Weighing Up the Evidence and Local Experience of Residential Care

2017 ◽  
Vol 42 (4) ◽  
pp. 240-247 ◽  
Author(s):  
Susan Tregeagle
Keyword(s):  
Young People ◽  
Residential Care ◽  
Therapeutic Approaches ◽  
Shift Workers ◽  
Healing Environment ◽  
Safe Environment ◽  
Local Experience ◽  
History Of ◽  
The Cost

Therapeutic residential care is currently seen as an answer to managing the increasing disruption experienced by many young people in care. Yet the history of residential care in Australia is problematic and the international evidence for the efficacy of therapeutic approaches is very poor. The author's own agency's experience of providing residential care also indicates that caution is needed before increasing the numbers of residential ‘beds’. Problems include young people's dislike of residential options and the stressfulness of an environment that involves shift workers and multiple transient relationships. Further, residential care can be a financial drain on child welfare budgets (being tendered to non-government agencies at over seven times the cost of community care), and has the potential danger – when beds are empty – of being used for young people who do not need this level of care. Residential care may appear to be the only option for a handful of adolescents no longer suited to foster care; but before developing therapeutic residential care further, government must be able to guarantee, at a minimum: a safe environment, a nurturing and healing environment, continuity of care, and the capacity to meet young people's developmental and permanency needs. These standards must be met, not just now, but over the long term.

Empowering and Directive Leadership: The Cost of Changing Styles

2021 ◽  
pp. 227853372110083
Author(s):  
Smita Mukherjee ◽  
Zubin R. Mulla
Keyword(s):  
Laboratory Experiment ◽  
Leadership Styles ◽  
Leadership Style ◽  
Affective Commitment ◽  
Team Outcomes ◽  
History Of ◽  
Satisfaction With The Leader ◽  
The Cost ◽  
First Time

We examine the cost of leaders changing between empowering and directive leadership styles on team outcomes. In a laboratory experiment, we collected data from 240 participants in 80 teams. Confederates enacted different leadership styles and led teams of participants in performing a series of tasks. When leaders changed their style from directive to empowering, teams took time to respond in terms of higher satisfaction with leader and affective commitment. However, when leaders changed their style from empowering to directive, the deterioration of satisfaction with leader and reduction in affective commitment were immediate. Moreover, teams of leaders who had been consistently directive showed higher affective commitment as compared to teams of leaders who had a history of being empowering but later shifted to being directive. First time managers can get inputs on how they should enact their leadership style and be aware that switching between styles may impose long-term costs on the team’s affective commitment and satisfaction with the leader.

scholarly journals Measuring the cost of leaving care in Victoria

2006 ◽  
Vol 31 (3) ◽  
pp. 26-33 ◽  
Author(s):  
Catherine Forbes ◽  
Brett Inder ◽  
Sunitha Raman
Keyword(s):  
Young People ◽  
Independent Living ◽  
The State ◽  
Family Welfare ◽  
Life Outcomes ◽  
The Social ◽  
Measuring Outcomes ◽  
Poor Outcomes ◽  
The Cost

On any given night in Victoria, around 4,000 children and young people live under the care and protection of the State. For many young people, this care extends over a long period of time, sometimes until their 18th birthday. It is well documented that young people leaving State care often lack the social and economic resources to assist them in making the transition into independent living. As a consequence, the long-term life outcomes from this group are frequently very poor. A recent report from the Centre for Excellence in Child and Family Welfare in partnership with Monash University estimated that, for a typical cohort of 450 young people who leave care in Victoria each year, the direct cost to the State resulting from these poor outcomes is $332.5 million. The estimated average outcomes of the leaving care population are based on a recent survey involving sixty young people who had spent at least two years in care as teenagers. This paper provides an overview of the economic methodology used to estimate this cost, and provides discussion of the motivation for measuring outcomes in terms of costs to the State.

scholarly journals Multisystemic therapy compared with management as usual for adolescents at risk of offending: the START II RCT

2020 ◽  
Vol 8 (23) ◽  
pp. 1-114
Author(s):  
Peter Fonagy ◽  
Stephen Butler ◽  
David Cottrell ◽  
Stephen Scott ◽  
Stephen Pilling ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Young People ◽  
Multisystemic Therapy ◽  
Self Report ◽  
Second Phase ◽  
Secondary Outcomes ◽  
Start Trial ◽  
The Cost

Background The Systemic Therapy for At Risk Teens (START) trial is a randomised controlled trial of multisystemic therapy (MST) compared with management as usual (MAU). The present study reports on long-term follow-up of the trial (to 60 months). Objectives The primary objective was to compare MST and MAU for the proportion of young people in each group with criminal convictions up to 60 months post baseline. Secondary outcomes included group comparisons of psychological and behavioural factors. An economic analysis was carried out to determine the cost-effectiveness of MST compared with MAU. Two qualitative studies were conducted to better understand the subjective experiences of the participants. Design Primary outcomes (collected up to 60 months) were collected using a centralised police database. Secondary outcomes were evaluated using self-report questionnaires completed by both young people and parents or carers at the 24-, 36- and 48-month follow-ups. Research assistants were blind to treatment allocation. Setting Participants were recruited from participating MST sites in nine areas of England. Secondary outcomes were typically collected within the family home. Participants A total of 684 families were recruited into the START trial and allocated randomly to a treatment group. Of these, 487 remained in the second phase of the trial. Young people were aged, on average, 13.8 years at baseline, with 63% male and 37% female. Interventions MST is a manualised programme for young people exhibiting antisocial behaviour and their families that uses principles from cognitive–behavioural and family therapy to provide an individualised approach. MAU content was not prespecified, but consisted of the standard care offered to young people who met eligibility for the trial. Main outcome measures Young people’s offending was evaluated using the Police National Computer. Secondary measures included validated self-report measures completed by both the young person and their parent or carer. The economic evaluation took a broad perspective and outcomes were assessed in terms of quality-adjusted life-years and offending. Results No significant differences were found in the proportion of offending between the groups (hazard ratio 1.03, 95% confidence interval 0.84 to 1.26; p = 0.78). No differences were found between the groups on secondary outcome measures, with a few exceptions that did not hold up consistently across the follow-up period. The economic analysis did not find evidence to support the cost-effectiveness of MST compared with MAU. Outcomes from the qualitative studies suggest that families mostly felt positive about MST, and that MST was associated with greater maturity in young men. Limitations Some intended evaluations were not possible to deliver. Selective attrition may have influenced the nature of the sample size. It is also unclear how representative the MAU services were of reality. Future research Recommendations are made for the evaluation of MST in populations with more severe behavioural problems, as well as for identifying and testing new moderators. Conclusions The results of the second phase of the START trial do not support the long-term superiority of MST to MAU, but elements of the intervention may be adapted successfully. Trial registration Current Controlled Trials ISRCTN77132214 and London South-East REC registration number 09/H1102/55. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 23. See the NIHR Journals Library website for further project information.

scholarly journals Cost-Utility Analysis of Malaysian Elderlies Living in Public Long-Term Care Institutions

2021 ◽  
Vol 29 (4) ◽  
pp. 2389-2400
Author(s):  
Syazreen Niza Shair ◽  
Thomas Sachi Purcal
Keyword(s):  
Nursing Home ◽  
Residential Care ◽  
Long Term Care ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Nursing Home Care ◽  
Utility Analysis ◽  
Term Care ◽  
The Cost

This research compares the quality of life of Malaysian elderlies living in public formal long-term care institutions, including residential care and nursing home care. It provides evidence of the cost-effectiveness of both programs. The sample of Malaysian elderlies aged 60 years and above was collected from the World Health Survey, including five dimensions of health status: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. Each of the dimensions has three levels, including 1 (“no problems”), 2 (“some problems”) and 3 (“major problem”). The quality-adjusted life-years (QALYs) of elderlies living in both institutions are estimated using a generic health-related measurement method, EQ-5D. In addition, cost-utility analysis is adopted to compare the effectiveness of programs in allocating resources. The QALY of those living in nursing home care is reasonably lower than those in residential care due to their worse chronic health conditions. The majority are categorised as severely disabled. The cost-effectiveness evaluation of each public long-term care model suggests that the residential care program is cost-effective, with the cost per QALY being MYR22 945. At the same time, a nursing home for disabled people is not effective as the cost per QALY is MYR57 822, falls outside the willingness to pay (WTP) range between (MYR 19,929–MYR 28,470).

scholarly journals Improving Financial Performance Using Capital Budgeting Method Towards Cleaner Eyewear Product: A Case Study of Nasho

2020 ◽  
Vol 5 (6) ◽  
pp. 128-135
Author(s):  
Mia Juliani ◽  
Raden Aswin Rahadi
Keyword(s):  
Financial Performance ◽  
Cash Flow ◽  
Net Present Value ◽  
Secondary Data ◽  
Capital Budgeting ◽  
Primary Data ◽  
Financial History ◽  
History Of ◽  
The Cost

The purpose of this study was to know the factor that can be improved in the financial performance of Nasho. Nasho is a brand that focuses on offering products for eyeglass and helmet application that can be water, dew and dust repellent by utilizing the application of nanotechnology in the scope market of Bandung. However, to adapt the technology for Nasho is currently hampered by the limited capital to develop the technology itself. The company needs to manage the capital and minimize the cost to optimize the finance. The company needs to control the cost and expenses to avoid the high number of costs and expenses in terms of the development business stage. The research will use a qualitative approach by conducting interviews to Mr. Reza optics that will cooperate with Nasho to sell the product and use secondary data information from literature review, journal, books and primary data from financial history of Nasho and survey from the consumer of Nasho namely College student, Medical staff and Motorcycle riders and the components that are relevant to the conceptual framework. Survey used to get the consumer product and buying tendency information from Nasho’s consumer to validate the assumption of brand, price and buying intencity. Interview was conducted to get the suitable number of sales that are being used for cash flow forecasting scenario. The findings of this research is Nasho had low financial performance in the first two years of the business. After the evaluation, this can be improved by making a financial planning mix for short term and long term using the capital budgeting method in the form of three optimal scenarios of cash flow, Net Present Value (NPV), IRR and payback period that can be used as an optimal plan to run this business for the next five years.

scholarly journals Response to Ainsworth and Holden's Review of ‘Weighing Up the Evidence and Local Experience of Residential Care’

2018 ◽  
Vol 43 (3) ◽  
pp. 173-174
Author(s):  
Susan Tregeagle
Keyword(s):  
Young People ◽  
Residential Care ◽  
Allocation Of Resources ◽  
Policy And Practice ◽  
Local Experience ◽  
Protection Systems

Debate on Australian policy and practice about residential care is to be welcomed as it has important implications for the care and wellbeing of vulnerable young people, as well as the allocation of resources to care and protection systems. I therefore welcome the commentary provided by Ainsworth and Holden on the arguments offered in ‘Weighing Up the Evidence and Local Experience of Residential Care’. Whilst these reviewers of my Practice Commentary have accepted many of the points made, I wish to take this opportunity to reinforce my arguments in light of their critique.

scholarly journals The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 773
Author(s):  
Kalaimani Elango ◽  
Awad Javaid ◽  
Banveet K. Khetarpal ◽  
Sathishkumar Ramalingam ◽  
Krishna Prasad Kolandaivel ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Arterial Calcification ◽  
Frequent Monitoring ◽  
Cardiovascular Morbidity And Mortality ◽  
Retrospective Cohort Studies ◽  
History Of ◽  
The Cost

Warfarin has been utilized for decades as an effective anticoagulant in patients with a history of strong risk factors for venous thromboembolism (VTE). Established adverse effects include bleeding, skin necrosis, teratogenicity during pregnancy, cholesterol embolization, and nephropathy. One of the lesser-known long-term side effects of warfarin is an increase in systemic arterial calcification. This is significant due to the association between vascular calcification and cardiovascular morbidity and mortality. Direct oral anticoagulants (DOACs) have gained prominence in recent years, as they require less frequent monitoring and have a superior side effect profile to warfarin, specifically in relation to major bleeding. The cost and lack of data for DOACs in some disease processes have precluded universal use. Within the last four years, retrospective cohort studies, observational studies, and randomized trials have shown, through different imaging modalities, that multiple DOACs are associated with slower progression of vascular calcification than warfarin. This review highlights the pathophysiology and mechanisms behind vascular calcification due to warfarin and compares the effect of warfarin and DOACs on systemic vasculature.

scholarly journals Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

2017 ◽  
Vol 21 (64) ◽  
pp. 1-244 ◽  
Author(s):  
Ana Duarte ◽  
Teumzghi Mebrahtu ◽  
Pedro Saramago Goncalves ◽  
Melissa Harden ◽  
Ruth Murphy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Young People ◽  
Clinical Effectiveness ◽  
Children And Young People ◽  
Biological Treatments ◽  
Randomised Controlled ◽  
The Cost

Background Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration This study is registered as PROSPERO CRD42016039494. Funding The National Institute for Health Research Health Technology Assessment programme.

Has the Time Come for More Publicly Operated WTE Facilities in the United States?

2011 ◽  
Author(s):  
Paul L. Hauck ◽  
Anthony M. LoRe ◽  
Kevin Trytek
Keyword(s):  
The United States ◽  
Waste To Energy ◽  
Term Contract ◽  
Design Build ◽  
History Of ◽  
Almost All ◽  
The Cost ◽  
Public Versus Private ◽  
The U.S

When the current generation of U.S. waste-to-energy (WTE) facilities was developed during the 1980s and early 1990s, there were a large number of companies competing to design, build, operate and maintain them under a long term contract. Over the years, almost all of these firms have left the WTE business for a variety of reasons leaving essentially only two U.S. firms actively competing for renewed operating and maintenance (O&M) contracts for publicly owned WTE facilities. This consolidation has significantly reduced the level of competition for public owners who are interested in rebidding their WTE O&M contracts at the end of their initial or extended terms and, as a result, has the potential to increase the cost of service. Consolidation has likewise reduced the level of competition for potential new WTE projects in the U.S. This paper reviews the history of public sector operation of WTE facilities in the U.S., the unique challenges presented by public operation and whether it is time for more public owners to consider this alternative for existing WTE facilities in light of the lack of competition by private operating companies. Perceived risks and impediments to public operation of WTE facilities and suggestions on how to overcome them are presented as well as the benefits and opportunities available to public owners. The keys to a successful public WTE operating venture are also discussed based on the experiences of ecomaine, a consortium of 21 member municipalities in southern Maine that have operated and maintained their own 550 ton per day (tpd) WTE facility for more than 20 years. Public versus private operating practices for European WTE facilities are also explored as well as public ownership and operation of new WTE facilities including those based on alternative or emerging technologies.

Primary varicose veins

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 133-137
Author(s):  
H. Partsch
Keyword(s):  
Varicose Veins ◽  
Compression Therapy ◽  
Daily Practice ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Primary Varicose Veins ◽  
The Cost ◽  
Convincing Data ◽  
Long Term Studies

SummaryBackground: Compression stockings are widely used in patients with varicose veins. Methods: Based on published literature three main points are discussed: 1. the rationale of compression therapy in primary varicose veins, 2. the prescription of compression stockings in daily practice, 3. studies required in the future. Results: The main objective of prescribing compression stockings for patients with varicose veins is to improve subjective leg complaints and to prevent swelling after sitting and standing. No convincing data are available concerning prevention of progression or of complications. In daily practice varicose veins are the most common indication to prescribe compression stockings. The compliance depends on the severity of the disorder and is rather poor in less severe stages. Long-term studies are needed to proof the cost-effectiveness of compression stockings concerning subjective symptoms and objective signs of varicose veins adjusted to their clinical severity. Conclusion: Compression stockings in primary varicose veins are able to improve leg complaints and to prevent swelling.

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