Nicolas-Foglia, Laure. "Les relations humaines à l'hôpital général, structures formelles et informelles, institutionnelles et groupales : essai sur le transfert familial dans quelques services d'un hôpital général". Paris 10, 1991. http://www.theses.fr/1991PA100004.
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La recherche porte sur le fonctionnement d’un groupe de 55 soignants repartis en huit catégories socio-professionnelles (médecins individus du groupe "psy", surveillante, secrétaire, infirmières, aides-soignantes, axillaires de puériculture, agents de service hospitalier) d'un service de pédiatrie d'un centre hospitalier général. L'objectif principal est de mettre en évidence les relations individuelles et groupales, intra-catégorielles et inter-catégorielles. Les instruments d'investigation sont l'entretien semi-directif et sept planches de la thématique aperception test (1, 2, 3, 8bm, 9gf, 9bm, 17bm). Le fonctionnement mis en évidence se compose d'un transfert familial avec des affects fraternels : la tendresse, le sentiment de vécu commun, la communauté "contre", la haine, la rivalité, l'inceste, et avec des affects parentaux : la confiance, le respect, la crainte, le don de soi. Il se compose également d'un transfert groupal avec des phénomènes groupaux tels que le leader père idéal, le leader mégalomaniaque, l'intégration, la réparation, la mégalomanie, l'appareil psychique groupal, la projection des angoisses psychotiques sur le cadre. Des fantasmes groupaux ont émergé tels que les fantasmes de dévoration, de violence fondamentale, de parents combines, de parents s'autodétruisant, de castration, de séduction, de scène primitiveThe research shows the functioning of a group of 55 persons working in a service of pediatric, divided in eight categories (doctors, persons of "psy" group, head nurse, secretary, nurses, assistant-nurses, nursery-nurses, and maintenance staff). The instruments of investigation are the half-guiding interview and seven images of Thematic Apperception Test (1, 2, 5, 8bm, 9gf, 9bm, 17bm). The functioning of the service consists of a familial transfer with brotherly affects : tenderness, feeling of common experiences, the community "against", the hate, the rivalry, the incest; and with parents affects : the confidence, the respect, the fear, the gift of himself. It also consists of a groupal transfer with a specific phenomenology: the ideal father leader, the megalomaniac leader, the integration, the reparation, the megalomania. . . Many phantasms emerged: devoration, fundamental violence, castration, seduction. .
15
Decool, Stéphane. "Les hospitalisations pour bronchiolite et asthme dans un service de pédiatrie générale : évolution sur trente années". Lille 2, 1994. http://www.theses.fr/1994LIL2M056.
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Faivre, Thierry. "Les hospitalisations alternantes en psychiatrie". Lyon 1, 1994. http://www.theses.fr/1994LYO1M272.
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Lesturgeon, Jean-Alexandre. "Hospitalisation sans le consentement : indications cliniques ; devenir au bout d'un an de ces patients dans le secteur g08 d'ille-et-vilaine". Rennes 1, 1994. http://www.theses.fr/1994REN1M112.
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Gibson, Rachel Purthenia. "Identity and hospitalisation in a secure unit : patient experiences". Thesis, University of Hertfordshire, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.427521.
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Prud'homme, Geneviève. "Linking Preventable Hospitalisation Rates to Neighbourhood Characteristics within Ottawa". Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23136.
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Enhancing primary care is key to the Canadian health care reform. Considered as an indicator of primary care access and quality, hospitalisations for ambulatory care sensitive (ACS) conditions are commonly reported by Canadian organisations as sentinel events signaling problems with the delivery of primary care. However, the literature calls for further research to identify what lies behind ACS hospitalisation rates in regions with a predominantly urban population benefiting from universal access to health care. A theoretical model was built and, using an ecological design, multiple regressions were implemented to identify which neighbourhood characteristics explained the socio-economic gradient in ACS hospitalisation rates observed in Ottawa. Among these neighbourhoods, healthy behaviour and - to a certain extent - health status were significantly associated with ACS hospitalisation rates. Evidence of an association with primary care accessibility was also signaled for the more rural neighbourhoods. Smoking prevention and cessation campaigns may be the most relevant health care strategies to push forward by policy makers hoping to prevent ACS hospitalisations in Ottawa. From a health care equity perspective, targeting these campaigns to neighbourhoods of low socio-economic status may contribute to closing the gap in ACS hospitalisations described in this current study. Reducing the socio-economic inequalities of neighbourhoods would also contribute to health equity.
20
Raškauskas, Vytautas. "Prevalence and clinical characteristics of involuntary hospitalisation in psychiatry". Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2010. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2010~D_20100623_093914-57934.
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The study is aimed at determining the prevalence of formal and informal involuntary hospitalisation, the clinical profile of involuntarily hospitalised patients, the factors that have an impact on the degree of coercion and the objective outcomes of involuntary hospitalisation. Assessment of the prevalence of formal involuntary hospitalisation was carried out. Socio-demographic and clinical data of formally and informally involuntarily hospitalised were collected from medical records and patient interviews. Medical documentation was used to measure the duration of the studied hospitalisation and the following indicators of re-hospitalisations within 3 years after discharge from the studied hospitalisation: the presence of at least one rehospitalisation, the number of re-hospitalisations and time to rehospitalisation. The established indicator of involuntary hospitalisations per 105 residents per year in period concerned was from 23.0 to 39.5. 17 per cent of voluntary patients perceived coercion during the process of hospitalization. The majority of the socio-demographic, psychopathology, quality of life and treatment characteristics of formally involuntarily hospitalised patients and informally involuntarily hospitalised patients are similar. Formally involuntarily hospitalised patients feel stronger coercion, more often display aggression and are less satisfied with treatment than informally involuntarily hospitalised patients. The degree of coercion felt during... [to full text]Darbo tikslas – nustatyti formalaus ir neformalaus priverstinio hospitalizavimo į psichiatrijos stacionarą paplitimą, priverstinai hospitalizuojamų pacientų klinikinį profilį, prievartos stiprumą įtakojančius veiksnius ir priverstinio hospitalizavimo objektyvias baigtis. Darbas vykdytas registruojant priverstinius hospitalizavimus, tyrimo instrumentais apklausiant formaliai priverstinai ir savo noru hospitalizuotus pacientus bei naudojant perspektyvųjį tyrimo metodą iš medicininės dokumentacijos įvertinant rehospitalizavimo rodiklius. Buvo nustatytas 23–39 105 gyventojų per metus formalių priverstinių hospitalizavimų rodiklis Vilniaus miesto psichikos sveikatos centro aptarnaujamoje teritorijoje 2003–2005 m. Iš visų savo noru hospitalizuotų pacientų 17 procentų jautė prievartą hospitalizavimo metu, t. y. buvo neformaliai priverstinai hospitalizuoti. Formaliai priverstinai hospitalizuotų ir neformaliai priverstinai hospitalizuotų pacientų dauguma socialinių demografinių, psichopatologijos, gyvenimo kokybės bei gydymo charakteristikų buvo panašios, tačiau formaliai priverstinai hospitalizuoti pacientai jaučia stipresnę prievartą, pasižymi dažnesne agresija, mažiau patenkinti gydymu nei neformaliai priverstinai hospitalizuoti pacientai. Hospitalizavimo metu jaučiamos prievartos stiprumas buvo labiausiai susijęs su verbaline agresija. Tyrimo metu nustatyta, kad formaliai priverstinai ir neformaliai priverstinai hospitalizuoti pacientai, palyginus su savo noru hospitalizuotais ir... [toliau žr. visą tekstą]
21
Mitchell, Johanna. "Transition experience in adults after hospitalisation for anorexia nervosa". Thesis, City, University of London, 2018. http://openaccess.city.ac.uk/21702/.
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Research into the experiences of hospitalization for people with eating disorders (ED) has previously focused on the inpatient stay itself and generally been limited to the adolescent experience. Very little is mentioned in terms of the experience of being discharged from specialist eating disorder units and concerns have been raised about the issue of this transition in terms of other psychiatric conditions. In view of the paucity of research into the discharge transition in ED, this study investigated the lived experiences of the transition from inpatient to outpatient care following hospitalization for anorexia nervosa. Participants were six women who were recruited from one specialist outpatient service. The study design was qualitative, using semi structured interview data, analysed using Interpretative Phenomenological Analysis (IPA). Two superordinate themes emerged: living with ambivalence to change and living in recovery. Participants' accounts highlighted psychological blocks that accompanied the environmental transition. Transition from hospital brought to mind the continued ambivalence that the women felt towards their eating disorder. Moreover, a focus on recovery was revealed: recovery involved letting go of inpatient relationships, harnessing support from others in the community and having a vision of the recovered self. Ambivalence was experienced in a complex manner with elements of conflict, confusion and shame attached to it. It is suggested that these findings may be useful for the psychological reformulation of current ambivalence at point of discharge and clinical implications are presented.
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Agneray, Fabien. "Schizophrénies et chronicité : enjeux psychopathologiques de la première hospitalisation". Thesis, Amiens, 2020. http://www.theses.fr/2020AMIE0011.
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Introduction : les schizophrénies sont les pathologies les plus représentées dans la population hospitalisée au long cours en psychiatrie. L'objectif est d'analyser la chronicisation à l'hôpital au sein de cette population. Méthode : à partir de quatre cas cliniques issus de notre pratique clinique et d'entretiens semi-structurés avec treize patients schizophrènes, nous avons effectué une analyse clinique et psychopathologique centrée sur la compréhension phénoménologique de l'expérience de la première hospitalisation. Ce matériel verbal a fait l'objet d'une analyse à la fois qualitative et quantitative. Résultats : plusieurs facteurs tels que l'atteinte du soi minimal, de l'expérience de la temporalité, du lien aux proches, mais aussi l'expérience de la violence, participent à l'installation d'une chronicité chez ces patients. En revanche, l'hôpital semble rarement être investi comme un chez-soi. Associée à la passivité induite par la dynamique institutionnelle, l'altération majeure du soi minimal entrave l'appropriation de l'expérience chez ces patients. Discussion : la chronicité dans l'expérience schizophrénique est une réalité clinique irréductible. Cela suppose de considérer le temps existentiel et d'interroger sans cesse le cadre de soins. Le sujet étant limité dans son processus de territorialisation au moment même de l'évènement de son hospitalisation, nous relevons dans son discours un défaut de transpassibilité de celui-ci, signant sa difficulté d'appropriation et conduisant à l'incompréhension au sens évènemential de l'hospitalisation et de son issue. Conclusion : dans les schizophrénies les enjeux existentiels sont inhérents à l'expérience de l'hospitalisation. L'institution doit elle-même être soignée afin de préserver sa capacité de pensée et maintenir une dynamique ajustée à la prise en charge des patients souffrant de schizophrénieIntroduction : Among the long-term psychiatric hospitalized population, schizophrenia is the most frequent diagnosis. The objective is to analyze chronicity within this population of patients. Method : based on four clinical cases from our clinical practice and semi-structured interviews with thirteen schizophrenic patients, we performed a clinical and psychopathological analysis focused on the phenomenological understanding of the experience of first hospitalization. This verbal material underwent double analysis, both qualitative and quantitative rooted in statistics and n'vivo. Results : Several factors as the alteration of minimal self, the experience of temporality and the bonds with significant others participate, as well as the experience of violence, in establishing chronicity for these patients. On the other hand, the hospital seems to be invested as a home infrequently. Associated with the passivity induced by the institutional dynamics, the major alteration of minimal self hinders the appropriation of experience in these patients. Discussion : chronicity in the schizophrenic experience is an irreducible clinical reality. It involves considering existential time and constant screening of the setting. As the patient is limited in his territorialization process at the very moment of the event of his hospitalization, we identify in his speech a lack of transpassability that indicates a difficulty in appropriation leading to incomprehension of hospitalization and its outcome. Conclusion : in schizophrenia, the existential stakes are inherent to the experience of hospitalization. The institution itself must be questioned in order to preserve its capacity of thought and holding in order to maintain a dynamic specifically adjusted to the care of schizophrenic patients
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GUERAUD, MARIE-LAURENCE. "Hospitalisation a domicile a marseille : aspects organisationnels et economiques". Aix-Marseille 2, 1993. http://www.theses.fr/1993AIX20148.
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Naaman, Roba Khalil. "Food choices and intake in older patients during hospitalisation". Thesis, University of Glasgow, 2019. http://theses.gla.ac.uk/8588/.
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Dugnat, Michel. "Hospitalisation mere-enfant en pedopsychiatrie : strategie d'une prevention primaire". Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20952.
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Meunier, Sylvie. "Hospitalisation des adolescents au centre hospitalier de montlucon : etude sur une periode de cinq mois". Clermont-Ferrand 1, 1989. http://www.theses.fr/1989CLF13033.
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ESPEILLAC, DOMINIQUE. "Role de l'hopital dans la prise en charge des enfants malades : a propos d'une enquete sur le recrutement d'un service du chu en 1988". Toulouse 3, 1988. http://www.theses.fr/1988TOU31507.
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MORES, GANTELME MARIE-NOELLE. "Profil de l'asthmatique hospitalise". Lille 2, 1988. http://www.theses.fr/1988LIL2M077.
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MARCON, FRANCOISE. "La rougeole en milieu hospitalier : enquete portant sur quatre annees". Aix-Marseille 2, 1989. http://www.theses.fr/1989AIX20106.
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RUBINSZTAJN, ROBERT. "L'hospitalisation des adolescents dans un c. H. U". Amiens, 1991. http://www.theses.fr/1991AMIEM089.
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EUVRARD, GHISLAINE. "Role de l'hopital public dans les soins aux detenus : etude a partir de 102 patients admis au bloc de securite de l'hopital purpan sur 2 ans". Toulouse 3, 1992. http://www.theses.fr/1992TOU31090.
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VALLEZ, VERONIQUE. "Hospitalisations dans un service de neurologie du c. H. U. De lille : etude d'activite a partir de 252 hospitalisations successives". Lille 2, 1989. http://www.theses.fr/1989LIL2M430.
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Nisand, Gabriel. "Hospitalisations iteratives precoces des personnes agees". Nancy 1, 1989. http://www.theses.fr/1989NAN11199.
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Tsang, Man-ching y 曾文正. "Financial burden of hospitalisation for child abuse in Hong Kong". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/196546.
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Child abuse is a well-known child care problem. Classically, there are four main types of abuse: physical, sexual and emotional abuse, and neglect. The incidence is often underestimated because a number of cases are not severe enough for caregivers to seek medical help. However, the more severe forms of child abuse can lead to significant morbidity and even mortality. Many studies have addressed the characteristics and outcomes of child abuse. However, the financial burden of child abuse that individuals and society bear has not been well examined.
In this study, the economic burden of hospitalisation for child abuse in Hong Kong is analysed. Data of 7,713 child hospitalisations and of 61,879 child visits to accident and emergency departments of public hospitals, all resulting from child abuse from 2003 to 2012, were retrieved from the Clinical Data Analysis and Reporting System. The data are analysed with particular respect to cost of child abuse.
The total inpatient cost of child abuse is HK$186,046,210, which is higher than the total inpatient cost of children with acute lymphoblastic leukaemia (HK$171,895,920) but lower than that of children with asthma (HK$1,156,082,970). The average inpatient cost of child abuse per visit is HK$24,127, which is higher than the average inpatient cost of children with asthma (HK$14,458) but lower than the cost of children with acute lymphoblastic leukaemia (HK$39,165). In comparisons of the average inpatient costs of the various types of child abuse to those of asthma and acute lymphoblastic leukaemia, each type of child abuse has higher average inpatient costs than asthma but lower than acute lymphoblastic leukaemia. Neglect produces the highest average cost (HK$33,606), followed by multiple abuse (HK$25,849) and then emotional abuse (HK$25,807), unspecified abuse (HK$25,090), physical abuse (HK$24,432) and sexual abuse (HK$17,807).
The overall accident and emergency department cost for child abuse is HK$43,394,400, which is much higher than the overall cost for children with acute lymphoblastic leukaemia (HK$1,193,500) but lower than that for children with asthma (HK$120,297,100). The mean cost for abuse per child is HK$5,784, which is higher than that per child with acute lymphoblastic leukaemia (HK$2,411) but lower than that per child with asthma (HK$6,389). Comparisons of the mean accident and emergency department costs of the various types of child abuse to asthma and acute lymphoblastic leukaemia showed that each type of child abuse has a higher mean cost than that of acute lymphoblastic leukaemia, while only neglect and emotional abuse have higher mean costs than asthma. Of the mean accident and emergency department charges for each type of child abuse, neglect has the highest average cost (HK$7,108), followed by emotional abuse (HK$6,489), and then sexual abuse (HK$5,890), multiple abuse (HK$5,851), unspecified abuse (HK$5,823) and physical abuse (HK$5,720).
The total and average costs of hospitalisation for child abuse in the Chinese population are higher than those in the non-Chinese population. Comparisons of the total cost and the average cost of hospitalisation between sexes showed that girls account for a higher total cost but lower average cost than boys. Of the three age groups of children, the 6-12 year-olds incur the highest total hospitalisation cost and the 0- to 6-year-olds had the highest mean hospitalisation cost. The costs of hospitalisations by different pay codes for child abuse, asthma, and acute lymphoblastic leukaemia are analysed.
In conclusion, compared to children with asthma, the severity of child abuse is high while the frequency of it is low. Interventions to reduce the severity of child abuse are to be considered. To compare to the other control group, the frequency of child abuse is more common and the severity of it is lower than that of children with ALL. Interventions to reduce the frequency of child abuse are in high priority compared to ALL. To the overall costs of hospitalisations for types of abuse, the financial burden of overall inpatient cost of physical abuse is high while financial burden of inpatient cost of individual cases of it is just average. Hence the frequency of physical abuse is high but its severity is low. Meanwhile, the financial burden per inpatient case of neglect is high while the total financial burden of hospitalisations for neglect is low. Hence the severity of neglect is high but its frequency is low. The data in this study could be used to further analyse the cost of child abuse, including non-medical costs and indirect costs, and for cost-effectiveness analysis.published_or_final_version
Paediatrics and Adolescent Medicine
Master
Master of Medical Sciences
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Mayor, Sharon. "Hospitalisation for influenza and pneumonia and the effectiveness of vaccination". Thesis, Cardiff University, 2004. http://orca.cf.ac.uk/55537/.
Texto completoResumen
Between 1991-1999, the Patient Episode Database for Wales (PEDW) was investigated and an association between influenza A viruses circulating in the community and demand for inpatient management of lower respiratory tract illness demonstrated r=0.73 a finding which supports influenza contributing significantly to the winter bed crises seen in the Welsh NHS in recent years. Once admitted to hospital, the clinical outcomes of influenza and pneumonia are poor the average length of the inpatient stay being 14 days with approximately one third of elderly and high-risk individuals dying during the inpatient period. To assess the effectiveness of the inactivated influenza vaccine in preventing such hospitalisations, a prospective case-control study was undertaken in Gwent, South East Wales during the winter of 1999-2000. After controlling for age, sex, chronic disease status, pneumococcal vaccine uptake, previous inpatient management and primary care consultations in an unconditional logistic model, the inactivated influenza vaccine was found to reduce admissions for acute respiratory illness significantly OR .30 (95% CI: .21 to .44 ) this translating to a 70% reduction in admissions. Furthermore, the risk of death once hospitalised was reduced by 75% in vaccinees OR .25 (95% CI:.l 1 to .60). Vaccination coverage in South East Wales during this season was poor and examination of the determinants of respiratory vaccine uptake suggests that the chronic medical conditions for which vaccination are recommended are not equally weighted. Vaccines appear to be targeted at individuals with chronic pulmonary disease, leaving many other high-risk groups, particularly individuals with cardiovascular disease vulnerable to influenza and its sequelae. Smokers were also significantly less likely to have received the influenza and pneumococcal vaccines, the OR's being .40 (95% CI: .27 to .57) and .57 (95% CI: .36 to .91) respectively. The widespread use of respiratory vaccines in elderly and identified high-risk groups has substantial resource implications for secondary care services in Wales. The review of the literature in Chapters 1 and 2 highlights a paucity of epidemiological data on the impact of influenza and pneumonia within a UK setting. Furthermore, the evidence base for influenza and pneumococcal vaccination, both of which are integral components of primary care prevention strategies, rests on observational studies conducted predominantly in North America. This thesis aims to draw together a number of studies to develop an epidemiological picture of individuals hospitalised with influenza and pneumonia during the 1990s in Wales. Furthermore, specific public health issues, such as the delivery and uptake of respiratory vaccines and the effectiveness of influenza vaccination are examined. The methodologies of the studies are outlined in chapter 3. In Chapter 4, trends of hospitalisations for influenza and pneumonia in Wales are examined and mean annual rates of hospitalisations for influenza, pneumococcal pneumonia and broad sub categories of pneumonia reported. The relationship between surveillance data reporting influenza like illness at primary care level and demand for inpatient management of lower respiratory tract illness is examined. The hypothesis that influenza contributes significantly to the winter bed crisis in the Welsh NHS is also investigated. Potential risk factors for and outcomes of hospitalisation due to influenza and pneumonia are also reported which subsequently inform the planning of the case control study outlined in Chapters 3 and 5. In addition, the missed opportunity for reducing the demand for inpatient management of vaccine preventable respiratory disease is assessed and determinants of influenza and pneumococcal vaccine uptake described. Finally, in Chapter 5, the effectiveness of the inactivated influenza vaccine in reducing admissions for respiratory disease during an influenza outbreak period is reported and the impact of increased acute respiratory admissions on a district general hospital in South East Wales described.
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PARCHIN, NADINE. "Hospitalisation psychiatrique a l'adolescence : etude sur une unite psychiatrique d'adolescents". Clermont-Ferrand 1, 1993. http://www.theses.fr/1993CLF1M022.
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MUCHERY, FLORENCE. "Hospitalisation d'adolescents dans une unite fonctionnelle de pedopsychiatrie : quel partenariat ?" Lille 2, 1994. http://www.theses.fr/1994LIL2M229.
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Grousset, Danièle. "L'hospitalisation à domicile en France : étude menée à partir de l'expérience du Var". Montpellier 1, 1988. http://www.theses.fr/1988MON11158.
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Delavauvre, Hubert. "Étude des hospitalisations d'adolescents dans un service d'accueil de psychiatrie adulte". Bordeaux 2, 1989. http://www.theses.fr/1989BOR25159.
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REUMAUX, EMMANUELLE. "Evaluation des hospitalisations inappropriees aux urgences du centre hospitalier d'armentieres". Lille 2, 1994. http://www.theses.fr/1994LIL2M297.
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Millar, Tracy. "A discourse analysis of young women's accounts of acute psychiatric hospitalisation". Thesis, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252232.
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Burton, Jennifer Kirsty. "New care home admission following acute hospitalisation : a mixed methods approach". Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31501.
Texto completoResumen
Care home admission following acute hospitalisation is a lived reality across Scotland, experienced by over 8,000 people annually. The aim of this thesis was to develop an understanding of new care home admission following acute hospitalisation. Methods and findings from the mixed-methods approach are presented in three parts. Part One: Identifying relevant research - includes a review of quality assessment tools for systematic reviewing; a systematic review and meta-analysis of quantitative data from observational studies of predictors of care home admission from hospital; and a methodological chapter on developing a search filter to improve accessibility of existing research findings supported by the findings of an international survey of care home researchers. The systematic review identified 53 relevant studies from 16 countries comprising a total population of 1,457,881 participants. Quantitative synthesis of the results from 11 of the studies found that increased age (OR 1.02 per year increase; 95%CI 1.00-1.04), female sex (OR 1.41; 95%CI 1.03-1.92), dementia & cognitive impairment (OR 2.14; 95%CI 1.24-3.70) and functional dependency (OR 2.06; 95%CI 1.58-2.69) were all associated with an increased risk of care home admission after hospitalisation. Despite international variation in service provision, only two studies described the model of care provided in the care home setting. The survey identified that there is a lack of shared terminology in the published literature to describe settings for adults who are unable to live independently in their own homes and require care in a long-term institutional setting. A search filter to identify relevant research could help to overcome differences in terminology and improve synthesis of existing research evidence. Part Two: Exploring current clinical practice - reports the findings of a retrospective cohort study of new care home admissions from hospital using case-note review methodology accompanied by findings from inductive thematic analysis of a single dataset from a qualitative case study design exploring the experiences of a patient, their family, and practitioners (n=5). The cohort study (n=100) found a heterogeneous picture with long hospital admissions (range 14-231 days), frequent transfers of care (31% experienced three or more transfers), varied levels of documented assessment and a lack of documented patient involvement in the decision-making processes. The qualitative interviews allowed the patient voice to emerge, alongside the professional and family narrative which dominated case-note documentation. Inductive thematic analysis identified nine major themes exploring how decisions are made to discharge individuals directly into a care home from the acute hospital setting: biography & personality; professional role; family role; limitations in local model of care; ownership of decision; risk; realising preferences; uncertainty of care home admission process; and psychological impact of in-hospital care. Part Three: Harnessing routinely-collected data - includes the challenges of identifying care home residency at admission and discharge from hospital, presenting analysis of the accuracy of Scottish Morbidity Record 1 (SMR01) coding in NHS Fife and the Community Health Index (CHI) Institution Flag in NHS Fife and NHS Tayside. This is followed by a descriptive analysis of the Scottish Care Home Census (2013-16) as a novel social care data source to explore care home admissions from hospital and the methodology for a data linkage study using these data. Identifying care home residents in routine data sources is challenging. In 18,720 admissions to NHS Fife, SMR01 coding had a sensitivity of 86.0% and positive predictive value of 85.8% in identifying care home residents on admission. At discharge the sensitivity was 87.0% and positive predictive value was 84.5%. From a sample of 10,000 records, the CHI Institution Flag had a sensitivity of 58.6% in NHS Fife and 89.3% in NHS Tayside, with positive predictive values of 99.7% and 97.7% respectively. From 2013-16, of 21,368 admissions to care homes in Scotland, 56.7% were admitted from hospital. There was significant regional variation in rates of care home admission from hospital (35.9-64.7%) and proportion of Local Authority funded places provided to admissions from hospital (34.4-73.9%). Those admitted from hospital appeared to be more dependent and sicker than those admitted from home. This thesis has established a series of challenges in how care homes and their residents are identified. It has questioned the adequacy of the evidence to guide practitioners and sought to raise the profile of this vulnerable and complex population and how best to support them in making decisions regarding admission from the acute hospital. It has progressed our understanding of this under-explored area and proposes a programme of future mixed-methods research involving patients, families, practitioners and policy-makers.
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Gueneret, Laurence. "Effets indésirables médicamenteux du sujet âgé découverts au cours d'une hospitalisation". Paris 5, 1989. http://www.theses.fr/1989PA05P075.
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Champion, Nathalie. "Prescriptions médicamenteuses : enquête sur les variations des prescriptions après une hospitalisation". Bordeaux 2, 1995. http://www.theses.fr/1995BOR2P076.
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SIRIOUD, SERGE. "Enquete de morbidite des services de soins de suite en region rhone-alpes". Lyon 1, 1994. http://www.theses.fr/1994LYO1M040.
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SERRER, MARION. "Prise en charge des patients sideens au centre hospitalier de bastia : etude a propos de 62 cas". Nice, 1994. http://www.theses.fr/1994NICE6570.
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LEMAITRE, RACT ISABELLE. "Prise en charge et evolution de 61 cas d'angor instable hospitalises entre 1981 et 1990". Lyon 1, 1993. http://www.theses.fr/1993LYO1M161.
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LE, FLOCH CATHERINE. "La personne agee hospitalisee pour chute, aspects medico-sociaux". Nantes, 1991. http://www.theses.fr/1991NANT051M.
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Demonté, Nathalie. "Les enjeux du jeu a l'hopital : constats et reflexions sur le sejour de l'enfant a l'hopital". Nancy 1, 1991. http://www.theses.fr/1991NAN11089.
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VALLICCIONI, BESSOLO DOMINIQUE. "Recrutement d'un service de pediatrie generale sur une periode d'un an". Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20009.
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