Publications by authors named "Fenyo A"

Background: A 32 year old patient who sustained an ipsilateral Gustilo Anderson 3C open fractures of the distal femur and tibia, following an MVA (Motor Vehicle Accident). The femoral shaft fracture had a 6 cm gap, which was spanned with a tibial diaphyseal autograft harvested from the amputated ipsilateral leg and stabilized with a retrograde intramedullary nail, thus enabling preservation of the knee joint and a functional weight bearing below knee prosthesis.

Conclusion: Distal femur segmental gap reconstruction using ipsilateral amputated tibia in trauma setting was shown to be a feasible surgical technique.

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Lumbar disc herniation is a medical condition in which obscurity exists in the relation between the clinical and the radiological definition. The following paper was written by both surgeons and a radiologist, who are engaged in the field of spine surgery. The aim is to provide clear definitions as to the different pathologies involving disc herniation.

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Background: Analysing costs measures in conjunction with psychiatric case register (PCR) data can provide important epidemiologically-based information on resource utilization. Costing the service use patterns of first-ever patients can indicate the shape and likely resource consequences for mental health services operating within a community-based system of care.

Methods: Yearly costs were calculated for the 299 first-ever patients and 768 longer-term patients who contacted the South-Verona Psychiatric Case Register between 1 January 1992 and 31 December 1993.

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The aim of this study was to show the usefulness of adding cost information to a routine data collection provided by a case register for analysing the association between patients' characteristics and the direct costs of the psychiatric care actually provided. All patients (n = 706) who in 1992 had at least one contact with services which report to the South Verona psychiatric case register and who received an ICD-10 diagnosis were included in the study. The costs of specialist psychiatric care provided during the 365 days following the first contact in 1992 were calculated using a unit cost list.

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Among the many questions concerning the replacement of long-stay hospital services with community-based care are those of cost and cost-effectiveness. Is community care more expensive than hospital care? Are levels of expenditure associated with clients' needs and changes in their well-being? By following a cohort of people discharged from seven long-stay hospitals in Northern Ireland, this wide-ranging evaluation was able to address such cost-related questions. Although nearly three-quarters of the sample were living in private sector residential or nursing homes, a six-fold variation in the total costs of support was found.

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There has been considerable debate concerning the cost-effectiveness of selective serotonin re-uptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) thus far using crude prescription price comparisons or reductionist decision-analytic models. This paper employs a retrospective quasi-experimental design where data on service utilisation, use of medication and informal care were collected for two groups of patients in general practice settings. The mean cost of treatment was marginally greater for those people receiving TCA medication due to greater use of psychiatric services.

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Background: Long-stay patients with learning disabilities (n = 214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation.

Method: Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers.

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Background: In the UK the replacement of long-term in-patient care with community-based support has been part of central government health policy for many years. One of the challenges of implementing such a policy is the prediction of support and service needs in the community and the associated costs.

Method: Using research data from north London analyses were undertaken to examine the associations between service use and costs in the community and the characteristics of hospital in-patients.

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Background: The Daily Living Programme (DLP) offered problem-oriented, home-based care for people aged 17-64 with severe mental illness facing emergency admission to the Bethlem-Maudsley Hospital. The multidisciplinary DLP team acted as direct provider and link with other services. Each patient had a key worker.

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The development of community services to replace two long-stay psychiatric hospitals in the North East Thames Health Authority region of the UK has been the subject of a research programme since 1985. The economic evaluation is conducted by the Personal Social Services Research Unit; research results relating to the first five cohorts of hospital leavers are reported in this paper. When followed up 1 year after discharge, almost half of the sample were living in highly supported residential care units, most of which were managed by district health authorities.

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There is a tendency in discussions of mental health policy and psychiatric practice to talk of the cost of a treatment, facility, or policy and to ignore variations. These variations can be considerable, which alone suggests they should not be overlooked, and they can be explored and perhaps exploited to improve the delivery of services. This article describes a theoretical framework for the examination of cost differences, applies it to a particularly rich data base on people with long-term mental health problems moving from hospital to the community, and uses the empirical evidence to address four key policy questions.

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