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Objective: As the use of “dayhospitals” increases, conceptual models of these services are changing dramatically across Europe. Therefore, the need arises for mental health services research to assess this process cross-nationally in a standardised and systematic way. Such research approaches should seek to maximise the generalisability of results from high-quality (e. g. randomised controlled) single- or multi-site trials assessing
Thomas W. Kallert; Matthias Glöckner; Stefan Priebe; Jane Briscoe; Joanna Rymaszewska; Tomasz Adamowski; P?tr Nawka; Helena Reguliova; Ji?í Raboch; Andrea Howardova; Matthias Schützwohl
This is the second in a series of three reports on the 1978 Psychiatric Drug Survey. The purpose of this report is to describe the usage of psychiatric drugs in three Veterans Administration (VA) outpatient treatment settings: mental hygiene clinics, day ...
The effectiveness of psychiatricdayhospital care in elderly patients remains disputed. Based on a therapeutic community approach, psychotherapeutic dayhospital treatment was evaluated in 122 elderly depressed patients and 76 demented patients suffering from behavioural and psychological symptoms. Neuropsychiatric symptoms, quality of life and therapeutic community progress were assessed at dayhospital admission and discharge. In absence of any change in pharmacological treatment, results show a significant reduction of depressive and neuropsychiatric symptoms as well as improved adhesion to therapeutic community treatment, even in the demented patients. Results further reveal improved mental quality of life and subjective perception of clinical progress in depressed patients. PMID:18549082
This study assessed selected chronicity, social support, and personality variables as predictors of outcome in a 3-week psychiatricdayhospital program. Measured outcome included pre- and post-treatment scores on the BDI, STAI, and SCL-90-R from 224 patients. A single outcome variable based on the average standardized residual changes scores for these measures was derived to assess whether symptom severity at
M. Potvin Kent; K Busby; M Johnston; J Wood; C Docherty
A psychiatricdayhospital was opened with a goal of optimizing the treatment of soldiers by applying the principles of combat psychiatry. This is the first time a psychiatricdayhospital has been operational at Fort Hood. The operation of one psychiatri...
This study evaluated the effect of menstruation on psychiatrichospitalization. We conducted a retrospective chart review of the medical records of 177 women who met the eligibility criteria. Data collected included demographic details, primary and secondary diagnoses, date of last menstrual period (LMP), medication adherence, psychiatrichospitalization length of stay, previous psychiatric admissions (including those related to menstruation), discharge referrals, and readmissions. The majority of women were admitted for major depression, were single, Caucasian, and had a mean age of 34. A disproportionate percentage (37%) of women had their LMP within 5 days of psychiatrichospitalization (p = 0.0006). The overall average length of stay was 4.37 days, and 48.3% had a previous psychiatric admission. Medication adherence was routinely not documented (77.4%). Psychiatrichospitalizations for women are significantly greater within 5 days of their LMP. Nursing education and improved documentation are warranted to decrease the potential for readmission. PMID:22694781
Weston, Jaclyn; Speroni, Karen Gabel; Ellis, Terri; Daniel, Marlon G
Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community.
This article presents a qualitative study on the therapeutic experience in a psychiatricdayhospital six months after discharge. The study explores the impact of this experience on the lives of people with mental disorders. A qualitative design using semi-structured individual interviews was completed with 18 participants six months after their discharge of a dayhospital. Results showed that the dayhospital experience was particularly helpful to improve symptoms and relationship with self. It activated a self-transformational process that continued afterwards. Termination created for many, an abrupt void. Issues at stake during the first six months were continuity of care, social support and maintaining skills and knowledge acquired. PMID:21983906
Establishing nonsmoking policies in hospitals--even on acute psychiatric units--requires patience, planning, and a bit of nerve. The benefits of such a move, however, can be significant for patients and staff. When Vancouver General Hospital implemented a complete indoor nonsmoking policy on its psychiatric assessment and inpatient psychiatry units, workplace conditions noticeably improved, and some long-standing beliefs about psychiatric patients were disproved. Several conditions provided the impetus to change to a nonsmoking policy. With a few exceptions (palliative care, the burn unit) the indoor areas were nonsmoking; nevertheless, the hospital environmental committee considered a site-wide (indoor and outdoor) ban on smoking. One reason was that the community funding that had provided psychiatric patients with cigarettes would soon be cut off. Another reason was that all psychiatry units were anticipating moving into the new hospital tower--a facility slated to be smoke-free--on its completion. PMID:8487222
Introduction: Numerous epidemiological international studies as well as knowledge based on clinical experience show high prevalence and the importance of the psychiatric comorbidity with depressive and anxiety disorders. Goal: The aim of this study is to analyze prevalence of comorbid anxiety disorders and depression in subjects at the DayHospital of the Psychiatric Clinic, Clinical Center of Sarajevo University (CCUS) and examine the demographic profile of the patients. Material and methods: Study involved 230 randomly selected patients (aged between 18 and 65 years, N=230, who were hospitalized at the DayHospital of the Psychiatric Clinic of Clinical center of University of Sarajevo from January 1st to December 31st 2011) and who were interviewed by the Structural Clinical Interview (SCID) which generated ICD-X diagnoses and assessment of the comorbidity. Depressive symptoms were assessed by Beck’s Depression Inventory with 28 items. Anxiety symptoms were assessed with Beck’s Anxiety Inventory scale with 21 items. Study is retrospective, clinical and epidemiological. Results: Of the total number of patients (230) it was determined that 107 (46.5%) have depressive episode; 71 (30.9%) anxiety disorder. Comorbidity of these two disorders was found in 14 (6.1%) cases. Anxiety disorders were more represented in women (61.2%), as well as depressive disorders and comorbidity (70.1% and 85.7%). Subjects with depression on average was 52.9±7.4 years old (range 29-64 years), patients with anxious disorders 50±9.5 years (range 22-65 years) while patients with comorbidity of these two entities was at mean age of 54.5±4.5 years. The least common category of education was retired persons and respondents with university education for all three entities. Hospitalization duration for depression, anxiety, and comorbidity of these two disorders is highest for depression (47.1±9.7 days) and shortest in case of comorbidity (45.9±6.9 days). Conclusion: Depression and anxiety often coexist. When they occur in comorbidity, both anxiety and depression appear to be more severe. Severely depressed and anxious patients have reduced capacity to work and as such represents a considerable burden to the family and the community. Overview of depression, anxiety and the comorbidity of these two diagnoses (listed as primary diagnosis) in the baseline sample showed that there was most patients with depression (107 or 46.5%), followed by anxiety (71 or 30.9%) and comorbidity with 14 patients or 6.1%. Effective assessment, evaluation, diagnosis and treatment can lead to better treatment outcomes in primary care and improved quality of life.
|During a psychiatrichospitalization of 5 to 10 days, cognitive-behavioral therapy (CBT) strategies can be used for the management of inpatients and to support the transition to outpatient treatment. This format was chosen after several years of frustration dealing with crisis inpatient care. The use of CBT is well known, and it seemed that an…
The purpose of the present study was to determine whether the Recruit Temperament Survey (RTS) can predict psychiatrichospitalization for the first two years and the last two years of a sailor's first enlistment in the U.S. Navy. The results indicate tha...
Background: This prospective cohort study assessed the cost-effectiveness of treating 30 women with postnatal depression (PND) at a specialised psychiatric Parent and Baby Day Unit (PBDU), compared to 30 women treated using routine primary care (RPC). Methods: Following recruitment, the women were assessed on three occasions (initially, 3- and 6-months), using a variety of social and psychiatric outcome measures. Direct
|Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou PsychiatricHospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…
Aims. It is often assumed that psychiatric units at general hospitals attract less stigma than do specialized psychiatrichospitals, but so far this has not been examined empirically. Methods. We conducted a representative population survey in Germany (n = 2410) in order to compare attitudes towards psychiatric units and attitudes towards psychiatrichospitals. Two subsamples were presented with identical items concerning either psychiatric units or hospitals. We conducted multinomial logit analyses of answer categories to detect any differences in attitudes. Results. A majority of respondents held favourable opinions of psychiatric in-patient care at both psychiatric units and psychiatrichospitals. Attitudes towards units and hospitals did not differ meaningfully. Conclusions. The influence of location on the image of psychiatric care has been over-estimated. We discuss other implications of locating psychiatric care at general hospitals. PMID:22995060
This paper analyzes the patterns of clinial treatments prescribed to patients diagnosed with schizophrenia who were admitted to state and county mental hospitals, private for-profit psychiatrichospitals, and private nonprofit psychiatrichospitals in July 1980. Treatment patterns were specified by examining the distribution of treatment types provided to patients over a 3-month period through standard tabular arrays and matrix analysis
Nancy Wolff; Paul R. Henderson; Robin L. MacAskill; Marilyn J. Rosenstein; Laura J. Milazzo-Sayre; David Larson; Ronald Manderscheid
...services of hospitals other than psychiatrichospitals. 424.13 Section 424...services of hospitals other than psychiatrichospitals. (a) Content of certification...services of hospitals other than psychiatrichospitals only if a physician...
...services of hospitals other than psychiatrichospitals. 424.13 Section 424...services of hospitals other than psychiatrichospitals. (a) Content of certification...services of hospitals other than psychiatrichospitals only if a physician...
...services of hospitals other than psychiatrichospitals. 424.13 Section 424...services of hospitals other than psychiatrichospitals. (a) Content of certification...services of hospitals other than psychiatrichospitals only if a physician...
Objective: We sought to assess the epidemiology of medication errors (MEs) and adverse drug events (ADEs) in a psychiatrichospital. Methods: We conducted a 6-month prospective observational study in a 172-bed academic psychiatrichospital. Errors and ADEs were found by way of chart review, staff reports and pharmacy intervention reports. Physicians rated incidents as to the presence of injury, preventability
Jeffrey M. Rothschild; Klaus Mann; Carol A. Keohane; Deborah H. Williams; Cathy Foskett; Stanley L. Rosen; James A. Chu; David W. Bates
OBJECTIVE--To assess the proportion of acutely ill psychiatric patients who can be treated in a dayhospital and compare the outcome of day patient and inpatient treatment. DESIGN--Prospective randomised controlled trial of day patient versus inpatient treatment after exclusion of patients precluded by severity of illness or other factors from being treated as day patients. All three groups assessed at three and 12 months. SETTING--Teaching hospital serving small socially deprived inner city area. Dayhospital designed to take acute admissions because of few beds. PATIENTS--175 Patients were considered, of whom 73 could not be allocated. Of the remaining 102 patients, 51 were allocated to each treatment setting but only 89 became established in treatment--namely, 41 day patients and 48 inpatients. 73 Of these 89 patients were reassessed at three months and 70 at one year. INTERVENTIONS--Standard day patient and inpatient treatment. MAIN OUTCOME MEASURES--Discharge from hospital and return to previous level of social functioning; reduction of psychiatric symptoms, abnormal behaviour, and burden on relatives. RESULTS--33 Of 48 inpatients were discharged at three months compared with 17 of 41 day patients. But at one year 9 of 48 inpatients and three of 41 day patients were in hospital. 18 Of 35 day patients and 16 of 39 inpatients were at their previous level of social functioning at one year. The only significant difference at three months was a greater improvement in social role performance in the inpatients. At one year there was no significant difference between day patients and inpatients in present state examination summary scores and social role performance, burden, or behaviour. CONCLUSIONS--Roughly 40% of all acutely ill patients presenting for admission to a psychiatric unit may be treated satisfactorily in a well staffed dayhospital. The outcome of treatment is similar to that of inpatient care but might possibly reduce readmissions. The hospital costs seem to be similar but further research is required to assess the costs in terms of extra demands on relatives, general practitioners, and other community resources.
Creed, F; Black, D; Anthony, P; Osborn, M; Thomas, P; Tomenson, B
Numerous studies have mentioned to the high percentage of violent deaths in prison psychiatrichospitals, with suicide being the principal cause. The aim of this study was to analyze the circumstances related with the deaths recorded in a high security institution. Postmortem reports on all the deaths at the Alicante Psychiatric Prison between 1984 and 1997 were studied (36 cases
Mar??a D Pérez-Cárceles; Cristina Íñigo; Aurelio Luna; Eduardo Osuna
Positive patient outcomes are related to patient satisfaction and the meaningfulness of their hospital experience. Limited attention has been paid to how adolescent psychiatric in-patients experience their treatment course. This study was developed to examine how hospitalized adolescents experience the treatment milieu during an acute hospitalization in a crisis stabilization unit. The study consisted of a survey administered to 105
...Reduction of inpatient psychiatric benefit days available in the initial benefit period...Reduction of inpatient psychiatric benefit days available in the initial benefit period...inpatient in a psychiatrichospital on the first day of Medicare entitlement and for any...
Traditional asylum care of psychiatric patients leads to the isolation, confinement, and restraint of the patients, and to isolation of psychiatric practice from the rest of medicine. Modern psychiatric advances have demonstrated the disadvantages to both patients and their families of such isolation, confinement and restraint. It is in the best interests of patients and professional workers that inpatient psychiatric services be continuous with, and contiguous to, other medical services and to rehabilitation services of all kinds. Examination of currently available information reveals a shortage of psychiatric beds in California, particularly for diagnosis and brief treatment. Thus, not only is there a need to develop psychiatric inpatient facilities, but also an opportunity to develop them along several different lines. Since both the Hill-Burton Act (federal) and the Short-Doyle Act (state) give financial assistance to only those psychiatric services established in general hospitals or affiliated with general hospitals, this requirement calls for examination in the light of experience with services so operated. At first, the Short-Doyle Act was perceived as a panacea for the psychiatric ills of the state. Now it is beginning to be recognized as one method of providing additional mental health resources, rather than the exclusive method. As more short-term cases are treated in local, tax-supported, psychiatric units in general hospitals, an impact can be expected on the state hospital program. In its administration of the Short-Doyle Act, the Department of Mental Hygiene attempts to respond to community needs as locally determined. It tries to insure local option and encourage local responsibility while furthering high standards of staffing and of service.
THE HOSPITALIZATION PRONENESS SCALE (HPS) IS AN EMPIRICALLY DEVELOPED SCALE DESIGNED TO PREDICT PSYCHIATRICHOSPITALIZATION FROM A COMMUNITY CLINIC. THE PREDICTION WAS MADE FROM VARIABLES DEFINING THE PATIENT'S EFFECTIVENESS IN SOCIAL INTERACTIONS, COGNITIVE PERFORMANCE, AND SOCIAL ATTAINMENT, AS ASSESSED AT INTAKE. THE SCALE WAS DEVELOPED ON A GROUP OF 45 HOSPITALIZED AND 97 NONHOSPITALIZED SCHIZOPHRENIC OUTPATIENTS TREATED WITH PLACEBO FROM
NORBERT FREEDMAN; BERNARD ROSEN; DAVID M. ENGELHARDT
A competitive and dynamic healthcare environment requires that psychiatrichospital administrators and physicians continually monitor their hospital's ability to deliver quality services to their patients. To ensure that hospitals stand for and abide by psychiatrichospital practice ethics, the National Association of Private PsychiatricHospitals (NAPPH) Board of Trustees has formally approved and distributed to the industry a "Statement of Principles of PsychiatricHospital Practice Ethics." Adopted at the June 22, 1989, Board meeting, the guidelines not only summarize views long held in the industry, but are a condition of NAPPH membership. Nine critical areas are identified in the NAPPH statement: admissions, advertising, marketing and referral development, resource allocation and appropriateness of care, treatment rendered, patients' rights, family rights and involvement, competition, and financial resources. Central to ethical hospital practice is a moral responsibility--shared among administrators, trustees, physicians and staff--to ensure access to care, quality of care, and fair treatment of patients. NAPPH represents more than 300 private psychiatrichospitals throughout the United States, and the NAPPH mission includes the promotion of high-quality care and treatment, efficient hospital operation, and advocacy for the patients served by its member hospitals. Each NAPPH hospital actively supports the appropriate, safe, and compassionate treatment of the mentally ill. PMID:10296960
The high cost of inpatient hospitalization and the rise in the number of private psychiatric beds for children and adolescents prompt several questions about who is using these services. To examine these issues, a review focusing on the use of psychiatric inpatient services by children was undertaken. The history of inpatient care of children is briefly outlined, recent public policies contributing to the rise in the number of psychiatric beds are considered, and findings from available studies are reviewed. We conclude that the data base is inadequate to draw many conclusions about who is using child psychiatric inpatient services. There appear, however, to be important differences in use of inpatient services according to age and perhaps by institutional type and geographic region. Suggestions for future research and some of the social policy implications are discussed as well.
There is a considerable body of research on the assessment and prediction of aggression in psychiatrichospitals. A range of clinical and demographic characteristics associated with aggressive inpatients, such as young age and active symptoms of psychosis, have repeatedly been shown to contribute to aggression. Environmental factors have also been shown to be important. The study examined aggressive behaviours in
The present study investigates the impact of a recent history of psychiatrichospitalization on obtaining parole for an exit cohort of male offenders. Legal variables (number of prior imprisonments, prior arrest for violent crime, use of violence in current offense, conviction for drug-related offense, history of drug use, and annual prison infraction rate), social and community support variables (marital status,
To assess the lunar hypothesis as predictive of mental health emergencies and antisocial behavior, the relation of the lunar hypothesis and the occurrence of psychiatrichospital admissions of developmentally disabled adults was examined. The full moon phase of the lunar cycle did not explain a higher rate of hospital admission and accounted for only .007% of the variance. A critique of the methodology in prior research led to the suggestion that more immediate stressors and environmental factors are more plausible contributing factors to hospital admission. PMID:7886164
The objective of this study was to identify common features between people that have been recently discharged from psychiatrichospitalization. A quantitative exploratory study was performed at an outpatient mental health service center. The sample was comprised by patients who had recently been discharged. A questionnaire was used and the study was approved by the Review Board. Interviews were performed with 48 patients who were in average 39 years old. Diagnosis for Schizophrenia and Schyzotypal Disorders were prevalent for 33.3% of the sample. An average 13 patients were discharged from psychiatrichospitalization every month, 62.5% of which had been previously hospitalized. In the studied period, 12.5% of the sample required rehospitalization. Psychiatrichospitalization proved to be a necessary resource in crisis episodes and as part of the psychiatric treatment, especially of severe mental disorders. It is evinced that there is a need for adequate treatment maintenance in community health care services to avoid the need of rehospitalizations. PMID:21445493
Beginning in September 1987, the British public will have the right to consult their computerized medical records and by extension, it is expected, noncomputerized ones as well. The author analyzed the case notes of 100 consecutive patients admitted under his care to a psychiatricdayhospital. He classified material likely to affect patients adversely as puzzling or unintelligible, alarming, apparently insulting or objectionable, or sensitive information from or about others. Sergeant rejects proposals to omit sensitive material, to keep secret notes, or to grant access only to some psychiatric patients or to deny access to psychiatric patients as a class. Maintaining that there is no dividing line between somatic and psychological medicine, he concludes that access to personal health data for all patients should be limited to the disclosure of bare administrative details. Further information should be supplied within the traditional medical consultation. PMID:2878185
OBJECTIVE: To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness. DESIGN: Randomised controlled trial with outcome and costs assessed over 12 months after the date of admission. SETTING: Teaching hospital in an inner city area. SUBJECTS: 179 patients with acute psychiatric illness referred for admission who were suitable for random allocation to dayhospital or inpatient treatment. 77 (43%) patients had schizophrenia. INTERVENTIONS: Routine inpatient or dayhospital treatment. MAIN OUTCOME MEASURES: Direct and indirect costs over 12 months, clinical symptoms, social functioning, and burden on relatives over the follow up period. RESULTS: Clinical and social outcomes were similar at 12 months, except that inpatients improved significantly faster than day patients and burden on relatives was significantly less in the dayhospital group at one year. Median direct costs to the hospital were 1923 pounds (95% confidence interval 750 pounds to 3174 pounds) per patient less for dayhospital treatment than inpatient treatment. Indirect costs were greater for day patients; when these were included, overall dayhospital treatment was 2165 pounds cheaper than inpatient treatment (95% confidence interval of median difference 737 pounds to 3593 pounds). Including costs to informants when appropriate meant that dayhospital treatment was 1994 pounds per patient cheaper (95% confidence interval 600 pounds to 3543 pounds). CONCLUSIONS: Day patient treatment is cheaper for the 30-40% of potential admissions that can be treated in this way. Carers of dayhospital patients may bear additional costs. Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission, but dayhospital treatment leads to less burden on carers in the long term.
Length of stay in psychiatric inpatient units has received increasing attention with the external pressures for treatment cost-effectiveness and evidence that longer hospital stays do not appear to have significant advantages over shorter hospital stays. This study examined the relationship between length of psychiatrichospital stay and…
The Mississippi Health Care Commission adopted additional regulations for PsychiatricHospitals on November 17, 1983. The regulations become effective December 22, 1983. PsychiatricHospitals are free - standing facilities established to offer facilities,...
|Psychiatrichospitalization is an intensive intervention designed to stabilize adolescents who are experiencing an acute mental health crisis. Reintegrating to school after discharge from psychiatrichospitalization can be overwhelming for many adolescents (E. V. Clemens, L. E. Welfare, & A. M. Williams, 2010). The authors used a consensual…
Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.
...2010-10-01 false Special provisions applying to psychiatrichospitals. 482.60 Section 482.60 Public Health... Â§ 482.60 Special provisions applying to psychiatrichospitals. Psychiatrichospital mustâ (a)...
...2012-10-01 false Special provisions applying to psychiatrichospitals. 482.60 Section 482.60 Public Health... Â§ 482.60 Special provisions applying to psychiatrichospitals. Psychiatrichospital mustâ (a)...
...2011-10-01 false Special provisions applying to psychiatrichospitals. 482.60 Section 482.60 Public Health... Â§ 482.60 Special provisions applying to psychiatrichospitals. Psychiatrichospital mustâ (a)...
...2009-10-01 false Special provisions applying to psychiatrichospitals. 482.60 Section 482.60 Public Health... Â§ 482.60 Special provisions applying to psychiatrichospitals. Psychiatrichospital mustâ (a)...
Families of currently hospitalized patients in an extended-care psychiatric facility were interviewed concerning their views of hospitalization and discharge. Although most were sad that their relative was hospitalized, only a third felt that they would rather be caring for their relative at home. Families felt communication with hospital staff was poor and many of their needs were unmet. Families indicated
Objective: To examine the clinical implications of manic symptoms in psychiatricallyhospitalized children aged 5–12. Methods: DSMIIIR manic symptoms, along with symptoms of other psychiatric disorders, were rated by parents and teachers on the Child Symptom Inventory IIIR prior to hospitalization. The Child Behavior Checklist (CBCL; was also completed. During hospitalization children were evaluated by structured interview (K-SADS-E), and numerous
Recent and dramatic changes in this country's mental healthcare service are widely documented. To assess the extent and timing of those changes at one private psychiatrichospital, the authors examined length of stay, number of admissions, and patient age for general trends between 1980 and 1990 and more closely examined trends between July 1990 and December 1991. We related our findings to data for other private psychiatrichospitals and compared them with data from psychiatric units in general hospitals. The results are discussed in terms of changes in insurance coverage, changing utilization by different age groups, and a national shift from inpatient to outpatient care. PMID:10123737
A geriatric dayhospital was established as part of the psychogeriatric unit of the Royal Ottawa Hospital. While initially this dayhospital was integrated with dayhospital programs of other units, it became apparent that a separate facility was desirable. The activities and programs of the psychogeriatric dayhospital, run by one registered nurse, were integrated with those of the geriatric inpatient unit. It was found to be advantageous for inpatients and dayhospital patients to share the same physical facilities. The majority of dayhospital patients came from the inpatient unit; almost all had affective disorders. The emphasis was on reintegration into the community. During the 1st year of operation there were 75 patients in the program; only 3 needed admission to the inpatient unit and 1 was readmitted after discharge.
|This study examined predictors of psychiatrichospitalization among children with autism spectrum disorders (ASD). Data were collected from 760 caregivers of children with ASD. Cox regression was used to determine factors associated with hospitalization. Almost 11% were hospitalized. Youth in single parent homes were more likely to be…
Acommon perception is that public psychiatrichospitals receive little or no Medicaid funds because of the Institutions for Mental Diseases (IMD) exclusion. This policy prohibits Medicaid reimbursement for care provided to individuals older than 21 years ...
ObjectivesWe intend to review the importance of appropriately recognizing and managing attention deficit\\/attention deficit hyperactivity disorder (ADD\\/ADHD) in the acute psychiatrichospital setting.
Ricardo Castaneda; Robert Levy; Charles Hazzi; Stephen Ross; William Roman; Hamada Hamid
Pediatric patients with autism spectrum disorders (ASD) and/or intellectual disabilities (ID) are at greater risk for psychiatrichospitalization compared to children with other disorders. However, general psychiatrichospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatrichospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children's hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33%) and decreased average lengths of inpatient stay (as short as 26 days versus 45 days). Available data from a subset of patients (n = 43) in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes.
Gabriels, Robin L.; Agnew, John A.; Beresford, Carol; Morrow, Mary Ann; Mesibov, Gary; Wamboldt, Marianne
The Israeli Treatment of Mental Patient Law of 1991 reflects an innovative approach which promotes the use of compelled treatment order in the community as the least restrictive environment alternative for involuntary psychiatrichospitalization. This law grants the Regional Psychiatric Committees with authorities regarding the involuntary placement of such patients by court. The proportion of court order induced involuntary psychiatrichospitalizations among the total psychiatrichospitalizations is increasing with time. The 2004 Correction to the Act, clause 29a, states that a psychiatric patient may be represented in the Regional Psychiatric Committee by a legal advocate, and settles the options to materialize this right. The 2004 Correction is not yet applied in all regions in Israel. The Committees do not usually promote compelled treatment in outpatient clinics as a follow-up or an alternative for involuntary psychiatrichospitalizations. Involuntary hospitalizations by court order bear no time limits despite a former decision of the Israeli High Court of Justice. The lack of an obligatory legal representation for the psychiatric patient further ensures that the option of compelled treatment in outpatient clinics is not satisfactorily considered. In our opinion, the current reality of involuntary hospitalization orders that bear no time limits; the underuse of the compelled out patient clinic treatment option; and the lack of obligatory legal representation for the patients, results in an inappropriate application of the treatment policy of least restrictive environment. The patient is often regarded as present-but-missing. The awareness to patients' human rights in the Israeli psychiatric system must be emphasized, and suitable resources should be allocated to promote the option of treatment and rehabilitation in the community as the least restrictive option. However, if patients' rights are not appropriately kept, public safety may well be compromised, as well as patients' rights. PMID:17853559
The objective of this study was to characterize the degree of dependence in relation to nursing care of patients hospitalized in a Psychiatric Unit of a teaching hospital, using the Instrument to Classify the Level of Dependence in Psychiatric Nursing. In total, 11.07 patients/day were classified in the Psychiatric Ward (EPQU) and 7.76 patients/day in the brief intervention Psychiatric Ward (EPIB). The average rate of bed occupancy in these units was 79.1% and 86.3%, respectively. Most patients were female (55.8%) and aged between 20 and 30 years (34.8%). The modest degree of nursing care prevailed both at EPQU (62.7%) and at EPIB (61.8%). The research permitted knowing this clientele's demands of nursing care and provided elements that showed the need of new studies regarding the composition of the nursing staff at this unit. PMID:22031378
A meta-analysis was conducted on nine studies of an assertive outreach model for frequent users of psychiatrichospitals.\\u000a Four studies used experimental or quasi-experimental designs and five used pre-post designs. Findings at one-year follow-up\\u000a were examined for retention in community mental health services, psychiatric inpatient days, quality of life, and client level\\u000a of functioning. Eighty-four percent of assertive outreach clients
|This study estimated the ASD prevalence in a psychiatrichospital and evaluated the Social Responsiveness Scale (SRS) combined with other information for differential diagnosis. Chart review, SRS and clinical interviews were collected for 141 patients at one hospital. Diagnosis was determined at case conference. Receiver operating characteristic…
Mandell, David S.; Lawer, Lindsay J.; Branch, Kira; Brodkin, Edward S.; Healey, Kristin; Witalec, Robert; Johnson, Donielle N.; Gur, Raquel E.
More than 60% of all inpatient psychiatric episodes occur in general hospitals. The need for psychologists' involvement in this important area is discussed. Changes in general hospital inpatient care from 1980 to 1985 are described. These include important and controversial changes in public policy, most notably Medicare's prospective payment system. Substantial changes in the de facto system occurred in patterns
One hundred and twenty patients presenting for admission to a state psychiatrichospital were randomly allocated into two groups. Control patients received standard hospital care and after-care. Experimental patients were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol
...of participation: Special staff requirements for psychiatrichospitals. 482.62 Section 482.62 Public Health...participation: Special staff requirements for psychiatrichospitals. The hospital must have adequate...
...of participation: Special staff requirements for psychiatrichospitals. 482.62 Section 482.62 Public Health...participation: Special staff requirements for psychiatrichospitals. The hospital must have adequate...
Thistletown Hospital is a children's psychiatrichospital which was established by the Department of Health of the Province of Ontario. Special legislation permitting control of the admissions procedures was enacted. The administrative organization consists of a series of committees made up of the heads of hospital departments. An advisory board of distinguished psychiatrists and psychologists advises the Minister of Health directly on major policy changes or innovations envisaged for the hospital. Clinical organization is related to four functions: (1) service (treatment and assessment), (2) research, (3) training of staff, and (4) community education. The basic units of the hospital are related to the treatment or research design necessary in special diagnostic categories. A children's psychiatrichospital should not be restricted to in-patient facilities but should consist of a totally community-oriented service.
Tardive dystonia is a relatively uncommon long term complication of neuroleptic therapy. The prevalence of this syndrome is unknown. This study, of chronic hospitalised psychiatric patients, revealed a tardive dystonia prevalence of 1.5%. Risk factors in this small population appeared to be mental retardation and convulsive therapy.
The last decade has seen an enormous increase in the use of business techniques in the ownership and operation of psychiatrichospitals. Many physicians have reacted negatively to these developments and have raised many concerns about their impact on patient care. However, commercialism in hospitals is not new. Certain key business values, including attention to a guiding mission statement, the needs of consumers, accountability, and marketing, have a positive impact on the quality of milieu treatment. PMID:10296947
The problems experienced by a sample of 30 female offender-patients in a secure psychiatrichospital were surveyed using the Behavioral Coding System (BCS). Common problems are emotional difficulties, antisocial behaviors, auditory hallucinations, and self-injury. Problem profiles derived from medical records, key workers' reports, and patients' self reports differed. The survey revealed the necessity of revising the BCS better to identify
Males (ages 7 to 17) in a psychiatrichospital were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with childhood maltreatment experiences. Lowest DBH levels were found in boys maltreated before 72 months of age or with the principal diagnosis of conduct disorder solitary aggressive…
The aim of this study is to analyze psychiatric comorbidity of alcohol dependence with respect to prevalence rates, time of onset and indications for the course of alcoholism. 100 hospitalized alcohol-dependent patients were investigated. They were diagnosed according to the criteria of ICD-10 assessed by the Composite International Diagnostic Interview (CIDI). In 54% of the patients, at least one additional
M. Driessen; V. Arolt; U. John; C. Veltrup; H. Dilling
An account is given of clinical and statistical study of the groups of patients in psychiatric and psychoneurological institutions. It includes a historical reference, a general glance at the studies on the daily intro-hospital census of patients and a de...
Studies examining aggression in psychiatrichospitals have focused primarily on the clinical and demographic characteristics of aggressive inpatients. Contextual contributors to aggression, while often acknowledged, have less often been the focus of research. This study considered the effects of aspects of physical environment on aggression. The opportunity to examine these environmental contributors to inpatient aggression arose from the closure of
|Males (ages 7 to 17) in a psychiatrichospital were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with childhood maltreatment experiences. Lowest DBH levels were found in boys maltreated before 72 months of age or with the principal diagnosis of conduct disorder solitary…
...participation: Special medical record requirements for psychiatrichospitals. 482.61 Section 482.61 Public Health...participation: Special medical record requirements for psychiatrichospitals. The medical records maintained by a...
...participation: Special medical record requirements for psychiatrichospitals. 482.61 Section 482.61 Public Health...participation: Special medical record requirements for psychiatrichospitals. The medical records maintained by a...
Background An increasing number of empirical studies indicate that infants, toddlers and preschoolers may suffer from non-transient mental illnesses featuring developmental psychopathology. A few innovative child psychiatric approaches have been developed to treat infants, toddlers and preschoolers and their families, but have not yet been conceptually presented and discussed in the framework of different healthcare systems. The organizational and clinical experience gained while developing specific approaches may be important across disciplines and guide future developments in psychiatric treatment of infants, toddlers, preschoolers and their families. Results This article introduces the Preschool Family DayHospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. This hospital is unique in the German healthcare system with regard to its social-service institution division of labor. Specifically, it uses an intermittent treatment approach and an integrated interactional family psychiatric approach to treat children and their parents as separate patients. This multidisciplinary, developmentally and family-oriented approach includes components of group treatments with children and separate treatments with parents. Specific techniques include video-assisted treatments of the parent–child interaction, psychiatric and psychotherapeutic treatments for parents, and conjoint family therapies that include both parents and siblings. Conclusions The Family DayHospital for infants, toddlers and preschoolers and their families offers innovative family-oriented treatments for those who suffer from a wide range of severe child psychiatric disorders that cannot be sufficiently treated in outpatient settings. Treatment is based on the need for family-oriented approaches to the early psychiatric treatment of infants, toddlers and preschoolers. Family dayhospitals are an innovative approach to preschool child psychiatry that requires further evaluation.
There is conflicting literature describing how psychiatric patients, particularly those with schizophrenia, respond to overwhelming environmental disasters, with some reports describing marked improvement in their symptoms. This view is contrary to the notion that those individuals who are most vulnerable (i.e. people with serious psychiatric illness) are at high risk for further increase in psychiatric symptoms subsequent to stressful events. Since the terrorist attack of September 11, 2001, was such a catastrophic event, the following project was undertaken to examine its consequences on a population of hospitalized and thus severely ill psychiatric patients. Medical records for 156 New York City psychiatric inpatients were examined to evaluate their psychiatric condition during the time prior to and subsequent to the September 11, 2001, terrorist attacks on the World Trade Center in New York City. We failed to find any difference between the patients who had the opportunity to directly view the disaster through windows and those who did not. However, significantly more patients with a schizophrenia spectrum diagnosis showed evidence of worsening in their symptoms than those with affective disorder or other diagnoses in response to the events of September 11. PMID:15590047
DeLisi, Lynn E; Cohen, Tiffany H; Maurizio, Andrea M
This study explores stigma apprehension (fear of being devalued or rejected) and its correlates among 102 adolescents, interviewed within 7 days of discharge from their first psychiatrichospitalization. Components of the Model of Stigma-Induced Identity Threat by Major and O'Brien (Annu Rev Psychol 56:393-421, 2005) comprise the study model, including collective stigma representations and group and domain identification; additional clinical, personal, and contextual characteristics such as social affiliation, interpersonal support, self-identification as having a mental disorder, and perceived need for others' approval were added to the model. We found that, on average, the participants reported "a little" stigma apprehension, and 21% reported substantial stigma apprehension. Multivariate analysis demonstrated that higher stigma apprehension was most associated with the female sex, younger age at initiation of mental health treatment, lower self-esteem, greater need for others' approval, more experiences with personal stigmatization, and not identifying or affiliating with peers who have mental health or behavior challenges. These factors collectively accounted for 46% of the variance. The study's findings particularly highlight the role of social context and external contingencies of self-worth in determining adolescents' perceptions of stigma-related threat. PMID:21964272
Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatrichospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended. PMID:9885632
Investigated whether the Beck Depression Inventory (BDI) is a psychometrically sound instrument for measuring depressive symptomatology in 78 12–16 yr old psychiatrically disturbed adolescents. Test–retest, item-total, and coefficient alpha estimates of reliability were found to be statistically acceptable. BDI scores discriminated between patients with a hospital diagnosis of major depressive disorder and a diagnostically heterogeneous group of patients with nonaffective
Michael Strober; Jacquelyn Green; Gabrielle Carlson
In a follow up to previous work (Kiesler, Simpkins, & Morton, 1989), we predicted where in a general hospital a psychiatric patient would be treated: psychiatric unit, chemical dependency unit, or scatter bed. Independent a priori clinical assumptions and multiple-discriminant function predictions were compared for 5,033 patients receiving psychiatric inpatient treatment in general hospitals with specialized units in the 1980
Charles A. Kiesler; Celeste G. Simpkins; Teru L. Morton
Little is known about the problems that necessitate admission to psychiatrichospital or about how services provided to psychiatric patients are related to their presenting problems. The present study examined a cohort of admissions to a public psychiatrichospital. Previously established methods were used to discover homogeneity in patient problems and patient subtypes. Also examined were the interrelationships of presenting
The Tel Aviv-Central District Office of the Public Defenders' Office has begun, as a trial project, to represent patients hospitalized under enforced commitments at district psychiatric committee hearings concerning their welfare. This experimental trial was carried out at the Abarbanel Mental Health Center starting 1st January 2000. The results illustrate that the chances of a patient hospitalized under enforced commitment being discharged from hospital are better if he is represented. It is particularly better when cooperation exists between his public defender and his treating psychiatrist. The results emphasize that the inclusion of the defender in the process affects the work program of the committee and its decisions, especially the examination of facts, the hearing of witnesses, the quality of the psychiatric assessment, the examination of the legal aspects and the summing up of the findings. From feedback received, it appears that all parties involved in the process feel that representation on behalf of the patients by the legal defenders results in more just and worthy decisions in every public aspect of the process. The authors recommend that legal representation be extended to all patients who are hospitalized under enforced commitments. PMID:12653049
Coercive measures that restrict personal freedom have been in the focus of critical public interest since the beginning of modern psychiatry. Psychiatrichospitals have the two-fold mission to prevent danger to self or danger to others on the one side and on the other to keep optional coercive measures as little restrictive and as short as possible. Critical and regardful handling of coercive measures has both qualitative and quantitative aspects. For quantitative comparisons, we introduced benchmarking in psychiatrichospitals in Baden-Wuerttemberg, which in the meantime have been joined by hospitals in other German federal states, Switzerland, and Luxemburg. The most important quality indicators include the percentage of admissions exposed to coercive measures and the mean duration of a coercive measure. For the purpose of benchmarking, the results of four quality indicators are presented, separated for each ICD-10 principal diagnostic group, both cross-sectionally and longitudinally. The project has been continuously pursued since 2004. Participating hospitals were allowed to develop their own projects to reduce coercive measures according to the benchmarking results. PMID:21767794
Research has found that people with psychiatric disabilities Taiwan tended to utilize passive and emotional-focused strategies to cope with their illness unlike Western studies. A self-reported questionnaire that incorporated categories: socio-demographic characteristics, the self-impact of illness, illness adaptation, and coping strategy scale was administrated to 140 persons with psychiatric disabilities routinely hospitalized over a long period of time to explore the strategies of coping with their mental disorders. Analysis of survey data found the sense of helplessness and the overall illness adaptation significantly impact negative emotion coping utilization. Those who felt highly impact by the illness, more sense of helplessness, less actively managing their illness, and more social support availability were more likely to use positive emotion as a coping strategy. The better overall adaption to the illness significantly impact procrastination and previous illness experience utilization. Only a positive coping strategy was found significantly to manage the illness. PMID:19826952
This study estimated the ASD prevalence in a psychiatrichospital and evaluated the Social Responsiveness Scale (SRS) combined with other information for differential diagnosis. Chart review, SRS and clinical interviews were collected for 141 patients at one hospital. Diagnosis was determined at case conference. Receiver operating characteristic (ROC) curves were used to evaluate the SRS as a screening instrument. Chi-squared Automatic Interaction Detector (CHAID) analysis estimated the role of other variables, in combination with the SRS, in separating cases and non-cases. Ten percent of the sample had ASD. More than other patients, their onset was prior to 12 years of age, they had gait problems and intellectual disability, and were less likely to have a history of criminal involvement or substance abuse. Sensitivity (0.86) and specificity (0.60) of the SRS were maximized at a score of 84. Adding age of onset < 12 years and cigarette use among those with SRS <80 increased sensitivity to 1.00 without lowering specificity. Adding a history substance abuse among those with SRS >80 increased specificity to 0.90 but dropped sensitivity to 0.79. Undiagnosed ASD may be common in psychiatrichospitals. The SRS, combined with other information, may discriminate well between ASD and other disorders. PMID:21846667
Mandell, David S; Lawer, Lindsay J; Branch, Kira; Brodkin, Edward S; Healey, Kristin; Witalec, Robert; Johnson, Donielle N; Gur, Raquel E
BACKGROUND: and aim: Lack of cultural adaptation may risk or worsen mental illness among immigrants, and interfere with assessment and treatment. Language proficiency (LP) seems essential for access to foreign environments, and the limited research concerning its effects on mental health care encouraged this preliminary study. METHODS: We reviewed clinical records of all immigrant psychiatric patients hospitalized at the University of Foggia in 2004-09 (N = 85), and compared characteristics of patients with adequate versus inadequate LP. RESULTS: Subjects (44 men, 41 women; aged 35.7±10.0 years) represented 3.62±0.94% of all hospitalizations in six years. (2004-09). Most (60.0%) had emigrated from other European countries. Many were diagnosed with a DSM-IV unspecified psychosis (40.0%) or adjustment disorder (18.8%), and 45.9% were in first-lifetime episodes. Average comprehension and spoken LP was considered adequate in 62.4% and inadequate in 37.6%. In multivariate modelling, adequate LP was more prevalent among women, emigration from another European country, receiving more psychotropic drugs at hospitalization, and having entered Italy legally. CONCLUSION: Findings support an expected importance of LP among immigrant psychiatric inpatients, and encourage language assessment and training as part of the comprehensive support of such patients, especially men. PMID:23741004
Ventriglio, Antonio; Baldessarini, Ross J; Iuso, Salvatore; La Torre, Antonella; D'Onghia, Antonio; La Salandra, Michela; Mazza, Maristella; Bellomo, Antonello
This study attempted to identify predictors of completion of a 27 h\\/week 4-week dayhospital program for cocaine dependence. The research subjects were 95 lower socioeconomic, primarily African American male veterans. Of a wide range of predictor variables available at baseline, including sociodemographic and historical information, Addiction Severity Index data, psychiatric diagnoses, SCL-90 measures, and measures of craving and familial
Arthur I. Alterman; James R. McKay; Frank D. Mulvaney; A. T. McLellan
SUMMARY The socio-demographic and clinical characteristics of psychiatric referrals in emergency O. P. D. of a teaching general hospital were studied from January 1986 to December 1987. The referral rate was 1.5%. The source, reason and purpose of referrals were studied. Hysterical fits, altered sensorium and excitements together constituted three fourth of all emergency referrals. The diagnosis of neurosis was made in one third of the patients and about one fourth of all patients were labelled as suffering from hysterical neurosis (fits being the most common presentation).
In this study, standardized mortality ratios (SMR - observed deaths/expected deaths) were calculated among a cohort of psychiatric patients hospitalized in Livorno (Italy) in the years 1990-2003. Findings show an excess of deaths due to both natural (SMR=2.37) and non natural (SMR=2.37) causes, with a higher rate of excess mortality in younger patients and in the first years after discharge. A slightly decreasing trend in excess deaths was found from 1990-2003. Better and more timely access to healthcare, aimed at improving physical as well as well as mental health, is warranted in this population. PMID:17786168
The planning and organization of mental health care in developing countries frequently lacks empirical data. The World Health Organization recommended psychiatric brief inpatient programms in general hospitals for these countries as a cost-effective alternative to the traditional mental hospital. Length of hospital stay is a crucial factor in a cost-effective mental health care organization. In a newly organized psychiatric inpatient
Background Patients admitted to a psychiatrichospital with suicidal behavior (SB) are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan. Method 155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II) and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined. Results The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD). SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range) of the total number of SBs in the lifetime history was 7 (1-141). Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified. Conclusions Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission and frequent SB repetition in the lifetime history. Gender and age appeared to have an influence on SB method selection and SB-preceding processes. The findings have important implications for assessment and treatment of psychiatric suicidal patients.
A psychiatric investigation was carried out on patients aged 65-80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance. At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis.
The role of community factors in psychiatrichospital utilization in rural and urban Ireland was evaluated using Hollingshead & Redlich's conceptual model. Rural and urban differences in identification of psychiatric disorders, attitude to psychiatric facilities and social isolation were assessed using a community survey (N=200). No difference was found in the recognition of schizophrenic behavior. Rural residents tended to normalize
Aim To study demographic characteristics, comorbidities, and diagnoses of patients admitted for personality disorders to PsychiatricHospital Vrap?e between 1879 and 1929. Methods Data were collected from the archives of Vrap?e PsychiatricHospital for a 50-year period from November 1879 to December 1929. The ratio between the number of patients with personality disorder and the number of all admitted patients was determined. We used 3 systems of definitions of personality disorder: for cases before 1923, we used Prichard's concept of moral insanity and unpublished definitions of one of the hospital managers at that time; for cases after 1923, we used Schneider's classification of psychopathic personalities and unpublished definitions of one of the hospital managers at that time. Results The total number of admissions during the study period was 18?960, 141 (0.74%) of which were for a personality disorder. Of the admitted patients, 85.8% were men and 59.7% were single. The average age was 29.70?±?9.52 years. Most of them (61.7%) were sent to the hospital by courts or police, and the median length of stay was 92 days (interquartile range, 92.0?-?127.5 days). The first patient with a personality disorder was admitted in 1889 with a diagnosis of moral insanity. Until 1920, only 3 terms were used for personality disorder: moral insanity, psychopathic inferiority, and psychopathy. The term was subdivided only after that year. Of the 141 patients admitted for personality disorder, 34 (24.1%) were discharged with comorbid disorders, mainly substance abuse. The most common single comorbid diagnosis was Ganser syndrome (prison psychosis). Conclusion Archives of the Vrap?e PsychiatricHospital contain reliable data about the earliest nomenclature of personality disorders, the increase in the prevalence of personality disorders, and further subdivision of the term personality disorder. Nomenclature for these disorders used at the Vrap?e PsychiatricHospital was consistent with that used in clinical practice in other parts of the world at the time.
As the United States prepares to engage in a major policy debate around the availability, cost, and effectiveness of health care, an opportunity is presented for examining a special component of that care system: psychiatrichospitalization for children and adolescents. Over 15,000 children are hospitalized in psychiatric facilities at any one time in the U.S., representing an expenditure of well
|Psychiatric reasons are among the most common causes of hospitalization for adolescents. A Consensual Qualitative Research approach was used to explore mental health professionals' perceptions of the needs of adolescents as they transition from psychiatrichospital to school. Academic, social, and emotional domains emerged as important areas of…
Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.
Psychiatric reasons are among the most common causes of hospitalization for adolescents. A Consensual Qualitative Research approach was used to explore mental health professionals' perceptions of the needs of adolescents as they transition from psychiatrichospital to school. Academic, social, and emotional domains emerged as important areas of…
Clemens, Elysia V.; Welfare, Laura E.; Williams, Amy M.
There is a high prevalence of psychiatric disorders in children and adolescents who have acquired brain injury (ABI). We examined the records of 82 students with ABI who were admitted to a community-based school for education and neurorehabilitation over a three-year period to determine how many experienced one or more psychiatrichospitalizations before admission, and whether hospitalization status was related
James K. Luiselli; Denise Dion; Erin Hammil; Andrea Potoczny-Gray; Ronald C. Savage; Donald L. Sherak
The widespread use of seclusion and restraint in child psychiatrichospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatrichospital during a 3-year period. Twenty-eight percent of the patients
This research profiles the 472 patients hospitalized during an an-nual period at Central New York Psychiatric Center, which is the sole provider of hospitalization for any of New York State's 40,000 sentenced inmates who require acute inpatient psychiatric care. Patient characteristics are compared with those of the State's general prison population. Application of this form of analysis may prove useful
Outpatient treatment is standard care for adolescents discharged following a psychiatrichospitalization. There is little research, however, on the amount and types of psychotherapy these clients receive in the community. We examined therapy attendance and therapist report of outpatient therapy practice with adolescents discharged from psychiatrichospitalization following either a suicide attempt or severe suicidal ideation in the Northeastern USA.
Anthony Spirito; Valerie Simon; Mary Kathryn Cancilliere; Rachel Stein; Candace Norcott; Katherine Loranger; Mitchell J. Prinstein
This article describes the objectives and operations of a behavioral psychology service within a partial hospitalization program for adults with psychiatric disorders and developmental disabilities. Partial hospitalization programs are an effective model of psychiatric service delivery but are not common for patients with mental retardation\\/mental illness. Phases of intake behavioral assessment, treatment planning and implementation, and discharge are described with
Objective: This study aims at examining the pattern of psychiatric referrals with particular reference to (1) age and gender (2) source of referrals and (3) diagnosis of referred patients within a teaching hospital Method: Four hundred and twenty seven referrals (n=427) for psychiatric consultation within KKUH were selected prospectively by systematic randomization over a period of one year, and were compared with a general hospital (n=138) and primary health care (n=402) psychiatric referrals to a mental health facility. Results: The age of referred patients across the three settings differed significantly and the male patients were slightly over-represented in the teaching hospital referrals. Pediatric clinics in the teaching hospital constituted significant sources of psychiatric referrals as compared to the general hospitals. Schizophrenic disorders and acute psychoses were significantly less among teaching hospital referred patients, whereas anxiety and mood disorders were much more common among teaching hospital and primary care patients. The number of personality disorders diagnosed in teaching hospital settings was significant. Conclusions: In Saudi Arabia, sources of psychiatric referrals and diagnostic patterns of mental disorders differ across the three levels, and this is comparable to international research on psychiatric referrals. Besides exploring other aspects of referral process, researchers at the three settings should carry out follow-up studies to assess the impact of psychiatric consultations on the global outcome of referred consultees.
Cytogenetic survey of 257 mentally retarded individuals. A cytogenetic inquiry was undertaken among 257 patients with mental retardation of two psychiatrichospitals. 25 patients show chromosomes anomalies (10%). We found: --18 trisomy 21 (Down's syndrome); --3 sexual chromosome anomalies: 47, XYY syndrome; 47, XYY/46, XY mosaïcism; 47, XXY, or Klinefelter syndrom; --1 partial delection of long arm of chromosome number 18 (46, XX, 18 q--); --3 translocations; 45, XX, t (1, 13) (p 36, q 11); 46, XX, t (5 p--, 18 p+) (p 12, p 11); 46, XY, t (9, 19) (q 21, p 18). We also found 9 large Y chromosomes (46, XY q+), 8 cases of variant chromosomes, 1 case with chromosomes associations..., we report a case of masculine Turner phenotype or Noonan syndrom. PMID:135524
Bourgeois, M; Bénézech, M; Tournier-Zerbid, N; Constant-Boy, M; Benazet-Rissou, J
The results of a retrospective study of fall incidence during a 1-year period in a psychiatrichospital in Singapore are reported, involving 309 patients who fell one or more times during their stay. The profile of inpatients involved in falls was identified. Data were derived from standard incident forms completed whenever patients had a fall. A total of 348 falls were identified for the 1-year period. Results revealed higher fall rates in younger male epileptic patients; elderly female patients, age 70 and older with depression or dementia; individuals with concomitant medical conditions; and patients taking three types of medication. The majority of falls occurred when the activity level was high in the ward. Young epileptic patients and elderly depressed patients were prone to repeated falls. These results have the potential to assist in identifying patients at high risk and in designing and implementing strategies to prevent such incidents. PMID:11008674
Tay, S E; Quek, C S; Pariyasami, S; Ong, B C; Wee, B C; Yeo, J L; Yeo, S G
This exploratory research paper investigated the coping strategies of families of hospitalizedpsychiatric patients and identified their positive and negative coping strategies. In this paper, the coping strategies of 45 family members were examined using a descriptive, correlational, mixed method research approach. Guided by the Neuman Systems Model and using the Family Crisis Oriented Personal Evaluation Scales and semistructured interviews, this paper found that these family members used more emotion-focused coping strategies than problem-focused coping strategies. The common coping strategies used by family members were communicating with immediate family, acceptance of their situation, passive appraisal, avoidance, and spirituality. The family members also utilized resources and support systems, such as their immediate families, mental health care professionals, and their churches.
Eaton, Phyllis M.; Davis, Bertha L.; Hammond, Pamela V.; Condon, Esther H.; McGee, Zina T.
Objective To examine smoking behaviour and motivation to reach abstinence among staff and patients of a psychiatrichospital.Methods In two due day surveys all in-patients and staff of the Centre for Psychiatry Weissenau were interviewed by a questionnaire.Results The response rate was 78.5 %. 442 (48 %) out of 933 subjects (523 patients, 410 staff) were smokers. Patients were smoking more frequently than staff (58 % vs. 34 %) and were more severely nicotine-dependent. Significant gender differences were observed with regard to prevalence and nicotin dependence. 57 % said they wanted to stop smoking and 34 % would appreciate therapeutic offers. There were no significant differences between patients and staff.Conclusions Psychiatric patients are as motivated as staff for offers about smoking cessation. There is a need for therapeutic offers. PMID:22422161
Background Adherence to ethical principles in clinical research and practice is becoming topical issue in China, where the prevalence of mental illness is rising, but treatment facilities remain underdeveloped. This paper reports on a study aiming to understand the ethical knowledge and attitudes of Chinese mental health professionals in relation to the process of diagnosis and treatment, informed consent, and privacy protection in clinical trials. Methods A self-administered survey was completed by 1110 medical staff recruited from Shanghai’s 22 psychiatrichospitals. Simple random selection methods were used to identify target individuals from the computerized registry of staff. Results The final sample for analysis consisted 1094 medical staff (including 523 doctors, 542 nurses, 8 pharmacologists and 21 other staff). The majority reported that their medical institutions had not established an Ethics Committee (87.8%) and agreed that Ethics Committees should be set up in their institutions (72.9%). Approximately half (52%) had not received systematic education in ethics, and almost all (89.1%) of the staff thought it was necessary. Nearly all participants (90.0%) knew the Shanghai Mental Health Regulations which was the first local regulations relating to mental health in China, but only 11% and 16.6% respectively knew of the Nuremberg Code and the Declaration of Helsinki. About half (51.8%) thought that the guardian should make the decision as to whether the patient participated in clinical trials or not. Conclusions The study indicates that most psychiatrichospitals in Shanghai have no Medical Ethics Committee. More than half the medical staff had not received systematic education and training in medical ethics and they have insufficient knowledge of the ethical issues related to clinical practice and trials. Training in ethics is recommended for medical staff during their training and as ongoing professional development.
Objective: In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatrichospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3 inverted exclamation markA16.5 years with age range of 18-92 years. The average length of stay was 11.4 inverted exclamation markA15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch inverted exclamation mark s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of inverted exclamation markY10. The mean BPRS score was 23.6 inverted exclamation markA22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02). Conclusion: These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid Cway facilities for their rehabilitation. PMID:19582331
Taiwo, H; Ladapo, O; Aina, O F; Lawal, R A; Adebiyi, O P; Olomu, S O; Aina, R B
Ontario government statistics have indicated that during the 1960s the proportion of readmissions to psychiatrichospitals doubled to form two thirds of all admissions. Since this pertained to events rather than to individuals, a cohort of patients first admitted in 1969 was followed for 4 years to trace the pattern of readmission and the characteristics of patients at risk of readmission. Routinely returned data were linked and a sample from the greater metropolitan Toronto area was randomly selected. Of the cohort, 31% were readmitted, 8% three or more times. Age and diagnosis distinguished those readmitted. Most with multiple readmissions were under 25 years of age. Although diagnoses were equally distributed on first admission among psychotic, neurotic and other nonpsychotic disorders, with no significant change on readmission or multiple readmission, there was a predictably greater proportion of functional psychoses among the high-risk group and also an equal representation of personality, addictive and the remaining nonpsychotic conditions. The vulnerable few are identifiable early in their intermittent hospital career. It can be concluded that statistics suggesting that two thirds of admissions are readmissions are misleading.
Within hospitals, a plan for quality improvement consists of numerous steps to be taken by an inclusive management team, implicating all of the actors involved. The establishment of an instrument panel of indicators is the outcome of such a participatory process. The existence of best practice referentials allows for the construction of a coherent plan to improve the quality of care. A query of the francophone bibliographic databases reveals very few publications from internal audits on the relevance of care. Nevertheless, external audits demonstrate the significance of evaluation of the quality of care in psychiatrichospitals. The authors are therefore surprised to note the existing hiatus between the wealth of references and their lack of being used in the publications of the professionals concerned. The analysis of the relevance of the medical decision is not widely accepted. Clinical practice is still considered as an art form even though it has become a technique which now calls on the collective experience of peers. PMID:12891818
We assessed the predictors of clozapine initiation among youth 18 years and younger within a state psychiatrichospital. Administrative data (n = 358) were evaluated of inpatients from a long-term state child and adolescent psychiatrichospital. We investigated 25 background and clinical patient characteristics to determine which factors predicted clozapine initiation following the first 21 days of hospital admission. A Cox proportional model was used to evaluate factors that independently predicted the hazard rate of clozapine initiation. Emergency medication administration during the first 3 weeks of admission, which was more common among the clozapine (84.9 %) than control (61.7 %) patients (p < 0.001), was associated with a significantly increased probability of clozapine initiation (Hazard Ratio = 1.9, 95 % Confidence Interval = 1.2-3.1). Use of a mood stabilizer during the first 3 weeks of the inpatient was non-significantly related to an increased probability of clozapine initiation (Hazard Ratio = 1.7, 95 % Confidence Interval = 1.0-2.9). In this setting, emergency medication use predicts clozapine initiation suggesting that it may be used to treat patients with aggressive behavior. PMID:23224347
Bobb, Vanessa; Weinberg, Michael; Gabel, Stewart; Kranzler, Harvey; Olfson, Mark
This study's objective was to investigate how peer support relates to psychiatrichospitalization and crisis stabilization utilization outcomes. The likelihood of experiencing a psychiatrichospitalization or a crisis stabilization was modeled for consumers using peer support services and a control group of consumers using community mental health services but not peer support with 2003 and 2004 Georgia Medicaid claims data; 2003 and 2004 Mental Health, Developmental Disability, and Addictive Diseases (MHDDAD) Community Information System data; and 2003 and 2004 MHDDAD Hospital Information System data. Peer support was associated with an increased likelihood (odds = 1.345) of crisis stabilization, a decreased but statistically insignificant likelihood (odds = 0.871) of psychiatrichospitalization overall, and a decreased and statistically significant (odds = .766) likelihood of psychiatrichospitalization for those who did not have a crisis stabilization episode. PMID:19551502
Objective To estimate the prevalence of mental capacity to make decisions on treatment in people from different diagnostic and legal groups admitted to psychiatrichospital.Design Cross sectional study.Setting General adult acute psychiatric inpatient units.Participants 350 consecutive people admitted to psychiatric wards from the community over 16 months.Main outcome measure Mental capacity assessed by clinical interview and the MacArthur competence assessment
Gareth S Owen; Genevra Richardson; Anthony S David; George Szmukler; Peter Hayward; Matthew Hotopf
Objective: To evaluate the rehabilitation programme in a geriatric dayhospital.Design: An observational study.Setting: An urban geriatric rehabilitation dayhospital.Subjects: Three hundred and fifty-three older patients admitted to a rehabilitation dayhospital during 2000: 163 post stroke, 113 with deconditioning and 77 post orthopaedic surgery (hip fracture and joint replacement).Main outcome measures: Functional Independence Measure (FIM), Nottingham Extended ADL Index,
Avital Hershkovitz; Daniel Gottlieb; Yichayaou Beloosesky; Shai Brill
BACKGROUND: The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospitalpsychiatric units, called SPDCs (Servizio Psichiatrico Diagnosi e Cura; in English, the psychiatric service for diagnosis and management). The aims of this paper are: (i) to describe the epidemiological and clinical characteristics of patients, including sociodemographic features, risk factors, life habits
Andrea Ballerini; Roberto M Boccalon; Giancarlo Boncompagni; Massimo Casacchia; Francesco Margari; Lina Minervini; Roberto Righi; Federico Russo; Andrea Salteri; Sonia Frediani; Andrea Rossi; Marco Scatigna
The objective of this study was to explore suicidal behaviors documented at time of discharge from acute psychiatrichospitalization. Data from 114 acute psychiatric admissions were reviewed for 22 veterans with a history of traumatic brain injury (TBI). Information extracted included presence of suicidal ideation, nature of suicide attempts, and TBI characteristics. The Lethality of Suicide Attempt Rating Scale was
Peter M. Gutierrez; Lisa A. Brenner; Joseph A. Huggins
The issues related to recruiting African American psychiatric inpatients are discussed in the context of a study on the influence of ethnicity on psychiatric diagnosis. Ethnically diverse psychiatric residents interviewed 960 Black and White inpatients in 2 urban psychiatrichospitals. Despite the obstacles cited in the literature about recruiting and retaining African Americans into research, 78% of this sample were
Estina E. Thompson; Cheryl Munday; James S. Jackson
|Over a quarter of a million U.S. students each year reside for a period of time in a psychiatric inpatient hospital setting to receive mental health treatment. Following inpatient treatment, most children are transitioned from the hospital into a regular school setting. Little is known about how these transitions are managed by hospital or school…
Over a quarter of a million U.S. students each year reside for a period of time in a psychiatric inpatient hospital setting to receive mental health treatment. Following inpatient treatment, most children are transitioned from the hospital into a regular school setting. Little is known about how these transitions are managed by hospital or school personnel. The current study examined
The paper analyzes the hospital experience of patients with psychiatric diagnoses in a national sample of short-term non-federal general hospitals. The analyses will use a data base compiled by the Hospital Cost and Utilization Project (HCUP) at the Natio...
To investigate the specific behavioural and cognitive characteristics which may account for academic deficits in children with psychiatric disorders, 50 children admitted to a day treatment and school program were assessed using behaviour questionnaires for parents and teachers, and tests assessing intelligence (WISC-R), language (CELF-R) and academic performance (Kaufman Test of Educational Achievement). The academic measures Reading Decoding, Reading Comprehension
S. Kotsopoulos; S. Walker; K. Beggs; B. Jones; A. Kotsopoulos; P. Patel
... Ask Before PsychiatricHospitalization Of Your Child Or Adolescent Quick Links Facts for Families - Numerical List Facts ... of available treatment options when a child or adolescent is mentally ill. Parents are naturally concerned and ...
In 1989, the Department of Veterans Affairs (VA) identified six primarily psychiatrichospitals in which 38 patient deaths may have occurred due to likely quality-of-care problems in the medical treatment these individuals received. Before this, in 1988, ...
This study examined relations between suicidal behavior history (i.e., no suicidality, suicidal ideation, single attempters, and multiple attempters) and psychiatric functioning. Adolescents, aged 12-17, admitted to an inpatient psychiatric unit, were categorized by suicidal behavior history based on self- and clinician-report data. Groups were…
D'Eramo, Kristen Schoff; Prinstein, Mitchell J.; Freeman, Jennifer; Grapentine, W. L.; Spirito, Anthony
Reviewed the psychiatric and medical care of female veterans using 69 interviews at a veterans psychiatric facility. The data suggested that female veterans are satisfied with care in general but are less satisfied with certain gender-related components of care. Reviews the facility's responses to the findings and suggests changes. (JAC)
Fourteen elderly psychiatric patients who attempted or committed homicide are described. Most were cognitively impaired. None were intoxicated despite many having histories of alcohol abuse. Few patients went to court, had a history of domestic violence or previous psychiatric treatment. The sole patient to complete homicide was the only patient who used a gun. None had attempted suicide. The frequency
Describes the types of psychiatric and behavioral disturbance present in 169 preschoolers with developmental disabilities admitted to a specialized psychiatric inpatient unit. Differences in the proportion of some diagnoses and behavior problems across cognitive functioning level and across age were found. Seventytwo percent of the sample had one or more medical diagnosis. Similarities and differences with earlier reports in the
Cynthia R. Johnson; Martin J. Lubetsky; Kelley A. Sacco
Ethnic minorities from disadvantaged socioeconomic backgrounds report increased utilization of mental health emergency services;\\u000a however findings have been inconsistent across ethnic\\/racial groups. In this study we describe patients who present to a rural\\u000a crisis unit in Southern California, examine rates of psychiatrichospitalizations across ethnic\\/racial groups, and investigate\\u000a factors that are associated with increased psychiatrichospitalizations in this sample. This
Alvaro Camacho; Bernardo Ng; Anabel Bejarano; Alan Simmons; Denise Chavira
The acceptance and consumption of a new two-dayhospital liquid diet were evaluated and compared to the liquid diets currently served at eight military hospitals. On alternating days, patients whose jaws were wired because of a dental procedure or jaw inj...
Background: There is a dearth of studies which are related to consultation-liaison psychiatry in India. The psychiatric referral rates in India are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a hospital. Studying the pattern of psychiatric referrals may pave the way for interventions to improve the current scenario. Methods: The study population comprised of all the patients who were referred for psychiatric consultation from other departments (both in-patient and out-patient) of the hospital over a period of two years. Data which was related to socio-demographic profile, source of referral, reason for referral and the psychiatric diagnosis were recorded and analyzed by using descriptive statistical methods. Results: A total of 520 patients were referred for psychiatric consultation, with a referral rate of 0.42%. A majority of the psychiatric referrals (59%) were from the department of medicine and the most common reason for referral was medically unexplained somatic complaints (23.1%), followed closely by anxiety (21%) and abnormal behaviour (13.1%). The most commonly diagnosed psychiatric disorders were neurotic, stress related and somatoform disorders (41.7%) followed by mood disorders (12.9%) and substance use disorders (12.7%). Conclusion: There is a need to encourage multi-disciplinary interaction in the management of patients who attend general hospitals, so as to better identify the psychiatric morbidity. Further studies should focus on interventions that can improve referral rates through early recognition of the common psychiatric conditions, with particular emphasis on sensitizing the general physicians, who are the most common source of psychiatric referrals.
A 1967-1971 study discovered better adjustment in long-term psychiatric patients when placed in a high expectation halfway house rather than the usual, more limited, low expectation services. The high expectation program provided patient autonomy and stru...
Hospital expenditures continue to increase at rates that are higher than that of GNP growth. Policymakers are experimenting with a number of reimbursement methods in an attempt to curtail the growth in hospital costs. This article empirically assesses the impact of various hospital reimbursement methods on the use of hospital services. We specified and estimated a model of hospital duration for Medicaid psychiatric patients. A new semiparametric approach to estimation was implemented for a large national sample of hospital discharges. The empirical findings show significant reductions in hospital duration are associated with per case prospective payment as compared with cost-based reimbursement. PMID:10304283
The English language and Scandinavian literatuare include an ample discussion of the problem of negative psychological and psychiatric sequelae of abortion. However, most works are based on an epistemologically incorrect methodology, being limited to a statistical comparison of the absence and presence of sequelae. The present study is based on a specially prepared clinical evaluation scale, investigating 11 women, 18 months after abortion, all with negative psychological sequelae. In 6 women, psychiatric sequelae were encountered. A considerable incidence of depression and profound emotional disturbance was evident. A clinical comparison using the same scale between the sequelae 20 days and 18 months after abortion revealed increased disturbance in 7 women. It is emphasized that the psychological sequelae following a hospital abortion should be considered iatrogenic and a direct result of the introduction of hospital abortions, a barbarous bloodletting indicative of the self-destructive dominance of technology and ideology. (author's modified) PMID:6621300
Ethnic differences in rehospitalization were examined in a program of intensive services for severely mentally ill hospital recidivists. The purpose was to determine whether ethnicity-related differences in psychiatric admissions observed in national data would appear among clients at great risk for hospitalization but enrolled in a program of case-managed care to promote community adjustment and tenure. After accounting for differences
We surveyed 222 nurses, nursing assistants, and clerks at a psychiatrichospital in Taiwan on responses to workplace violence, treatment of violent patients, and reporting behavior. Staff reported 78 incidents of physical violence (PV), 113 of verbal abuse (VA), 35 of bullying/ mobbing (BM), 21 of sexual harassment (SH), and 10 of racial harassment (RH) over the course of one year. Among affected staff, only 31% of those experiencing PV and < 10% of those experiencing other categories of violence completed a formal report. Highest levels of reporting to senior staff were among those affected by SH. Patients who were physically violent were more likely to be injected with medication than patients showing other violent behaviors. More VA-affected staff considered the incident not important enough to report. Other reasons for not reporting the incident were fear of negative consequences, especially for BM, and shame for SH. Reliable systems for responding to and reporting patient violence should be developed. PMID:19496484
This study was conducted to evaluate the risk factors of scabies introduction into a hospital. We addressed the following question: Do patients transferred from other institutions pose a higher risk than patients from the community? From July 2003 to May 2006, a trained physician surveyed the inpatients and staff of a psychiatrichospital (six wards, 300 beds) on a monthly basis. During the study period, specific infection control measures beyond standard precautions, such as prophylactic treatment, were not adopted. There were 333 newly-admitted patients during the study period and among them, 122 were transferred from other institutions. Seven patients were diagnosed with scabies. Two of these patients were infected while in the hospital (secondary infection), thus the number of introduced scabies cases (index cases) was five. Four of the index cases were transferred from other institutions (three from psychiatrichospitals and one from a nursing home). The source of infection for one index case was unexplained. The rate of scabies infection among transferred patients was 3.3% while the infection rate among patients from the community was 0.5%. Therefore, transferred patients pose a higher risk than those from the community. The average time from admission to diagnosis of scabies was 141 days (range 34-313 days). The hospital personnel checked the skin condition of all patients at admission and none of the four patients showed symptoms of scabies. PMID:21950623
This paper presents the initial findings from an action research study designed to explore and improve rehabilitation practice in a geriatric dayhospital, The role of nurses in dayhospitals and their contribution to rehabilitation form the focus of the discussion, which emanates from the analysis of semi-structured interviews with 13 members of the multi-disciplinary team, and observation of team meetings and patient reviews. Factors which influence the therapeutic activity of nurses are identified and tentative interpretations offered. The findings indicate that the nurse's role in dayhospitals is multifaceted and varied and the conclusion is drawn that, far from being marginalized in rehabilitative and therapeutic terms, the nurse's central coordinating role should be recognized as the lynchpin of dayhospital activity. PMID:8708189
|Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using…
Kozyrskyj, Anita; Black, Charlyn; Chateau, Dan; Steinbach, Carmen
Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using Manitoba’s health care databases, the
Anita L. Kozyrskyj; Charlyn Black; Dan Chateau; Carmen Steinbach
A Behavioral Model of Health Services Utilization approach was used to examine the impact of comorbid mental illness on mortality of veterans admitted to Veterans Affairs Medical Centers in fiscal year 2001 with a primary diagnosis of congestive heart failure (n= 15,497). Thirty percent had a psychiatric diagnosis, 4.7% died during the index hospitalization and 11.5% died during the year following discharge. Among those with mental illness, 23.6% had multiple psychiatric disorders. Multivariable logistic regression models found dementia to be positively associated with inpatient mortality. Depression alone (excluding other psychiatric disorders) was positively associated with one-year mortality. Primary care visits were associated with a reduced likelihood of both inpatient and one-year mortality. Excepting dementia, VA patients with a mental illness had comparable or higher levels of primary care visits than those having no mental illness. Patients with multiple psychiatric disorders had more outpatient care than those with one psychiatric disorder.
Banta, Jim E.; Andersen, Ronald M.; Young, Alexander S.; Kominski, Gerald; Cunningham, William E.
Nurses who attend patients with psychiatric disorders often encounter ethical dilemmas and experience difficulties in making the right decision. The present study aimed to evaluate the decisions of psychiatric nurses regarding their duty to warn third parties about the dangerousness of the patient, the need for compulsory hospitalization, and the competence of patients. In total, 111 nurses working in the field of psychiatry in Turkey completed a questionnaire form consisting of 33 questions. The nurses generally assessed the decision-making competency of the patient correctly. However, their decisions regarding whether the patient should be compulsorily hospitalized and their understanding of their duty to warn/protect were less consistent. A significant relationship was found between the decisions of the psychiatric nurses and their work experience, them having children, and them having postgraduate education in psychiatric nursing. The nurses stated their desire to be part of the team that decided on ethical problems in psychiatry. PMID:22918056
...other hospitals because the care furnished in psychiatrichospitals is often purely custodial and thus not covered...every 30 days. (e) Other requirements. Psychiatrichospitals must also meet the requirements set forth...
|A study was conducted to examine the concurrent validity of the Children's Interview for Psychiatric Syndromes (ChIPS) for adolescent inpatients aged 12 to 18. The results reveal moderate agreement between ChIPS diagnoses and Schedule for Affective Disorder sand Schizophrenia for School-Age Children-Present and Lifetime version diagnoses.|
Swenson, Lance P.; Esposito-Smythers, Christianne; Hunt, Jeffrey I.; Hollander, Beth L. G.; Dyl, Jennifer; Rizzo, Christie J.; Steinley, Douglas L.; Spirito, Anthony
Disruptive behaviors are common among hospitalized patients with psychiatric and substance abuse behaviors. Nurses working on nonpsychiatric units, however, may lack competencies to care for patients with such behaviors. A survey was developed and administered to 844 nurses across three hospital settings that revealed a lack of nurse confidence to intervene in situations that require de-escalation techniques and crisis communication. This study provides direction for further research and interventions in hospital settings with similar professional development needs. PMID:24060662
Rutledge, Dana N; Wickman, Mary E; Cacciata, Marysol; Winokur, Elizabeth J; Loucks, Jeannine; Drake, Diane
Background In-hospital mortality measures, which are widely used to assess hospital quality, are not based on a standardized follow-up period and may systematically favor hospitals with shorter lengths of stay (LOS). Objective To assess the agreement between performance measures of U.S. hospitals using risk-standardized in-hospital and 30-day mortality rates. Design Observational study. Setting U.S. acute care non-federal hospitals with at least 30 admissions for acute myocardial infarction (AMI), heart failure (HF) and pneumonia in 2004–2006. Patients Medicare fee-for-service patients admitted for AMI, HF, and pneumonia from 2004–2006. Measurements The primary outcomes are in-hospital and 30-day risk-standardized mortality rates. Results There were 718,508 AMI admissions to 3,135 hospitals, 1,315,845 HF admissions to 4,209 hospitals, and 1,415,237 pneumonia admissions to 4,498 hospitals. The hospital-level mean patient LOS in days varied across hospitals for each condition, ranging (min-max) for AMI, HF and pneumonia from 2–13, 3–11, and 3–14 days, respectively. The mean risk-standardized mortality rate differences (30-day minus inhospital) were 5.3% (SD=1.3) for AMI, 6.0% (SD=1.3) for HF, and 5.7% (SD=1.4) for pneumonia, with wide distributions across hospitals. Hospital performance classifications differed between in-hospital and 30-day models for 257 hospitals (8.2%) for AMI, 456 (10.8%) for HF, and 662 (14.7%) for pneumonia. Hospital mean LOS was positively correlated with in-hospital RSMR for all three conditions. Limitations Our study uses Medicare claims data for risk adjustment. Conclusions In-hospital mortality measures provide a different assessment of hospital performance than 30-day mortality and are biased in favor of hospitals with shorter LOS.
Drye, Elizabeth; Normand, Sharon-Lise T.; Wang, Yun; Ross, Joseph S.; Schreiner, Geoffrey C.; Han, Lein; Rapp, Michael; Krumholz, Harlan M.
Day Care Hospitals represent efficient structures for the treatment of various psychatric disorders through a large variety of medical care. In the litterature, multiple terms are used to define the various models of Day Care Hospitals, according to their use, their orientation and their therapeutic programmes. Our aim in this study is to compare, through a search on "Medline", the various existing models of Day Care Hospitals in France and in Belgium. Thereafter, the "specific" model which exists at the Centre Hospitalier du Luxembourg will be described. Two main types of Day Care Hospitals are described in the litterature: the "classical" type, with mainly a support fuction, resides on the downstream side of hospitalisation and the "specific" type, with a care function for a short duration, resides on its upstream side. The model developed at the Centre Hospitalier du Luxembourg is upstream the hospital. From our study, it is concluded that, rather of being an inconvenience, the large number of existing Day Care Hospitals, which differ by various specificities, represent excellent complementary opportunities for the current care of mental diseases. PMID:18561596
We examine the use of the mental hospital and alternative residential facilities by 149 chronic psychiatric patients in Ontario. All major movements of patients since the time of first admission were recorded, including the number of episodes and duration of hospitalization and placement in alternative facilities and in the community. Clinical and social variables thought likely to influence use were correlated with duration, placement, and mobility. In spite of the lack of formal criteria for placement, relatively discrete and homogeneous populations were found in each facility and clear patterns of use could be distinguished. For many patients, their present placement represents their most typical setting and implies a particular route through the psychiatric services. We describe factors relating to different types of movements, and emphasize the continuing importance of the mental hospital in long-term psychiatric care. PMID:407883
Racial disparities in mental health outcomes have been widely documented in non-institutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness were followed for a year after hospital discharge to examine the presence of disparities in mental health outcomes between African American and White individuals diagnosed with a severe psychiatric condition. Results from a series of individual growth curve models indicated that African American individuals with severe mental illness experienced significantly less improvement in global functioning, activation and anergia symptoms, and were less likely to return to work in the year following hospitalization. Racial disparities persisted after adjustment for sociodemographic and diagnostic confounders, and were largely consistent across gender, socioeconomic status, and psychiatric diagnosis. Implications for social work research and practice with minorities with severe mental illness are discussed.
Background The epidemiology of suicidality shows considerable variation across sites. However, one of the strongest predictors of suicide\\u000a is a suicidal attempt. Knowledge of the epidemiology of suicidal ideas and attempts in the general population as well as in\\u000a the health care system is of importance for designing preventive strategies. In this study, we will explore the role of the\\u000a psychiatric
Terje ØiesvoldTony; Tony Bakkejord; Vidje Hansen; Mary Nivison; Knut W. Sørgaard
Background The incidence and risk factors of suicide reattempts within 1 year after psychiatrichospital discharge in mood disorder patients remain uninvestigated in Thailand. Objective To determine incidence and risk factors of suicide reattempts within 1 year after psychiatrichospital discharge in mood disorder patients. Methods A retrospective cohort study was conducted by reviewing medical charts at Suanprung PsychiatricHospital, Chiang Mai, Thailand. Mood disorder patients, diagnosed with the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes F31.x, F32.x, and F33.x, who were admitted owing to suicide attempts between October 2006 and May 2009 were eligible. The influence of sociodemographic and clinical risk factors on suicide reattempts was investigated using Cox’s proportional-hazards regression analysis. Results Of 235 eligible mood disorder patients, 36 (15.3%) reattempted suicide (median 109.5 days, range 1–322), seven (3.0%) completed suicide (median 90 days, range 5–185), and 192 (84.2%) neither reattempted nor completed suicide during follow-up. Of all nonfatal suicide reattempts, 14 patients (38.9%) did so within 90 days. Among suicide completers, one (14.3%) did so 5 days after discharge, and four (57.1%) did so within 90 days. The following three risk factors explained 73.3% of the probability of suicide reattempts: over two previous suicide attempts before the index admission (adjusted hazard ratio [HR] 2.48; 95% confidence interval [CI] 1.07–5.76), being concomitantly prescribed typical and atypical antipsychotics (adjusted HR 4.79; 95% CI 1.39–16.52) and antidepressants, and taking a selective serotonin reuptake inhibitor alone (adjusted HR 5.08; 95% CI 1.14–22.75) or concomitantly with norepinephrine and/or serotonin reuptake inhibitors (adjusted HR 6.18; 95% CI 1.13–33.65). Conclusion Approximately 40% of suicide reattempts in mood disorder patients occurred within 90 days after psychiatrichospital discharge. For mood disorders and when there have been over two previous suicide attempts, prescribed antipsychotics or antidepressants may help predict suicide reattempts.
Personal characteristics of patients and environmental factors at psychiatrichospitals have been identified as predictors of absconding. This study seeks to establish a relationship between time of the year and absconding. All characteristics of absconders were analysed over a two-year period using hospital records (N= 104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calendar. Friday was the most popular day of the week for absconding, males tend to escape more on the weekends compared to females, females tend to escape more during the wet season, and Christmas was the most popular holiday season for absconding to take place. The full moon phase had the largest percentage of absconding when compared to other phases. Recommendations are that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase.
Personal characteristics of patients and environmental factors at psychiatrichospitals have been identified as predictors of absconding. This study seeks to establish a relationship between time of the year and absconding. All characteristics of absconders were analysed over a two-year period using hospital records (N= 104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calendar. Friday was the most popular day of the week for absconding, males tend to escape more on the weekends compared to females, females tend to escape more during the wet season, and Christmas was the most popular holiday season for absconding to take place. The full moon phase had the largest percentage of absconding when compared to other phases. Recommendations are that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase. PMID:21206811
ACCESSIBLE SUMMARY: Over half of the violent incidents considered in this study were unexplained. The risk for violent behaviour inside the hospital was the highest for civil patients. The risk rate in this group was 12 compared to criminal patients' risk rate of one. ABSTRACT: The aim of this paper was to explore the frequency and provocation of physically violent incidents in a Finnish forensic psychiatrichospital. Three years (2007-2009) of violent incident reports were analysed retrospectively. The data were analysed by content analysis, and statistically by Poisson regression analysis. During the study period a total of 840 incidents of physical violence occurred. Six main categories were found to describe the provocation of violence where three of these categories seemed to be without a specified reason (61%), and three represented a reaction to something (36%). The risk for violent behaviour was highest for the civil patients (RR = 11.96; CI 95% 9.43-15.18; P < 0.001), compared to criminal patients (RR = 1). The civil patients represented 36.7% of the patients, and in 43.6% of the studied patient days, they caused 89.8% of the reported violence incidents. Patients undergoing a forensic mental examination did not frequently behave aggressively (RR = 1.97; CI 95% 0.91-4.28). These results can be used in the reorganization of health-care practices and the allocation of resources. PMID:23634912
|Major differences between the recidivist and nonrecidivist patient groups were that, of those who were successful in staying in the mainstream, more returned to school, more had at least one biological parent in the home, fewer had had a significant family member hospitalized, and they had shorter hospitalizations prior to discharge. (Author)|
In the past decade, the Norwegian government has emphasized user participation as an important goal in the care of mentally ill patients, through governmental strategic plans. At the same time, the governmental documents request normalization of psychiatric patients, including the re-socialization of psychiatric patients back into society outside the psychiatrichospital. Milieu therapy is a therapeutic tool to ensure user participation and re-socialization. Based on an ethnographic study in a long-term psychiatric ward in a psychiatrichospital, we identified how staff tried to implement user participation in their milieu-oriented therapy work. We have identified three major tensions and challenges in implementing user participation in milieu-therapeutic work. First, it is difficult to implement individual-based user participation and at the same time take collective house rules and codes of conduct into consideration. Second, user participation proved a difficulty when patients' viewpoints challenged staff judgements on proper conduct and goals for which patients might aim. Third, user participation becomes a challenge when trying to establish relationships based on equality when using milieu therapy in a biomedical hierarchical hospital structure. These tensions and challenges are seen in light of paradoxical political frames and demands on one side, and milieu therapy as a complex tradition anchored in different ideologies on the other. PMID:19906279
Oeye, Christine; Bjelland, Anne Karen; Skorpen, Aina; Anderssen, Norman
In this article the fate of Mr. B. is described as an example for the fate of hundreds of mentally ill patients of the "Landes-Irrenanstalt of Klagenfurt", murdered during the era of National Socialism. This extraordinary fate marks two outstanding aspects of history of medicine, the treatment of syphilis with malaria and the organised mass murder of mentally ill people during the cynic era of National Socialism. Beyond this historical perspective reconstructive biographical work together with relatives is presented as a proactive duty of psychiatric institutions. PMID:22990646
In order to estimate rates and identify risk factors for assaults on employees of a state psychiatrichospital, we examined workers' compensation claims, hospital-recorded incident reports, and data collected in a survey of ward staff. Results revealed 13.8 workers' compensation claims due to assault per 100 employees per year. Assaults were responsible for 60% of total claims. Incident reports revealed 35 injuries due to assault per 100 employees per year. Survey data revealed 415 injuries due to assault per 100 employees per year. Of the respondents, 73% reported at least a minor injury during the past year. Assault management training in the past year was associated with less severe injuries. Working in isolation, the occupation of mental health technician, and working on the geriatric-medical hospital unit were associated with more severe injuries during the past year. Assaults on staff in psychiatrichospitals represent a significant and underrecognized occupational hazard. PMID:8986260
Objective This study aimed to determine the incidence of psychiatric disorders among health care workers in Toronto in the one- to two-year period after the 2003 outbreak of severe acute respiratory syndrome (SARS) and to test predicted risk factors. Methods New-onset episodes of psychiatric disorders were assessed among 139 health care workers by using the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale. Past history of psychiatric illness, years of health care experience, and the perception of adequate training and support were tested as predictors of the incidence of new-onset episodes psychiatric disorders after the SARS outbreak. Results The lifetime prevalence of any depressive, anxiety, or substance use diagnosis was 30%. Only one health care worker who identified the SARS experience as a traumatic event was diagnosed as having PTSD. New episodes of psychiatric disorders occurred among seven health care workers (5%). New episodes of psychiatric disorders were directly associated with a history of having a psychiatric disorder before the SARS outbreak (p=.02) and inversely associated with years of health care experience (p=.03) and the perceived adequacy of training and support (p=.03). Conclusions Incidence of new episodes of psychiatric disorders after the SARS outbreak were similar to or lower than community incidence rates, which may indicate the resilience of health care workers who continued to work in hospitals one to two years after the SARS outbreak. In preparation for future events, such as pandemic influenza, training and support may bolster the resilience of health care workers who are at higher risk by virtue of their psychiatric history and fewer years of health care experience.
Lancee, William J.; Maunder, Robert G.; Goldbloom, David S.
People with psychiatric disabilities (PD) are a vulnerable group, and should be offered support and rehabilitation when needed. Day centres that provide individually matched daily occupations are an important link to provide that. The present study aimed at gaining knowledge regarding the occupations performed in day centres, in terms of the participants' descriptions of what they were doing. Eighty-eight persons with PD completed a time-use diary that focused on the most recent day. The participants were selected from six different day centres, meeting-place-oriented as well as more work-oriented ones. By qualitative content analysis six categories were identified, representing the occupations performed; social occupations, maintenance occupations, creative occupations, manufacturing occupations, service occupations, and information-focused occupations. A main theme termed ?being at the day centre means participating in occupations with different levels of demand? was also discerned. The day centres served as a social meeting point and an opportunity to be involved in occupations with different levels of demand. This study highlights the role day centres could play in the rehabilitation of people with PD, and the potential that lies in the knowledge of the levels of occupational demands when meeting individual occupational needs and when analysing and planning interventions. PMID:21702742
In this study, the relationship between psychopathy, according to the Dutch language version of Hare’s Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation
Despite the clinical importance of race effects on comorbidity and symptom patterns in recent community studies, little is known about such effects in various treatment facilities. This study evaluated the effect of race on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatrichospital. The factor that most strongly distinguished the racial groups
Jack R Cornelius; Horacio Fabrega; Marie D Cornelius; Juan Mezzich; Patrick J Maher; Ihsan M Salloum; Michael E Thase; Richard F Ulrich
This exploration of the relationships between task and structural variables and two dimensions of organizational effectiveness in 76 private psychiatrichospitals revealed that high levels of centralization were associated with patient care effectiveness. High levels of centralization and formalization were associated with administrative effectiveness. An enhancing effect of organizational structure is suggested as contributing to organizational effectiveness.
|Racial disparities in mental health outcomes have been widely documented in noninstitutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness was followed for a year after…
Background This study has explored the classification of bipolar disorder in psychiatrichospital. A review of the literature reveals that there is a need for studies using stringent methodological approaches. Methods 480 first-time admitted patients to psychiatrichospital were found eligible and 271 of these gave written informed consent. The study sample was comprised of 250 patients (52%) with hospital diagnoses. For the study, expert diagnoses were given on the basis of a structured diagnostic interview (M.I.N.I.PLUS) and retrospective review of patient records. Results Agreement between the expert's and the clinicians' diagnoses was estimated using Cohen's kappa statistics. 76% of the primary diagnoses given by the expert were in the affective spectrum. Agreement concerning these disorders was moderate (kappa ranging from 0.41 to 0.47). Of 58 patients with bipolar disorder, only 17 received this diagnosis in the clinic. Almost all patients with a current manic episode were classified as currently manic by the clinicians. Forty percent diagnosed as bipolar by the expert, received a diagnosis of unipolar depression by the clinician. Fifteen patients (26%) were not given a diagnosis of affective disorder at all. Conclusions Our results indicate a considerable misclassification of bipolar disorder in psychiatrichospital, mainly in patients currently depressed. The importance of correctly diagnosing bipolar disorder should be emphasized both for clinical, administrative and research purposes. The findings questions the validity of psychiatric case registers. There are potential benefits in structuring the diagnostic process better in the clinic.
Trauma exposure and posttraumatic stress disorder (PTSD) symptoms in youth have been associated with both internalizing and externalizing disorders. This study examined the prevalence of PTSD and comorbid disorders in a sample of 377 psychiatricallyhospitalized adolescents. Adolescents diagnosed with PTSD had higher rates of comorbid major depressive disorder and conduct disorder as compared to adolescents without PTSD. In addition,
Maureen A. Allwood; Jennifer Dyl; Jeffrey I. Hunt; Anthony Spirito
|This study examined the role of attachment in adolescent psychopathology among psychiatricallyhospitalized adolescents. Subjects consisted of 60 adolescents and 27 of their mothers. Measures included the Adult Attachment Interview classification for both the adolescents and their mothers, and a battery of diagnostic and personality assessment of…
The uses of photography and poetry in qualitative research are explored in this article. Selected findings of a photographic exploration of the first psychiatrichospital in China and poems written in response to these images are presented. The authors contextualize these findings with a discussion of the use of the arts in qualitative research, the history of poetry and photography
Nursing professionals have long recognized the importance to practice of research and the value of research evidence. Nurses still do not use research findings in practice. The purpose of this paper was to describe nurses' skills in using literature databases and the Internet in psychiatrichospitals and associations of nurses' gender, age, and job position with their information retrieval skills. The study was carried out in 2004 among nursing staff (N=183) on nine acute psychiatric wards in two psychiatrichospitals in Finland (n=180, response rate 98%). The Finnish version of the European Computer Driving Licence test (ECDL) was used as a data collection instrument. The study showed that there were clear deficits in information retrieval skills among nurses working in psychiatrichospitals. Thus, nurses' competence does not support the realization of evidence-based practice in the hospitals. Therefore, it is important to increase nurses' information retrieval skills by tailoring continuing education modules. It would be also advisable to develop centralized systems for the internal dissemination of research findings for the use of nursing staff. PMID:19386551
Koivunen, Marita; Välimäki, Maritta; Hätönen, Heli
Despite the clinical importance of gender effects on symptom patterns and comorbidity patterns in alcoholics, little is known about such effects in treatment facilities other than alcoholism treatment centers. This study evaluated the effect of gender on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatrichospital. It demonstrated that major depression and
Jack R Cornelius; Patricia J Jarrett; Michael E Thase; Horacio Fabrega; Gretchen L Haas; Amy Jones-Barlock; Juan E Mezzich; Richard F Ulrich
This paper examines the impending closure of Tokanui (Psychiatric) Hospital in the Waikato region of New Zealand. We view this event as both a single occurrence in the unfolding narrative of deinstitutionalization and a specific manifestation of restructuring. Following a consideration of the particularities of mental health care deinstitutionalization and health care restructuring in New Zealand and guided by a
A survey of patient satisfaction with physical and social conditions was carried out in the long-stay wards of a large inner city psychiatrichospital in London, Britain. Patient satisfaction was assessed by means of an administered questionnaire which was developed specifically for this purpose. Factor analysis identified eight com ponents of patient satisfaction. Of 143 eligible patients, 104 (73%) successfully
The aim of this study was to identify how different areas of function (role performance, interpersonal relationships, sexual activity and recreational enjoyment) differentially recover from a manic episode during the 8 months following a first psychiatrichospitalization. Fifty patients with bipolar disorder, 16–45 years of age, who met the criteria for a current manic episode were recruited during their first
Stephen M Strakowski; Jamie R Williams; David E Fleck; Melissa P Delbello
|Women with severe psychiatric illness face numerous risks and challenges during pregnancy and as parents. Mental health professionals can help these mothers and their infants by supporting the attachment relationship and by providing the external supports that are necessary for successful parenting. The authors describe a hospital-based…
Almeida, Ana; Merminod, Gaelle, Schechter, Daniel S.
|Objective: Increasingly, researchers and clinicians are recognizing that there may be biological markers associated with increased risk of suicide. The objective of this study was to compare white matter hyperintensities in psychiatricallyhospitalized children and youth with and without a history of suicide attempt while controlling for other…
Ehrlich, Stefan; Noam, Gil G.; Lyoo, In Kyoon; Kwon, Bae J.; Clark, Megan A.; Renshaw, Perry F.
|Examined intelligence quotient and academic achievement of 76 psychiatricallyhospitalized children (mean age 10 years). Found relative deficit in verbal abilities for conduct-disordered children. Depressed children were characterized by underachievement. Children with anxiety disorder had lower intelligence quotient than children without anxiety…
|The authors investigated changes in treatment team functioning in an adult inpatient psychiatrichospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then…
Singh, Nirbhay N.; Singh, Subhashni D.; Sabaawi, Mohamed; Myers, Rachel E.; Wahler, Robert G.
Background Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatrichospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway) and the differences in the treatment of depressive episodes. Methods A convenience sample of 11 Flemish psychiatrichospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43). The websites of the hospitals were searched for information on their approach to treating depressive episodes. Results A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment), discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes. Conclusion This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.
Desplenter, Franciska A; Laekeman, Gert M; Simoens, Steven R
Two Baton Rouge, La., hospitals--usually strong competitors--decided to join forces and collaborate on a special event for the women of the community. "A Woman's Comfort Day," now in its third year, was the successful result. If they're feeling good about themselves, can the Super Bowl be far behind? PMID:10144064
In 1989, the Public Psychiatry Training Program of the Oregon Health Sciences University Department of Psychiatry and Dammasch State Hospital opened a collaborative Professional Education Unit with the author as Director. This article describes the Unit's structure and programs, as an example of successful state\\/university collaboration and a possible model for other training programs in public psychiatry.
Psychiatrichospital recidivism has been and continues to be a persistent problem in treating individuals with chronic mental illness. Conditional release, a form of involuntary outpatient commitment, has been suggested as one possible solution. Guided by therapeutic jurisprudence, this article presents a proposal about conditional release that would maximize convergence of social values and would be empirically testable. Specifically, a scientifically validated treatment intervention for individuals with chronic mental illness, contingency management, is integrated with conditional release. From this proposal, a number of empirical hypotheses and legal questions about discharging psychiatric patients are generated and discussed. PMID:11018777
OBJECTIVE--To identify risk factors which increase the likelihood of readmission for long stay psychiatric patients after discharge from hospital. DESIGN--Follow up for five years of all long stay patients discharged from two large psychiatrichospitals to compare patients readmitted and not readmitted. SETTING--Friern and Claybury Hospitals in north London and their surrounding catchment areas. Most patients were discharged to staffed
Background Given the current tendency to shorten psychiatrichospitalization and change its organization, an issue could be raised regarding\\u000a its outcomes.\\u000a \\u000a \\u000a \\u000a \\u000a Purpose To analyze features related to length of stay in a short-term inpatient treatment, to study outcomes and to evaluate the diagnosis-specific\\u000a effects of hospitalization.\\u000a \\u000a \\u000a \\u000a \\u000a Method A sample of 310 consecutive hospitalized patients, with psychotic disorder, depressive disorder and bipolar disorder (DSM
Paola Rocca; C. Mingrone; T. Mongini; C. Montemagni; L. Pulvirenti; G. Rocca; F. Bogetto
AbstractObjectives : To provide (via the Mental Health Act Commission's “national visit”) empirical evidence on ward occupancy levels, use of the Mental Health Act 1983, nurse staffing, and care of female patients on acute adult psychiatric wards.Design : One day survey of a stratified random sample.Settings : 119\\/250 (47%) acute adult psychiatric inpatient units in England and Wales.Subjects : End
Richard Ford; Graham Durcan; Lesley Warner; Pollyanna Hardy; Matt Muijen
Research has focused on changes in the psychiatric treatment of youth in outpatient settings, but less is known about trends in inpatient care. This study documents changes in the lengths of stay (LOS), clinical profiles of youth, and medication use within an inpatient setting in Massachusetts between 1991 and 2008. A chart review of 233 medical records of psychiatricallyhospitalized youth was conducted at three points in time (1991, 1998, and 2008). Sample includes youth between ages 4 and 18. Clinical data, including LOS, diagnoses and other clinical variables, and number and type of medications prescribed were compared across sample years. Findings indicate a significant decrease in the LOS coupled with a concurrent increase in psychotropic medication use between each successive sample year. The prescription of anti-psychotic medications, in particular, increased significantly. On clinical indices, findings show that there was an increase in the diagnosis of bipolar spectrum disorders and a concurrent decrease in unipolar diagnoses in the 2008 sample. Attention-deficit and developmental disorders showed little change. Trauma-related disorders were significantly less frequently diagnosed in 2008. Children hospitalized in 1998 and 2008 had more prior hospitalizations and presented with greater acuity than those in the 1991 sample. Results highlight important changes that have occurred in child/adolescent inpatient settings over the past two decades. Data suggest that these changes have not resulted in decreased rates of inpatient hospitalization for youth with more severe psychiatric disorders. PMID:22855261
Meagher, Susan M; Rajan, Anjana; Wyshak, Grace; Goldstein, Joel
Background: In Mexico, six of every twenty Mexicans suffer psychiatric disorders at some time in their lives. This disease ranks fifth in the country. The objective was to determine and compare the cost-effectiveness of two models for hospital care (partial and traditional) at a psychiatrichospital of Instituto Mexicano del Seguro Social (IMSS). Methods: a multicenter study with a prospective cohort of 374 patients was performed. We made a cost-effectiveness analysis from an institutional viewpoint with a six-month follow-up. Direct medical costs were analyzed, with quality of life gains as outcome measurement. A decision tree and a probabilistic sensitivity analysis were used. Results: patient care in the partial model had a cost 50 % lower than the traditional one, with similar results in quality of life. The cost per successful unit in partial hospitalization was 3359 Mexican pesos while in the traditional it increased to 5470 Mexican pesos. Conclusions: treating patients in the partial hospitalization model is a cost-effective alternative compared with the traditional model. Therefore, the IMSS should promote the infrastructure that delivers the psychiatric services to the patient attending to who requires it. PMID:24144144
Compulsory admission to psychiatric inpatient treatment can be experienced as disempowering and stigmatizing by people with serious mental illness. However, quantitative studies of stigma-related emotional and cognitive reactions to involuntary hospitalization and their impact on people with mental illness are scarce. Among 186 individuals with serious mental illness and a history of recent involuntary hospitalization, shame and self-contempt as emotional reactions to involuntary hospitalization, the cognitive appraisal of stigma as a stressor, self-stigma, empowerment as well as quality of life and self-esteem were assessed by self-report. Psychiatric symptoms were rated by the Brief Psychiatric Rating Scale. In multiple linear regressions, more self-stigma was predicted independently by higher levels of shame, self-contempt and stigma stress. A greater sense of empowerment was related to lower levels of stigma stress and self-contempt. These findings remained significant after controlling for psychiatric symptoms, diagnosis, age, gender and the number of lifetime involuntary hospitalizations. Increased self-stigma and reduced empowerment in turn predicted poorer quality of life and reduced self-esteem. The negative effect of emotional reactions and stigma stress on quality of life and self-esteem was largely mediated by increased self-stigma and reduced empowerment. Shame and self-contempt as reactions to involuntary hospitalization as well as stigma stress may lead to self-stigma, reduced empowerment and poor quality of life. Emotional and cognitive reactions to coercion may determine its impact more than the quantity of coercive experiences. Interventions to reduce the negative effects of compulsory admissions should address emotional reactions and stigma as a stressor. PMID:23689838
A Behavioral Model of Health Services Utilization approach was used to examine the impact of comorbid mental illness on mortality of veterans admitted to Veterans Affairs medical centers in fiscal year 2001 with a primary diagnosis of congestive heart failure (n = 15,497). Thirty percent had a psychiatric diagnosis, 4.7% died during the index hospitalization, and 11.5% died during the year following discharge. Among those with mental illness, 23.6% had multiple psychiatric disorders. Multivariable logistic regression models found dementia to be positively associated with inpatient mortality. Depression alone (excluding other psychiatric disorders) was positively associated with one-year mortality. Primary care visits were associated with a reduced likelihood of both inpatient and one-year mortality. Excepting dementia, VA patients with a mental illness had comparable or higher levels of primary care visits than those having no mental illness. Patients with multiple psychiatric disorders had more outpatient care than those with one psychiatric disorder. PMID:20968262
Banta, Jim E; Andersen, Ronald M; Young, Alexander S; Kominski, Gerald; Cunningham, William E
This paper assessed the periodontal status of inpatients at Government Mental Hospital, Vadodara, India, and studied the possible relationship between periodontal status and age, length of hospitalization, type of mental illness, and medication and tobacco use. Information about psychiatric diagnosis, length of hospitalization, and prescribed medication was obtained from hospital records. We interviewed 165 inpatients and recorded their chief dental complaints (if any) and relevant histories. Periodontal status was assessed using the Community Periodontal Index (CPI). Descriptive statistics, nonparametric tests, and multiple logistic regression analyses were used. The most prevalent periodontal condition was shallow pockets (47.27%). Some subjects (10.3%) had loss of attachment (LOA) of 9-11 mm. Age and length of hospitalization were significantly associated with periodontal status. Multiple logistic regression revealed that only age was significantly associated with periodontal pockets. Male gender, age, and tobacco-related habits were significantly associated with LOA of more than 0-3 mm. PMID:22943772
Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities, from the perspective of hospital staff. Focus groups were conducted with emergency psychiatry staff from 6 hospitals in Toronto, Canada. Hospital staff reported a lack of knowledge regarding intellectual disabilities and a shortage of available community resources. Hospital staff argued that caregivers need more community and respite support to feel better equipped to deal with the crisis before it escalates to the ER and that hospital staff feel ill prepared to provide the necessary care when the ER is the last resort. Input from hospital staff pointed to deficiencies in the system that lead caregivers to use the ER when other options have been exhausted. Both staff and caregivers need support and access to appropriate services if the system is to become more effective at serving the psychiatric needs of this complex population. PMID:19006431
The attitudes of psychiatric doctors and nurses toward the mentally ill in a large urban psychiatrichospital in China were compared using the Community Attitudes toward the Mentally III (CAMI). Data indicated that the attitude of professionals differed on 11 of the 40 questions of this instrument. Those questions are divided along 4 dimensions: authoritarianism, benevolence, social restrictiveness and rehabilitation
Robert Sévigny; Yang Wenying; Zhang Peiyan; Jacques D. Marleau; Yang Zhouyun; Su Lin; Li GuowangUOWAN; Xu Dong; Wang Yanling; Wang Haijun
|The article describes a psychosocial model of intervention with psychiatric patients in long-term hospitalization in a psychiatric ward in Israel and reports the findings of the evaluation conducted of its effectiveness. The model was aimed at maintaining or improving the patients' functioning in four main areas: personal hygiene, environmental…
The article describes a psychosocial model of intervention with psychiatric patients in long-term hospitalization in a psychiatric ward in Israel and reports the findings of the evaluation conducted of its effectiveness. The model was aimed at maintaining or improving the patients' functioning in four main areas: personal hygiene, environmental…
D. B. Cohen reported that dark-haired\\/light-eyed college females may be more susceptible to psychopathology than other groups. Data from a similar survey in an inpatient psychiatrichospital fail to confirm his findings; there was no significant difference between male and female distributions, nor was there an obvious skewing of the color combinations in favor of the dark\\/light combination. (1 ref)
This study investigates a new method of measuring quality of care. Taking place at a tertiary psychiatric hos pital with 5,128 admissions from January 1989 through December 1995, this study uses artificial neural networks (ANNs) to predict hospital length-of-stay (LOS) and uses the standard deviation of LOS in a formula to measure quality of care, Q. ANNs are trained with
George E. Davis; Walter E. Lowell; Geoffrey L. Davis
A retrospective analysis of the violent incident forms returned over a one year period in a psychiatrichospital recorded 283 incidents involving 144 patients. Almost all were of a petty nature, none leading to lasting injuries. Compared with the average daily in-patient population, offending patients were more likely to be male, to be less than 45 years old, and to have a diagnosis of schizophrenia. PMID:3779282
The present study investigated the performance of indices of schizophrenia from the Personality Assessment Inventory (PAI-SCZ; L. C. Morey, 1991) and Rorschach (Rorschach SCZI; J. E. Exner, 1993) in a heterogeneous sample of 24 inpatients at a public psychiatrichospital in the southeastern United States. Results indicated modest agreement between the PAI-SCZ and Rorschach SCZI. More important, the PAI-SCZ but
The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatrichospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n?=?155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatrichospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses (Spearman r?=?0.38, P?0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues. PMID:23773346
A 27-month prospective study was conducted of patient assaults on nurses in a Canadian psychiatrichospital. Rates were low (4% of the patients committing an assault) and the injuries mostly trivial. Schizophrenics accounted for 43% of attacks, but when allowance was made for the disproportionate number of patients in the hospital with this diagnosis, individuals with mental retardation or dementia were approximately twice as likely to be assaultive as schizophrenics. Repeat assaulters (greater than 4 attacks) were more likely to be suffering from paranoid schizophrenia. PMID:1950611
Background Individuals with mental disorders have increased rates of obesity and metabolic syndrome. Here we evaluated factors influencing obesity in individuals with mental disorders who were attending psychiatricday-care facilities on an outpatient basis. Methods The subjects (n = 108) were outpatients attending hospital-based rehabilitation programs. We assessed body fat, weight, height, waist circumference, body mass index (BMI), blood pressure, Geriatric Depression Scale-15 (GDS) scores, frequency of day-care visits, satisfaction with body shape, physical comorbidity and lifestyle habits. Lifestyle habits were evaluated using Breslow's health index based on health-related choices. Results The subjects were divided into 2 groups: obese group (BMI ? 25 kg/m2) and non-obese group (BMI < 25 kg/m2). The physical parameters and attributes of both groups were compared, and factors related to BMI were statistically analyzed. The prevalence of obesity was 47.2% in all patients, 42.4% in males and 54.8% in females. Weight, waist circumference, body fat and systolic and diastolic blood pressure were significantly higher in the obese group than in the non-obese group. Body fat, waist circumference, systolic blood pressure and diastolic blood pressure exhibited significant positive correlations with BMI, whereas the frequency of day-care visits, satisfaction with body shape, GDS score and Breslow's health index exhibited significant negative correlations with BMI. Conclusion The present results showed that the prevalence of obesity was high in outpatients with mental disorders. Improvement in lifestyle choices is necessary to prevent obesity and the onset of metabolic syndrome in such patients.
The author developed argument that a cause of the present condition of our country, in which psycho-social approaches have not fully spread though its clinical efficacy has been well recognized, is in the medical institution side. Because, our psychiatric reforms over 17 years, that reduced the average duration of hospitalization from about 2156 days to 61 days, has attained by deployment of various psycho-social approaches based on "therapeutic community model" and "psychodynamic team treatment". Furthermore, it has done by the affinity, continuity and complementarities of "psychodynamic team treatment" and psychosocial approaches with following special features. That is, since psycho-social approaches is 1. techniques to acquire the social life skill and to prevent re-hospitalization, 2. the group psychotherapy by facilitating the patient's mutual help capability, 3. based on "acceptance of the disease" by "noticing the diagnosis". Even if the therapeutic orientation or assumption of the psychiatrichospital does not comprehend above all of 1-3, it is important whether it is in the same direction or not. In other words, it is the issue of the medical-economical-management system, medical model and also the kind of psychiatry that is the source of them. Our hospital is for short term hospitalization and in focus on the outpatient treatment with "psychodynamic team treatment" based on "therapeutic community model". That is why our hospital has a potential advantage to take in and utilize the psycho-social approaches. On the other hand, there is the same reason why it is difficult for the traditional psychiatrichospital for long term hospitalization with higher hierarchical "physical medicine model" based on the descriptive psychiatry. The further problem is that both psychiatrichospital staff and psycho-social therapists do not realize it. The most important issue for us is having the recognition and exploring the method not to adapt to a psychiatrichospital but to improve and spread psycho-social approaches to psychiatrichospital. PMID:22420149
The information presented in this paper was the outgrowth of a symposium held in Dusseldorf, West Germany, in 1985. This gathering of professionals involved in daypsychiatric treatment of children and adolescents from German-speaking areas represented a first step in a "getting-to-know-you" process. The data collated from the meetings are presented briefly in both tabular and narrative form and include a description of the history and current status of day-hospital treatment as a therapeutic modality in West Berlin, Dortmund, Dusseldorf, Kassel, Cologne, Mannheim, Marburg, Munich, and Zurich. PMID:10294635
Individuals with adult or juvenile Huntington disease can be cared for within psychiatrichospitals. In this paper, nurses' perceptions about the appropriateness of a psychiatric setting for these patients were explored. Semistructured interviews were conducted with 10 Maltese nurses involved in the care of these individuals. Their responses were analyzed using thematic analysis. Three main themes were identified from this study: (i) Huntington disease is not a mental illness; (ii) the lack of specialized staff and equipment within a psychiatric setting; and (iii) a need for alternative care options. The findings provide an insight into the perceptions of nurses, as they play a key role in the care and management of individuals with Huntington disease in a psychiatric setting. The findings demonstrated the need to provide alternative residential options in the community, and to improve the care and support provided both within psychiatrichospitals and the community through staff education and the provision of necessary facilities and equipment. PMID:23656578
From 1981 until present the Department of Psychology of the University of Nebraska-Lincoln has collaborated with the Lincoln Regional Center, a state hospital, on an inpatient psychiatric rehabilitation project. The University provides clinical psychology services under contract, including direct clinical services and consultation on program development. The project includes a 40-bed inpatient treatment unit, which represents a clinical training and research site for University faculty and graduate students. Program evaluation data indicate the collaboration has produced a cost-effective state-of-the-art treatment program, now considered a model for psychiatric rehabilitation services across the state. The collaboration played a key role in securing two major grants, one for specialty training for clinical psychologists in schizophrenia and psychiatric rehabilitation, one for a treatment outcome study. Facilitating factors in the project include convergence of the collaborators' professional and research interests with national and state mental health policy. Obstacles include hospital administrative policies which fail to recognize or appreciate requirements for program management and accountability, and unwillingness to recognize program leadership from nonmedical professionals. PMID:1773601
Background: Few studies in Nigeria have investigated HIV risk behavior among persons with severe mental disorders. This study examined HIV risk behavior and associated factors among patients receiving treatment at a Nigerian psychiatrichospital. Aim: To determine the HIV risk behavior in persons with severe mental disorders in a psychiatrichospital. Subjects and Methods: This was a cross-sectional survey involving 102 persons with serious mental disorders receiving treatment at a major psychiatric facility in Southwestern Nigeria. HIV risk screening instrument was self-administered to assess HIV risk behavior. A questionnaire was used to elicit socio-demographic variables while alcohol use was assessed with the alcohol use disorder identification test. Differences in HIV risk levels were examined for statistical significance using Chi square test. Results: Forty eight percent of the respondents engaged in HIV risk behavior. This study revealed that 10.8% (11/102) gave a history of sexually transmitted disease, 5.9% (6/102) reported sex trading and no reports of intravenous drug use was obtained. A single risk factor was reported by 19.6% (20/102), 12.7% (13/102) reported two risk factors and 15.7% (16/102) reported three or more risk factors. HIV risk behavior was significantly related to alcohol use (P = 0.03). Conclusion: Mental health services provide an important context for HIV/AIDS interventions in resource-constrained countries like Nigeria.
Abayomi, O; Adelufosi, A; Adebayo, P; Ighoroje, M; Ajogbon, D; Ogunwale, A
Internet-based patient support systems are widely assumed to predict a future trend in patient education. Coherent information is still lacking on how patient education is adopted in psychiatrichospitals and how information technology is used in it. Our aim was to describe nurses' adoption of an Internet-based patient education programme and the variables explaining it. The study was based on Rogers' model of the diffusion of innovation. The Internet-based patient education sessions were carried out by nurses on nine acute psychiatric inpatient wards in two Finnish hospitals. They were evaluated with reports and analysed statistically. Out of 100 nurses, 83 adopted the programme during the study period. The nurses fell into Rogers' groups, late majority (72%), laggards (17%), early majority (7%), early adopters (3%) and innovators (1%). Three groups were formed according to their activity: laggards, late majority, adopters (including early majority, early adopters, innovators). There was a statistical difference between the nurses' programme adoption between the two hospitals (P= 0.045): more laggards (65% vs. 35%) and adopters (73% vs. 27%) in the same hospital. The findings help to provide insight into the contexts and settings when adopting information technology programmes in the area of mental health care. PMID:22070578
Anttila, M; Välimäki, M; Koivunen, M; Luukkaala, T; Kaila, M; Pitkänen, A; Kontio, R
The consultancy activity performed by Biella Ward of the local general hospital in 1979-1987 is described. After presenting data regarding the quantity and nature of consultancy requests, the medico-hospital cultural background relating to mental suffering is analysed. The hospital often tends to address only the patient's bidimensional aspects, excluding his internal being. Because of a mutual, tacit contact between physician and patient, the moment of admission is seen as a "somatic repair service". The psychological crisis usually arises in the form of the breakdown of the contract when the possible uncertainty of diagnosis and the prolongation of clinical examination affects the personality. In the specific case of Biella Psychiatry, the forced closure of the Psychiatric Diagnosis and Care Service about six years ago helped push the Psychiatrist towards a "liaison" role. PMID:2325864
Merra, S; Bosusco, G; Campisi, P; Lomonaco, E; Gioeli, A
World War II created many psychiatric casualties but precise incidences were not accurately established. Battle shock was under-reported as some commanding officers were reluctant to admit that their men experienced battle stress. The objective in triage of any casualties was to retain as many patients in the war zone as possible, if further useful service was feasible. This also applied to soldiers with stress-related symptoms, who were treated in base hospitals as near to an operational zone as possible. The main treating maxims were "immediacy, proximity and expectancy", which involved rapid early treatment in the war zone, hoping for an early return to duty (which often meant active duty). Only those with severe psychiatric illness were sent back to their home country. The medical officer had to be sure that the patient had not responded to treatment before sending him home. During the war, the terminology used for psychological responses to the stress of combat was derived from several classifications in textbooks. Psychiatric nomenclature, barely adequate for civilian psychiatry, was totally inadequate for military psychiatry during that period. The aim of classification was to facilitate data collection rather than to provide definitive diagnoses. Psychiatric therapies during World War II were, at least to some degree, diagnostically non-specific. Diagnosis varied according to the soldier's proximity to the war zone (i.e., less severe diagnoses were given to men closer to the frontline, who would be required in battle). In addition, as psychiatrists were rarely available, medical officers without relevant (or having only limited) specialty training usually diagnosed and treated soldiers with psychiatric problems. At the beginning of the war, traumatic psychiatric reactions were classified into psychoneurosis, anxiety state and anxiety reaction, psychoneurosis mixed, and conversion hysteria. By the end of the war, the United States Surgeon General released a revised nomenclature with two new diagnostic categories: transient personality reactions to acute and special stress; and neurotic-type reactions to routine military stress. It was not until the 1950s that formal criteria for the diagnosis of trauma appeared, in the first diagnostic and statistical manual (DSM-I) of the American Psychiatric Association. PMID:8538560
Examined the relationship between the Hospitalization Proneness Scale (HPS) and incidence of hospitalization in 2 successive clinic samples of 446 and 149 schizophrenic outpatients. Ss had been randomly assigned to either placebo, chlorpromazine, or promazine and treated under double-blind conditions. The HPS predicted hospitalization for placebo- and chlorpromazine-treated groups in both clinic samples (p < .01). For the 2 promazine-treated
Aim To study social, demographic, clinical, and forensic profiles of frequently re-hospitalized (revolving-door) psychiatric patients. Methods The study included all patients (n?=?183) who were admitted to our hospital 3 or more times during a 2-year period from 1999 through 2000. We compared these patients to 2 control groups of patients who were admitted to our hospital in the same period. For comparison of forensic data, we compared them with all non revolving-door patients (n?=?1056) registered in the computerized hospital database and for comparison of medical and clinical data we compared them with a random sample of non revolving-door patients (n?=?98). The sample was sufficiently large to yield high statistical power (above 98%). We collected data on the legal status of the hospitalizations (voluntary or involuntary) and social, demographic, clinical, and forensic information from the forensic and medical records of revolving-door and non revolving-door patients. Results In the period 1999-2000, 183 revolving-door patients accounted for 771 (37.8%, 4.2 admissions per patient) and 1056 non revolving-door patients accounted for 1264 (62.5%, 1.2 admissions per patient) of the 2035 admissions to our hospital. Involuntary hospitalizations accounted for 23.9% of revolving-door and 76.0% of non revolving-door admissions. Revolving-door patients had significantly shorter mean interval between hospitalizations, showed less violence, and were usually discharged contrary to medical advice. We found no differences in sex, marital status, age, ethnicity, diagnoses, illegal drug and alcohol use, or previous suicide-attempts between the groups. Conclusions Revolving-door patients are not necessarily hospitalized for longer time periods and do not have more involuntarily admissions. The main difference between revolving-door and non revolving-door patients is greater self-management of the hospitalization process by shortening the time between voluntary re-admission and discharge against medical advice.
Oyffe, Igor; Kurs, Rena; Gelkopf, Marc; Melamed, Yuval; Bleich, Avi
Several hospitals, countries and cultures claim the privilege of being the first to have provided care to people suffering mental illnesses. Among them, the <Hospital de los Inocentes> (Hospital of the Innocents) founded in Valencia in 1410 stands out due to its originality and there are historic and cultural reasons to recognize its primacy. Furthermore, the organization and functioning of this institution and the model, spread like wildfire through the entire Iberian Peninsula during the 15th Century and shortly after through American Spanish speaking countries. For centuries, these establishments were considered exemplary and were copied in other European Countries. At the beginning of the 19th Century in Spain a forced sale of the Catholic Church properties or their disamortization among other a large number of hospitals establishments took place. This lead to a terrible collapse of health care for the mentally. From then on it took more than one century to recover a decent standard. The vicissitudes of the creation and progress of the hospital of Valencia and others which followed the example that allows to affirm that it was really the first psychiatrichospital in the World are analyzed in this present work. PMID:18286394
As part of a Clinical Affiliation Agreement between a major state psychiatric facility and a state university, it was agreed that the hospital's staff would be assessed in terms of: burnout, nursing functioning, and ward atmosphere. The assessment data would be used to examine hospital characteristics as they relate to the strategies necessary to transform an approach of custodial care
Barbara A. Caldwell; Kenneth J. Gill; Elaine Fitzgerald; Michael Sclafani; Peg Grandison
In the United Kingdom there are plans to close most mental hospitals over the next 10 years. There is continuing uncertainty about the effectiveness of community psychiatric services that will be expected to cope with mental hospital inpatients after discharge, most of whom have schizophrenia. A survey was conducted to assess the severity of illness among such patients and implications
D. A. Curson; M. Patel; P. F. Liddle; T. R. Barnes
SUMMARY The socio-demographic and clinical characteristics of one hundred consecutive referrals from emergency O.P.D. of a teaching general hospital were studied. The referral rate was 5.4%. The source, reason and purpose of the referrals were studied. Half of the patients had presented with somatic symptoms. Altered sensorium, suicidal attempt and excitements together constituted one third of all emergency referrals. The diagnosis of neurosis was given in half of the patients and one third of all patients were labelled as suffering from hysterical neurosis. The nature of the presenting complaints and psychiatric diagnoses were comparable to that of the other studies.
|The purpose of this study was to examine the etiology and cultural underpinnings of adolescent violence as collective case study analysis of three inter-related groups: psychiatricallyhospitalized rural adolescents, their parent/guardian, and various hospital staff. Violence among adolescents is a serious societal issue that has had varying…
This study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric…
OBJECTIVE--To identify risk factors which increase the likelihood of readmission for long stay psychiatric patients after discharge from hospital. DESIGN--Follow up for five years of all long stay patients discharged from two large psychiatrichospitals to compare patients readmitted and not readmitted. SETTING--Friern and Claybury Hospitals in north London and their surrounding catchment areas. Most patients were discharged to staffed or unstaffed group homes. SUBJECTS--357 psychiatric patients who had been in hospital for over one year, of whom 118 were "new" long stay and 239 "old" long stay patients. MAIN OUTCOME MEASURES--Readmission to hospital and length of subsequent stay. RESULTS--Of all discharged patients 97 (27%) were readmitted at some time during the follow up period, 57 (16%) in the first year after discharge, and 31 (9%) then remained in hospital for over a year. The best explanatory factors for readmission were: male sex, younger age group, high number of previous admissions, higher levels of symptomatic and social behavioural disturbance, a diagnosis of manic-depressive psychosis, and living in a non-staffed group home. CONCLUSIONS--During the closure of psychiatrichospitals, facilities need to be preserved for acute relapses among long term, and especially younger, discharged patients. Staffed group homes may help prevent relapse and reduce the number of admission beds required.
The distinctiveness of management of a university psychiatrichospital which has the status of a public health institution is manifested in the following ways: * Distinctive features and characteristics of managing service provider organizations compared to those whose operational results involve tangible products; * Distinctive features of management which originate from its role as a regional hospital and a tertiary research and educational institution in the field of psychiatry, with special importance for the Republic of Slovenia as a whole; * Distinctive features of management that are defined by the social and legal framework of operation of public health institutions and their special social mission. This paper therefore discusses the specific theoretical and practical findings regarding management of service provider organizations from the viewpoint of their social mission and significance, as well as their legal organization, internal structure and values. PMID:18587280
Police are a major source of referral to psychiatrichospitals in industrialized countries with mental health legislation. However, little attention has been paid to nurses' experience of caring for police-referred patients to psychiatrichospitals. This study utilized a Heideggerian phenomenological framework to explore the experiences of nine nurses caring for patients referred by the police, through semistructured interviews. Two major themes emerged from the hermeneutic analyses of interviews conducted with nurse participants: (i) 'expecting "the worst"?'; and (ii) 'balancing therapeutic care and forced treatment'. Expecting 'the worst' related to the perceptions nurse participants had about patients referred by the police. This included two sub-themes: (i) 'we are here to care for whoever they bring in'; and (ii) 'but who deserves care?' The second theme balancing therapeutic care and forced treatment included the sub-themes: (i) 'taking control, taking care'; and (ii) 'managing power'. The study raises ethical and skill challenges for nursing including struggling with the notion of who deserves care, and balancing the imperatives of legislation with the need to work within a therapeutic framework. PMID:23009594
There is considerable evidence linking substance use and delinquent behavior among adolescents. However, the nature and temporal ordering of this relationship remains uncertain, particularly among early adolescents and those with significant psychopathology. This study examined the temporal ordering of substance use and delinquent behavior in a sample of psychiatricallyhospitalized early adolescents. Youth (n = 108) between the ages of 12 and 15 years completed three assessments over 18 months following hospitalization. Separate cross-lagged panel models examined the reciprocal relationship between delinquent behavior and two types of substance use (e.g., alcohol and marijuana). Results provided evidence of cross-lagged effects for marijuana: delinquent behavior at 9 months predicted marijuana use at 18 months. No predictive effects were found between alcohol use and delinquent behavior over time. Findings demonstrate the stability of delinquent behavior and substance use among young adolescents with psychiatric concerns. Furthermore, results highlight the value of examining alcohol and marijuana use outcomes separately in order to better understand the complex pathways between substance use and delinquent behavior among early adolescents.
Becker, Sara J.; Nargiso, Jessica E.; Wolff, Jennifer C.; Uhl, Kristen M.; Simon, Valerie A.; Spirito, Anthony; Prinstein, Mitchell J.
Objective: to examine the effects of footwear on balance in a sample of older women attending a dayhospital. Design: this was a crossover trial with a quasi-randomised allocation. Setting: assessments took place in the geriatric dayhospital. Subjects: a cohort of 100 older women aged 60 years and over attending a dayhospital. Methods: demographic data and a brief
N. FRANCES HORGAN; F IONA CREHAN; E MMA BARTLETT; F IONA KEOGAN; A. M. O'Grady; A LLAN R. MOORE; C. F. Donegan; M ARTINA CURRAN
Title. Impact of hospital nursing care on 30-day mortality for acute medical patients Aim. This paper reports on structures and processes of hospital care influencing 30-day mortality for acute medical patients. Background. Wide variation in risk-adjusted 30-dayhospital mortality rates for acute medical patients indicates that hospital structures and processes of care affect patient death. Because nurses provide the majority
Ann E. Tourangeau; Diane M. Doran; Linda McGillis Hall; Linda O'Brien Pallas; Dorothy Pringle; Jack V. Tu; Lisa A. Cranley
Background. The efficacy of a multidisciplinary, intensive and integrated day-hospital treatment was evaluated in a group of overeaters (bulimia nervosa, binge eating disorder, obesity without binging). Methods. The study sample included 72 subjects consecutively admitted to DH who were evaluated at the first contact with the service, on admission, after 5 weeks of treatment, and at discharge. The primary outcome was the total score at the Eating Disorder Inventory (EDI), and the secondary outcome was change in body mass index (BMI). The effects of the duration of treatment on results were also assessed. The improvement of EDI and BMI was compared between the two groups of bingers and non-bingers. Results. Four patients dropped during the treatment period. In the whole sample, both EDI and BMI improved significantly after 5 weeks (p=0.00) and continued to improve until the end of treatment (p=0.00). The duration of treatment did not have a significant impact on BMI improvement (p=0.07), but significantly affected EDI improvement (p=0.006), although only during the treatment period. No significant differences were observed between obese/overweight bingers and non-bingers in BMI improvement (p=0.41), whereas EDI improvement was higher in bingers (p=0.02). Conclusions. The relatively good compliance and the efficacy data suggest that in overeating subjects resistant to previous outpatient treatments a more intensive DH treatment may be useful. Our findings show that such a multidisciplinary therapeutic-rehabilitative treatment significantly improves both total EDI score (especially in bingers) and BMI. PMID:24056830
Aragona, Massimiliano; Pucci, Daniela; Balbi, Andrea
The present paper forms part of the High Secure PsychiatricHospitals’ Nursing Staff Stress Survey and explores the causal role of generalized and specific stress resistance resources (SRRs) in the stress process following physical assault. Confidential self-report questionnaires were administered to all nurses working in English and Scottish High Secure PsychiatricHospitals. A total of 636 nurses responded to questionnaires
Ulrich Reininghaus; Tom Craig; Kevin Gournay; Patrick Hopkinson; Jerome Carson
DNAi location: Chronicle>In the Third Reich>"the final solution" In January, 1940 a shower room fitted with a carbon monoxide vent was first tested to kill patients at the psychiatrichospital in Brandenberg, outside Berlin. Gas chambers on the Brandenberg model were quickly set up at Bernberg and other sites around Germany to accept patients marked for death. In 1940-41, more than 70,000 patients were poisoned with carbon monoxide at these extermination centers. Other patients were starved; given sleeping pills, morphine or scopolamine; or slowly administered poisons to disguise the cause of death. No such ruse was thought necessary in Poland and East Prussia, where storm troopers simply shot thousands of mental patients.
Clostridium perfringens, the third most common cause of foodborne illness in the United States (1), most often causes a self-limited, diarrheal disease lasting 12-24 hours. Fatalities are very rare, occurring in <0.03% of cases (1). Death usually is caused by dehydration and occurs among the very young, the very old, and persons debilitated by illness (2). On May 7, 2010, 42 residents and 12 staff members at a Louisiana state psychiatrichospital experienced vomiting, abdominal cramps, and diarrhea. Within 24 hours, three patients had died. The three fatalities occurred among patients aged 41-61 years who were receiving medications that had anti-intestinal motility side effects. For two of three decedents, the cause of death found on postmortem examination was necrotizing colitis. Investigation by the Louisiana Office of Public Health (OPH) and CDC found that eating chicken served at dinner on May 6 was associated with illness. The chicken was cooked approximately 24 hours before serving and not cooled in accordance with hospital guidelines. C. perfringens enterotoxin (CPE) was detected in 20 of 23 stool specimens from ill residents and staff members. Genetic testing of C. perfringens toxins isolated from chicken and stool specimens was carried out to determine which of the two strains responsible for C. perfringens foodborne illness was present. The specimens tested negative for the beta-toxin gene, excluding C. perfringens type C as the etiologic agent and implicating C. perfringens type A. This outbreak underscores the need for strict food preparation guidelines at psychiatric inpatient facilities and the potential risk for adverse outcomes among any patients with impaired intestinal motility caused by medications, disease, and extremes of age when exposed to C. perfringens enterotoxin. PMID:22895383
Objective: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. Method: Between 1998 and 2000, 289 psychiatricallyhospitalized, suicidal youth, ages 12 to 17 years,…
Huth-Bocks, Alissa C.; Kerr, David C. R.; Ivey, Asha Z.; Kramer, Anne C.; King, Cheryl A.
|The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatricallyhospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that…
Bridgett, David J.; Valentino, Kristin; Hayden, Lisa C.
Ethnographic research in a forensic psychiatrichospital demonstrates a prevalent ambiguity about the relationship between emotion and reason and a suspicion that many inmate-patients are not mentally ill. Nonetheless, central to the discourse and method of inmates and staff are skills in suppressing one's own emotions and in producing and manipulating others' emotions. Drawing upon Foucault's insights, the author suggests
The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatricallyhospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that…
Bridgett, David J.; Valentino, Kristin; Hayden, Lisa C.
This study examined the personal characteristics and social context of two groups of women with learning disabilities and psychiatric disorders who resided in some form of community residential facility. One group of women had been admitted to hospital in the past 12 months (N = 20) and the other had been maintained in the community without any admissions (N =
Purpose: This study aimed to explore the effectiveness of music therapy in reducing anxiety in hospitalizedpsychiatric patients.Methodology: The authors used a randomized clinical trial design and randomly allocated the 24 enrolled participants to the experimental or the control group. Patients in the experimental group received music therapy in a therapy room at a set time for 30 min each
The contribution of contextual factors to aggressive incidents in psychiatrichospitals has tended to be ignored. This study used a functional analysis framework to investigate 130 incidents. Staff interviews were used to identify antecedents and m anagem ent strategies em ployed. Reported aggression rates varied greatly between wards including those serving sim ilar functions. No difference was found between the
Background: Burnout and psychological stress symptoms represent a major problem among health care professionals. The aim of this study was to investigate the prevalence of and the relationship between psychiatric morbidity and burnout among a convenience sample of Italian primary care physicians (GPs) and hospital physicians (HPs). Method: The sample consisted of 328 physicians (182 GPs and 146 HPs) who
|Objective: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. Method: Between 1998 and 2000, 289 psychiatricallyhospitalized, suicidal youth, ages 12 to 17…
Huth-Bocks, Alissa C.; Kerr, David C. R.; Ivey, Asha Z.; Kramer, Anne C.; King, Cheryl A.
Forty children with day and night wetting were compared with 46 with night wetting only to see if day wetting was then associated with particular clinical features. Interviews with mothers, questionnaries completed by teachers, physical investigations, and measurement of functional bladder capacities were used. Day wetting combined with bed wetting occurred equally in boys and girls and was associated with
OBJECTIVE. We analyze the costs and benefits of two strategies-intensive home-based services and increased remuneration for providers of community-based placements--to decrease excessive length of stay in a children's psychiatrichospital. DATA SOURCES AND STUDY SETTING. Clinical, demographic, and financial data were collected retrospectively on all children discharged during 1987 through 1989 from the state children's psychiatrichospital that serves Wayne County, Michigan. Characteristics of the discharged children were similar to those reported in other studies of intensive home-based services. STUDY DESIGN. A sample of 22 children was used for a simulation analysis. Excessive length of stay was defined as the duration of hospitalization after readiness for discharge and associated planning were indicated in the record. For the simulated analysis of the intensive home-based program, costs included estimated charges for the program and charges for the children hospitalized due to failure of the intervention. For analysis of the increased remuneration strategy, costs included charges for the out-of-home placement and charges for hospitalization. For both strategies benefits were defined as averted hospitalization charges. DATA COLLECTION/EXTRACTION METHODS. Charts of the discharged children were reviewed and 21 clinical, demographic, and financial variables were extracted. PRINCIPAL FINDINGS. Analysis of costs and benefits of intensive home-based services produced a favorable cost-benefit ratio of .47. Analysis of the strategy to increase remuneration for providers of community-based placements resulted in a cost-benefit ratio of 1, indicating no financial savings. CONCLUSIONS. Intensive home-based services represent an efficient strategy to decrease excessive length of stay for children in psychiatrichospitals by averting hospitalization altogether. Although increased remuneration to providers of community-based placements in order to increase the supply of placements as a means to hasten discharge from the hospital has a neutral cost-benefit ratio, the opportunity to provide care in the "least restrictive" environment argues in its favor as well.
Abstract Objective: This study investigated attendees' motivation and motives for participation in day centres and their satisfaction with the rehabilitation, while also addressing the influence of day centre orientation (work- or meeting-place orientation), gender and age. Methods: Ninety-three Swedish day centre attendees participated in a cross-sectional study and completed questionnaires about motivation, motives, and satisfaction with the rehabilitation. Data were analysed with non-parametric statistics. Results: The participants were highly motivated for going to the day centre and set clear goals for their rehabilitation. Female gender, but not age, was associated with stronger motivation. The strongest motives for going to the day centre were getting structure to the day and socializing. Attendees at work-oriented day centres more often expressed that they went there to get structure to the day and gain social status. Satisfaction with the rehabilitation was high, and the most common wishes for further opportunities concerned earning money and learning new things. Conclusions and implications for practice: The rehabilitation largely seemed to meet the attendees' needs, but the findings indicated that further developments were desired, such as participation in work on the open market and more work-like occupations in the day centre, accompanied by some kind of remuneration. PMID:23721255
BACKGROUND: To test the ease of use, reliability, responsiveness and construct validity of the Patient Generated Index, an individualised quality of life score, in older people attending a Medicine for Older People DayHospital. METHODS: Prospective longitudinal study in patients attending a specialist Medicine for Older People DayHospital in Scotland. The Patient Generated Index was administered at baseline, one
Miles D Witham; Roberta L Fulton; Lucy Wilson; Carolyn A Leslie; Marion ET McMurdo
A one-day survey was carried out in 14 acute care hospitals in Lebanon in May 1997, to determine the prevalence of nosocomial infection (NI) by site of infection, hospital department, micro-organism and pathology. Hospitals (N=14) with more than 50 beds were selected at random from the official Lebanese Health Ministry Registration Directory. All patients who presented that day on the
The purpose of the psychiatrichospital changed dramatically during the twentieth century. Formerly the primary location for psychiatric treatment, the hospital now plays a more circumscribed role within a community-based system of care. Crisis stabilization, safety, and a focus on rapid discharge are the critical components of the acute inpatient stay. Subspecialized units focus on geriatrics, children, adolescents, dual diagnosis (substance abuse and mental illness), trauma disorders, eating disorders, and forensics. When integrated with the general medical system and a comprehensive base of community-delivered day treatment, residential services, and outpatient services, psychiatrichospitalization is a humane alternative to long-term institutional care. PMID:18729730
Sixteen pupils in a psychiatrichospital were assigned to two tutorial reading classes and balanced on six pupil characteristics and teacher preferences for the children. The effects of reward and cost procedures in a token program were assessed using both within- and between-subject comparisons in the following phases: (1) Baseline; (2) Token I, teacher evaluated and reinforced children for appropriate behavior; (3) Withdrawal of Tokens; (4) Token II, same as Token I; (5) Token III, same as Token I and II, but switched order of class meeting time; and (6) Self-Evaluation, students rated their own behavior and received prizes based on their rating, rather than the teacher's rating. The token program was markedly successful in reducing disruptive behavior and in increasing reading skills in both the Reward and Cost Classes, but there were no significant differences in the effects of the reward versus the cost procedure. While cost may be seen as a punishment procedure, there were no adverse side effects observed in the Cost Class at any time when the token program was in effect. The order of the classes was unrelated to the level of disruptive behavior or academic progress. The Self-Evaluative Phase, in which the students rated their own behavior, was included as an alternative to the abrupt withdrawal of tokens. In this phase, disruptive behavior remained at the previous low level.
Background: Psychiatric morbidity in gynecological oncology patients is relatively less studied. Aims: This cross-sectional observational study was undertaken to assess the common psychiatric disorders in women who consult the gynecological oncology outpatients’ department. Materials and methods: We assessed a total of 101 outpatients who were recruited by convenience method of sampling. The main outcome measures were PRIME-MD PHQ diagnoses, gynecological and sociodemographic profiles. Results: Psychiatric disorders as detected by PRIME –MD PHQ were diagnosed in 44% of the patients. Mood disorders were most common. Major depression was present in 25.7% of patients. Anxiety disorders were diagnosed in 16.8% of the patients. Among 44 patients with a psychiatric diagnosis only one patient was on psychiatric treatment. Major depression was much more common (34.4%) in cancer patients than in women with benign conditions (16.6%). Conclusion: The findings of our study reveal a high rate of psychiatric morbidity in the gynecological oncology outpatients.
Background Hospital readmissions within 30 days are increasingly targeted as a quality parameter. Frail nursing home patients are at high risk for hospitalization. The purpose of this study was to examine baseline prevalent chronic diseases associated with hospital readmission within 30 days. Methods We collected data on demographics and prevalent diseases for all patients admitted to one hospital-affiliated nursing home between January 2003 and December 2006, with follow-up data on pneumonia episodes and hospitalizations through June 2011. Multivariable logistic regression models identified baseline prevalent chronic diseases associated with hospital readmission within 30 days of nursing home admission. Results Of 238 patients (mean age 83.4, range 45-103) admitted to the nursing home, 156 (65.5%) originally came from hospitals, 54.6% were female, 92.4% were Asian, 43.6% were on Medicaid, and 76.5% were first admitted for intermediate care and 23.5% for skilled nursing care. Although recent pneumonia was the factor most strongly associated with hospital readmission (OR = 14.5, P <.0001), in the model without pneumonia, chronic diseases associated with 30-dayhospital readmission included pulmonary disease (OR = 2.2, 95%CI = 1.1–4.3, P = .019) and congestive heart failure (OR = 1.8, 95%CI = 1.0–3.4, P = .055). There were no significant associations between hospital readmission and myocardial infarction, stroke, cancer, diabetes, and dementia. Conclusions Among nursing home patients, although recent pneumonia was the strongest risk factor for 30-dayhospital readmission, those with baseline chronic pulmonary disease and congestive heart failure were at especially high risk for hospital readmission within 30 days of nursing home admission. These patients may benefit from care focused on preventing hospital readmissions.
Background This study compared 1-year risk of psychiatrichospitalization and treatment costs in commercially insured patients with bipolar disorder, treated with aripiprazole, ziprasidone, olanzapine, quetiapine or risperidone. Methods This was a retrospective propensity score-matched cohort study using the Ingenix Lab/Rx integrated insurance claims dataset. Patients with bipolar disorder and 180 days of pre-index enrollment without antipsychotic exposure who received atypical antipsychotic agents were followed for up to 12 months following the initial antipsychotic prescription. The primary analysis used Cox proportional hazards regression to evaluate time-dependent risk of hospitalization, adjusting for age, sex and pre-index hospitalization. Generalized gamma regression compared post-index costs between treatment groups. Results Compared to aripiprazole, ziprasidone, olanzapine and quetiapine had higher risks for hospitalization (hazard ratio 1.96, 1.55 and 1.56, respectively; p < 0.05); risperidone had a numerically higher but not statistically different risk (hazard ratio 1.37; p = 0.10). Mental health treatment costs were significantly lower for aripiprazole compared with ziprasidone (p = 0.004) and quetiapine (p = 0.007), but not compared to olanzapine (p = 0.29) or risperidone (p = 0.80). Total healthcare costs were significantly lower for aripiprazole compared to quetiapine (p = 0.040) but not other comparators. Conclusions In commercially insured adults with bipolar disorder followed for 1 year after initiation of atypical antipsychotics, treatment with aripiprazole was associated with a lower risk of psychiatrichospitalization than ziprasidone, quetiapine, olanzapine and risperidone, although this did not reach significance with the latter. Aripiprazole was also associated with significantly lower total healthcare costs than quetiapine, but not the other comparators.
The brief behavioral activation treatment for depression (BATD) is a relatively uncomplicated, time-efficient, and cost-effective method for treating depression. Because of these features, BATD may represent a practical intervention within managed care-driven, inpatient psychiatrichospitals. Based on basic behavioral theory and empirical evidence supporting activation strategies, we designed a treatment to increase systematically exposure to positive activities and thereby help
Derek R. Hopko; C. W. Lejuez; James P. Lepage; Sandra D. Hopko; Daniel W. McNeil
A biometrical model-fitting approach was applied to data from a full adoption design to study phenotypic variation and covariation among multiple discontinuous traits. Using statistical methods available for factor analyses of dichotomous-item data, generalized least-squares estimates were obtained for parameters of additive polygenic and environmental influences on criminal convictions and psychiatric-hospital diagnoses in 2532 Danish male adoptees and their family
This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatrichospital in the North of England we explore the perceived significance for wellbeing of 'smoking spaces' (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatrichospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatrichospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider the implications for hospital design and the model of care. PMID:24161095
Wood, Victoria J; Curtis, Sarah E; Gesler, Wil; Spencer, Ian H; Close, Helen J; Mason, James M; Reilly, Joe G
The aim of this study is to cross-culturally explore the crucial and often conflicting issues of least restrictive placement of long-term psychiatric patients in Hawaii and Japan, and the need to provide high-quality care for such patients. Policy implications are discussed. A survey instrument facilitated the comparison of records from psychiatric patients hospitalized over 1 year in Hawaii, as of January 1993, and psychiatric patients hospitalized over 1 year in Japan, as of January 1996. The survey instrument was translated and validated for use in both countries. Interrater reliability averaged 0.96. The 30 subjects in Japan were all men (Japanese), and primarily unmarried. The 83 subjects in Hawaii were mostly men (Hawaiian or other ethnic minority), and unmarried. Subjects in Japan tended to be older, hospitalized longer, and were judged to be more dysfunctional than those in Hawaii. No significant relationship was revealed between nursing diagnoses and Axis I diagnoses in either sample. Although significant clinical differences were found between the two groups, the policy issues are similar: how to place patients in the least restrictive environment and how to provide high quality of care given the limited available resources. Nurses in both countries must become more vocal advocates for policy changes to improve the care of long-term patients. PMID:10894650
Anders, R L; Kawano, M; Mori, C; Kokusho, H; Tomai, J
Objectives To assess the association between mortality and the day of elective surgical procedure. Design Retrospective analysis of national hospital administrative data. Setting All acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11. Participants Patients undergoing elective surgery in English public hospitals. Main outcome measure Death in or out of hospital within 30 days of the procedure. Results There were 27?582 deaths within 30 days after 4?133?346 inpatient admissions for elective operating room procedures (overall crude mortality rate 6.7 per 1000). The number of weekday and weekend procedures decreased over the three years (by 4.5% and 26.8%, respectively). The adjusted odds of death were 44% and 82% higher, respectively, if the procedures were carried out on Friday (odds ratio 1.44, 95% confidence interval 1.39 to 1.50) or a weekend (1.82, 1.71 to 1.94) compared with Monday. Conclusions The study suggests a higher risk of death for patients who have elective surgical procedures carried out later in the working week and at the weekend.
The effects of environmental crowding on the behavior of persons in institutional and noninstitutional setting have been studied extensively, but much less frequently with psychiatric patients. The relationship of violent patient behavior, as measured by incidents of seclusion and\\/or restraint, and population density, as measured by the average census of patients in psychiatric units, was determined in this retrospective study.
Kathryn L. Brooks; Jane S. Mulaik; Maggie P. Gilead; Betty S. Daniels
Prior to the implementation of predictive-testing programs for Huntington disease (HD), significant concern was raised concerning the likelihood of catastrophic events (CEs), particularly in those persons receiving an increased-risk result. We have investigated the frequency of CEs-that is, suicide, suicide attempt, and psychiatrichospitalization-after an HD predictive-testing result, through questionnaires sent to predictive-testing centers worldwide. A total of 44 persons (0.97%) in a cohort of 4,527 test participants had a CE: 5 successful suicides, 21 suicide attempts, and 18 hospitalizations for psychiatric reasons. All persons committing suicide had signs of HD, whereas 11 (52.4%) of 21 persons attempting suicide and 8 (44.4%) of 18 who had a psychiatrichospitalization were symptomatic. A total of 11 (84.6%) of 13 asymptomatic persons who experienced a CE during the first year after HD predictive testing received an increased-risk result. Factors associated with an increased risk of a CE included (a) a psychiatric history =5 years prior to testing and (b) unemployed status. The frequency of CEs did not differ between those persons receiving results of predictive testing through linkage analysis in whom there was only changes in direction of risk and those persons receiving definitive results after analysis for the mutation underlying HD. These findings provide insights into the frequency, associated factors, and timing of CEs in a worldwide cohort of persons receiving predictive-testing results and, as such, highlight persons for whom ongoing support may be beneficial.
Almqvist, E W; Bloch, M; Brinkman, R; Craufurd, D; Hayden, M R
OBJECTIVES: To examine the relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units and to explore the range of alternative residential options. DESIGN: Cross sectional survey, combined with one day census data; ratings by and interviews with staff; examination of routine data sources. SETTINGS: Nationally representative sample of acute psychiatric units. SUBJECTS: 2236 patients who were inpatients on census day. MAIN OUTCOME MEASURES: Bed occupancy levels, judged need for continuing inpatient care, reasons preventing discharge, scores on the Health of the Nation outcome scales. RESULTS: Bed occupancy was related to social deprivation and total availability of acute beds (r = 0.66, 95% confidence interval 0.19 to 0.88, F = 8.72, df = 2.23; P = 0.002). However, 27% (603/2215) of current inpatients (61% (90/148) of those with stays of > 6 months) were judged not to need continuing admission. The major reasons preventing discharge were lack of suitable accommodation (37% (176/482) of patients in hospital < 6 months v 36% (31/86) of those in hospital > 6 months); inadequate domiciliary based community support (23% (113) v 9% (8)); and lack of long term rehabilitation places (21% (100) v 47% (40)). Scores on the Health of the Nation outcome scale were generally consistent with these staff judgments. CONCLUSIONS: The shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds. Patients currently inappropriately placed on acute admission wards should be relocated into more suitable accommodation, either in hospital or in the community. A range of provisions is required; simply providing more acute beds is not the answer.
Shepherd, G.; Beadsmoore, A.; Moore, C.; Hardy, P.; Muijen, M.
...BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Psychiatric Evaluation and Treatment...case, must be present at the hearing and must present clinical data and background information relative to the...
Objective In the 30?days after hospital discharge, hospital utilisation is common and costly. This study evaluated the association between gender and hospital utilisation within 30?days of discharge. Design Secondary data analysis using Poisson regression stratified by gender. Participants 737 English-speaking hospitalised adults from general medical service in urban, academic safety-net medical centre who participated in the Project Re-Engineered clinical trial (clinicaltrials.gov identifier: NCT00252057). Main outcome measure The primary end point was hospital utilisation, defined as total emergency department visits and hospital readmissions within 30?days after index discharge. Results Female subjects had a rate of 29 events for every 100 people and male subjects had a rate of 47 events for every 100 people (incident rate ratio (IRR) 1.62, 95% CI 1.28 to 2.06). Among men, risk factors included hospital utilisation in the 6?months prior to the index hospitalisation (IRR 3.55, 95% CI 2.38 to 5.29), being unmarried (IRR 1.72, 95% CI 1.12 to 2.64), having a positive depression screen (IRR 1.53, 95% CI 1.09 to 2.13) and no primary care physician (PCP) visit within 30?days (IRR 1.64, 95% CI 1.08 to 2.50). Among women, the only risk factor was hospital utilisation in the 6?months prior to the index hospitalisation (IRR 3.08, 95% CI 1.86 to 5.10). Conclusions In our data, male subjects had a higher rate of hospital utilisation within 30?days of discharge than female subjects. For men—but not for women—risk factors were being retired, unmarried, having depressive symptoms and having no PCP visit within 30?days. Interventions addressing these factors might lower hospital utilisation rates observed among men.
Woz, Shaula; Hesko, Caroline; Paasche-Orlow, Michael; Greenwald, Jeffrey; Chetty, V K; O'Donnell, Julie; Jack, Brian
Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage.
Deliberate and recurrent foreign body ingestion is a common problem among institutionalised patients. We review our experience\\u000a with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric patients, thirty of whom were institutionalised\\u000a at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in contrast, psychiatric patients\\u000a presented with few, if any, symptoms.
S. T. O’Sullivan; C. M. Reardon; G. T. McGreal; D. J. Hehir; W. O. Kirwan; M. P. Brady
The Adult Literacy Program at Hawaii State Hospital utilized techniques drawn from the Morningside Model of Generative Instruction. In a study involving psychiatric inpatients, participants were taught reading, mathematics, or both over a 6- to 8-month time span. Using the Woodcock-Johnson Psychoeducational Battery-Revised, it was determined that nearly half of the participants demonstrated academic gains during the study period. Further, a behavioral observation system indicated that participants were on-task 80% of the observation time and staff engaged in positive interactions nearly 20% of the observation time. This study is the first of its kind to document any efficacy for academic instruction with a psychiatric inpatient population. PMID:15690738
Schirmer, Todd N; Meyer, Kim A; Samarasinghe, Roshani
In settings with low seroprevalence, people with severe mental illness have a higher prevalence of HIV infection compared to the general population. In the high-prevalence countries of southern Africa, where the pandemic taxes resources for HIV prevention, care, and treatment, the needs of people with mental illness can be easily overlooked if they are not identified as vulnerable to infection. Yet, few African studies have investigated HIV seroprevalence in psychiatric settings. We systematically examined the HIV seroprevalence among psychiatric patients admitted to a public psychiatric institution in KwaZulu Natal province, South Africa, between 27 July and 14 November 2003. We conducted anonymous testing among 151 patients who were psychiatrically stable and able to give informed consent. Forty patients (26.5%) were HIV-positive; women were more likely to be infected than men (OR 2.74; 95% CI=1.25-6.04; P=0.012). Our findings demonstrate that in the midst of a generalized AIDS epidemic, people with mental illness are also vulnerable and must be included in prevention and treatment efforts. These results underscore the importance of integrated mental health and HIV care in institutional and outpatient mental health settings and affirm the need for detailed HIV risk assessment as a routine part of psychiatric care. Correspondingly, HIV care and treatment programs should be made available to people with psychiatric symptoms. PMID:20024743
Background Depression can be treated in an outpatient, inpatient or dayhospital setting. In the German health care system, episodes of inpatient or dayhospital treatment are common, but there is a lack of studies evaluating effectiveness in routine care and subgroups of patients with a good or insufficient treatment response. Our study aims at identifying prognostic and prescriptive outcome predictors as well as comparative effectiveness in psychosomatic inpatient and dayhospital treatment in depression. Methods/Design In a naturalistic study, 300 consecutive inpatient and 300 dayhospital treatment episodes in seven psychosomatic hospitals in Germany will be included. Patients are assessed at four time points of measurement (admission, discharge, 3-months follow-up, 12-months follow-up) including a broad range of variables (self-report and expert ratings). First, the whole sample will be analysed to identify prognostic and prescriptive predictors of outcome (primary outcome criterion: Quick Inventory of Depressive Symptoms QIDS-total score, expert rating). Secondly, for a comparison of inpatient and dayhospital treatment, samples will be matched according to known predictors of outcome. Discussion Naturalistic studies with good external validity are needed to assess treatment outcome in depression in routine care and to identify subgroups of patients with different therapeutic needs. Trial registration Current Controlled Trials ISRCTN20317064
... August 15, 2013 Related MedlinePlus Pages Mental Health Quitting Smoking THURSDAY, Aug. 15 (HealthDay News) -- Psychiatric patients who took part in a smoking-cessation program while they were in the hospital for ...
Background Over 20% of hospital bed use is inappropriate, implying a waste of resources and the increase of patient iatrogenic risk. Methods This is a cluster, pragmatic, randomised controlled trial, carried out in a large University Hospital of Northern Italy, aiming to evaluate the effect of a strategy to reduce unnecessary hospitaldays. The primary outcome was the percentage of patient-days compatible with discharge. Among secondary objectives, to describe the strategy’s effect in the long-term, as well as on hospital readmissions, considered to be a marker of the quality of hospital care. The 12 medical wards with the longest length of stay participated. Effectiveness was measured at the individual level on 3498 eligible patients during monthly index days. Patients admitted or discharged on index days, or with stay >90 days, were excluded. All ward staff was blinded to the index days, while staff in the control arm and data analysts were blinded to the trial’s objectives and interventions. The strategy comprised the distribution to physicians of the list of their patients whose hospital stay was compatible with discharge according to a validated Delay Tool, and of physician length of stay profiles, followed by audits managed autonomously by the physicians of the ward. Results During the 12 months of data collection, over 50% of patient-days were judged to be compatible with discharge. Delays were mainly due to problems with activities under medical staff control. Multivariate analysis considering clustering showed that the strategy reduced patient-days compatible with discharge by 16% in the intervention vs control group, (OR=0.841; 95% CI, 0.735 to 0.963; P=0.012). Follow-up at 1 year did not yield a statistically significant difference between the percentages of patient-days judged to be compatible with discharge between the two arms (OR=0.818; 95% CI, 0.476 to 1.405; P=0.47). There was no significant difference in 30-day readmission and mortality rates for all eligible patients (N=3498) between the two arms. Conclusions Results indicate that a strategy, involving physician direct accountability, can reduce unnecessary hospitaldays. Relatively simple interventions, like the one assessed in this study, should be implemented in all hospitals with excessive lengths of stay, since unnecessary prolongation may be harmful to patients. Trial registration ClinicalTrials.gov, identifier NCT01422811.
Objective: Little research is conducted on service closures. We examined the social, clinical and service use impact of the closure of a partial hospitalisation service (dayhospital) on its users. Methods: Patients attending the closing dayhospital were studied at closure and one year after, and compared to patients at an unchanged dayhospital. Results: The closure did not increase
A review of the literature on gender identity disorders is integrated with a case study presentation of a psychiatrically\\u000a disturbed nineteen-year-old transvestite youth. Accommodations and interventions made both with this patient and in the day\\u000a care program for psychiatrically disturbed youths that allowed him to live at home and be maintained despite severe pathology\\u000a are discussed.
Collaboration between state clinical treatment services and academic research is fertile ground for clinical research opportunities. Such joint initiatives require careful planning, including provisions for joint training, integration of research staff into clinical activities, and integration of clinical treatment staff into research activities. The authors describe the planning and development of a 24-bed research unit at the Nathan S. Kline Institute for Psychiatric Research, colocated on the same campus as Rockland Psychiatric Center, each of which is an independent facility operated by the New York State Office of Mental Health. PMID:18757586
Background While morbidity outcomes for major disease categories during extreme heat have received increasing research attention, there has been very limited investigation at the level of specific disease subcategories. Methodology/Principal Findings We analyzed daily hospital admissions for cardiovascular (CVD), respiratory (RD), genitourinary (GU) and mental diseases (MD), diabetes (DIA), dehydration (DEH) and ‘the effects of heat and light’ (HEAT) in Sydney between 1991 and 2009. We further investigated the sensitivity to heat of subcategories within the major disease groups. We defined hot days as those with temperatures in the 95th and 99th percentiles within the study period. We applied time-stratified case-crossover analysis to compare the hospital admissions on hot days with those on non-hot days matched by day of the week. We calculated the odds ratios (OR) of admissions between the two types of days, accounting for other environmental variables (relative humidity, ozone and particulate matter) and non-environmental trends (public and school holidays). On hot days, hospital admissions increased for all major categories except GU. This increase was not shared homogeneously across all diseases within a major category: within RD, only ‘other diseases of the respiratory system’ (includes pleurisy or empyema) increased significantly, while admissions for asthma decreased. Within MD, hospital admissions increased only for psychoses. Admissions due to some major categories increased one to three days after a hot day (e.g., DIA, RD and CVD) and on two and three consecutive days (e.g., HEAT and RD). Conclusions/Significance High ambient temperatures were associated with increased hospital admissions for several disease categories, with some within-category variation. Future analyses should focus on subgroups within broad disease categories to pinpoint medical conditions most affected by ambient heat.
A prospective audit of 225 children was conducted to evaluate current pain management strategies both in-hospital and at home following day surgery at British Columbia Children’s Hospital (Vancouver, British Columbia). Anesthetic, postanesthetic care unit and surgical day care unit records were collected to generate in-hospital data. A telephone questionnaire was administered 48 h postdischarge for at home data. Pain reports and scores were significantly higher (P<0.01) at home compared with in-hospital. Children undergoing certain procedures were more likely to experience significant pain. Although good pain control was commonly achieved after surgery, improvements may be possible by increasing the use of multimodal analgesia, providing standardized written discharge instructions and using surgery-specific pediatric analgesia guidelines.
Purpose Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP) to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-dayhospital readmission, and Emergency Room (ER) visits for adults over 60 years with high Elder Risk Assessment scores. Patients and methods This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-dayhospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL). Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores. Results Of the 40 patients enrolled, 36 completed all study visits. The 30-dayhospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37). The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4) for the CTP participants (P < 0.01) and no differences in gait speed or grip strength. Conclusion Based on this pilot study of care transition, we found nonsignificant lower hospital and ER utilization rates and improved physical QOL scores for patients in the CTP group. However, the data leads us to recommend future studies with larger sample sizes (N = 250).
Takahashi, Paul Y; Haas, Lindsey R; Quigg, Stephanie M; Croghan, Ivana T; Naessens, James M; Shah, Nilay D; Hanson, Gregory J
Microendoscopic techniques for surgical intervention find wide application in both in-patient and out-patient settings. High efficiency of low-invasive surgical methods make them applicable to treat paranasal cavity pathology, septal deformities, and cystic-polypous processes, etc. The authors consider peculiarities of operations under endoscopic control with the use of microsurgical instruments, discuss their efficiency under conditions of a dayhospital, and illustrate the possibility to avoid prolonged hospitalization of a patient based on this approach. PMID:20517279
Objectives We sought to determine the range and prevalence of practices being implemented by hospitals to reduce 30-day readmissions of patients with heart failure or acute myocardial infarction (AMI). Background Readmissions of patients with heart failure or AMI are both common and costly; however evidence on strategies adopted by hospitals to reduce readmission rates is limited. Methods We used a web-based survey to conduct a cross-sectional study of hospitals’ reported use of specific practices to reduce readmissions for patients with heart failure or AMI. We contacted all hospitals enrolled in the Hospital to Home (H2H) quality improvement initiative as of July 2010. Of 594 hospitals, 537 completed the survey (response rate of 90.4%). We used standard frequency analysis to describe the prevalence of key hospital practices in the areas of 1) quality improvement resources and performance monitoring, 2) medication management efforts, and 3) discharge and follow-up processes. Results Nearly 90% of hospitals agreed or strongly agreed that they had a written objective of reducing preventable readmission for patients with heart failure or AMI. More hospitals reported having quality improvement teams to reduce preventable readmissions for patients with heart failure (87%) than for patients with AMI (54%). On average, hospitals used 4.8 of 10 key practices; fewer than 3% of hospitals utilized all 10 practices. Conclusions Although most hospitals have a written objective of reducing preventable readmissions of patients with heart failure or AMI, the implementation of recommended practices varied widely. More evidence establishing the effectiveness of various practices is needed.
Bradley, Elizabeth H.; Curry, Leslie; Horwitz, Leora I.; Sipsma, Heather; Thompson, Jennifer W.; Elma, Mary Anne; Walsh, Mary Norine; Krumholz, Harlan M.
BackgroundAdults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual disabilities (ID).
|In this study, the relationship between psychopathy, according to the Dutch language version of Hare's Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient…
Hildebrand, Martin; De Ruiter, Corine; Nijman, Henk
The functions and operations of a short-term psychiatric inpatient unit for children and adolescents are discussed. Staffing pattern, programming, and statistical data are reviewed. The author concludes that short-term inpatient treatment has much to offer when complemented by careful research and evaluation.
|William Menninger (1948) reported research results indicating a significant relationship in a former patient's ability to stay well and his participation in recreation. J. Bates (1963) indicated one reason patients return to psychiatric facilities was the lack of skills that center around recreation. This study was conducted to investigate the…
|Background: Adults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual…
|Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual…
Data regarding the concomitant occurrence of substance abuse and other psychiatric disorders in an inpatient treatment program for adolescents is presented. Comparison with three other similar studies reveals that conduct and mood disorders appear to be the most prevalent concurrent diagnoses of inpatient adolescent substance abusers.
Despite demonstrations of the utility and cost effectiveness of behavioral methods for improving care for people with psychiatric impairments, they are seldom employed effectively in inpatient settings. This study evaluated the impact of an administrative procedure to effect a behavioral consultation for cases of high seclusion\\\\restraint utilization. Seclusion\\\\restraint use for the 53 cases was reviewed for a time period of
Patient satisfaction studies concerning various treatment modalities are few among involuntary forensic psychiatric treatment. They indicate general satisfaction with medication, interactive treatment and occupational therapy but dissatisfaction with lack of privacy, insufficiently explained rules and inadequately explained reasons of seclusion. In order to find out patients' opinions concerning prerequisites of cooperation, we investigated by using an anonymous questionnaire, opinions and
Eila Repo-Tiihonen; Osmo Vuorio; Hanna Koivisto; Paula Paavola; Panu Hakola
OBJECTIVE:: Thirty-dayhospital readmission rate is receiving increasing attention as a quality of care indicator. The objective of this study was to determine readmission rates and to identify factors associated with readmission among persons living with HIV. DESIGN:: Prospective multicenter observational cohort. SETTING:: Nine U.S. HIV clinics affiliated through the HIV Research Network. SUBJECTS:: Patients engaged in HIV care during 2005-2010. MAIN OUTCOME MEASURE(S):: Readmission rate was defined as the proportion of hospitalizations followed by a readmission within 30 days. Factors in multivariate analyses included diagnostic categories, patient demographic and clinical characteristics, and having an outpatient follow-up visit. RESULTS:: Among 11,651 total index hospitalizations, the 30-day readmission rate was 19.3%. AIDS defining illnesses (ADI, 9.6% of index hospitalizations) and non-AIDS defining infections (26.4% of index hospitalizations) had readmission rates of 26.2% and 16.6%, respectively. Factors independently associated with readmission included lower CD4 count (AOR 1.80 [1.53, 2.11] for CD4 <50 vs. ?351 cells/?l), longer length of stay (1.77 [1.53, 2.04] for ?9 days vs. 1-3 days), and several diagnostic categories including ADI. Having an outpatient follow-up clinic visit was not associated with lower readmission risk (AHR 0.98 [0.88, 1.08]). CONCLUSIONS:: The 19.3% readmission rate exceeds the 13.2% rate reported for the general population of 18-64 year-olds. HIV providers may use the 19.3% rate as a basis of comparison. Policymakers may consider the impact of HIV when estimating expected readmissions for a hospital or region. Preventing or recovering from severe immune dysfunction may be the most important factor to reducing readmissions. PMID:23612008
Berry, Stephen A; Fleishman, John A; Yehia, Baligh R; Korthuis, P Todd; Agwu, Allison L; Moore, Richard D; Gebo, Kelly A
The objective of the study was to develop and validate predictors of 30-dayhospital readmission using readily available administrative data and to compare prediction models that use alternate comorbidity classifications. A retrospective cohort study was designed; the models were developed in a two-thirds random sample and validated in the remaining one-third sample. The study cohort consisted of 29,292 adults aged 65 or older who were admitted from July 2002 to June 2004 to any of seven acute care hospitals in the Dallas–Fort Worth metropolitan area affiliated with the Baylor Health Care System. Demographic variables (age, sex, race), health system variables (insurance, discharge location, medical vs surgical service), comorbidity (classified by the Elixhauser classification or the High-Risk Diagnoses in the Elderly Scale), and geographic variables (distance from patient's residence to hospital and median income) were assessed by estimating relative risk and risk difference for 30-day readmission. Population-attributable risk was calculated. Results showed that age 75 or older, male sex, African American race, medical vs surgical service, Medicare with no other insurance, discharge to a skilled nursing facility, and specific comorbidities predicted 30-day readmission. Models with demographic, health system, and either comorbidity classification covariates performed similarly, with modest discrimination (C statistic, 0.65) and acceptable calibration (Hosmer-Lemeshow ?2 = 6.08; P > 0.24). Models with demographic variables, health system variables, and number of comorbid conditions also performed adequately. Discharge to long-term care (relative risk, 1.94; 95% confidence interval, 1.80— 2.09) had the highest population-attributable risk of 30-day readmission (12.86%). A 25% threshold of predicted probability of 30-day readmission identified 4.1 % of patients ?65 years old as priority patients for improved discharge planning. We conclude that elders with a high risk of 30-dayhospital readmission can be identified early in their hospital course.
Qin, Huanying; Mercer, S. Quay; Fong, Jaclyn; Haydar, Ziad
For the past seven years, Parkview Hospital has provided the educational component of Cancer Day. The hospital has distributed pamphlets that educate about different forms of cancer. Last year, the marketing department undertook the subject of colon cancer. PMID:10177638
Purpose:Bilateral extravesical ureteral reimplantation has been associated with urinary retention. We developed a critical pathway and modification of surgical technique to determine whether the bilateral extravesical procedure could be performed in toilet trained children with patients discharged home after a 1-dayhospitalization and without urinary retention.
The 121st General Hospital, Seoul, South Korea, is the only Army Medical Treatment Facility for all United States armed forces assigned to the Republic of Korea. The 121st currently lacks a same-day surgery program and likely has never had such a program....
Background: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, dayhospital, and inpatient treatment. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health
Anna Bartak; Helene Andrea; Marieke D. Spreeuwenberg; Uli M. Ziegler; Jack Dekker; Bert V. Rossum; Elisabeth F. M. Hamers; Wubbo Scholte; Janneke Aerts; Jan J. V. Busschbach; Roel Verheul; Theo Stijnen; Paul M. G. Emmelkamp
Background Hospital readmissions are a quality of care indicator, yet little is known about their occurrence and predictors after myocardial infarction (MI) in the community. Objective Examine 30-dayhospital readmissions after incident MI. Design Retrospective cohort study Setting Population-based registry in Olmsted County, Minnesota Patients 3010 patients admitted to an Olmsted County hospital with first-ever MI from 1987 to 2010 that survived to hospital discharge. Measurements Diagnoses, therapies, and complications during incident and subsequent admissions were identified. Manual chart review was performed to determine the cause of all readmissions. The hazard ratios and cumulative incidence of 30-day readmissions were determined using Cox proportional hazard regression models. Results Among 3010 patients (mean age 67 years, 40.5% female) with incident MI (31.2% ST-elevation), 643 readmissions occurred within 30 days in 561 (18.6%) patients. Overall, 30.2% of readmissions were unrelated to the incident MI and 42.6% were related; the relationship was unclear in 27.2% of readmissions. Angiography was performed in 153 (23.8%) readmissions. Revascularization was performed in 103 (16.0%) readmissions, of whom 46 (44.7%) had no revascularization during the index admission. After adjustment for potential confounders, diabetes, COPD, anemia, higher Killip class, longer length of stay during the index hospitalization, and a complication of angiography or reperfusion/revascularization were associated with increased readmission risk. The 30-day incidence of readmission was 35.3% and 31.6% in patients who experienced a complication of angiography or reperfusion/revascularization during the index MI admission, respectively, compared with 16.8% in patients who had reperfusion/revascularization without complications. Limitations This represents the experience of a single community. Conclusions Comorbidity, longer length of stay, and complications of angiography and revascularization/reperfusion are associated with increased 30-day readmission risk after MI.
Dunlay, Shannon M.; Weston, Susan A.; Killian, Jill M.; Bell, Malcolm R.; Jaffe, Allan S.; Roger, Veronique L.
Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error?=?0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.
Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.
Background: Stigma is one of the obstacles in the treatment and regaining the mental health of people with mental illness. The aim was determination of mental illness stigma among nurses in psychiatric wards. This study was conducted in psychiatric wards of teaching hospitals in Tabriz, Urmia, and Ardabil in the north-west of Iran. Materials and Methods: This research is a descriptive analysis study in which 80 nurses participated. A researcher-made questionnaire was used, which measured demographic characteristics and mental illness stigma in the three components of cognitive, emotional, and behavioral. All data were analyzed using SPSS13 software and descriptive and analytical statistics. Results: Majority of nurses (72.5%) had medium level of stigma toward people with mental illness. About half of them (48.8%) had great inclination toward the social isolation of patients. The majority of them (62.5%) had positive emotional responses and 27.5% had stereotypical views. There was a significant correlation between experience of living with and kinship of nurses to person with mental illness, with prejudice toward and discrimination of patients. There was also a significant correlation between interest in the continuation of work in the psychiatric ward and prejudice, and also between educational degree and stereotypical views. Conclusions: The data suggest there is a close correlation between the personal experience of nurses and existence of mental illness stigma among them. Therefore, the implementation of constant educational programs on mental illness for nurses and opportunities for them to have direct contact with treated patients is suggested.
Two decades ago the laws regulating involuntary mental hospitalization were very flexible and allowed for substantial abuse. Due to recent court rulings and changes in law, the legal context of involuntary hospitalization has been drastically changed. In the present paper we briefly review recent court rulings on rights of the mentally ill and then systematically review the laws regulating involuntary
TO ASSIST YOUNG, MENTAL PATIENTS IN OVERCOMING SOME OF THEIR SOCIAL DEFICITS, TWO RESOCIALIZATION PROJECTS (PRE- AND POST-DISCHARGE) WERE INITIATED TO MOVE THE PATIENT FROM A MENTAL HOSPITAL SETTING INTO THE LARGER COMMUNITY, WITH A COMMUNITY CENTER AS THE LEARNING GROUND. CAREFULLY SELECTED PATIENTS FROM THE HOSPITAL WERE GIVEN THE OPPORTUNITY TO…
Examination of the records of 240 inpatients with mental retardation and 7 with autism discharged from a university hospital indicated that elderly adults had more medical problems than did adults, more elderly adults were transferred to a state hospital, and the most common diagnosis in both adults and elderly adults was chronic schizophrenia,…
This paper emphasizes that psychology can make significant contributions to state mental hospitals. Psychologists should be encouraged to work in these institutions as fruitful fields for service and research. A greater interest on the part of the profession in the problems of psychology in state hospitals will yield a social return in the advancement of the treatment, research, and training
BACKGROUND:: Heart failure is a clinical syndrome that incurs a high prevalence, mortality, morbidity, and economic burden in our society. Patients with heart failure may experience hospitalization because of an acute exacerbation of their condition. Recurrent hospitalizations soon after discharge are an unfortunate occurrence in this patient population. OBJECTIVE:: The purpose of this study was to explore the clinical and diagnostic characteristics of individuals hospitalized with a primary diagnosis of heart failure at the time of discharge and to compare the association of these indicators in individuals who did and did not experience a heart failure hospitalization within 60 days of the index stay. METHODS:: The study is a descriptive, correlational, quantitative study using a retrospective review of 134 individuals discharged with a primary diagnosis of heart failure. Records were reviewed for sociodemographic characteristics, health histories, clinical assessment findings, and diagnostic information. RESULTS:: Significant predictors of 60-day heart failure readmissions were dyspnea (? = 0.579), crackles (? = 1.688), and assistance with activities of daily living (? = 2.328), independent of age, gender, and multiple other factors. By using hierarchical logistical regression, a model was derived that demonstrated the ability to correctly classify 77.4% of the cohort, 78.2% of those who did have a readmission (sensitivity of the prediction), and 76.7% of the subjects in whom the predicted event, readmission, did not occur (specificity of the prediction). CONCLUSION:: Hospitalizations for heart failure are markers of clinical instability. Future events after hospitalization are common in this patient population, and this study provides a novel understanding of clinical characteristics at the time of discharge that are associated with future outcomes, specifically 60-day heart failure readmissions. A consideration of these characteristics provides an additional perspective to guide clinical decision making and the evaluation of discharge readiness. PMID:23612038
Background Kidney disease is common among patients with heart failure, but relationships between worsening renal function (WRF) and outcomes after hospitalization for heart failure are poorly understood, especially among patients with preserved systolic function. We examined associations between WRF and 30-day readmission, mortality, and costs among Medicare beneficiaries hospitalized with heart failure. Methods We linked data from a clinical heart failure registry to Medicare inpatient claims for patients aged 65 years or older hospitalized with heart failure. We defined WRF as a change in serum creatinine ?0.3 mg/dL from admission to discharge. Main outcome measures were readmission and mortality at 30 days after hospitalization and total inpatient costs. Results Among 20,063 patients hospitalized with heart failure, WRF was common (17.8%) and more likely among patients with higher baseline comorbidity and more impaired renal function. In unadjusted analyses, WRF was associated with similar subsequent mean inpatient costs ($3255 vs $3277; p=0.2) but higher readmission (21.8% vs 20.6%; p=0.01) and mortality (10.0% vs 7.2%; p<0.001). The differences persisted after adjustment for baseline patient and hospital characteristics (hazard of readmission, 1.10 [95% confidence interval, 1.02–1.18]; hazard of mortality, 1.53 [95% confidence interval, 1.34–1.75]). Associations of WRF with readmission and mortality were similar between patients with reduced and preserved systolic function. Conclusions WRF during hospitalization for heart failure is an independent predictor of early readmission and mortality in patients with reduced and preserved systolic function.
Patel, Uptal D.; Greiner, Melissa A.; Fonarow, Gregg C.; Phatak, Hemant; Hernandez, Adrian F.; Curtis, Lesley H.
Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n?=?357) from 32 clinical units in two psychiatrichospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. PMID:22962847
Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S
Background The Critical Access Hospital (CAH) designation was established to provide rural residents local access to emergency and inpatient care. CAHs, however, have poorer short-term outcomes for pneumonia, heart failure, and myocardial infarction compared to other hospitals. We assessed whether 30-day risk-standardized mortality rates (RSMRs) and readmission rates (RSRRs) after ischemic stroke differ between CAHs and non-CAHs. Methods The study included all fee-for-service Medicare beneficiaries ?65 years old with a primary discharge diagnosis of ischemic stroke (ICD-9 433, 434, 436) in 2006. Hierarchical generalized linear models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, medical history, and comorbid conditions. Non-CAHs were categorized by hospital volume quartiles and the RSMR and RSRR posterior probabilities in comparison to CAHs were determined using linear regression with Markov chain Monte Carlo simulation. Results There were 10,267 ischemic stroke discharges from 1,165 CAHs and 300,114 discharges from 3,381 non-CAHs. The RSMRs of CAHs were higher than non-CAHs (11.9%±1.4% vs. 10.9%±1.7%, p<0.001), but the RSRRs were comparable (13.7%±0.6% vs. 13.7%±1.4%, p=0.3). The RSMRs for the two higher volume quartiles of non-CAHs were lower than CAHs (posterior probability of RSMRs higher than CAHs=0.007 for quartile 3, probability<0.001 for quartile 4), but there were no differences for lower volume hospitals; RSRRs did not vary by annual hospital volume. Conclusions Critical Access Hospitals had higher RSMRs compared with non-CAHs, but readmission rates were similar. The observed differences may be partly explained by patient characteristics and annual hospital volume.
Lichtman, Judith H.; Leifheit-Limson, Erica C.; Jones, Sara B.; Wang, Yun; Goldstein, Larry B.
The aim of this study was to identify predictors of (1) short-term outcome and (2) short-term compliance with treatment (for non-hospitalized patients) in psychiatric emergency patients. Subjects comprised 457 patients referred to the emergency ward of a French general hospital and requiring examination by a psychiatrist. Clinical and therapeutic assessments were carried out at baseline, using DSM-IV diagnoses and overall
Didier Cremniter; Christine Payan; Antoine Meidinger; Guillermo Batista; Jacques Fermanian
Objective: This investigation examined several adverse outcomes in clients with serious mental illness in a randomized trial of Assertive Community Treatment (ACT) versus usual care. Method: 163 subjects were randomized to one of two ACT experimental conditions (staffed by consumers or non-consumers) or usual community care. Conditions were compared on psychiatrichospitalization, emergency room visit, arrest, and homelessness, within the
Gregory N. Clarke; Heidi A. Herinckx; Ronald F. Kinney; Robert I. Paulson; David L. Cutler; Karen Lewis; Evie Oxman
Background: There is virtually no information in the medical literature on the quality of antibiotic prescribing in mental healthcare setting. We report the results of an antibiotic utilization review focused on pneumonia in a university-affiliated psychiatrichospital comprising 410 adult beds.Methods: We implemented a computerized system for declaring any bacterial infection. This system was automatically triggered as soon as an
Objective: This study aimed at assessing social behavior and independent living skills in a sample of psychiatric patients before their discharge from a mental hospital and after 2 years living in community facilities. Method: A cross-sectional study was carried out in two stages using the Independent Living Skills Survey and the Social Behavior Scale. Results: Most patients were male (58.7%).
Carlos Eduardo; Leal Vidal; Costa Dias; Macedo Gontijo; Marina Bittencourt Bandeira
BackgroundFamily caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives.ObjectiveTo explore family caregivers' experience of involuntary admission of their relative.Method30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across England. Interviews were analysed using thematic analysis.ResultsFour major themes of experiences were identified: relief
Jelena Jankovic; Ksenija Yeeles; Christina Katsakou; Tim Amos; Richard Morriss; Diana Rose; Peter Nichol; Rosemarie McCabe; Stefan Priebe; Ben J. Harrison
INTRODUCTION: Higher compliance with Surviving Sepsis Campaign (SSC) recommendations has been associated with lower mortality. The authors evaluate differences in compliance with SSC 6-hour bundle according to hospital entrance time (day versus night) and its impact on hospital mortality. METHODS: Prospective cohort study of all patients with community-acquired severe sepsis admitted to the intensive care unit of a large university tertiary care hospital, over three and half years with a follow-up until hospital discharge. Time to compliance with each recommendation of the SSC 6-hour bundle was calculated according to hospital entrance period: day (8:30am to 8:30pm) vs. night (8:30pm to 8:30am). For the same periods, clinical staff composition and the number of patients attending the emergency department (ED) was also recorded. RESULTS: In this period 300 consecutive patients were included. Compliance rate was (night vs. day): serum lactate measurement 57% vs. 49% (p=0.171), blood cultures drawn 59% vs. 37% (p<0.001), antibiotics administration in the first three hours 33% vs. 18% (p=0.003), central venous pressure > 8 mmHg 45% vs. 29% (p=0.021) and central venous oxygen saturation (SvcO2) > 70%, 7% vs. 2% (p=0.082); fluids were administered in all patients with hypotension in both periods and vasopressors were administered in patients with hypotension not responsive to fluids in 100% vs. 99%. Time to get specific actions done was also different (night vs. day): serum lactate measurement (4.5 vs. 7h, p=0.018), blood cultures drawn (4 vs. 8h, p<0.001), antibiotic administration (5 vs. 8h, p<0.001), central venous pressure (8 vs. 11h, p=0.01) and SvcO2 monitoring (2.5 vs. 11h, p=0.222). The composition of the nursing team was the same around the clock; the medical team was reduced at night with a higher proportion of less differentiated doctors. The number of patients attending the ED was lower overnight. Hospital mortality rate was 34% in patients entering in the night period vs. 40% in those entering during day (p=0.281). CONCLUSION: Compliance with SSC recommendations was higher at night. A possible explanation might be the increased ratio nurse to patient in that period. Adjustment of the clinical team composition to the patients' demand is needed to increase compliance and improve prognosis. PMID:23618351
This study adopted a quasi-experimental design to compare the treatment outcomes of inpatient-outpatient programs and dayhospital programs for chronic, combat-related posttraumatic stress disorder. Data were drawn from 202 Vietnam veterans who had completed treatment at four programs across Australia. The veterans were assessed on a range of psychological and social variables at intake to the programs and followed up at 3 and 9 months after discharge. A significant main effect was found for time, with veterans from both program models demonstrating improvements that were maintained over the 9-month follow-up period. Group by time effects were not significant, which suggests that inpatient-outpatient programs are not more efficacious than the less expensive dayhospital alternatives. In line with current mental health policy directions, the current study lends broad support to the recommendation that treatment services for veterans with posttraumatic stress disorder be delivered in the least restrictive environment. PMID:11923653
Creamer, Mark; Forbes, David; Biddle, Dirk; Elliott, Peter
The only dayhospital for children and adolescents in the German-speaking part of Switzerland is located in Zurich. It has been operating since 1975 within the philosophical principles of dialogics. In this paper the author describes in detail the concept of dialogics as it relates to the beliefs and practices in carrying out an integrated therapeutic environment for children and their parents. PMID:10294634
This controlled study, utilizing matched pairs, evaluates the relative cost effectiveness of dayhospitalization to inpatient treatment in a group of 18- to 24-year-old black schizophrenic males. Global Assessment Scale scores were measured upon intake, at the time of discharge, and at the three-month follow-up to determine the level of patient functioning for each treatment group. Cost outcome measures were made for each program and a side-by-side cost effective analysis was conducted between the two. Results reveal evidence that day treatment was superior to inpatient care at a lower cost for a longer period of time.
Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed. PMID:22855350
Interest in the concerns of cancer patients' carers has been growing steadily over the last decade reflected in key cancer service policy documents [DOH, 1995. A Policy Framework for Commissioning Cancer Services (Calman-Hine Report). London, HMSO; DOH, 2002. The NHS Cancer Plan]. Despite this acknowledgement, it can be argued that less is known about carers' experience in the cancer treatment context. Carers can be defined as someone who shares the experience of cancer with the patient. The aim of this study was to explore the lived experience of caregivers in a chemotherapy dayhospital and how this compared with their experience of inpatient care. Using a phenomenological approach, face-to-face interviews were conducted with a purposive sample of ten caregivers. Data were analysed using Polkinghorne's [1995. Narrative Knowing & the Human Sciences. University of New York Press, Albany] two stages of narrative analysis. The findings indicated that the caregivers experienced similar transitions to the patients with regards to health-illness transition and organisational transitions. The caregivers adopted various roles in the dayhospital such as Companion 'being with' their relative, Protector 'keeping an eye'; Practical Caregiver and assuming an Advocate Role. The findings of this study are important for cancer nursing practice as health professionals need to acknowledge the role of carers in the chemotherapy dayhospital setting and facilitate their involvement in care. PMID:16443392
A sample of 119 consecutively hospitalized adolescents, including 32 sexually abused teenagers, was assessed with the Trauma Symptom Checklist for Children (TSCC). Participants also completed the Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), Adolescent- Dissociative Experience Scale, Minnesota Multiphasic Personality Inventory (MMPI), Rorschach, and the Family Environment Scale. The reliability and validity of each of the six TSCC scales and four
Tested 416 college students for degree of moral tolerance and self-acceptance before and after completing undergraduate psychology courses. 16 of the students concurrently did volunteer work in mental hospitals. The within-Ss analysis indicates the volunteer experience did not significantly change the moral tolerance scores, whereas it did result in greater self-acceptance scores.
The author reviews the clinical and special social environmental data from the Soteria Project and its direct successors. Two random assignment studies of the Soteria model and its modification for long-term system clients reveal that roughly 85% to 90% of acute. and long-term clients deemed in need of acute hospitalization can be returned to the community without use of conventional
|This study explored clinical and nonclinical predictors of inpatient hospital admission decisions across a sample of children in foster care over 4 years (N = 13,245). Forty-eight percent of participants were female and the mean age was 13.4 (SD = 3.5 years). Optimal data analysis (Yarnold & Soltysik, 2005) was used to construct a nonlinear…
Snowden, Jessica A.; Leon, Scott C.; Bryant, Fred B.; Lyons, John S.
The development of dayhospital programmes for patients with anorexia nervosa has received much interest of late. However, there has often been little attention paid to the unique nature of this disorder. For this reason, we set out to design dayhospital treatment programmes to reflect and incorporate an understanding of the ambivalence towards change demonstrated by the majority of
Stephen Touyz; Christopher Thornton; Elizabeth Rieger; Louise George; Peter Beumont
There are concerns about the safety of the dextropropoxyphene and acetaminophen fixed-dose combination, particularly in patients with psychiatric morbidity, which has led to a phased withdrawal of this fixed-dose combination in many countries. A retrospective prescription audit was conducted to evaluate the dextropropoxyphene + acetaminophen fixed-dose combination prescribing pattern in the major psychiatrichospital of Bahrain. The data analysis was performed using SPSS/PC+ version 14.0. Prescriptions with the dextropropoxyphene + acetaminophen fixed-dose combination comprised 11.8% of all dispensed prescriptions and in most instances for outpatients undergoing substance abuse rehabilitation. Nearly half of the patients received >or=20 tablets of this fixed-dose combination (mean +/- SD: 30.9 +/- 13.1; range 20-126) as multiple doses. The dextropropoxyphene + acetaminophen fixed-dose combination was often co-prescribed with psychotropics, such as benzodiazepines (BZDs) (25.4%), BZDs + antidepressants (62.9%), BZDs + antipsychotics (3.7%) and BZDs + anticonvulsants (1.9%). Approximately 40% of prescriptions with the dextropropoxyphene + acetaminophen fixed-dose combination were written 'as required' (prn), basis. Despite poor safety and efforts to restrict or withdraw worldwide, the dextropropoxyphene + acetaminophen fixed-dose combination continues to be irrationally prescribed to outpatients undergoing substance abuse rehabilitation in Bahrain. Health policy decision-makers should introduce a phased withdrawal of this drug from clinical use. In the meanwhile, it is important to create awareness among prescribers of the risks associated with over-dosage of the dextropropoxyphene + acetaminophen fixed-dose combination and its interaction with other psychotropic medications. PMID:19645819
Al Khaja, Khalid A J; Al-Haddad, Mohammed K; Al-Offi, Adel R; Abdulraheem, Masooma H; Sequeira, Reginald P
As a part of the basis for planning of prevention of suicide and suicide attempt, 154 suicidal ideators registered between 1988 and 1991, were recruited for an analysis of their psychiatric morbidity pattern. 59.74% had depression. The representation of substance abuse disorder and psychoses were 9.74% each 7.14% had neurotic disorders. 9.09% had bipolar affective disorder and 0.65% had normal mental status. 40% of the sample were housewives. Majority of them were between the age group of 16 and45years, having an educational status below 10th Standard The four year follow up findings showed that 8 of the sample completed suicide, of which four were suffering from psychosis. Repeaters suffered from disociation disorder. 15 of the depressives had resistant depression with nonremittent suicidal ideas. Psychotic patients and patients with somatic complaints were not free communicators of their suicidal idea. Implication of the results in the cunicalmanagement and further research on these patients are discussed.
This report deals with the psychiatric symptomatology in patients with primary hyperparathyroidism (HPT). In a retrospective search of hospital records, psychiatric symptoms were found in 102 (23%) of 441 patients, 78 of whom had depressive and anxiety states. The presence of psychiatric symptoms was not related to the degree of hypercalcemia. Screening for HPT in 101 old patients hospitalized at
Charlotte Joborn; Jerker Hetta; Henry Johansson; Jonas Rastad; Hans Ågren; Göran Åkerström; Sverker Ljunghall
National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) irk short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for
This study examined associations between substance use behaviors and self-reported health among hospitalized heroin users. Of the 112 participants, 53 (47%) reported good or better health. In multivariable logistic regression models, each day of heroin use in the last month was associated with an 8% lower odds of reporting health as good or better (OR=.92; 95% CI 0.87, 0.97, p<.05). Cocaine, cannabis, cigarettes, alcohol use, unintentional overdose, nor injection drug use was associated with health status. PMID:24045030
Meshesha, Lidia Z; Tsui, Judith I; Liebschutz, Jane M; Crooks, Denise; Anderson, Bradley J; Herman, Debra S; Stein, Michael D
Objectives Equity in physical health of patients with severe mental disorders is a major public health concern. The aim of this cohort study was to examine equity in access to coronary care among persons with a history of severe mental disorder in 1998–2009. Design Nationwide register linkage cohort study. Setting Hospital care in the Finnish healthcare system. Population The study population consisted of all residents in Finland aged 40?years or older. All hospital discharges in 1998–2009 with a diagnosis of coronary heart disease or severe mental disorder were obtained from the Care Register. Primary outcome measures Data on deaths, hospitalisations and coronary revascularisations were linked to the data set using unique personal identifiers. Results Patients with severe mental disorders had increased likelihood of hospital care due to coronary heart disease (RR between 1.22, 95% CI 1.18 to 1.25 and 1.93, 1.84 to 2.03 in different age groups) and in 40–49-year-olds also increased likelihood of revascularisation (1.26, 1.16 to 1.38) compared with persons without mental disorders. Access to revascularisation was poorer among older persons with severe mental disorders in relation to need suggested by increased coronary mortality. In spite of excess coronary mortality (ranging from 0.95, 0.89 to 1.01 to 3.16, 2.82 to 3.54), worst off were people with a history of psychosis, who did not have increased use of hospital care and had lower likelihood of receiving revascularisations (ranging from 0.44, 0.37 to 0.51 to 0.74, 0.59 to 0.93) compared with persons without mental disorders. Conclusions Selective mechanisms seem to be at work in access to care and revascularisations among people with severe mental disorders. Healthcare professionals need to be aware of the need for targeted measures to address challenges in provision of somatic care among people with severe mental health problems, especially among people with psychoses and old people.
Arffman, Martti; Sund, Reijo; Haukka, Jari; Keskimaki, Ilmo; Wahlbeck, Kristian
Mortality rate has been proposed as a metric of hospital chronic obstructive pulmonary disease (COPD) care in light of variation seen in national COPD audits. Using Hospital Episode Statistics (hospital 'coding') we examined 30-day mortality after COPD hospitalisation in 150 UK hospitals during 2006-2007 and 2007-2008. Mean and median 30-day mortalities were similar each year but the coefficient of variation was >20% and hospitals could change from a low or high quartile to the median by chance. We could not detect any reasons for hospitals being at the extremes. 30-day mortality after COPD hospitalisation is a complex variable and unlikely to be useful as a primary annual COPD metric. PMID:23788585
Walker, P P; Thompson, E; Crone, H; Flatt, G; Holton, K; Hill, S L; Pearson, M G
Background Family caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives. Objective To explore family caregivers' experience of involuntary admission of their relative. Method 30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across England. Interviews were analysed using thematic analysis. Results Four major themes of experiences were identified: relief and conflicting emotions in response to the relative's admission; frustration with a delay in getting help; being given the burden of care by services; and difficulties with confidentiality. Relief was a predominant emotion as a response to the relative's admission and it was accompanied by feelings of guilt and worry. Family caregivers frequently experienced difficulties in obtaining help from services prior to involuntary admission and some thought that services responded to crises rather than prevented them. Family caregivers experienced increased burden when services shifted the responsibility of caring for their mentally unwell relatives to them. Confidentiality was a delicate issue with family caregivers wanting more information and a say in decisions when they were responsible for aftercare, and being concerned about confidentiality of information they provided to services. Conclusion Compulsory admission of a close relative can be a complex and stressful experience for family caregivers. In order for caregivers to be effective partners in care, a balance needs to be struck between valuing their involvement in providing care for a patient and not overburdening them.
As research examining sluggish cognitive tempo (SCT) advances, it is important to examine the structure and validity of SCT in a variety of samples, including samples of children who are clinically-distressed but not referred specifically for attention-deficit/hyperactivity disorder (ADHD). The present study used a large sample of psychiatricallyhospitalized children (N?=?680; 73 % male; 66 % African American) between the ages of 6 and 12 to examine the latent structure of SCT, ADHD, oppositional defiant disorder (ODD), depression, and anxiety using confirmatory factor analysis (CFA). Results of the CFA analyses demonstrated that SCT is distinct from these other dimensions of child psychopathology, including ADHD inattention, depression, and anxiety. Regression analyses indicated that SCT symptoms were positively associated with depression and, to a lesser degree, anxiety. SCT symptoms were also positively associated with children's general social problems, whereas SCT symptoms were negatively associated with an observational measure of behavioral dysregulation (i.e., frequency of time-outs received as a part of a manualized behavior modification program). These associations were significant above and beyond relevant child demographic variables (i.e., age, sex, race), children's other mental health symptoms (i.e., ADHD, ODD, depression, anxiety symptoms), and, for all relations except child anxiety, parents' own anxiety and depression symptoms. PMID:23359144
Becker, Stephen P; Luebbe, Aaron M; Fite, Paula J; Stoppelbein, Laura; Greening, Leilani
Three hundred sixty-three patients representing two groups of consecutive medical admissions to a large city hospital were evaluated on admission to determine what factors might predict "non-medical" or social stay. Periodic follow-up determined when patients were ready for discharge and when their social stay began. A composite index, the 4-Score, was derived as a simple indicator of risk for subsequent social stay; it is defined as the number of positive answers to the questions: 1) Is the patient 80 years old or more? 2) Will the patient have to live somewhere new at discharge? 3) Is there any disorientation? AND 4) If so, is the disorientation chronic? Eighteen per cent of the total inpatient hospitaldays of this group of patients could be attributed to social stay. The 56 patients with a 4-Score of two or more on admission had on average a week each of social stay while the 307 patients with a score of less than two averaged only one social day each. Images FIGURE 2
Glass, R I; Mulvihill, M N; Smith, H; Peto, R; Bucheister, D; Stoll, B J
Background: This UK-based study compares the pathways to the psychiatrichospital and the provision of in-patient and after-care for\\u000a Asian, black and white patients with non-affective psychoses. Methods: Two overlapping samples of 120 patients, 40 from each ethnic group, were drawn; one on admission and the other at discharge.\\u000a In addition to socio-demographic data, details were obtained on the pathways
M. J. Commander; R. Cochrane; S. P. Sashidharan; F. Akilu; E. Wildsmith
This study examined the extent to which posthospitalization change in connectedness with family, peers, and nonfamily adults predicted suicide attempts, severity of suicidal ideation, and depressive symptoms across a 12-month follow-up period among inpatient suicidal adolescents. Participants were 338 inpatient suicidal adolescents, ages 13 to 17, who were assessed at 3, 6, and 12 months posthospitalization. General liner models were fitted for depressive symptoms and suicidal ideation outcomes, and logistic regression was used for the dichotomous suicide attempt outcome. The moderating effects of gender and multiple attempt history were examined. Adolescents who reported greater improvements in peer connectedness were half as likely to attempt suicide during the 12-month period. Improved peer connectedness was also associated with less severe depressive symptoms for all adolescents and with less severe suicidal ideation for female individuals, but only at the 3-month assessment time point. Improved family connectedness was related to less severe depressive symptoms and suicidal ideation across the entire year; for suicidal ideation, this protective effect was limited to nonmultiple suicide attempters. Change in connectedness with nonfamily adults was not a significant predictor of any outcome when changes in family and peer connectedness were taken into account. These results pointing to improved posthospitalization connectedness being linked to improved outcomes following hospitalization have important treatment and prevention implications given inpatient suicidal adolescents' vulnerability to suicidal behavior. PMID:22417194
Context To better guide strategies intended to reduce high rates of 30-day readmission after hospitalization for heart failure, acute myocardial infarction, or pneumonia, further information is needed about readmission diagnoses, readmission timing, and the relationship of both to patient age, sex, and race. Objective To examine readmission diagnoses and timing among Medicare beneficiaries readmitted within 30 days after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Design, Setting, and Patients We analyzed 2007 to 2009 Medicare Fee-For-Service claims data to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare & Medicaid Services’ Condition Categories. Readmission timing was determined by day after discharge. Main Outcomes Measures We examined (1) the percentage of 30-day readmissions occurring on each day (0–30) after discharge; (2) the most common readmission diagnoses occurring during cumulative time periods (days 0–3, 0–7, 0–15, and 0–30) and consecutive time periods (days 0–3, 4–7, 8–15, and 16–30) after hospitalization; (3) median time to readmission for common readmission diagnoses; and (4) the relationship between patient demographic characteristics and readmission diagnoses and timing. Results From 2007 to 2009, we identified 329,308 30-day readmissions after 1,330,157 heart failure hospitalizations (24.8% readmitted), 108,992 30-day readmissions after 548,834 acute myocardial infarction hospitalizations (19.9% readmitted), and 214,239 30-day readmissions after 1,168,624 pneumonia hospitalizations (18.3% readmitted). The proportion of patients readmitted for the same condition was 35.2% after index heart failure hospitalization, 10.0% after index acute myocardial infarction hospitalization, and 22.4% after index pneumonia hospitalization. Of all readmissions within 30 days, 61.0%, 67.6%, and 62.6% occurred with 15 days of discharge after hospitalization for heart failure, acute myocardial infarction, or pneumonia, respectively. The diverse spectrum of readmission diagnoses was largely similar in both cumulative (days 0–3, 0–7, 0–15, and 0–30) and consecutive (days 0–3, 4–7, 8–15, and 16–30) time periods after discharge. Median time to 30-day readmission was 12 days, 10 days, and 12 days for patients initially hospitalized with heart failure, acute myocardial infarction, or pneumonia, respectively, and was comparable across common readmission diagnoses. Neither readmission diagnoses nor timing substantively varied by age, sex, or race. Conclusions Among Medicare Fee-for-Service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, 30-day readmissions are frequent throughout the month following hospitalization and result from a similar spectrum of readmission diagnoses regardless of age, sex, race, or time after discharge.
Dharmarajan, Kumar; Hsieh, Angela F.; Lin, Zhenqiu; Bueno, Hector; Ross, Joseph S.; Horwitz, Leora I.; Barreto-Filho, Jose Augusto; Kim, Nancy; Bernheim, Susannah M.; Suter, Lisa G.; Drye, Elizabeth E.; Krumholz, Harlan M.
Incidence and risk factors for occupational exposure to blood-borne pathogens (OEBBPs) in a tertiary hospital in Saudi Arabia was assessed. Reported sharps injuries from 2009 to 2010 were analyzed and benchmarked using patient days. OEBBPs caused by sharps injuries increased from 41 in 2009 to 65 in 2010, with an incidence rate of 4.09/10 000 patient days in 2009 and 5.9/10 000 patient days in 2010. Most episodes (41%) occurred during recapping of hollow bore needles after obtaining blood specimens. The highest incidence was among nursing staff (n/N = 87/106; 82%), and injuries also occurred in housekeeping staff (3.7%). A correlation between morning shift and OEBBPs was observed, and the highest number of episodes occurred in the emergency room (21.5%) and renal dialysis unit (16.9%). There was exposure to HCV (n = 13) and HBV (n = 4) but not to HIV (n = 0), and no seroconversions were documented. Education on adherence to universal precaution measures and use of safety engineered devices as well as the introduction of an OEBBP notification hotline are recommended. PMID:22743860
Mazi, Waleed; Senok, Abiola C; Assiri, Abdullah M; Kazem, Najla; Abato, Avigail Tan
|This workshop was the third and final phase of a project to determine what goals, methods, content, and learning experiences in psychiatric-mental health nursing should be included in diploma and associate degree education for nursing in light of present day trends in psychiatric care. The project indicates that the hospital is no longer the…
National League for Nursing, New York, NY. Mental Health and Psychiatric Nursing Advisory Service.
AIM: To evaluate the applicability and safety of ambulatory laparoscopic cholecystectomy (LC) and to compare day case and overnight stay LC. METHODS: Data were collected retrospectively and consecutively for day case and overnight stay LC patients from July 1, 2009 to April 30, 2011. Outcomes were analyzed for patient demographics, operation time, blood loss during operation and frequency and reasons for unexpected or prolonged hospitalization in each group. RESULTS: There was no hospital mortality and no patient was readmitted with serious morbidity after discharge. 50 patients received a day case LC and 19 had an overnight stay LC. There was a significant difference in age between both groups (P < 0.02). There were no significant differences between the day case LC performed (n = 41) and failed (n = 9) groups and between the day case LC performed and the one night stay LC (n = 12) groups. There was a significant difference in age between the one night stay and more nights stay LC groups (P < 0.05). Thus, elderly patients showed a tendency to like to stay in hospital rather than being a day case. The proportion of unexpected or prolonged hospitalization was not significantly different between the day case and overnight stay LC groups, when the patient’s request was excluded. CONCLUSION: Day case LC can be performed with a low rate of complications. In overnight stay patients, there are many who could be performed safely as a day case. Moreover, we need to take special care to treat elderly patients.
This paper has been undertaken by people with experience with mental health issues and mental health care systems. The aim of the research was to explore psychiatric inpatients' strategies for coping with mental ill health and in what ways acute inpatient psychiatrichospital services are facilitative to the individual attempting recovery. Ten focus groups were facilitated and data were analysed through systematic content analysis. Findings revealed that the main areas of concern for inpatients were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans, and the physical environment. The authors also make a case to improve the status of user-led research as a means to understand the needs of mental health service users. PMID:19148819
The paper analyses the work of the psychiatrist in Biella Hospital D.E.A. between 15-1-83 and 15-1-87. The general outlines of the study are described under Material and Method. This is followed by a description of the way patients arrive at the D.E.A. during which it is pointed out that both the general practitioner and the local psychiatric service are generally excluded from the emergency circuit. The reasons for the emergency, the diagnosis arrived at and the types of treatment proposed by the psychiatrist are then reviewed. One section is dedicated to recurrences with particular emphasis on the so-called major users of the psychiatric emergency service. PMID:3683962
Merra, S; Lomonaco, E; Carotti, P; Zanin, L; Melina, A
BACKGROUND: This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. METHODS: During two months, all consecutive patients (n = 139) in a psychiatrichospital in Western Norway were interviewed (response rate 72%). RESULTS: Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma
The study analyzed length-of-stay and treatment differences between Medicaid and privately insured patients under care for some form of psychiatric illness. Results showed that Medicaid patients in all age and sex groups averaged shorter stays than privat...
Background While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care. Methods This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatrichospitals in London were interviewed in the community. Results Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships. Conclusion Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems.
Objectives This study aimed to determine the suitability of the Chinese version of the Hypomania Symptom Checklist (HCL-32) scale for psychiatric department outpatients with mood disorders in Chinese general hospitals, and provide a theoretical basis for the application of the HCL-32 scale. Methods Outpatients with mood disorders receiving continuous treatment in the psychiatric medicine department of three top-ranking general hospitals in three cities completed scoring the HCL-32 scale. Results A total of 1010 patients were recruited. 417 were diagnosed with bipolar disorder (236 for type I and 181 for type II) and 593 were depression. Four factors with eigenvalues >1 were considered. Factor 1 with an eigenvalue of 5.5 was labeled “active/cheerful”. Factor 2 with an eigenvalue of 2.7 was labeled “adventurous/irritable.” The coefficient of internal consistency reliability of the HCL-32 total scale was 0.84, and the coefficients for factors 1 and 2 were 0.84 and 0.88, respectively. With the total score of HCL-32?14 as positive standard, the sensitivity of HCL-32 was calculated at 69.30% and the specificity was 97.81%. Conclusions Results showed that HCL-32 had a preferable reliability and validity and was suitable as auxiliary means for bipolar disorder screening in general hospitals.
It is difficult to trace full details of the path which irregular or illegal immigrants follow when seeking assistance in\\u000a the network of the various hospital departments and health structures. The aim of this work was to analyze the health needs\\u000a of immigrant people by reviewing the types of treatment given to them in the day-hospital of our Department of
Andrea Affronti; Salvatore Pagano; Maurizio Soresi; Lydia Giannitrapani; Miriam Valenti; Emanuele La Spada; Giuseppe Montalto
Background: Hospital antibiotic use can be measured by calculating daily doses as defined by the WHO\\/ATC index (DDD) divided by the number\\u000a of patient or occupied bed days. We wondered whether changes in antibiotic use density over time at a university hospital\\u000a using this data format are similar in order of magnitude when compared with a different, alternative dose definition and
Background Length of stay at US acute care hospitals has been steadily decreasing since 1960, and there is ongoing concern that increasing financial pressures on hospitals with high proportions of Medicaid patients may be causing unduly short lengths of stay. Objective To study temporal trends in hospital utilization on internal medicine services at Temple University Hospital, which has the highest percentage of Medicaid and uninsured patients in the state of Pennsylvania. Design Examination of temporal changes in hospital practice over three time periods spanning 13 years. Measurements Numbers of discharges, 1- and 12-month re-admission rates, and lengths of stay. US census data from 1990 to 2000 were examined for the eight major zip codes in which hospitalized patients live. Main Results The number of internal medicine admissions increased from 1991 (117/month) to 2004 (455/month); p?0.0001. Mean length of stay for the index admission decreased from 8.7 to 4.9 days; p?0.001. The percentage of patients readmitted within 12 months of the discharge date of the index admission increased from 42.3% to 49.5%; p?=?0.045. Mean cumulative length of stay over 12 months, including readmissions, decreased significantly (15.8 to 12.5 days; p?=?0.031). Compared to all US hospitals, our hospital had a greater increase in admissions and a greater decrease in length of stay. During this time period, in surrounding zip codes, there were decreases in total population and total number of persons living in poverty, but also multiple closures of area hospitals that served poor patients. Conclusion During the 13-year study period, despite increased readmission rates, the overall number of hospitalizeddays per year on the internal medicine inpatient service decreased. As local hospitals serving this inner city low income area have closed, our hospital had atypically high increases in numbers of admissions and decreases in length of stay. This raises questions about current adequacy of hospital care in inner city areas of poverty.
The chaplain experience in modern-dayhospital medicine is largely one of marginalization. It is not, however, an experience without agency. Working within the constraints of difference, chaplains learn how to negotiate on the margins of medicine. This starts with learning the language of hospital medicine, learning to skillfully see, speak, and move in ways that minimize difference. Successes in socialization and acclimation do not, however, guarantee the chaplain a place in the hospital, where chaplains encounter both structural marginalization (resulting from inequalities in power and hierarchy) and ideological marginalization (resulting from inequalities in accepted forms of knowledge and practice). Using the theories of Michel Foucault (1973) and Byron Good (1994), I examine how chaplains negotiate structural and ideological marginality, at times embracing their connection to medicine (downplaying their connection to the institution of religion) and at other times embracing their connection to religion and religious practices. The result is an ambivalent chaplain who strategically embraces one or the other paradigm in order to survive. Using data gathered during a 12-month ethnography of chaplain interns at a university teaching hospital, this article examines the structural and ideological differences between science and religion through the modern-day practice of hospital chaplains. It both introduces readers to the modern-day chaplain, a healer largely absent in ethnography, and adds a renewed perspective to a long-standing body of literature on the relationship between structure and agency, and science and religion. PMID:16546831
|Background: This study reflects a growing concern with the placement of people with intellectual disabilities and complex mental health problems in out of area placements at a distance from their families and communities. Materials and methods: We interviewed service users (n = 17) living in out of area in-patient psychiatric units using a…
It has been hypothesized that the immune system plays a pathogenetic role in psychiatric disorders, in particular in major depression and schizophrenia. This hypothesis is supported by a number of reports on altered circulating levels and in vitro production of cytokines in these disorders. However, the respective evidence is not consistent. This may be in part due to an incomplete
M. Haack; D. Hinze-Selch; T. Fenzel; T. Kraus; M. Kühn; A. Schuld; T. Pollmächer
Between 20% and 70% of psychiatric patients have a co-occurring substance use disorder and rates of substance abuse among patients with psychotic disorders are especially high. Patients with co-existing psychosis and substance use disorders typically have poorer outcomes than patients diagnosed with either disorder alone. Frequently, treatment services for such dually diagnosed patients are not integrated and organizational barriers may
Shelly F. Greenfield; Roger D. Weiss; Maurico Tohen
To identify the pattern and determinants of psychiatric illness and the predictors of long stay among long-stay patients at the Mental Health Hospital, Taif, Saudi Arabia, we examined a total of 430 records of patients who had been admitted during the period January 1999-January 2009 and had stayed for > 9 months. More than half these patients had a history of drug addiction (60.7%). The majority were diagnosed with schizophrenia (88.8%) and mental retardation was reported in 17.7%. Personality disorders and epilepsy were diagnosed in 3.7% and 1.9% of the participants respectively. The mean duration of hospital stay was 6.16 (standard deviation 2.32; range 1-10) years. Multivariate logistic regression analysis showed that patients diagnosed with schizophrenia accompanied by mental retardation, those with lower education levels, and those with a history of co-morbid chronic diseases stayed for more than 2 years. PMID:23520904
Physical rehabilitation dayhospitals are widely used community-based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored…
Kneebone, Ian I.; Hurn, Jane S.; Raisbeck, Elizabeth; Cropley, Mark; Khoshnaw, Hiro; Milton, Jane E.
An outbreak of scarlet fever involving 12 children occurred at a hospitalday care centre from February to March 1996. Twenty-five throat isolates of Streptococcus pyogenes (GAS, group A streptococcus) available from 24 children, including 10 children with scarlet fever and 14 asymptomatic carriers, and one asymptomatic staff member were studied for the presence of genes encoding streptococcal pyrogenic exotoxin
We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11,017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982-1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77%) vs 6687 out of 10,630 (62.9%) (OR = 2.0, 95% CI = 1.6-2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7-99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5-38.1) and schizophrenics more than a 30-fold (OR = 37.5, 95% CI = 19.1-73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2-4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2-4.2, vertebral column disorders (OR = 4.2, 95% CI = 1.8-9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2-3.6) and induced abortions (OR = 1.8, 95% CI = 1.2-2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0-31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1-5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8-42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable morbidity in their patients. PMID:9724944
Mäkikyrö, T; Karvonen, J T; Hakko, H; Nieminen, P; Joukamaa, M; Isohanni, M; Jones, P; Järvelin, M R
Chronic obstructive pulmonary disease (COPD) is common in patients undergoing percutaneous coronary intervention (PCI), but the impact of COPD on outcomes after PCI has received limited attention. Consecutive patients with coronary heart disease (n = 5155) undergoing PCI were enrolled in this study; 645 patients (73% men) aged 68.4 ± 13.2 years had COPD and 4510 patients (71% men) aged 64.7 ± 12.1 years did not. During the in-hospital period after PCI, the patients with COPD experienced a significantly higher incidence of angina (P < .001), arrhythmias (P < .001), and composite major adverse cardiac events (MACEs; P < .001) and longer hospital stay (P < .001) than those without COPD. Additionally, severity of COPD (measured by pulmonary function tests) was associated with increased composite MACE (P < .001) and hospital stay (P < .001) after PCI. In conclusion, COPD is associated with significantly increased composite MACE and hospital stay in patients after PCI. Increasing severity of COPD is associated with increased composite MACE and hospital stay after PCI. PMID:22942128
Zhang, Jian Wei; Zhou, Yu Jie; Yang, Qing; Yang, Shi Wei; Nie, Bin; Xu, Xiao Han
SUMMARY Evidence suggests that patients with psychiatric illnesses may be more likely to experience a delay in diagnosis of coexisting cancer. The association between psychiatric illness and timely diagnosis and survival in patients with esophageal cancer has not been studied. The specific aim of this retrospective cohort study was to determine the impact of coexisting psychiatric illness on time to diagnosis, disease stage and survival in patients with esophageal cancer. All patients with a diagnosis of esophageal cancer between 1989 and 2003 at the Portland Veteran’s Administration hospital were identified by ICD-9 code. One hundred and sixty patients were identified: 52 patients had one or more DSM-IV diagnoses, and 108 patients had no DSM-IV diagnosis. Electronic charts were reviewed beginning from the first recorded encounter for all patients and clinical and demographic data were collected. The association between psychiatric illness and time to diagnosis of esophageal cancer and survival was studied using Cox proportional hazard models. Groups were similar in age, ethnicity, body mass index, and history of tobacco and alcohol use. Psychiatric illness was associated with delayed diagnosis (median time from alarm symptoms to diagnosis 90 days vs. 35 days in patients with and without psychiatric illness, respectively, P < 0.001) and the presence of advanced disease at the time of diagnosis (37% vs. 18% of patients with and without psychiatric illness, respectively, P = 0.009). In multivariate analysis, psychiatric illness and depression were independent predictors for delayed diagnosis (hazard ratios 0.605 and 0.622, respectively, hazard ratio < 1 indicating longer time to diagnosis). Dementia was an independent risk factor for worse survival (hazard ratio 2.984). Finally, psychiatric illness was associated with a decreased likelihood of receiving surgical therapy. Psychiatric illness is a risk factor for delayed diagnosis, a diagnosis of advanced cancer, and a lower likelihood of receiving surgical therapy in patients with esophageal cancer. Dementia is associated with worse survival in these patients. These findings emphasize the importance of prompt evaluation of foregut symptoms in patients with psychiatric illness.
O'Rourke, R. W.; Diggs, B. S.; Spight, D. H.; Robinson, J.; Elder, K. A.; Andrus, J.; Thomas, C. R.; Hunter, J. G.; Jobe, B. A.
Post-discharge outcomes following percutaneous coronary intervention (PCI) are important measures of quality of care and complement in-hospital measures. We sought to assess in-hospital and post-discharge PCI outcomes to 1) better understand the relationship between acute and 30 day outcomes, 2) identify predictors of 30-dayhospital re-admission, and 3) determine the prognostic significance of 30-dayhospital readmission. We analyzed in-hospital death and length of stay (LOS) and non-elective cardiac-related re-hospitalization following discharge in 10,965 patients following PCI in the Dynamic Registry. From 1999–2006, in-hospital death rate and LOS declined. The 30-day cardiac re-admission rate was 4.6%, with considerable variability over time and among hospitals. The risk of re-hospitalization was greater in women, those with CHF, unstable angina, multiple lesions and emergency PCI. Conversely, a lower risk of re-hospitalization was associated with a higher number of treated lesions. Patients re-admitted within 30 days had higher one-year mortality than those free from hospital readmission. In conclusion, while in-hospital mortality and LOS following PCI have decreased over time, the observed 30 day cardiac re-admission rate was highly variable and the risk of re-admission was more closely associated with underlying patient characteristics than procedural characteristics.
Ricciardi, Mark J.; Selzer, Faith; Marroquin, Oscar C.; Holper, Elizabeth M.; Venkitachalam, Lakshmi; Williams, David O.; Kelsey, Sheryl F.; Laskey, Warren K.
|A retrospective cohort of discharged patients from all public psychiatrichospitals in Hong Kong (1997-1999) was linked to suicide data from Coroner's court. Patients hospitalized shorter than 15 days had significantly lower suicide rates than longer stay patients. The results were fairly consistent across immediate/late post discharge periods,…
A retrospective cohort of discharged patients from all public psychiatrichospitals in Hong Kong (1997-1999) was linked to suicide data from Coroner's court. Patients hospitalized shorter than 15 days had significantly lower suicide rates than longer stay patients. The results were fairly consistent across immediate/late post discharge periods,…
Background: “Bounce-backs” (movements from a less intensive to a more intensive care setting) soon after hospital discharge are common, but reasons for bouncing-back remain unknown.Objective: To examine how the primary diagnosis for first rehospitalization relates to thirty-day bounce-back number and initial discharge destination in acute stroke.Population: Administrative data from 5,250 Medicare beneficiaries > 65 years discharged with acute ischemic stroke
Amy J. H. Kind; Maureen A. Smith; Nancy Pandhi; Jennifer R. Frytak; Michael D. Finch
BACKGROUND: Substance-abusing adults are admitted to hospitals for medical complications from their drug and alcohol use at substantially\\u000a higher rates than the general public; yet, their care is often defined by against medical advice (AMA) discharges and low\\u000a rates of referral to addiction treatment programs.\\u000a \\u000a \\u000a METHODS: We present findings from a chart review of consecutive admissions to an integrated medical-substance
Thomas P. O'Toole; Alicia Conde-Martel; J. Hunter Young; Jennifer Price; George Bigelow; Daniel E. Ford
'What is it that appears to make the mentally ill so vulnerable to therapeutic experimentation?'(1) One commentator wrote in the 1990s, regarding mental hospitals as repressive, coercive and custodial institutions where medical staff subjected patients to orgies of experimentation. A careful study of surviving documents of the Devon County Lunatic Asylum (DCLA), however, paints a different picture. Rather than medical staff, patients' relatives and the wider community exercised a considerable influence over a patient's hospital admission and discharge, rendering the therapeutic regime in the middle of the 20th century the result of intense negotiations between the hospital and third parties. PMID:23876990
As the role of Polish nurses continues to expand, so does their need for education at the university level. This is particularly evident for nurses joining the therapeutic teams in Poland's psychiatrichospitals. In the new structure of psychiatric service being offered, nurses are not only doctors' partners in the diagnostic, therapeutic, resocialization and psychotherapeutic processes but also fellow promoters of mental health. They are needed as a source of new ideas and solutions as well as to initiate new forms of activities in hospitals, consulting units or whatever setting they find themselves. PMID:2373607
Objective To examine the number of hospital discharges and 30-day case fatalities due to drug poisoning based on data from a Danish County Hospital Discharge Registry from 1979 to 2002. Methods All patients with a hospital discharge diagnosis of drug poisoning were identified and separated into groups taking: (1) opioid analgesics; (2) non-opioid analgesics; (3) anxiolytics; (4) antidepressants; (5) antipsychotics;
This study uses a new paradigm to calculate the min imum and the optimum number of involuntary psychi atric beds at a state hospital in Maine with 5538 admissions over a 7-year period. The method measures quality of care (Q) based upon the accuracy of predic tion of length-of-stay for the hospital, and of commu nity length-of-stay for the community,
George E. Davis; Walter E. Lowell; Geoffrey L. Davis
It is difficult to trace full details of the path which irregular or illegal immigrants follow when seeking assistance in the network of the various hospital departments and health structures. The aim of this work was to analyze the health needs of immigrant people by reviewing the types of treatment given to them in the day-hospital of our Department of Migration Medicine. Our study analyzed day-hospital admissions between 2003 and 2009. The patient charts used for managing day-hospital activity were adopted in 2002 in conformity with the "OSI project". From these it is possible to draw up a scale picture of the distribution of each pathology in the immigrant population. The sample population consisted of 1,758 subjects, representing 7.4% of potential users. More than half came from Africa, followed by Asia, and then Europe. Gastroenterological diseases ranked first, with dyspeptic syndromes most frequently diagnosed. Infections and parasitic diseases ranked second, and the most frequent diagnoses were sexually transmitted diseases. Third were diseases of the genitourinary system. Metabolic disorders ranked fourth, among them, more than half of the cases were of diabetes mellitus, in patients from south-east Asia. Diseases of the circulatory system were sixth, with hypertension the most frequent pathology. Our data confirm a marked persistence of the phenomenon known as the "healthy immigrant effect" in these types of patients, as well as the prominent role played by "social determinants" in conditioning the health of immigrants, particularly in the case of some infectious diseases. PMID:21647689
Affronti, Mario; Affronti, Andrea; Pagano, Salvatore; Soresi, Maurizio; Giannitrapani, Lydia; Valenti, Miriam; La Spada, Emanuele; Montalto, Giuseppe
Although postpartum depression and other perinatal disorders have been the subject of increased research attention, important questions remain regarding women who actively seek psychiatric treatment during pregnancy and the postpartum period. In this study, we examined clinical records of 500 perinatal psychiatric patients who received treatment in a psychiatricdayhospital (N = 398) or outpatient behavioral health clinic (N = 102). Patients' presenting diagnoses, psychiatric history, treatment course, and depressive symptoms were recorded. The majority of women had major depression as their primary diagnosis, with an average Edinburgh Postnatal Depression Scale score of over 20. Many depressed patients were diagnosed with comorbid anxiety and substance abuse disorders. Although most women were willing to take psychotropic medications, a sizable minority were not, particularly those who were breast-feeding. For more than a third of the sample, the treatment sought while pregnant or postpartum represented their first contact with the mental health system. Treatment implications are discussed. PMID:16699387
Battle, Cynthia L; Zlotnick, Caron; Miller, Ivan W; Pearlstein, Teri; Howard, Margaret
This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients. PMID:23568306
Barros, Juliana B; Goulart, Alessandra Carvalho; Alencar, Airlane P; Lotufo, Paulo A; Bensenor, Isabela M
This study sought to determine to what extent a multivariate model could predict psychiatric inpatient length of stay. Data were collected from psychiatric service discharges at the Jewish Hospital of Cincinnati during 10 months in 1992 and 1993. Descriptive and multivariate analysis were completed using twelve variables to predict length of stay. The results of this investigation indicated a statistically
Both positive and negative effects of the reform of the health care financing system are noted. Low prices offered by Sickness Funds for particular services (a bed-day, a visit) should be regarded as a negative effect of the reform. Particularly insufficient were the prices of services in some specialised psychiatric wards and in outpatient clinics. Prices in many community-based psychiatric facilities were also considerably underestimated. Undoubtedly, the reform has led to positive changes in the organization of inpatient care. These changes include: further reduction of beds in large hospitals organisational structure as well as a marked increase in the number of psychiatric wards at general hospitals, which should be the key units of psychiatric inpatient care. Increase in the number of dayhospitals is another positive effect of the reform. The programme of psychiatric care transformation is presented mostly in the Mental Health Programme. The main goal of this programme is to ensure appropriate care for the mentally disordered people, namely comprehensive and accessible health care as well as other forms of help and and support necessary for living in family and in society. This goal will be accomplished by health care and other forms of help mentioned in the Mental Health Act and in the Social Help Act. Community-based model of psychiatric care is the key element of this system. Also, the Programme states desired accessibility rates for staff, number of beds and number of particular forms of psychiatric and alcohol treatment care. Separate rates for adult and children/youth population have been elaborated. PMID:12043037
The present work is divided into four parts, the first part is a brief "Discourse on Emergency" that attempts to clarify the elements that distinguish psychiatric from medical emergency. The second part reviews the "Clinical pictures in which psychiatric emergency is not common". Psychopathological emergencies are briefly reviewed and mention is made of psychiatric emergencies deriving from non-psychiatric pathologies. The third part gives "Advice on the right approach to adopt in response to calls". Some integrated approaches are suggested. The fourth part presents several models of "Short-term psychotherapy in psychiatric emergency". Two cases of emergency treatment using multiple approach techniques are reported. PMID:3763026
The use of restraint and seclusion is highly regulated in psychiatric inpatient settings. However, the majority of studies of restraint and seclusion are based on public hospitals serving adult patients, with some limited data available on adolescents and children. This paper presents prospectively collected data on restraint and seclusion over a 2-year period at a private psychiatrichospital whose patients include large numbers of both adolescents and pre-adolescent children. 2 years of restraint and seclusion data were analyzed on a total of 2,411 unique patients. Types of seclusion included in-room seclusion on the treatment unit and off-unit seclusion in a separate seclusion annex. Restraints consisted solely of short term (<15 min) and longer term (>14 min) manual restraints. The use of IM medication was also recorded. The precipitants of these events were examined. These included physical and verbal threats, stabbing or throwing objects, attempts to elope, attempts to hurt one's self or another, or property destruction. Out of 2,411 child and adolescent in-patients admitted during the period under review, only 703 (29%) experienced restraint or seclusion. Among these, the modal number of events per patient was one (n = 156), but the maximum number of occurrences was 163. Child patients had a much higher frequency of events (n = 396, 53%) than adolescents (n = 307, 19%). There were notable differences in the types of seclusion events, with children typically experiencing in-room seclusion on the unit. When age was examined as a continuous variable, younger patients had a higher prevalence of restraint and seclusion, significantly more restraint and seclusion, and these restraint and seclusion events were significantly shorter than those seen in older patients. Multiple other potential determinants of these events were examined, including diagnosis, symptom severity at admission, age, and gender, but none of these predicted these events. Restraint and seclusion events were more common for children and less so for adolescents, with robust age effects for the likelihood of any seclusions, the number of seclusions and restraints, and the duration of seclusions and restraints. Patients who experienced restraint or seclusion typically required it only once during their hospitalization. Only age was found to be a predictor of the restraint and seclusion variables. Given these findings, it appears that management of agitated behavior in children and adolescents may be a qualitatively different phenomenon. Future research should be directed at understanding the determinants of high frequency agitated behavior and developing alternatives to seclusion or restraint. PMID:22194033
Pogge, David L; Pappalardo, Stephen; Buccolo, Martin; Harvey, Philip D
PROBLEM BEING ADDRESSED: The Geriatric Day Program (GDP) of the Capital Health Region in Victoria, BC, is concerned with effective team processes, accountability for health service outcomes, and improving the quality of programs. The GDP identified a need to improve its interdisciplinary processes and generate useful patient outcome data. OBJECTIVE OF PROGRAM: To determine whether Goal Attainment Scaling (GAS) could be introduced to facilitate interdisciplinary processes and to generate useful health outcome data. MAIN COMPONENTS OF PROGRAM: The GAS procedures were incorporated into clinical routines based on published guidelines. The authors determined GAS outcome scores for patients who completed the program and developed outcome scores for specific geriatric problem areas requiring intervention. Outcome scores were made available to the clinical care team and to program managers for continuous quality improvement purposes. CONCLUSIONS: The GAS process was successfully implemented and was acceptable to clinicians and managers at the GDP. Team processes were thought to be improved by focusing on patient goals in a structured way. The GAS provided data on both patient outcomes and outcomes of interventions in specific problem areas. Accountability for patient care increased. Goal Attainment Scaling provided indicators of care for which clinicians could develop program quality improvements.
Background Obesity is today’s principal neglected public health problem, as a rising proportion of adults will succumb to the medical complications of obesity. However, little is known about the burden of obesity in adults living in Ontario. Objectives To present an overview of the human and economic burden associated with BMI categories in Ontario, Canada, in terms of socio-demographics, comorbidities, health-related quality of life (HRQoL) and costs associated with hospitalization, same day procedures and physician visits. Methods The records of all Ontarians who participated in the Canadian Community Health Survey (CCHS), cycle 1.1 and provided consent to data linkage were linked to three administrative databases. Socio-demographic variables, medical characteristics, HRQoL, one year hospitalization, day procedure and physician costs were described per BMI category. Regression analyses were conducted to identify predictors of medical characteristics, HRQoL and costs. Results More than 50% of adult participants were either overweight or obese in 2000/2001. Obese adults, and to a lesser extent overweight adults, were more likely to report physician-diagnosed comorbid conditions, to use medications, and to have a lower HRQoL. After covariate adjustment, the hospitalization and physician costs were respectively 40% and 22% higher among obese and overweight adults than among normal-weight adults. No statistical cost differences were observed between normal and underweight individuals or between normal and overweight individuals. HRQoL was significantly lower in underweight and obese adults when compared to normal-weight individuals. Conclusions Due to the large human and economic burden associated with under- or excess-weight, policies promoting healthy weight should remain a priority for governments and employers.
Psychiatric abuse, such as we usually associate with practices in the former Soviet Union, is related not to the misuse of psychiatric diagnoses, but to the political power intrinsic to the social role of the psychiatrist in totalitarian and democratic societies alike. Some reflections are offered on the modern, therapeutic state's proclivity to treat adults as patients rather than citizens, disjoin rights from responsibilities, and thus corrupt the language of political-philosophical discourse.
DNAi location: Chronicle>In the Third Reich>"the final solution" In September 1939, Hitler attacked Poland. Sterilizations slowed nearly to a halt, likely because most people who fit the legal crtieria had already been sterilized. Acting on Hitler's suggestion that incurable mental patients "be granted mercy killing," a panel of psychiatrists and medical doctors completed a one-page questionnaire on each of 283,000 patients in mental hospitals throughout Germany. More than one-fourth of cases, those who were incurable or could not work, were marked with a "ÃÂ" for death.
Background To assess the incidence of venous thromboembolism (VTE) and bleeding events with or without thromboprophylaxis and the associated costs in a cohort of medically ill patients in both in-hospital and outpatient settings. Methods A large hospital drug database and linked outpatient files were used to identify patients eligible for this analysis, based on demographic and clinical characteristics. Results Among 11,135 patients identified, 1592 (14.30%) were admitted with chronic heart failure, 1684 (15.12%) with thromboembolic stroke, 3834 (34.43%) with severe lung disease, 1658 (14.89%) with acute infection, and 2367 (21.26%) with cancer. Of the 11,135 patients, 5932 received anticoagulant therapy at some point during their hospitalization and until 30 days after discharge. VTE events occurred in 1.30% of patients who received anticoagulant prophylaxis versus 2.99% of patients who did not. Risk-adjusted total healthcare costs for patients with a VTE or major or minor bleeding event were significantly higher than for those without events (VTE: $52,157 ± 24,389 vs $24,164 ± 11,418; major bleeding: $33,656 ± 18,196 vs $24,765 ± 11,974; minor bleeding: $33,690 ± 14,398 vs $23,610 ± 11,873). In a multivariate analysis, appropriate anticoagulant prophylaxis use was significantly associated with a reduced risk of clinical VTE, compared with no anticoagulant use (hazard ratio: 0.37). Patients admitted with thromboembolic stroke were less likely to have a VTE than patients admitted with cancer (hazard ratio: 0.42). Conclusions In this analysis, VTE and major bleeding event rates were lower for patients who received prophylaxis compared with those who did not. Prophylaxis use was associated with lower healthcare costs.
There have been several attempts made to reduce the occurrence of violence in hospital settings, with most professional organizations taking a stance. The impact of violent incidence on the therapeutic environment and the cost in human terms led to the declaration by the World Health Organization that violence is a public health problem. There are strategies for reducing violence that flow out of known trends. We sought to examine the trends in institutional violence in a contextual sense. We reviewed the records of all incidents of violence, categorized by severity, victims and trends over five years in a multilevel secure forensic hospital in Canada. The rate of violence perpetrated by female patients was significantly higher than for male patients. Higher occurrence of violence was recorded in the winter months compared with any other season and was related to unstructured activities. There is a window of opportunity to develop some engaging programmes during the long winter months and improve supervision at all times of unstructured activity. The reasons for increased women perpetration and the winter peak of violence require further investigation. PMID:23362235
Peluola, Akin; Mela, Mansfield; Adelugba, Olajide O
Hospital emergency services have been used increasingly in recent years. This has resulted in questions as to the true nature of patients' complaints and the appropriateness of this type of care. Since the increase in the number of psychiatric emergency patients has paralleled that for patients at other types of emergency clinics a study was conducted at the Clarke Institute of Psychiatry, Toronto, to examine the situation prior to the inception in 1977 of a crisis intervention unit. It was found that most patients had both psychiatric and social difficulties, and it was considered that planning should concentrate on strategies for efficient management of the clinical problems.
Eastwood, M. R.; Stiasny, S.; Cashman, F.; Littmann, S. K.; Voineskos, G.
This retrospective study analyzed the factors and variables that would impact on the implementation of a same-day surgery (SDS) program at the 121st General Hospital. The 121st General Hospital serves as the primary, definitive-care medical treatment faci...
Foundations for a two-stage dispensarization of patients with phlebothrombosis of the retina are given. The experience of work with one-dayhospital at the Office of Ophthalmoendocrinology and Vascular Pathology of the Eye has confirmed efficacy of this new form of ophthalmological aid beyond a hospital system. PMID:2733961
An attempt was made to formulate a tool that, when compared to the appropriateness evaluation protocol (AEP) used for evaluating the utilization of hospital services for medical patients, would be an improvement. To establish this, a four-phase project was evolved, which included: (a) taxonomy definition of medical and nonmedical reasons for acute-care hospital bed utiliza tion for a day of
B. Mozes; Y. Rosenblum; L. Rom; N. Friedman; E. Shabtai; A. Porat
Dr. Bayrakal believes that the time has come for the family physician to deal with minor psychiatric disturbances in his office as well as psychiatric emergencies in the emergency department. The newly emerging medico-social philosophy of both the federal and provincial governments, he says, is giving greater responsibility and authority to the family physician in every area of medicine, including psychiatry. The author discusses major psychiatric emergencies (suicide, suicidal attempt, homicide, social scandal, as well as other psychiatric emergencies) on the ward including adolescent psychiatry. (The descriptions and treatment procedures are given on a concrete clinical level without theoretical overload.) In the family physician's work, psychological understanding is of profound importance. Giving him the added scope of psychiatric consideration to see the patient in bio-psycho-social totality will enable him to practice a more humanized form of medicine.
|The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatrichospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…
The authors sought to identify college students at risk for experiencing a mental health crisis that warranted a psychiatric evaluation at a hospital and/or a psychiatrichospitalization. A retrospective chart review of college students evaluated at a comprehensive psychiatric emergency program during a 1-year period was conducted. Demographic…
...Publication of Updates to the inpatient psychiatric facility prospective payment system...Hospital Services of Inpatient Psychiatric Facilities Â§ 412.428 Publication of Updates to the inpatient psychiatric facility prospective payment...
...Publication of Updates to the inpatient psychiatric facility prospective payment system...Hospital Services of Inpatient Psychiatric Facilities Â§ 412.428 Publication of Updates to the inpatient psychiatric facility prospective payment...
...Method of payment under the inpatient psychiatric facility prospective payment system...Inpatient Hospital Services of Inpatient Psychiatric Facilities Â§ 412.432 Method of payment under the inpatient psychiatric facility prospective payment...
...Method of payment under the inpatient psychiatric facility prospective payment system...Inpatient Hospital Services of Inpatient Psychiatric Facilities Â§ 412.432 Method of payment under the inpatient psychiatric facility prospective payment...
Background: The present study aimed: to assess prescribing patterns in the treatment of major depression, bipolar disorder type I, cyclothymia, and dysthymia from 1996 to 2007 in a dayhospital setting; to evaluate the prevalence of the above-mentioned mood disorders and gender distribution; and to relate familiality, comorbidity, and marital status to each diagnosis. Methods: Medical records for 777 dayhospital patients with a diagnosis of major depression, bipolar disorder type I, cyclothymia, or dysthymia were grouped into two 6-year periods so as to compare the prescribing patterns of tricyclic antidepressants, selective serotonin reuptake inhibitors, noradrenergic reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic and specific serotonergic antidepressants, first-generation antipsychotics, second-generation antipsychotics, and mood stabilizers. Gender, prevalence, familiality, comorbidity, and marital status were related to each diagnosis. Results: The most common mood disorder, with a female preponderance, was major depression, regardless of marital status. High percentages of familiality and comorbidity were found for major depression, while a reduction was found in the utilization of tricyclic antidepressants. There was no statistically significant difference in rates of prescription of selective serotonin reuptake inhibitors and noradrenergic reuptake inhibitors, but some irregularities were found upon evaluating each diagnosis (eg, increased utilization of these agents in dysthymia and major depression, respectively). There was an increase in prescriptions for serotonin and norepinephrine reuptake inhibitors, but no marked differences in utilization of noradrenergic and specific serotonergic antidepressants, which remained basically low. There was no significant difference in prescribing of first-generation antipsychotic agents, although a reduction was found. There was a significant increase in utilization of second-generation antipsychotics and mood stabilizers. Conclusion: Our epidemiological findings are consistent with data reported in the literature regarding the high prevalence of major depression among the mood disorders, as well as the impact of familiality and comorbidity. Analysis of prescribing patterns for antidepressants, antipsychotics, and mood stabilizers in the treatment of mood disorders shows a shift from older to newer drugs, and wider use of mood stabilizers.
We describe the physical, psychological, and social complications and adaptation demands after epilepsy surgery and the risks of the development of psychiatric disorders when adequate stress processing fails. Practical strategies that can be followed in the prevention and treatment of postsurgical psychiatric complications are reviewed. The postoperative period is divided in three phases: (1) the early postoperative phase of stress processing until discharge from hospital; (2) the coping phase during the first months after discharge; and (3) the reorientation phase. The early postoperative course is often dominated by physical problems that hamper success in convalescence. They may initiate early psychiatric disturbances especially in patients with preoperative psychiatric comorbidity. The second phase after discharge from hospital is the typical time in which various psychiatric disorders may develop (either de novo or exacerbations of known disorders). At this time it is mandatory to keep in contact with patients, to start psychiatric treatments if necessary, and to assess for suicidal risk. The course of the third phase of reorientation depends on seizure outcome and on psychiatric state. Seizure-free persons without psychiatric comorbidities start to forget their epilepsy; those with less successful outcome conditions may need further support, especially for vocational integration. Epilepsy surgery brings about an overall strong improvement of psychiatric morbidity and quality of patients' life. Nevertheless, the first postoperative year is a fragile period that includes multiple physical, psychological, and social adaptation tasks. Patients with a history of psychiatric disorders are at a special risk of failing to cope with those health-related demands, but also for nonpsychiatric patients the months after epilepsy surgery are often stressful and exhausting. Professional help must be available during the postoperative coping time. PMID:23458466
Koch-Stoecker, Steffi; Schmitz, Bettina; Kanner, Andres M
Part-time hospitalization for persons with psychiatric disorders is underdeveloped, underutilized and often poorly understood, but should be encouraged in view of the unsatisfactory living conditions of patients discharged from hospital who still require care, the reductions in psychiatric impatient populations and numbers of beds, the increasing costs of health services and the current fiscal restraints. Day and night hospitals can provide an alternative to inpatient or outpatient treatment, rehabilitation for the long-term patient or treatment for the patient in transition from inpatient to outpatient status. The dayhospital can also provide a diagnostic setting. Such programs help preserve the patient's position in the family and the community, minimize the ill effects of hospitalization, and lower capital and operating costs of the psychiatric services. Awareness by medical and paramedical services of the value of these programs would increase their utilization. Shifting the emphasis of administrative and fiscal policies from inpatient to part-time hospitalization programs is also required.
Two epidemiologically defined cohorts of first-referred clients to outpatient clinics for alcoholics (1972 and 1982) were followed up. It was found that previous hospitalization is a pointer to admission to psychiatric institutions. More females are admitted than males and they are more often diagnosed as depressive. Over an 11-year follow-up period, the admitted males of the 1972 cohort spent an
|Because of the relatively poor treatment available, the high financial costs of hospitalization, multiple and complex issues of persons with severe mental illnesses, and advancements in pharmacotherapy, psychiatric patients are often only hospitalized for a few days before they are discharged. Thus, brief psychosocial interventions for persons…
According to data from Western countries, psychiatric disorders are relatively prevalent. For example, in the United States general population, data from the National Comorbidity Survey Replication study indicate that about one-quarter of individuals experience a psychiatric disorder in a given year, with lifetime rates at about 50 percent. For both prevalence designations, anxiety disorders are most common. According to data from the European Study of the Epidemiology of Mental Disorders, the 12-month and lifetime-prevalence rates for psychiatric disorders among European general populations are 11.5 and 25.9 percent, respectively, with mood and anxiety disorders evidencing approximately equal rates. As expected, in primary care settings, the prevalence of psychiatric disorders in the United States and Europe is high, with point-prevalence rates varying, but affecting approximately 25 to 30 percent of patients. In primary care settings, the most common psychiatric diagnoses are mood and anxiety disorders as well as somatoform disorders. While no global summary of cost of care is available, the high prevalence rates of psychiatric disorders correspond with high expenditures for mental healthcare, as evidenced by a number of sources. Given these latter findings, prevention becomes all the more relevant in terms of cost management.
...2012-10-01 2012-10-01 false Medical, psychiatric, and social evaluations...HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Medical, Psychiatric, and Social...
There has been considerable research on the influence of the lunar cycle on mental illness with conflicting findings. The objective of this study was to determine the relationship between full moon (FM), new moon (NM), and other moon (OM) days and the frequency of specific psychiatric disorders in patients seen at a tertiary psychiatrichospital in Goa and to examine relationships with eclipses. Analysis of all new patients in two calendar years (1997 & 1993) was carried out. Diagnoses of interest were : Non affective psychoses; depression; and mania. The numbers of new patients seen at the OPD of the Institute of Psychiatry & Human Behaviour, Goa, with these diagnoses were compared between FM, NM and OM days. Numbers of patients with these diagnoses on eclipse days (lunar/solar) were also examined. A significant trend was observed for greater numbers of patients with non-affective psychoses on FM days, but no pattern was observed for mania or depression. The excess of non-affective psychoses was more marked on days of a visible lunar eclipse. A relationship between FM and non-affective psychoses has been demonstrated. Its implications for further research and the potential mechanism to explain these findings are discussed.
Hospitalization for worsening chronic heart failure results in high post-discharge mortality, morbidity, and cost. However, thorough characterization, soon after discharge of patients with early post-discharge events has not been previously performed. The objectives of this study were to describe the baseline, in-hospital, and post-discharge clinical, laboratory, and neurohormonal profiles of patients hospitalized for worsening heart failure with reduced ejection fraction (EF) who die or are re-admitted for cardiovascular (CV) causes within 90 days of initial hospitalization. Retrospective analysis of 4,133 patients hospitalized for worsening heart failure with EF ?40% in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which randomized patients to tolvaptan or placebo, both in addition to standard therapy. Clinical and laboratory parameters were obtained within 48 h of admission, during hospitalization, and post-discharge weeks 1, 4, 8, and every 8 weeks thereafter for a median of 9.9 months. Patients with events within 90 days were compared with those with later/no events. All-cause mortality (ACM) and CV re-hospitalization were independently adjudicated. Within 90 days of admission, 395 patients (9.6%) died and 801 patients (19.4%) were re-hospitalized for CV causes. Significant baseline and longitudinal differences were seen between groups with early versus later (>90 days) or no events at 12 months post-randomization. Post-discharge outcomes were similar in the tolvaptan and placebo groups. Patients with early post-discharge events experienced clinically significant worsening in signs and symptoms, laboratory values, and neurohormonal parameters soon after discharge. Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization. PMID:21932146
Background National attention has increasingly focused on readmission as a target for quality improvement. We present the development and validation of a model approved by the National Quality Forum and used by the Centers for Medicare & Medicaid Services for hospital-level public reporting of risk-standardized readmission rates for patients discharged from the hospital after an acute myocardial infarction. Methods and Results We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with acute myocardial infarction. The model was derived using Medicare claims data for a 2006 cohort and validated using claims and medical record data. The unadjusted readmission rate was 18.9%. The final model included 31 variables and had discrimination ranging from 8% observed 30-day readmission rate in the lowest predictive decile to 32% in the highest decile and a C statistic of 0.63. The 25th and 75th percentiles of the risk-standardized readmission rates across 3890 hospitals were 18.6% and 19.1%, with fifth and 95th percentiles of 18.0% and 19.9%, respectively. The odds of all-cause readmission for a hospital 1 SD above average were 1.35 times that of a hospital 1 SD below average. Hospital-level adjusted readmission rates developed using the claims model were similar to rates produced for the same cohort using a medical record model (correlation, 0.98; median difference, 0.02 percentage points). Conclusions This claims-based model of hospital risk-standardized readmission rates for patients with acute myocardial infarction produces estimates that are excellent surrogates for those produced from a medical record model.
Krumholz, Harlan M.; Lin, Zhenqiu; Drye, Elizabeth E.; Desai, Mayur M.; Han, Lein F.; Rapp, Michael T.; Mattera, Jennifer A.; Normand, Sharon-Lise T.
BACKGROUND: To analyze the turnaround times of psychiatric patients within the Emergency Department (ED) from registration to discharge or hospitalization in a University Hospital in 2002. METHODS: Data from a one-year period of psychiatric admissions to the emergency service at a University Hospital were monitored and analyzed focused on turnaround times within the ED. Information on patients variables such as
Stefan Kropp; Christoph Andreis; Bert te Wildt; Udo Reulbach; Martin Ohlmeier; Irina Auffarth; Marc Ziegenbein
In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated. PMID:10135343
Fries, B E; Durance, P W; Nerenz, D R; Ashcraft, M L
Individual differences in behavioral regulation system (BRS) and stress response system (SRS) functioning may reflect greater biological sensitivity to context. The current study tested whether children's cortisol, a measure of the SRS, was related to observed dysregulated behavior, an indicator of the BRS, in a sample of children admitted for acute psychiatric inpatient care. In addition, cortisol and dysregulated behavior were tested as unique predictors of length of hospitalization over and above demographic factors, prior treatment history, and caretaker-reported psychiatric symptoms. The latter variables were tested as potential moderators of the relations of BRS and SRS functioning to length of hospitalization. Plasma cortisol was collected on the morning following hospital admission for 544 children (ages 6-12; 73% boys; 61% ethnic minority). Dysregulated behavior was operationalized as the mean number of timeouts administered by staff for noncompliant behavior per day of hospitalization. Caretakers reported on youth internalizing and externalizing symptomatology. Higher cortisol was modestly associated with greater dysregulated behavior. In a model including both cortisol and dysregulated behavior, each predicted longer hospitalization. Cortisol was positively related to length of stay only for children previously hospitalized, and the relation of dysregulated behavior to length of stay was stronger for older children. Dysregulated behavior and cortisol are related but independent predictors of acute psychiatrichospitalization duration. Direct measures of the SRS can add to the clinical picture regarding hospitalization in ways that observed behavior and caretaker report alone cannot. PMID:22417195
Luebbe, Aaron M; Elledge, L Christian; Kiel, Elizabeth J; Stoppelbein, Laura
To examine the psychiatric medication fill rates of adolescents after release from juvenile detention. The team reviewed 177 charts. A fill was defined as a psychiatric medication charge to Medicaid 30- or 90-days after release. Differences in demographic characteristics were compared among individuals with fills at 30- or 90-days and those with no medication fills. Forty-five percent of patients were on at least one psychiatric medication. Among detainees on a psychiatric medication, 62 % had a fill by 30 days after release, and 78 % by 90 days. At least 50 % of the adolescents on a psychiatric medication were on an atypical antipsychotic. There was no significant relationship between medication fill and race, age, or sex. Despite the known associations between mental health diagnosis and treatment-seeking with age, sex, and race, it appears that psychiatric medication fill patterns after release from detention are not associated with these factors. PMID:23381007
Neff, Mallery R; Aalsma, Matthew C; Rosenman, Marc B; Wiehe, Sarah E
|Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association…
Background: Length of hospital stay (LOS) in many diseases is determined by patient-related sociodemographic and clinical factors but also by the management of treatment and care. We examined the influence of the day of the week (DW) and month of admission on LOS in stroke patients. Methods: We used data from a large regional stroke registry in the northwest of
Wolf-Peter Schmidt; Dirk Taeger; Hans-Joachim Buecker-Nott; Klaus Berger
ObjectivesEvaluate the impact of an intensive insulin therapy and conventional glucose control protocol during staying in neurological intensive care unit (NICU) on infection rate, days in NICU, in-hospital mortality and long-term neurological outcome in severe traumatic brain injury (TBI) patients.
This paper describes some of the social trends of the 1970's that may be affecting patterns of psychiatric needs and presents data showing their impact. It suggests possible psychiatric and sociopolitical responses to meet these needs. Patients were studied in the outpatient and inpatient services of the Shands Teaching Hospital and Student Mental Health Services at the University of Florida.
Richard E. Gordon; Sharon Hamilton; Susan Webb; Katherine K. Gordon; Max Plutzky
Background This study aimed to examine the associations between psychiatric diagnoses, trauma and suicidiality in psychiatric patients at intake. Methods During two months, all consecutive patients (n = 139) in a psychiatrichospital in Western Norway were interviewed (response rate 72%). Results Ninety-one percent had been exposed to at least one trauma; 69 percent had been repeatedly exposed to trauma for longer periods of time. Only 7% acquired a PTSD diagnosis. The comorbidity of PTSD and other psychiatric diagnoses were 78%. A number of diagnoses were associated with specific traumas. Sixty-seven percent of the patients reported suicidal thoughts in the month prior to intake; thirty-one percent had attempted suicide in the preceding week. Suicidal ideation, self-harming behaviour, and suicide attempts were associated with specific traumas. Conclusion Traumatised patients appear to be under- or misdiagnosed which could have an impact on the efficiency of treatment.
A computerized psychiatric diagnostic interview was developed and administered to 121 adult acute psychiatric inpatients. Data on the 100 completers was evaluated for sensitivity and specificity of the computer diagnostic evaluation relative to the hospital discharge diagnosis and revealed sensitivity greater than 70% for major depression, alcohol/substance abuse, adjustment disorder, bipolar/mania, dependent personaltiy disorder, and histrionic personality disorder. Specificity was greater than 70% for schizophrania, alcohol/substance abuse, and borderline personality disorder. Meen interview time was 51 minutes. Eighty-two percent of patients evaluated the computerized interview as interesting and 78% rated it as thorough. The mouse input, large screen letters, and user-friendliness of the Macintosh computer make this ideal for patient-computer interaction.
Object A primary goal in the treatment of patients with warfarin-associated subdural hematoma (SDH) is reversal of coagulopathy with fresh-frozen plasma. Achieving the traditional target international normalized ratio (INR) of 1.3 is often difficult and may expose patients to risks of volume overload and of thromboembolic complications. This retrospective study evaluates the risk of mild elevations of INR from 1.31 to 1.69 at 24 hours after admission in patients presenting with warfarin-associated SDH. Methods Sixty-nine patients with warfarin-associated SDH and 197 patients with non-warfarin-associated SDH treated at a single institution between January 2005 and January 2012 were retrospectively identified. Charts were reviewed for patient age, history of trauma, associated injuries, neurological status at presentation, size and chronicity of SDH, associated midline shift, INR at admission and at hospitalDay 1 (HD1), concomitant aspirin or Plavix use, platelet count, and medical comorbidities. Patients were stratified according to use of warfarin and by INR at HD1 (INR 0.8-1.3, 1.31-1.69, 1.7-1.99, and ? 2). The groups were evaluated for differences the in rate of radiographic expansion of SDH and in the rate of clinically significant SDH expansion resulting in death, unplanned procedure, and/or readmission. Results There was no difference in the rate of radiographic versus clinically significant expansion of SDH between patients not on warfarin and those on warfarin (no warfarin: 22.3% vs 20.3%, p = 0.866; warfarin: 10.7% vs 11.6%, p = 0.825), but the rate of medical complications was significantly higher in the warfarin subgroup (13.3% for patients who did not receive warfarin vs 26.1% for those who did; p = 0.023). For warfarin-associated SDH, there was no difference in the rate of radiographic versus clinically significant expansion between patients reversed to HD1 INRs of 0.8-1.3 and 1.31-1.69 (HD1 INR 0.8-1.3: 22.5% vs 20%, p = 1; HD1 INR 1.31-1.69: 15% vs 10%, p = 0.71). Conclusions Mild INR elevations of 1.31-1.69 in warfarin-associated SDH are not associated with a markedly increased risk of radiographic or clinically significant expansion of SDH. Larger prospective studies are needed to determine if subtherapeutic INR elevations at HD1 are associated with smaller increases in risk of SDH expansion. PMID:23581582
Roguski, Marie; Wu, Kyle; Riesenburger, Ron I; Wu, Julian K
We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the\\u000a elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined\\u000a by $2,254 (in 2002 dollars) and covered days by 2.8. However, these changes are complicated by expanded use of skilled nursing\\u000a facilities and hospitalpsychiatric
Donald R. Hoover; Ayse Akincigil; Jonathan D. Prince; Ece Kalay; Judith A. Lucas; James T. Walkup; Stephen Crystal
Thirty one victims of bomb blast in a bus caused by terrorist activity in Dausa district, Rajasthan on 22.5.96, were evaluated for psychological reactions 3 days & 2 weeks after the incident. All hospitalized & non hospitalised bomb blast victims were assessed within 3 days of injury by objective predictors (percent of burnt area, facial disfigurement, limb amputations, fractures etc.) and subjective predictors (emotional distress and perceived social support). Detailed history, physical and mental state examination of all patients was carried out and for those having scores more then 17 on GHQ-60 (Hindi version), IPIS was administered. Diagnosis was made by 3 senior consultant psychiatrists of Psychiatric Centre, Jaipur, on the basis oflCD-10. At day 3 of 31 patients studied 11 (35.45%) had psychiatric morbidity. Out of which 6 (19.35%) had acute stress reaction, 3 (9.68%) had depression and 2 (6.45%) dissociative amnesia. Most commonly reported symptoms on IPIS were depersonalisation, derealisation, sleep disturbances specially generalised sleep loss, loss of appetite, nightmares, situational anxiety, depression, mental irritability, dulness of feelings, self blame, guilt, loss of interest, suicidal ideas, and worry about money, spouse, work and children. Most common physical injury was burns, followed by hearing disturbances, wounds received due to glass <& metal pieces and non specific pains and aches. Findings of follow up have been discussed and battery of tests for evaluation of victims of acute trauma has been suggested.
Objective Despite the recurring nature of the disease process in many psychiatric patients, individual careers and time to readmission rarely have been analysed by statistical models that incorporate sequence and velocity of recurrent hospitalisations. This study aims at comparing four statistical models specifically designed for recurrent event history analysis and evaluating the potential impact of predictor variables from different sources (patient, treatment process, social environment). Method The so called Andersen-Gil counting process model, two variants of the conditional models of Prentice, Williams, and Peterson (gap time model, conditional probability model), and the so called frailty model were applied to a dataset of 17’415 patients observed during a 12 years period starting from 1996 and leading to 37’697 psychiatric hospitalisations. Potential prognostic factors stem from a standardized patient documentation form. Results Estimated regression coefficients over different models were highly similar, but the frailty model best represented the sequentiality of individual treatment careers and differing velocities of disease progression. It also avoided otherwise likely misinterpretations of the impact of gender, partnership, historical time and length of stay. A widespread notion of psychiatric diseases as inevitably chronic and worsening could be rejected. Time in community was found to increase over historical time for all patients. Most important protective factors beyond diagnosis were employment, partnership, and sheltered living situation. Risky conditions were urban living and a concurrent substance use disorder. Conclusion Prognostic factors for course of diseases should be determined only by statistical models capable of adequately incorporating the recurrent nature of psychiatric illnesses.
The purpose of this study is to report on the experiment of a group of undergraduate students from the University of São Paulo at Ribeirão Preto College of Nursing, who use art (some aspects of the Clown Theatre) as a nursing resource in the care to hospitalized children. Having as basis the job performed by the group of physicians "Joy Doctors", and the theoretical grounding from Psychology and Pediatric and Neonatal Nursing, those students founded the Laugh Company that aims at rescuing laugh within the hospitalized child/family. This experiment has caused some changes in daily care: the hospital space has become more informal and relaxed, laugh can be heard more often and some items, such as, objects, sounds, movements, colours, rooms and people can become toys. PMID:9934241
Françani, G M; Zilioli, D; Silva, P R; Sant'ana, R P; de Lima, R A
The purpose of this study was to ascertain the amount of in-hospital social support received by coronary artery bypass grafting patients and the impact of this support on their feelings of fear and anxiety. As adapted from Kahn's theory, social support was understood as emotional, informational and tangible support. The bypass grafting fear scale was developed to measure the fear,
Meeri Koivula; Marja-Terttu Tarkka; Matti Tarkka; Pekka Laippala; Marita Paunonen-Ilmonen
A cost analysis study for the fiscal year 1989-1990 was conducted in the day care room (DCR) for thalassemia patients at the Yangon Children's Hospital in Myanmar to provide a basis for future cost-effectiveness, cost-benefit and efficiency analyses. Two types of costs, hospital costs and costs borne by the patients' families were studied by reviewing hospital records and by interviewing family members of patients. Of the total cost of DCR services for thalassemia 74 to 75% was contributed by material costs most of which were for imported items. The cost of each transfusion visit and the annual cost per patient were Kyats 166.5 to 173.3 and Kyats 1,108.6 to 1,208.7, respectively. The median cost (range) per treatment visit and the averaged annual median cost (range) borne by the patients' families were Kyats 21 (0-302) and Kyats 107 (0-1,509), respectively. PMID:1439981
Background/Aims Identifying factors related to readmission is important for successfully targeting appropriate interventions to groups at risk for readmission. The objective of this study was to investigate the association of long-term medication adherence with hospital readmission in a cohort of beneficiaries enrolled in a Medicare cost plan. Methods The study employed a retrospective cohort design using pharmacy and healthcare utilization claims from a Medicare Cost Contract plan for January 2009 through December 2009. Inpatient hospitalization was identified based on the revenue code (100–169, and 200–219). Eligible members were continuously enrolled through the study period, and experienced at least one hospitalization in 2009 after which they were discharged to home. About 1767 members were eligible and included in the analysis. Approximately 13% had a claim for a subsequent readmission during the study period. Medication adherence in the year before the index hospitalization was measured with the medication possession ratio (MPR), defined as the supply of medications in days minus the last fill days supply divided by the total number of days between the last fill date and the first fill date for drugs for chronic medication. Likelihood of readmission within 90 days was estimated using the logistic regression. Covariates entered into the model included demographics, MPR (both continuous and categorical with 3 categories: low (MPR<0.5), medium (.5 < MPR<.8), and high (MPR>.8 adherence), and having an office visits within 30 days of discharge. Results Members with high medication adherence were less likely than those with low adherence to have a claim indicating 90-day readmission (OR=.35, p=0.01). When considered as continuous, higher MPR was associated with decreasing risk of readmission (OR=0.24, p=0.02). Having an office visit within 30 days from the date of discharge was as associated with a decreased risk of readmission (OR=0.06, p<0.001). Discussion The health behavior of long-term adherence to medications was associated with risk of readmission. A major study limitation is the underestimation of readmission rates due to lack of complete capture of hospital claims. An important next step will be to replicate the study with a larger population for which all claims are captured.
Hochhalter, Angela; Basu, Rashmita; Prasla, Karim; Jo, Chanhee; Robinson, Linda
In recent years, the purpose and quality of provision delivered in acute inpatient psychiatric settings have been increasingly questioned. Studies from a service user perspective have reported that while some psychiatric inpatients feel safe and cared for, others feel their time in hospital is neither safe nor therapeutic. This paper explores the experiences of service users on acute inpatient psychiatric wards in England, with a particular focus on their feelings of safety and security. Interviews were conducted with 60 psychiatric inpatients in England. The majority of service users felt safe in hospital and felt supported by staff and other service users. However, anything that threatened their sense of security such as aggression, bullying, theft, racism and the use of alcohol and drugs on the ward, made some respondents feel insecure and unsafe. Psychiatric wards are still perceived by many as volatile environments, where service users feel forced to devise personal security strategies in order to protect themselves and their property. It would appear that there remains much to do before research findings and policies are implemented in ways that facilitate all service users to derive the maximum benefit from their inpatient experience. PMID:20465757
Cerebrotendinous xanthomatosis (CTX) is a rare and severe, but treatable, inborn disorder of bile acid biosynthesis and sterol storage with autosomal recessive inheritance and variable clinical presentation. CTX treatment consists of chenodeoxycholic acid and must be started as early as possible to prevent permanent disability. Psychiatric manifestations are rare and non-specific, and often lead to significant diagnostic and treatment delay. Therefore, better recognition of the gamut of psychiatric manifestations in CTX can diminish the risk of misdiagnosis and irreversible neurological deterioration. We hereby describe the psychiatric features in CTX. A complete review of all published cases of CTX in the medical literature was undertaken and the case reports with psychiatric presentation were collected and analyzed. We also describe the psychiatric features in relation to the neurological semeiology in six patients with CTX diagnosed at the La Salpêtrière Hospital. We conclude that psychiatric manifestations in CTX follow a bimodal/bitemporal pattern, appearing early in the disease course in the form of a behavioral/personality disorder associated with learning difficulties or mental retardation, or manifesting in advanced disease in the setting of dementia as rich neuropsychiatric syndromes, such as frontal, orbitofrontal or frontotemporal syndromes of cortico-subcortical dementia encompassing behavioral/personality disturbance, affective/mood disorders or psychotic disorders. Behavioral/personality disturbance in childhood or adolescence, especially when accompanied by learning difficulties, should therefore lead to further investigation to exclude CTX, as early diagnosis and treatment is critical for prognosis.
Cerebrotendinous xanthomatosis (CTX) is a rare and severe, but treatable, inborn disorder of bile acid biosynthesis and sterol storage with autosomal recessive inheritance and variable clinical presentation. CTX treatment consists of chenodeoxycholic acid and must be started as early as possible to prevent permanent disability. Psychiatric manifestations are rare and non-specific, and often lead to significant diagnostic and treatment delay. Therefore, better recognition of the gamut of psychiatric manifestations in CTX can diminish the risk of misdiagnosis and irreversible neurological deterioration. We hereby describe the psychiatric features in CTX. A complete review of all published cases of CTX in the medical literature was undertaken and the case reports with psychiatric presentation were collected and analyzed. We also describe the psychiatric features in relation to the neurological semeiology in six patients with CTX diagnosed at the La Salpêtrière Hospital. We conclude that psychiatric manifestations in CTX follow a bimodal/bitemporal pattern, appearing early in the disease course in the form of a behavioral/personality disorder associated with learning difficulties or mental retardation, or manifesting in advanced disease in the setting of dementia as rich neuropsychiatric syndromes, such as frontal, orbitofrontal or frontotemporal syndromes of cortico-subcortical dementia encompassing behavioral/personality disturbance, affective/mood disorders or psychotic disorders. Behavioral/personality disturbance in childhood or adolescence, especially when accompanied by learning difficulties, should therefore lead to further investigation to exclude CTX, as early diagnosis and treatment is critical for prognosis. PMID:24002088
Background:?The present study is part of a public health research project that evaluates restructured psychiatric community care for\\u000a chronic patients in Saxony after the German reunification. It focuses on the analysis of the individual (expert-based) normative\\u000a needs for mental health care of chronic schizophrenic patients in the Dresden region. Method:?A cohort of ICD-10 chronic schizophrenic patients (n=115) was examined at
Objective: To assess the outcomes for a group of elderly patients with mental illness following their discharge from a stand-alone psychiatric facility to seven extended care units (ECUs).Method: All patients (n = 60) who were relocated to the ECUs were assessed using a number of standardized clinical and general functioning instruments at 6 months and 6 weeks pre-move, and again
Tom Meehan; Samantha Robertson; Terry Stedman; Gerard Byrne
Comparative clinical outcomes after exposure to alternate low osmolar contrast media (LOCM) during invasive coronary angiography (ICA) and/or percutaneous coronary intervention (PCI) have been incompletely examined. From a retrospective multicenter observational study, we identified 107,994 adults without previous hemodialysis undergoing ICA and/or PCI with iohexol, iopamidol, or ioversol. We created a propensity score for contrast media type using age, gender, coverage status, route of hospitalization, illness severity, physician specialty, co-morbidities, and procedure type. Propensity matching was performed in a 1:1 fashion for iohexol (n = 10,204) and iopamidol (n = 10,204) and in a 1:1 fashion for iohexol (n = 19,482) and ioversol (n = 19,482). Groups were examined for differences in in-hospital mortality or subsequent hemodialysis, length of stay, and 30-day readmission for contrast-induced nephropathy (CIN). Compared to patients exposed to iohexol, no differences were observed for patients exposed to iopamidol or ioversol for in-hospital hemodialysis (0.5% vs 0.4%, p = 0.45; 0.3% vs 0.5%, p = 0.05), in-hospital mortality (0.7% vs 0.6%, p = 0.60; 0.5% vs 0.6%, p = 0.42), or composite hemodialysis or mortality (1.1% vs 1.0%, p = 0.58; 0.8% vs 1.0%, p = 0.06); for hospital length of stay (2.9 ± 2.7 vs 2.9 ± 2.7 days, p = 0.05; 2.8 ± 2.6 vs 2.9 ± 3.1 days, p = 0.35); or for 30-day readmission for CIN (0.1% vs 0.1%, p = 0.82; 0.1% vs 0.1%, p = 0.52). In conclusion, for patients undergoing ICA and/or PCI exposed to alternate LOCM, in-hospital death, need for hemodialysis, or readmission for CIN are uncommon, with no apparent clinical advantage among LOCM agents. PMID:22440116
LaBounty, Troy M; Shah, Manan; Raman, Subha V; Lin, Fay Y; Berman, Daniel S; Min, James K
This literature review will explore the relevant literature on several key questions regarding boarding of psychiatric patients in the ED. Is psychiatric boarding a problem. What are the reasons for boarding psychiatric patients. What kind of care is rece...
Objective: It has been shown in several studies that, 25-35% of hospitalized patients receive antibiotics, 40-50% of which are misused. Methods: This study investigates the trends in antibiotic use and the cost of inappropriate use by point prevalence method. The study was performed on a single day in surgical clinics of our tertiary care hospital . Results: On the day
M. Bülent; Hedef Özgün; M. Özlem Saylak; Nazmi Sayim
This article uses a historical case study of a dayhospital therapeutic community (TC) to explore the emergence of particular spaces of psychiatric contention. Using ideas from critical social geography, it employs the notion of 'convergent spaces' to understand how particular sites become important in the development of innovative practice and new social movements. It argues that these spaces of convergence enabled innovation to occur through a collectivised social setting where commonalities were expressed, new resistant identities forged and charismatic figures such as 'tricksters' emerge to challenge and subvert psychiatric authority. In discussing some of the problems which beset the dayhospital, it is proposed that the notion of 'paradoxical spaces' might also be helpful to understand how contested spaces can avoid imposing new forms of totalisation. It concludes by reflecting on the conditions of possibility for new spaces of contention. PMID:19269880
Oppositional defiant disorder (ODD) is associated with elevated rates of psychopathic traits and aggression. However, it remains unclear if attention-deficit/hyperactivity disorder (ADHD) symptoms exacerbate these relations, particularly in samples of children who are severely clinically distressed. The purpose of the present study was to test ADHD symptoms as a potential moderator of the relations of ODD symptoms to psychopathic traits (i.e., callous-unemotional [CU] traits, narcissism) and to aggressive subtypes (i.e., proactive, reactive aggression) in a large sample of children in an acute psychiatric inpatient facility (n = 699; ages 6-12). Multiple regression analyses indicated that, after controlling for child demographic variables, ADHD symptoms marginally exacerbated the relation between ODD symptoms and CU traits. Both ODD and ADHD symptoms had an additive, but not a multiplicative effect, in predicting narcissism. In addition, for a subset of the full sample for whom data were available (n =351), ADHD symptoms exacerbated the relation between ODD symptoms and both reactive and proactive aggression. These results suggest that ADHD symptoms tend to have a negative effect on the relation between ODD symptoms and markers of antisociality among children receiving acute psychiatric care. PMID:23436456
Becker, Stephen P; Luebbe, Aaron M; Fite, Paula J; Greening, Leilani; Stoppelbein, Laura
The aim of this study was to compare the views of secluded patients in a forensic setting with the views of those in a general psychiatric setting. Subjects numbered 106 secluded patients, in the two forensic psychiatrichospitals and in the general psychiatric in-patient units of two hospital districts in Finland during a one-year recruitment period. The subjects were interviewed
Alice Keski-Valkama; Anna-Maija Koivisto; Markku Eronen; Riittakerttu Kaltiala-Heino
In this enquiry a cross-sectional study of hospitalizedpsychiatric patients was undertaken to assess prevalence and nature of suicidal behaviour. We have been able to delineate these subjects into three categories i.e. non-communicators, partial communicators and definite communicators on the basis of their scores upon 31ucid.il intent questionnaire. A follow up study of these patients which is in progress may further provide knowledge about relationship between predictive criterion and their final outcome.
In this article, the quality of life (QoL) of mentally disordered offenders was investigated. The data of 44 forensic psychiatric inpatients were analyzed using the Lancashire Quality of Life Profile (LQoLP), Rehabilitation Evaluation Hall and Baker (REHAB), and the Psychopathy Checklist-Revised (PCL-R). Outcome on the LQoLP was compared with data of hospitalized male psychiatric patients. Results show that the QoL
Methods: The data of a 2 year open extension study of a 12 week, double blind, randomised, placebo controlled trial, in which all patients with AS were treated with 5 mg/kg infliximab, were used to investigate the effect of anti-TNF treatment on admissions to hospital and days of sick leave. All patients were interviewed at baseline and at regular intervals during the study to collect this information by questionnaires. Patients who completed 2 years of treatment (n = 49) and those who did not (n = 20) were analysed separately. Sick leave analysis was restricted to currently employed patients (n = 38). Results: During the 12 months before the screening visit, 20/49 (41%) completers had been admitted to hospital. After 1 and 2 years of treatment this percentage was reduced to 5/49 (10%; p<0.01), corresponding to a significant decrease in the mean number of inpatient days: from 11.1 to 0.6 after 1 year (p<0.01) and 2.9 after 2 years (p<0.01), respectively. No changes were seen in the dropout group. Conclusion: The use of infliximab in patients with active AS reduces some important costs of AS, but additional studies with detailed cost calculations are needed.
This study examined risk and determinants of rehospitalization of children and adolescents (n = 186) following a first psychiatrichospitalization. It specifically examined the role of post-discharge services. Data were collected for a 30-month follow-up period through structured telephone interviews with caregivers and case record abstractions. 43% of youth experienced readmissions during the follow-up period. Risk of rehospitalization was highest during the first 30 days following discharge and remained elevated for 3 months. 72% of youth received 284 post-discharge services during the follow-up period, which significantly reduced the risk of rehospitalization. Longer first hospitalizations and a higher risk score at admission increased risk.
The paper evaluates the hypothesis that cannabis abuse is associated with a broad range of psychiatric disorders in India, an area with relatively high prevalence of cannabis use. Retrospective case-note review of all cases with cannabis related diagnosis over a 11 -year period, for subjects presenting to a tertiary psychiatrichospital in southern India was carried out. Information pertaining to sociodemographic, personal, social, substance-use related, psychiatric and treatment histories, was gathered. Standardized diagnoses were made according to Diagnostic Criteria for Research of the World Health Organization, on the basis of information available. Cannabis abuse is associated with widespread psychiatric morbidity that spans the major categories of mental disorders under the ICD-10 system, although proportion of patients with psychotic disorders far outweighed those with non-psychotic disorders. Whilst paranoid psychoses were more prevalent, a significant number of patients with affective psychoses, particularly mania, was also noted. Besides being known as either the causative agent or a potent risk factor in cases of paranoid psychoses, cannabis appears to have similar capabilities with regard to affective psychoses, particularly in cases of mania. It is suggested that cannabis has the potential to act as a "life event stressor" amongst subjects vulnerable to develop affective psychoses and the possible aetiopathogenesis of such a finding is discussed.
This article reports on the diagnostic results of 232 patients who were examined in close collaboration by the paediatrician and the child psychiatrist at a Swiss children's hospital between 1971 and 1980. The main diagnosis was psychogenic disorders with mainly psychic symptoms in 53.9% of the cases, psychogenic disorders with mainly somatic symptoms in 37.1%, minimal brain damage in 11.2%, and disturbances of development in 8.6%. Psychosomatic symptoms as accessory findings were found in another 30%. Thus, functional somatic disorders were components of the polysymptomatic syndromes in more than 60% of the patients. PMID:3454348
Baumberger, R; Herzka, H S; Leuenberger, M; Fanconi, A
Hosted by award-winning National Public Radio (NPR) correspondent Alex Chadwick, Day to Day is a way for regular NPR listeners to listen to smart news coverage during the middle of the day or during their lunch-hour. Fortunately, Day to Day is available online, complete with an archive dating back to January 2003. Produced in the NPR West office in Los Angeles, and includes a number of NPR regulars and contributors from the online publication Slate. Day to Day also features the helpful daily reports from the Minnesota Public Radio show, Marketplace, which is "an informative conversation about business and economic news". Other regular features on Day to Day include commentaries on recent music releases from independent music critic Christian Bordal and curious and novel exposes and reports on the "odd underbelly" of the City of Angels, direct from Southern California.
It is a popularly held belief that psychiatric behavior worsens during a full moon. Research in this area has yielded mixed results. Records from Naval Medical Center San Diego for 1993-2001 were examined to see whether there were higher rates of psychiatric admission associated with particular phases of the moon. Records from 8,473 admissions revealed that there were no more admission on days with a full moon, a new moon, any quarter of the moon, a waxing moon, or a waning moon. This held true for psychiatric patients as a whole, as well as for individuals with particular diagnoses, such as those with a mood disorder or psychotic disorder. Records from 1,909 emergency psychiatric evaluations that occurred between 2002 and 2003 were also examined to see whether a higher percentage of patients might present, but not require hospitalization, during a particular phase of the moon. Once again, no significant effect was found. In summary, lunar phase was not associated in any significant way with psychiatric admissions or emergency presentation. PMID:17256692
This re-audit assessed whether wards at South West London and St Georges' mental health trust (SWLSTG) met agreed standards regarding informing inpatients about their legal status in hospital and rights, following an initial audit in 2009. Three general adult wards were re-audited, and other general and specialist wards (addictions, eating disorders, deaf services and obsessive compulsive disorder) were added. One hundred and five people (61 informal, 44 detained under the Mental Health Act 1983, revised 2007) on 10 wards were interviewed using an agreed proforma. The re-audit of wards A-C showed improvement: 81.3% of informal inpatients were aware of their legal status, versus 54.2% in 2009 (P = 0.101). Including new wards D-K, 90.2% knew their status (P = 0.0002). Of the informal patients, 65.6% knew they could refuse treatment (P = 0.0184) (on wards A-C, 68.8%, P = 0.105) versus 37.5% in 2009. Despite some improvement, the patient experience of informal admission or detention in hospital still sometimes crosses legal boundaries. This audit highlights the need to improve awareness of patient rights and demonstrated how local presentation of audit improves practice. PMID:22399028
Lomax, G Alice; Raphael, Frances; Pagliero, James; Patel, Rupal
Using data collected on 190 patients in a hospital-based substance abuse treatment center in a large midwestern city, this study compared psychiatric symptomatology between African Americans and Caucasians. Although the 2 groups were equivalent in consumption and frequency of usage, African-American alcoholics in the study used significantly more substances (beyond alcohol) than did Caucasians. With regard to psychiatric symptomatology, African
Thomas W. Pavkov; Mark P. McGovern; John S. Lyons; Eric S. Geffner
Objective: This study examines the independent effect of urbanisation on the risk for admission irrespective of age, sex and marital status. Method: Logit analysis was performed on a dataset containing all first admissions to Dutch general psychiatrichospitals and psychiatric teaching clinics in 1991. Results: Unmarried people and people living in urbanised municipalities have an increased risk of admission in
...2012-10-01 false Condition of participation: psychiatric and rehabilitation distinct...STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS Conditions of Participation: Critical Access Hospitals...
...2011-10-01 false Condition of participation: psychiatric and rehabilitation distinct...STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS Conditions of Participation: Critical Access Hospitals...
To evaluate the effectiveness of an intensive system of case management for high end users of inpatient care in reducing psychiatric inpatient utilization. A prepost study design with a contemporaneous comparison group was employed to determine the effects of a State designed intervention to reduce inpatient care for adults with a mental health disorder who had high utilization of inpatient psychiatric care between 2004 and 2007. Logit and negative binomial regression models were used to determine the likelihood, frequency and total days of inpatient utilization in the post period as a function of the intervention. Data from administrative reporting forms and Medicaid claims were used to construct inpatient utilization histories and characteristics of 176 patients. Patients in both groups had a significant reduction in mean inpatient days. However, being in the intervention program did not result in lower odds of being re-hospitalized or in fewer episodes during the study period. PMID:22290303
The report examines data from three sample surveys of admissions during 1980 to the inpatient psychiatric services of state and mental hospitals and private psychiatrichospitals and the separate inpatient psychiatric services of non-federal general hospitals. Findings revealed that an estimated 81,532 persons under 18 years were admitted to…
|The report examines data from three sample surveys of admissions during 1980 to the inpatient psychiatric services of state and mental hospitals and private psychiatrichospitals and the separate inpatient psychiatric services of non-federal general hospitals. Findings revealed that an estimated 81,532 persons under 18 years were admitted to…
Investigated the availability of psychiatric units in general hospitals, the variety of staff personnel employed, and the range of treatment methods utilized in Alabama. 36% of the responding hospitals provided inpatient psychiatric services. Larger hospitals were more apt to provide these services. The type of staff employed and treatment utilized were similar for both psychiatric institutions and general community hospitals.
J. Kevin Thompson; Frank L. Collins; Chester W. Jenkins
The purposes of the project were: to provide comprehensive, individually designed and coordinated services to recently discharged psychiatrichospital patients, and to determine the effectiveness of this approach in improving the expatient's utilization o...
This study was performed in order to determine the prevalence and predisposing factors of psychiatric disorders among infertile\\u000a and fertile women attending Vali-e-Asr Hospital. A total of 150 fertile women from Vali-e-Asr Reproduction Health Research\\u000a Center and fertile women from the Gynecology Clinic of Imam Khomeini Hospital were chosen by consecutive sampling. Data included\\u000a demographic information, SCL-90-R, and a semi-structured
Ahmad Ali Noorbala; Fatemeh Ramezanzadeh; Nasrin Abedinia; Mohammad Mehdi Naghizadeh
There are few examples in the literature of the application of functional analysis to psychiatric inpatient aggression. Structural assessment approaches have dominated. This paper introduces a system for classifying the functions of aggression in psychiatric inpatients that was applied to 502 aggressive behaviours exhibited by patients in a secure forensic psychiatrichospital. At least one function was identified for the
Aim: Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals' perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatrichospital. Materials and Methods: Self-administered questionnaire was em- ployed to
Decision-making processes of psychiatric inpatients were assessed at admission and prior to discharge, and compared to hospital staff members using a paired comparison paradigm in which subjects chose between hypothetical antipsychotic medications. Multidimensional analyses of binary choice matrices revealed that all subjects based decisions on the risks and benefits of medication, and weighted risks and benefits in roughly equal proportions.
The “Italian experience” of providing psychiatric care with comprehensive and integrated community services while blocking admissions to mental hospitals needs evaluation on the basis of quantitative evidence as well as opinion. In this paper, national statistics and local case-register data pertaining to this issue are reported. Questions referring to the structure of the services (whether or not the prescribed reorganisation