Silvia Mendes da Cunha
Full Text Available Introduction: Crack cocaine use is associated with polydrug abuse, and inpatients dependent on crack exhibit profiles of serious consumption patterns. Use of alcohol and tobacco and other drugs is a risk factor for experimentation of additional drugs, including crack cocaine.Objectives:The present study describes the characteristics and crack consumption patterns among inpatients in treatment during 2011 and 2012 at the Hospital Psiquiátrico São Pedro (Porto Alegre, Brazil. An additional objective was to identify the sequence of alcohol and tobacco consumption prior to crack use.Methods: The participants were 53 male inpatients addicted to crack with a mean age of 27.5±7.3 years. A sociodemographic questionnaire; the Alcohol, Smoking and Substance Involvement Screening Test and the Mini Mental State Examination were all administered to participants. Inclusion criteria were crack cocaine dependency (based on the 10th edition of the International Classification of Diseases [ICD-10] and being abstinent for 7 days. Patients with cognitive difficulties who were unable to understand and/or respond to the questionnaires were excluded from the sample.Results: The participants were young male adults with low educational level and low incomes and were polydrug users. The majority had made more than one attempt to quit. Use of legal drugs in early adolescence, prior to crack use, was identified.Conclusions: The profiles of the inpatients addicted to crack treated at this hospital indicate a serious usage pattern among those who seek specialized support. Crack use is frequent and is associated with use of other drugs and with difficulty sustaining abstinence. The pattern of progression from alcohol and tobacco use to crack cocaine dependency demands the attention of those responsible for prevention policies.
Botega, N J; Pereira, W A; Bio, M R; Garcia Júnior, C; Zomignani, M A
The 12-item General Health Questionnaire (GHQ-12) and the revised Clinical Interview Schedule (CIS-R) were used to estimate the prevalence of psychiatric morbidity among 78 consecutive admissions to a general medical ward in a Brazilian university hospital (43 males and 35 females; mean age = 43.2 years). The CIS-R was administered by three 5th-year medical students after a brief training. A prevalence rate of 36% was found for psychiatric disorders. The most frequent symptoms were sleep disorders (48.7%), worry (35.9%), depression (28.2%) and anxiety (26.9%). The sensitivity and specificity of the GHQ-12 were 71% and 76%, respectively. The CIS-R was simple to administer and acceptable both to patients and interviewers. Misunderstanding was most likely to occur with the poorly educated (20% were illiterate) in questions involving time calculation. Alternative options might be used to specify the length of time in future studies. The findings support the feasibility of the CIS-R and the use of 'lay' interviewers to produce epidemiological information on psychiatric disorders in developing countries at lower costs. PMID:7624806
Full Text Available Introduction: Severe Psychiatricillness is accompanied by gross disturbances in patient's occupational role. This study presents a comparative picture of work performance before and after psychiatric hospitalization. Method: Subjects comprised 440 psychiatric admitters from Noor Medical center - Isfahan - Iran, who were followed from November 1999 to November 2000. Their work adjustment was measured by means of Weiss man's index. Data were computer analyzed using SPSS by running paired t- student and ANOVA. Results: Majority of the patients (53 % were without permanent sources of income before psychiatric hospitalization, about 12 percent of those who were working prior to hospitalization lost their job after being discharged from hospital. Better work adjustment before hospitalization was positively correlated with better work adjustment after discharge for working patients (r =0/66. Working ability of the patients after discharge was lesser than before the attack f9r patients with regular and irregular job (P < 001. Discussion: Job loss or poor working ability after psychiatric admission reported by several researchers and has bean confirmed in this study as well. These observatoins have been discussed in view of the current socio economic problems in the society and nature of psychiatric disturbances.
Ferraz, Valéria de Souza
The Brazilians image is often associated with sympathy and joy. However these characteristics do not necessarily make them hospitable. To be hospitable it´s not just have a smile or be helpful, you must have hospitability, that is, the ability to offer hospitality. Hospitality is a social phenomenon that manifests in the domestic, commercial or public context. It is believed that the Brazilian has a natural talent for the domestic hospitality, which extends somehow into the ...
Full Text Available A prospective study was undertaken to compare the patterns of psychiatric referrals in two general hospitals in Bombay viz. the King Edward Memorial Hospital (64 cases and the Jaslok Hospital and Research Centre (62 cases. It was observed that depressive symptoms were the most common presenting symptoms in these patients attending either of the hospitals. Similarly, the commonest diagnoses were depression and organic mental disorder. Attempted suicide with organophosphorous compounds was the commonest reason for hospitalization at K.E.M. Hospital (p less than 0.001. A significant number of these patients were females (p less than 0.05. The psychiatric referrals at Jaslok had been hospitalized mainly for suspected medical or neurological illness (p less than 0.001. These patients belonged to higher economic strata and hence had a better paying capacity compared to patients at KEM hospital, a significant number of whom were unemployed (p less than 0.001. The duration of pre-referred illness of patients and their stay at Jaslok hospital were longer as compared to those at KEM Hospital (p less than 0.01. The number of non-relevant special investigations carried out on patients in Jaslok was more (p less than 0.01. Further analysis of diagnoses revealed that a significant number of patients at KEM Hospital were admitted as primary psychiatric illness (p less than 0.05.
Santos, Ana Luiza Gonçalves Dos; Farias, Francisco Ramos de; Pinto, Diana de Souza
The article explores the possibility of defending a society without secure psychiatric hospitals in Brazil. These hospitals have been sustained by persistent legal and psychiatric paradigms, including the notions "safety measure" and "dangerousness," in conjunction with particular social and historical circumstances. The open repression of so-called dangerous individuals is still practiced in the name of the principle of social defense, outdated concepts notwithstanding. Together, law and psychiatry constructed spaces of power/knowledge within these workings of social control. Addressing this topic from the transdisciplinary field of social memory means identifying the struggles within particular power/knowledge arrangements, which play out in a state of ongoing tension. PMID:26625915
Pedro L. Ritter
Full Text Available Objective: To evaluate trends in psychiatric bed occupancy by elderly inpatients in the Brazilian public health care system between 2000 and 2010 and to determine the leading psychiatric diagnosis for hospital admissions. Methods: Data from all 895,476 elderly psychiatric admissions recorded in the Brazilian Public Health Care Database (DATASUS between January 2000 and February 2010 were analyzed. Polynomial regression models with estimated curve models were used to determine the trends. The number of inpatient days was calculated for the overall psychiatric admissions and according to specific diagnoses. Results: A moderate decreasing trend (p < 0.001 in the number of inpatient days was observed in all geriatric psychiatric admissions (R2 = 0.768 and in admissions for organic mental disorders (R2 = 0.823, disorders due to psychoactive substance use (R2 = 0.767, schizophrenia (R2 = 0.680, and other diagnoses (R2 = 0.770, but not for mood disorders (R2 = 0.472. Most admissions (60 to 65% were due to schizophrenia. Conclusion: There was a decreasing trend in inpatient days for elderly psychiatric patients between 2000 and 2010. The highest bed occupancy was due to schizophrenia, schizotypal, and delusional disorders.
Regina Capanema de ALMEIDA
Full Text Available Nosocomial infection among male patients in a public psychiatric hospital was studied and the definitions for use in long-term care facilities were employed for diagnosis. The overall nosocomial infection rate was 6.7 per 1,000 day inpatients; 55.6% of these infections were identified in the respiratory tract, 50% of them being respiratory viral diseases; 38.9% of the nosocomial infections involved the eyes, ears, nose, throat and mouth, and 5.6% involved the skin and soft tissues. The epidemiological characteristics and the main clinical alterations of these inpatients were also identified.Foi estudada a Infecção Hospitalar (IH em pacientes masculinos internados em hospital psiquiátrico público e as definições sugeridas para uso em instituições de longa permanência (ILPs/Long-Term Care Facilities-LTCFs foram utilizadas para diagnóstico das IH. A taxa global de IH foi de 6,7 por 1000 pacientes-dia, 55,6% das infecções foram identificadas no trato respiratório, sendo que 50% dessas eram viroses respiratórias; 38,9% das IH relacionavam-se aos olhos, ouvidos, nariz, garganta e boca e 5,6% a pele e partes moles. As características epidemiológicas e as principais alterações clínicas desses pacientes também foram identificadas.
Silva Pereira, Yvonne Da; Estibeiro, Ajoy; Dhume, Rajesh; Fernandes, John
This retrospective study aimed to explore the Socio-demographic characteristics and clinical profile of patients aged 60 years and above, attending psychiatric services for the first time at the Institute of Psychiatry and Human Behaviour, Goa during 1993-1998. Hospital case files of six hundred and ninety-eight patients formed the study sample. Preliminary analysis revealed that 70% of the sample was between 60-69 years. Mean age was 65.8 years (Sd ±6.11). Sex ratio male to female was 38:62....
Balbinot, Alexandre Dido; Horta, Rogério Lessa; da Costa, Juvenal Soares Dias; Araújo, Renata Brasil; Poletto, Simone; Teixeira, Marina Bressaneli
ABSTRACT OBJECTIVE To investigate whether the psychiatric hospitalization rates due to use of psychoactive substances and average time of hospitalization suffered any changes after the first decade of effective implementation of the psychiatric reform in Brazil. METHODS This article examines the evolution of hospitalizations due to disorders arising from the use of alcohol or other substances in the state of Santa Catarina, Southern Brazil, from 2000 to 2012. This is an ecological, time-series study, which uses data from admissions obtained by the Informatics Service of the Brazilian Unified Health System. Hospitalization rates by 100,000 inhabitants and average time of occupancy of beds were estimated. Coefficients of variation of these rates were estimated by Poisson Regression. RESULTS The total and male hospitalization rates did not vary (p = 0.056 and p = 0.244, respectively). We observed an increase of 3.0% for the female sex (p = 0.049). We did not observe any significant variation for occupancy time of beds. CONCLUSIONS The deployment of services triggered by the Brazilian psychiatric reform was not accompanied by a reduction of hospitalization rates or mean occupancy time of hospitalized patients during this first decade of implementation of the reform. PMID:27253902
This paper considers the main problems of the current mental health facilities in China from the standpoint of architects on the background that mental disorder has become a serious threat to human health. In order to effectively learn from the developed countries, this paper reviews the brief history of the world’s mental health and the main phases of the evolution of psychiatric hospitals, analyzes the actual situation of mental health facilities abroad based on a large amount of data, compares the roles of public and private psychiatric hospitals from the viewpoint of government supervision, and investigates the functions and positions of psychiatric hospitals and the psychiatry divisions of general hospitals in the medical system. At last, this paper discusses the necessity of the systemization of mental health facilities, the role of psychiatric hospitals in this facility system and the developing approaches of psychiatric hospitals in China.
Sepehrmanesh, Zahra; Ahmadvand, Afshin; Moraveji, Alireza
Background: Substance use in patients with psychiatric disorder is an every-day seen. Detection of this comorbidity can significantly affect the treatment of these disorders, as well as substance use. Objectives: This study has been conducted to determine the prevalence and pattern of substance use in hospitalized psychiatric patients. Patients and Methods: In this cross-sectional study, 210 hospitalized psychiatric patients were selected by simple randomization from all records of hospitaliz...
Full Text Available INTRODUCTION: Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. Objective: To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar São João, Porto, Portugal. METHODS: Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS: Mean age upon admission rose from 32.7±12.1 years in the second half of the 1970s to 43.5±12.2 years in 2005-2009 (p for trend < 0.001. Most patients were female (63.2%, however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D and neurotic disorders (E, similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E substantially decreased, and affective disorders (D came to represent more than 50% of all admissions. CONCLUSIONS: Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia.
Huang, Wenhui; 黄文辉
Background Smoking prevalence is the highest in people with mental illness. As more and more countries develop governmental regulations to protect employees from exposure to environmental tobacco smoke, complete smoking bans or partial smoking bans have been introduced in many psychiatric hospitals. Objectives To systematically review the literature to examine the impact of smoking bans in psychiatric hospitals, to identify the obstacles to implement tobacco-free policy and provide ...
Mandell, David S.; Lawer, Lindsay J.; Branch, Kira; Brodkin, Edward S.; Healey, Kristin; Witalec, Robert; Johnson, Donielle N.; Gur, Raquel E.
This study estimated the ASD prevalence in a psychiatric hospital 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…
Leila Mariza Hildebrandt; João Fernando Marcolan
Objective: to understand the concepts of Nursing professionals about the hospitalization of people with mental disorders admitted to psychiatric units of general hospitals. Methods: this is a qualitative research developed in three general hospitals. The data collection was carried out through semi-structured interviews and systematic observation. Thirty Nursing professionals were interviewed. The data analysis was based on content analysis. Results: issues concerning fragility were identifie...
Orešković, Anto; Mihanović, Mate; Mimica, Nino; Bodor, Davor; Petrov, Božo
Alcohol addiction treatment represents complex and lingering therapeutic procedure which can be provided stationary, within specialized psychiatric wards, and through partial hospitalization or day care hospitals for alcoholism. A psychiatric hospital day care, or partial hospitalization, represents facility for patients requiring intensive psychiatric treatment within relatively structured environment. While it offers the same variety of treatment procedures as the mental h...
Full Text Available The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus. Evaluation using the MINI plus demonstrated that 46 (51% patients did not have any psychiatric diagnosis, while 44 (49% had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1% had a current mental disorder, out of which 22 (84.6% had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.
... hospitals. 482.60 Section 482.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... HOSPITALS Requirements for Specialty Hospitals § 482.60 Special provisions applying to psychiatric hospitals. Psychiatric hospital must— (a) Be primarily engaged in providing, by or under the supervision of a doctor...
The article discusses the hospital laws of several land governments enacted subsequent to the hospital financing law of the Federal Government, in respect of the influence exercised by these laws on the internal structure of the hospital. The fact that the laws apply to all kinds of hospitals, and hence also to big psychiatric hospitals, is considered a disadvantage for psychiatric care. Such care is obviously hampered, on the one hand, by the legislative demand for departmentalization of the individual fields according to specialist subjects, representing a setup which is opposed to the realization of patient care in accordance with the requirements of the communities and citizens who expect to be cared for on an individual and not on a schematic basis, whereas, on the other hand, the new structures of management stipulated by the law do not provide for the inclusion of representatives of the new groups of professions now engaged in psychiatric activities. The model of regrouping the hospital structure into sectors instead of medical specialist departments, is presented and contrasted with the proposed model. It is recommended to arrange for representation of the non-medical and non-nursing professions in the managing boards, as well as to take into account the sociotherapeutico-rehabilitative interests as forming part of the conceptual approach to care in psychiatric hospitals, via special hospital committees. PMID:643974
... 42 Public Health 3 2010-10-01 2010-10-01 false Requirements for inpatient services of hospitals other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... PAYMENT Certification and Plan Requirements § 424.13 Requirements for inpatient services of...
Eaton, Phyllis M.; Davis, Bertha L.; Pamela V. Hammond; Condon, Esther H.; McGee, Zina T.
This exploratory research paper investigated the coping strategies of families of hospitalized psychiatric 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 m...
Wolfersdorf, M; Vogel, R; Vogl, R; Grebner, M; Keller, F; Purucker, M; Wurst, F M
Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany. PMID:27090898
Lande, R Gregory; Pourzand, Miriam
This article describes the components of a psychiatric partial hospital military program and the characteristics of referrals received over the 5-year period from 2009 to 2013. The 5-year study period included ongoing combat operations in Iraq and Afghanistan along with their subsequent troop withdrawals and change in mission. A total of 1,194 service members were referred for this level of care, and even with the changing battlefield conditions, the number of psychiatric referrals remained steady throughout the 5-year period, with a significant spike in admissions in 2013. The principal diagnoses were major depressive disorder and post-traumatic stress disorder. One-third of the admissions came from service members with 4 to 8 years' time in service and slightly more than one-third were employed in direct combat roles or medical support. In terms of gender, females accounted for one-quarter of the admissions. PMID:26926745
Margoob, Mushtaq A; Dutta, K.S.
SUMMARY Socio-demographic variables of 189 out-patients with drug abuse who were registered at the Hospital for Psychiatric Diseases, Srinagar were studied. Most of the drug abusers were male, the majority (57.2%) being in the 26-35 age group. Cannabis was the commonest substance abused, followed by heroin. Cannabis abusers had the longest duration of drug use but the lowest rate of drug dependence (29.9%) and lowest rate of multiple drug abuse (6.1%), whereas heroin abusers had the highest r...
Full Text Available Abstract Background Patients admitted to a psychiatric hospital 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
José Augusto Bragatti
Full Text Available A great prevalence of psychiatric disorders in epilepsy is well demonstrated, although most studies have used unstructured psychiatric interviews for diagnosis. Here we present a study evaluating the prevalence of psychiatric comorbidities in a cohort of Southern Brazilian patients with temporal lobe epilepsy (TLE using a structured clinical interview. We analyzed 166 patients with TLE regarding neuropsychiatric symptoms through the Structured Clinical Interview for DSM-IV. One hundred-six patients (63.9% presented psychiatric comorbidities. Mood disorders were observed in 80 patients (48.2%, anxiety disorders in 51 patients (30.7%, psychotic disorders in 14 (8.4%, and substance abuse in 8 patients (4.8% respectively. Our results agree with literature data where most authors detected mental disorders in 10 to 60% of epileptic patients. This wide variation is probably attributable to different patient groups investigated and to the great variety of diagnostic methods. Structured psychiatric interviews might contribute to a better evaluation of prevalence of psychiatric comorbidities in TLE.
Duncan, Whitney L
This article examines experiences of returned migrants seeking mental health care at the public psychiatric hospital in Oaxaca, Mexico. Approximately one-third of the hospital's patients have migration experience, and many return to Oaxaca due to mental health crises precipitated by conditions of structural vulnerability and "illegality" in the United States. Once home, migrants, their families, and their doctors struggle to interpret and allay these "transnational disorders"-disorders structurally produced and personally experienced within the borders of more than one country. Considering how space and time shape illness and treatment among transnational migrants, I contend that a critical phenomenology of illegality must incorporate migrant experience and political economy on both sides of the border before, during, and after migration. PMID:25294096
Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt; Lisby, Marianne; Mainz, Jan
Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish university hospital during a 3-month period (September 2013-November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions. The proportion of patients found to have at least one PIP was 123/207 (59%) and the proportions of patients with at least one PIP assessed to be potentially serious or fatal was 69/207 (33%) and 24/207 (12%), respectively. Interactions between drugs 125/207 (36%) and too high doses of drugs 56/207 (16%) were the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP. PMID:26824679
Shireesh Shatwaji Shinde
Full Text Available Objective: The objective of this study is to assess mortality and its correlates among psychiatric inpatients of a tertiary care neuropsychiatric hospital. Given the background that such a study has never been undertaken in India, the findings would have a large bearing on policy making from a mental health-care perspective. Materials and Methods: The medical records of those psychiatric inpatients (n = 333 who died during their stay at the National Institute of Mental Health and Neurosciences in past 26 years (January 1983 to December 2008 constituted the study population. Results: During the 26 years, there were a total of 103,252 psychiatric in-patient admissions, out of which 333 people died during their inpatient stay. Majority (n = 135, 44.6% of the mortality was seen in the age group of 21-40 years. Most of the subjects were males (n = 202, 67%, married (n = 172, 56.8% and from urban areas (n = 191, 63%. About, 54% of the subjects had short inpatient stay (<5 days, median for the sample. In 118 (39% of the subjects, there was a history of physical illness. Leading cause of death were cardiovascular system disorders (n = 132, 43.6%, followed by respiratory system disorders (n = 45, 14.9%, nervous system disorders (n = 30, 9.9% and infections (n = 31, 10.1%. In 21 (7%, cause of death was suicide. Conclusions: Identifying the factors associated with the death of inpatients is of utmost importance in assessing the care in a neuropsychiatric hospital and in formulating better treatment plan and policy in mental health. The discussion focuses on the analysis of different factors associated with inpatient mortality.
Robert Schumann (1810-1856) spent the last two-and-a-half years of his life in the private psychiatric hospital in Endenich. His medical records emerged in 1991 and were published by B. R. Appel in 2006. Daily entries document the treatment typical at that time for what was at first considered to be "melancholy with delusions": Shielding from stimuli, physical procedures, and a dietary regimen. The feared, actual diagnosis, a "general (incomplete) paralysis," becomes a certainty in the course of the paranoid-hallucinatory symptoms with cerebro-organic characteristics and agitated states, differences in pupil size, and increasing speech disturbances. In the medicine of the time, syphilis is just emerging as the suspected cause, and the term "progressive paralysis" is coined as typical for the course. Proof of the Treponema pallidum infection and the serologic reaction is not obtained until 1906. People close to Robert, in particular his wife Clara and the circle of friends around Brahms and Joachim, cared intensively for him and suffered under the therapeutic isolation. The medical records and illness-related letters contradict the theory that Schumann was disposed of by being put into the psychiatric hospital; they show the concern of all during the unfavorable illness course. PMID:25684293
Full Text Available Abstract Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs. Information was focused on diagnosis (DSM-IV, reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS, the Modified Overt Aggression Scale (MOAS and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30. Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs completed both admission and discharge visits. A severe psychotic episode with (19.1% or without (47.7% aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge and depression (12.9% at admission and 14.7% at discharge were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0% patients had episodes of aggressiveness at admission and 8 (1.7% at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%, 686 (94.2% and 676 (92.9%. The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%, typical anti-psychotics (48.3%, 57.0%, 49.6%, atypical anti-psychotics (35.6%, 41.8%, 39.8% and antidepressants (40.9%, 48.8%, 43.2%. Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20
Ana Carolina Santos de Souza
Full Text Available The Custody and Psychiatric Treatment Hospital (CPTH is ambivalent and ambiguous in its essence, because it gathers not only the characteristics of a mental institution, but also those of a prison – epitomized by the security system. By analyzing this context, one can perceive the importance of implementing some knowhow able to attend the real needs of the individuals hospitalized in this type of institution. This interpretation of their needs must be done in association with a work in mental health based on the principles of the Brazilian Psychiatric Reform and Psychosocial Field Practice. The objective of this study is to reflect on the real possibilities of implementing mental health work based on the Brazilian Psychiatric Reform, inserted in the Psychosocial Field, in institutions such as CPTHs. This reflection occurs from the conflicts arisen in the beginning of Occupational Therapy service in a CPTH located in the state of Sao Paulo, Brazil, as well as through the analysis of the reality in which this Custody Hospital is inserted. When studying the Psychiatric Reform Law, ordinance 28.195/1988, which deliberates on the functions of Occupational Therapy in the CPTHs of the state of Sao Paulo, and the Penal Execution Law, the reality was analyzed from its dimensions, to conclude that the institutional forces ruled the work process of occupational therapists. Therefore, the structural, particular, singular dimensions that rule the CPTH were understood and, after that, the “nodes” that hinder the implementation of mental health work in the Psychosocial Field in this type of institution were revealed.
Chandra, P.S.; Krishna, V.A.S.; Ravi, V.; Desai, A.; Puttaram, S.
Recent reports have indicated an increasing prevalence of HIV infection in the mentally ill. Reports have also emphasised the etiological role of HIV infection in psychiatric illness. The aim of this study was to assess the clinical and risk profile of psychiatric inpatients found seropositive for HIV infection. All psychiatric inpatients from a psychiatric hospital who tested positive for HI V infection over a five year period were assessed. The assessments included a detailed clinical histo...
Tohyama, Teruhiko; Senko, Yoshitaka
This report is a kind of empirical study on disaster psychiatric services following the Great Hanshin Earthquake.Our work was performed at a general hospital (the Higashi-Kobe Hospital) located in the middle of the disaster area. Before the quake there were no psychiatric facilities at that hospital ; nevertheless many patients with mental problems visited there. And our team; consisting of several volunteer psychiatrists from all over Japan and some nurses of that hospital, immediately set u...
Phyllis M. Eaton
Full Text Available This exploratory research paper investigated the coping strategies of families of hospitalized psychiatric 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.
Keeshin, Brooks R; Strawn, Jeffrey R; Luebbe, Aaron M; Saldaña, Shannon N; Wehry, Anna M; DelBello, Melissa P; Putnam, Frank W
Many children and adolescents who require psychiatric hospitalization have been physically or sexually abused, yet the association between reported histories of abuse and the complexity and severity of mental illness among psychiatrically hospitalized youth is poorly described with regard to current inpatient psychiatric practice. We sought to determine the association between histories of abuse and psychiatric complexity and severity in psychiatrically hospitalized youth including comorbidity patterns, psychotropic medication use, reason for admission and length of hospitalization. A systematic chart review was performed on 1433 consecutive psychiatric hospitalizations of children and adolescents that occurred over a 10-month period. Children with a history of abuse were more likely to be diagnosed with multiple DSM-IV-TR disorders than non-traumatized children. A history of sexual abuse was associated with more medication use than in their non-traumatized peers and a higher likelihood of treatment with antipsychotic medications, both at admission and discharge. Physical and sexual abuse were independently associated with increased length of stays, with exposure to both physical and sexual abuse associated with a 2-day increase in duration of hospitalization compared to non-traumatized patients. The findings from this study draw attention to the adverse impact of abuse on psychiatric morbidity and complexity and suggest the need for trauma-informed treatment in psychiatric hospital settings. PMID:24041456
Renata Marques de Oliveira
Full Text Available Objective: To identify the opinion of patients with mental disorder about tobacco and its prohibition during psychiatric hospitalization. Method: An exploratory study with 96 patients smokers with mental disorders hospitalized in a psychiatric ward of a general hospital. The interviews were conducted individually, using an instrument designed for this study. The content from the interviews was recorded, transcribed and submitted to a thematic content analysis. Results: The patients with mental disorder were identified as perceiving smoking during the psychiatric hospitalization as a help to support the difficulties in socialization and in the lack of activities. The permission for smoking is seen as a signal of respect to their needs. The subjects mentioned to not accept the total smoking prohibition. Conclusion: Tobacco helps to face difficulties and conflicts in the psychiatric hospitalization. There is resistance regarding the possibility to totally withdraw the smoking permission during hospitalization.
Full Text Available Abstract Background While there is interest in measuring the satisfaction of patients discharged from psychiatric hospitals, it might be important to determine whether surveys of psychiatric patients should employ generic or psychiatry-specific instruments. The aim of this study was to compare two psychiatric-specific and one generic questionnaires assessing patients' satisfaction after a hospitalisation in a psychiatric hospital. Methods We randomised adult patients discharged from two Swiss psychiatric university hospitals between April and September 2004, to receive one of three instruments: the Saphora-Psy questionnaire, the Perceptions of Care survey questionnaire or the Picker Institute questionnaire for acute care hospitals. In addition to the comparison of response rates, completion time, mean number of missing items and mean ceiling effect, we targeted our comparison on patients and asked them to answer ten evaluation questions about the questionnaire they had just completed. Results 728 out of 1550 eligible patients (47% participated in the study. Across questionnaires, response rates were similar (Saphora-Psy: 48.5%, Perceptions of Care: 49.9%, Picker: 43.4%; P = 0.08, average completion time was lowest for the Perceptions of Care questionnaire (minutes: Saphora-Psy: 17.7, Perceptions of Care: 13.7, Picker: 17.5; P = 0.005, the Saphora-Psy questionnaire had the largest mean proportion of missing responses (Saphora-Psy: 7.1%, Perceptions of Care: 2.8%, Picker: 4.0%; P P Conclusion Despite differences in the intended target population, content, lay-out and length of questionnaires, none appeared to be obviously better based on our comparison. All three presented advantages and drawbacks and could be used for the satisfaction evaluation of psychiatric inpatients. However, if comparison across medical services or hospitals is desired, using a generic questionnaire might be advantageous.
Antônio Artur de Souza
Full Text Available This paper presents the results of a research that aimed at developing a financial analysis of a sample of Brazilian hospitals between 2006 and 2011. The data were collected from financial statements of 23 hospitals and from the Database of United Health System. These secondary data were analyzed through the following techniques: descriptive statistics, Spearman’s correlation, Kolmogorov-Smirnov’s test, Kruskal-Wallis’ test and Chi-square’s test. It was verified that the sample presents unsatisfactory general results about financial performance, especially when related to financial ratios of profitability and return. However, the analysis of different categories of hospitals displays relevant and significant divergences, especially about the type of hospitals: publics and voluntaries ones. The voluntary hospitals present higher liquidity ratios and the best profitability and their capital structure usually focus on long term financing obtained from external agents. These evidences suggest that those organizations focus on financial leverage to achieve better results without deteriorate their liquidity. On the other hand, the public hospitals present lower liquidity as well as worse profitability and return ratios. It was verified that the large-sized hospitals usually present lower financial ratios (liquidity, profitability and return than the medium-sized hospitals.
McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard
Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables—namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature—influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.
Langan-Martin, Julie; McLean, Gary; Cantwell, Roch; Smith, Daniel J.
Objective: To describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates. Methods: Scottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum perio...
Simon, Joan B.; Savina, Elena A.
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…
Russo Federico; Righi Roberto; Minervini Lina; Margari Francesco; Casacchia Massimo; Boncompagni Giancarlo; Boccalon Roberto M; Ballerini Andrea; Salteri Andrea; Frediani Sonia; Rossi Andrea; Scatigna Marco
Abstract Background The PERSEO study (psychiatric emergency study and epidemiology) is a naturalistic, observational clinical survey in Italian acute hospital psychiatric 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 and psychiatric diagnoses; and...
Abayomi, O; Adelufosi, A; Adebayo, P; Ighoroje, M; Ajogbon, D; Ogunwale, A
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 psychiatric hospital. Aim: To determine the HIV risk behavior in persons with severe mental disorders in a psychiatric hospital. Subjects and Methods: This was a cross-sectional survey involving 102 persons with serious mental disorders receiving treatment at a major psyc...
Robin L. Gabriels
Full Text Available Pediatric patients with autism spectrum disorders (ASD and/or intellectual disabilities (ID are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital 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 psychiatric hospital 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 (=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.
Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers;
hospital contact and was identified using The Danish Psychiatric Central Research Register. All diagnoses in Danish registries are coded according to ICD-8 or ICD-10. All hospital records were retrieved manually. Results: Among 5,178 deaths, 395 were due to SCD and autopsies were performed on 262 (66%). In...... 77 SCD cases, a previous psychiatric hospital contact was identified. The SCD incidence rate in psychiatric patients was 14.8 (95% CI, 11.7–18.5) per 100,000 person-years versus 3.8 (95% CI, 3.4–4.3) per 100,000 person-years in individuals without psychiatric hospital contact (incidence rate ratio...... often unexplained (65% vs 40%, P = .02), and cardiac symptoms were reported prior to death in 46% of psychiatric patients. Conclusions: Patients with prior psychiatric hospital contact have a 4-fold increased risk of SCD. Since almost 50% had possible cardiac symptoms prior to death, cardiovascular risk...
Kessler, Ronald; Warner, Christopher H.; Ivany, Christopher; Petukhova, Maria; Rose, Sherri; Bromet, Evelyn J.; Brown, Millard; Cai, Tianxi; Colpe, Lisa J.; Cox, Kenneth L.; Fullerton, Carol S.; Gilman, Stephen Edward; Gruber, Michael; Heeringa, Steven G.; Lewandowski-Romps, Lisa
IMPORTANCE: The US Army experienced a sharp increase in soldier suicides beginning in 2004. Administrative data reveal that among those at highest risk are soldiers in the 12 months after inpatient treatment of a psychiatric disorder. OBJECTIVE: To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target expanded posthospitalization care. DESIGN, SETTING, AND PARTICIPANTS: There were 53,769 hospitaliz...
Miettunen, Jouko; Lauronen, Erika; Veijola, Juha; Koponen, Hannu; Saarento, Outi; Isohanni, Matti
We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response. PMID:16923637
Macfarlane, D; Fortin, P; Fox, J; Gundry, S; Oshry, J; Warren, E
Riverview Hospital, B.C.'s only and Canada's largest remaining provincial psychiatric hospital began a formal planned "downsizing" process in 1992. This initiative was an important element in the Province's strategic plan to shift to a more community-focused mental health system and to bring tertiary psychiatric services "closer to home" by redeveloping Riverview Hospital on three sites. The paper summarizes the literature pertaining to the "downsizing" of psychiatric hospital services in relation both to clinical and human resource planning. It describes the mental health system in B.C. and the service system context in which this exercise is occurring. It is based on the first three years of experience in identifying the major challenges and the strategies developed to meet these challenges. It draws some conclusions about the effectiveness of these strategies and it speculates about the likely future challenges as the "downsizing" process continues. PMID:9021839
Chen, Wen-Ching; Hwu, Hai-Gwo; Wang, Jung-Der
We surveyed 222 nurses, nursing assistants, and clerks at a psychiatric hospital 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
Thomas, Joan; Lackey, Nancy
This article describes the successful evacuation of an entire psychiatric hospital from New Orleans, Louisiana, to Memphis, Tennessee, on a weekend night. The destination site was 400 miles away and buses were used for transport. The evacuation occurred shortly before Hurricane Katrina struck New Orleans and included 73 adult, adolescent, and child acute psychiatric patients. Thirty-five staff members also participated in the evacuation with their families and pets. This report is significant because little is known about how to implement a disaster plan that involves the transport of an entire psychiatric hospital-patients, nurses, physicians, staff, and family members--to another city. The knowledge gained can also benefit psychiatric nurses and their organizations when establishing or modifying their disaster plans. PMID:18251350
Swenson, Lance P.; Esposito-Smythers, Christianne; Hunt, Jeffrey I.; Hollander, Beth L. G.; Dyl, Jennifer; Rizzo, Christie J.; Steinley, Douglas L.; Spirito, Anthony
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.
Mercado Suárez Miguel Francisco; Arreola Valenzuela Miguel Ángel; Alvarado Esquivel Cosme; Espinoza Andrade Francisco
Abstract Background The epidemiology of the hepatitis B virus (HBV) infection in psychiatric patients from developing countries is poorly studied. Therefore, we sought to determine the frequency of HBV surface antigen (HBsAg) and HBV surface antibody (HBsAb) serological markers of HBV infection in a population of patients of a psychiatric hospital in Durango City, Durango, Mexico, and to determine whether there are any epidemiological characteristics of the subjects associated with the infect...
Sampson, E L; White, N.; Leurent, B.; Scott, S; Lord, K; Round, J; Jones, L.
BACKGROUND: Dementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff. AIMS To define the prevalence of BPSD and explore their clinical associations. METHOD: Longitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4...
Gimba, Solomon Musa; Duma, Sinegugu
This qualitative case study explored barriers to provision of psychiatric nursing care in a hospital in Plateau State, Nigeria, and revealed motivational factors that helped the nurses to cope with these barriers. Data collection methods included grand tour and in-depth interviews and participant observation. Motivational factors were related to the psychiatric nurse's individual intrinsic belief system, as well as to their intrinsic belief system as influenced by the environment. These motivational factors highlight how psychiatric nurses continue to cope with the barriers they face in provision of care. The findings indicate the need for hospital management to create and sustain an environment to complement the existing intrinsic motivation of psychiatric nurses to provide psychiatric nursing care, and to provide prompt and appropriate emotional and psychological support to psychiatric nurses worldwide. PMID:26309173
Buus, Niels; Angel, Sanne; Traynor, Michael;
Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in groupbased supervision and identifying psychosocial...... reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense...... of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses....
Flensborg-Madsen, Trine; Becker, Ulrik; Grønbæk, Morten;
hospital with a psychiatric disorder. The prospective cohort study, the Copenhagen City Heart Study (n=18,146), was used, containing three updated sets of alcohol intake and lifestyle covariates and up to 26 years follow-up. Alcohol intake was measured by self-report while psychiatric disorders were.......31-3.04) compared to women drinking below the sensible drinking limits. For men, the risk functions were slightly U-shaped; thus, a weekly low or moderate alcohol intake seemed to have a protective effect towards developing psychiatric disorders. The findings suggest sex differences in the association between...
Full Text Available To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services.We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder on outcomes.Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949 after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%, and 40% violently offended after discharge (n = 2,613 with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied-substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes.Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses.
Fazel, Seena; Wolf, Achim; Fimińska, Zuzanna; Larsson, Henrik
Objectives To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. Method We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes. Results Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes. Conclusion Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses. PMID:27196309
Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.
Ranieri, Veronica; Madigan, Kevin; Roche, Eric; Bainbridge, Emma; McGuinness, David; Tierney, Kevin; Feeney, Larkin; Hallahan, Brian; McDonald, Colm; O'Donoghue, Brian
While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted. PMID:26163727
Full Text Available Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a What was the readmission rate? (b What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports.
Barekatain, Majid; Maracy, Mohammad Reza; Hassannejad, Razeyeh; Hosseini, Reihane
Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective factors on readmission? Method. This cross-sectional study was conducted on a total number of 3935 patients who were admitted to Isfahan University Hospital Psychiatric Ward in Isfahan, Iran, from 2004 to 2010. Gender, age, marital status, education, self-report history of previous admission, type of psychiatric disorder, substance misuse, suicide, and the length of the current psychiatric disorder were collected from the registered medical files of patients. The data were analysed using the negative binomial regression model. Results. We found that factors such as psychiatric anxiety disorder, bipolar I, bipolar II, psychotic disorder, depression, and self report history of previous admission were statistically significant in the number of readmissions using the negative binomial model. Conclusion. Readmission to the psychiatric ward is mainly predictable by the type of diagnosis and psychosocial supports. PMID:24236285
Morrison, E F
Aggression and violence are significant clinical problems in psychiatric inpatient units. However, research exploring violent behavior is limited by the lack of an adequate research scale. This paper reports on the development and testing of the Violence Scale (VS), a behavioral rating scale which measures aggressive and violent behavior towards self, others and property. The VS has been tested in two studies of psychiatric inpatients (N = 162) and (N = 42). Tests of reliability included internal consistency, item analysis and stability. Tests of validity included content and construct validity. The psychometric results were evaluated through the application of standard statistical criteria [Carmines, E. G. and Zeller, R. A. (1979). Reliability and Validity Assessment. Sage University Press, Beverly Hills, CA; Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 197-333; Nunnally J. (1978). Psychometric Theory, McGraw-Hill, New York]. Coefficient alpha was 0.91 (study 1) and 0.68 (study 2) and stability was r = 0.79 (study 1). The items met most of the established criteria for item analysis and internal consistency. In factor analysis, the items met the criteria for loading onto the three predicted factors (others, self and property). Results of predictive model testing indicated that three of the four predicted relationships were supported. Initial testing indicates the scale is moderately stable, is internally consistent, and has evidence of initial limited construct validity. PMID:8449658
Huey, Jr., Stanley J.; Henggeler, Scott W.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Cunningham, Phillippe B.; Pickrel, Susan G.
This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization. Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or…
Ehrlich, Stefan; Noam, Gil G.; Lyoo, In Kyoon; Kwon, Bae J.; Clark, Megan A.; Renshaw, Perry F.
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 psychiatrically hospitalized children and youth with and without a history of suicide attempt while controlling for other…
Penkunas, Michael J; Hahn-Smith, Stephen
This study investigated the demographic and clinical predictors of psychiatric hospitalization during the first 2 years of treatment for adults participating in the full-service partnership (FSP) program, based on Assertive Community Treatment, in a large county in northern California. Clinical and demographic characteristics, data on prior hospitalizations, length of enrollment, and living situation for 328 FSP participants were collected from the county's internal billing system and the California Department of Health Care Services. In univariate models, the probability of hospitalization varied by diagnosis, age, and hospitalization history. In the multivariate model, younger age and frequent hospitalization prior to enrollment predicted hospitalization during enrollment. Findings support prior research on hospital recidivism and may be beneficial in refining future strategies for meeting the needs of adults with serious mental illness. PMID:25527223
Simoens Steven R
Full Text Available Abstract 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 psychiatric hospitals. 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 psychiatric hospitals 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.
Mercado Suárez Miguel Francisco
Full Text Available Abstract Background The epidemiology of the hepatitis B virus (HBV infection in psychiatric patients from developing countries is poorly studied. Therefore, we sought to determine the frequency of HBV surface antigen (HBsAg and HBV surface antibody (HBsAb serological markers of HBV infection in a population of patients of a psychiatric hospital in Durango City, Durango, Mexico, and to determine whether there are any epidemiological characteristics of the subjects associated with the infection. Methods Out of 150 patients of the psychiatric hospital of Durango City, 99 were examined for HBsAg and HBsAb by AUSZYME MONOCLONAL (Abbott Laboratories, Abbott Park, IL, USA assay and AUSAB (Abbott Laboratories, Abbott Park, IL, USA assay, respectively. Epidemiological data from each participant was also obtained. For comparison purposes, 2505 blood donors were examined for HBsAg seropositivity. Results Out of the 99 patients studied, twelve showed serological evidence of HBV infection (12.1%; 7 of them (7.1% were positive for HBsAg, and 5 (5.1% were positive for HBsAb. Out of the 2505 blood donors, 2 (0.0008% were HBsAg positive. Seropositivity to HBV markers was associated with an age of 45 years and older (OR = 4.27; 95%CI = 1.02–18.78. Other characteristics as gender, number of hospitalizations, duration of the last hospitalization, and clinical diagnosis were not associated with seropositivity to HBV infection markers. Patients showed a significantly higher HBsAg seropositivity than blood donors (p Conclusion HBV was found to be an important infectious agent in the Mexican psychiatric inpatient population studied. Health care strategies for prevention and control of HBV infection in psychiatric hospitals should pay special attention to patients aged forty-five years and older.
Levenson, J L
As a psychiatrist, I have focused in this paper on the medical model view of commitment. Directed against the medical model is the civil liberties position, mostly put forward by attorneys, which values autonomy over beneficence and sees psychiatric decision-making as biased, imprecise, and too paternalistic. Like the moral principles they champion, neither of these positions is "wrong." The tension between them is inevitable and sometimes beneficial. The conflict is inevitable because the proponents differ in their missions and how they think. Attorneys (and philosophers) think in terms of the general case, of classes of situations, whereas psychiatrists focus on individuals as unique. Chodoff has also pointed out that the medical model is a utilitarian one, i.e. the morality of an act is determined by, on balance, whether it increases the good for the individual or society. The civil liberties position, on the other hand, is a deontological one, i.e. the end does not justify the means; some moral principles must be considered even if they do not lead to maximally good outcomes. This conflict between positions can be ultimately beneficial, if we recognize that each is fighting for a good. As a society, we should expect psychiatrists and other mental health professionals to try their utmost to treat the mentally ill, and attorneys to protect their rights. When we view it as such a moral dilemma, "we are confronted not with melodrama, a contest of right against wrong, but rather with tragedy, a conflict of one right--to be at physical liberty--against another right--to be free dehumanizing disease." PMID:3562678
McTiernan, K; McDonald, N
Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions
Jacobowitz, William; Moran, Christine; Best, Cheryl; Mensah, Lucy
Assault of staff in psychiatric hospitals is a frequent occurrence, and studies indicate that hospital staff are at risk of developing post-traumatic stress disorder (PTSD). We performed a correlational study with a convenience sample of 172 staff in a psychiatric hospital and compared the rate of traumatic events (TEs), resilience, confidence, and compassion fatigue to PTSD symptoms (PTSS). Regression analyses identified two variables that were unique predictors of PTSS: (1) trauma-informed care (TIC) meeting attendance and (2) burnout symptoms. Severe TEs, age, and compassion satisfaction also contributed to the model. Attention to these factors may help reduce PTSS in psychiatric staff. PMID:26631861
Very few studies from Pakistan have examined the profile of patients seen by psychiatrists in general hospital. The aim of this research is to describe the clinical and demographic characteristics of patients referred to the psychiatric unit of a general hospital over a one year period. Methods: This cross-sectional study was conducted at the Ayub Teaching Hospital, Abbottabad, from January 1st to December 31st 2012. All patients being referred to psychiatry were included in the study over one year period. The information was recorded on a structured questionnaire and analysed the data using SPSS-19.0. Results: Out of the 105 patients referred to the psychiatric unit, 74 (72.3%) were females. A total of 69 (68.5%) patients were married. More than half were uneducated and only number 4 (3%) patients had university qualification. Housewives made up 64.4% of the patient population followed by students (11%). Majority 55 (53%) had less than Rs. 5000/ monthly income. About 30% patients were shifted to psychiatry ward while, nearly one tenth were discharged. In 35% cases the psychiatrist was asked to help in the management, while in 50% cases only opinion was sought. Aggressive and threatening behaviour was source of concern in majority of patients for the primary team while 34% exhibited suicidal behaviour. Depression was most frequent diagnosis in 45 43% patients, followed by conversion disorder 19 (17%) and delirium 16 (14%). Conclusion: The rate of psychiatric referrals is dismal with only one third of the patients being transferred to the psychiatric ward. The major psychiatric diagnosis was depression. Patients with aggressive and threatening behaviour were more frequently referred. (author)
Krumm, Silvia; Kilian, Reinhold; Becker, Thomas
There is an increasing awareness of gender-related issues in psychiatry. However, empirical findings on attitudes of psychiatric staff towards patient gender are limited. Gender-related issues are particularly relevant in the debate about mixed versus segregated sex wards, yet while the appropriateness of mixed-sex wards is questioned in Great Britain this is not the case in Germany. To investigate attitudes of psychiatric staff towards both patient gender and mixed versus segregated sex wards, we conducted a case study using focus groups with members of professional teams. We evaluated the transition process from two single-sex wards to two mixed-sex wards in a 330-bed psychiatric hospital in a rural area in south Germany. Staff described female patients as more externally oriented, motivating of others, demanding, and even sexually aggressive. Male patients, on the other hand, were described as more quiet, modest, or lazy. Furthermore, participants described the mixing process as a positive development whereas they did not see a need for gender-separated wards in order to protect vulnerable female patients. Some gender descriptions by professionals are "reversed" in comparison with gender stereotypes supposed to be present in wider society. The perception of crossed gender norms may affect staff attitudes towards the vulnerability of female patients in psychiatric settings and the provision of single-sex wards in in-patient psychiatric care. Practical implications are discussed against the background of a high rate of female patients with sexual abuse histories. PMID:16157434
Park, Subin; Ahn, Myung Hee; Na, Riji; Kim, Seon-Ok; Yoon, Jin Sang; Park, Jun-Hyuk; Hong, Jin Pyo
This study aims to highlight the factors associated with suicide method among psychiatric patients in a general hospital in Korea. In a sample of 467 suicides by patients who had received mental health care in a general hospital in Korea, the relationship between suicide method and time of death as well as clinical characteristics, including psychiatric adiagnosis, was examined using multinomial logistic regression analysis. Compared with the general population, psychiatric patients, regardless of disorder, committed suicide by jumping from heights more often than by hanging (OR=2.35-8.64). In particular, patients with psychotic disorders and female patients were more likely to use jumping from a height than hanging to kill themselves (OR=2.98 and 1.83, respectively). Patients were more likely to use suicide methods other than hanging (e.g., OR=6.7 for jumping, 5.3 for drowning, and 2.7 for self-poisoning) between midnight and dawn. Possible suicide-prevention strategies suggested by this study include limiting access to or fencing off tall structures in close proximity to psychiatric institutions and residential care homes. At night, limiting access to or instituting heightened supervision of tall structures is specifically indicated. PMID:24055162
Manoj Kumar Roy
Full Text Available Malaria, a highly prevalent parasitic disease in tropical country, have some atypical neuro-psychiatric manifestations seen in both vivax and falciparum malaria. We are reporting two cases of unusual neuro-psychiatric manifestations of malaria admitted in our hospital, one with intralobar haemorrhage and other with atypical psychiatric features. The rarity of the presentation has been highlighted with possible pathogenesis discussed after literature review. [Int J Res Med Sci 2014; 2(3.000: 1184-1187
Priscila Freitas Ramos
Full Text Available Psychiatric hospitalization is controversial, especially when there is no consent of the subject. Even in contemporary times, compulsory psychiatric hospitalization (IPC, is considered as a specific sector protective measure against the violation of elderly people’s rights. This paper identifies, based on court proceedings, how IPCs are done in a midsize city in the state of São Paulo. We used the documentary analysis of civil cases prosecutors, in the light of public health policies, of the mental health and of the Federal Constitution. The protection of the elderly is established via removal of the offender from his home. Actions by the Network of Guaranteed Inter-sectorial Care in the current public policies, previous to the IPC, were not identified.
Qin, Ping; Nordentoft, Merete
BACKGROUND: Persons with a history of admission to a psychiatric hospital are at high risk for suicide, but little is known about how this is influenced by factors related to psychiatric hospitalization. OBJECTIVE: To explore suicide risk according to time since admission, diagnosis, length of...... effect size and population attributable risk; and suicide risk associated with affective and schizophrenia spectrum disorders declines quickly after treatment and recovery, while the risk associated with substance abuse disorders declines relatively slower. This study also indicates that an admission...... history increases suicide risk relatively more in women than in men; and suicide risk is substantial for substance disorders and for multiple admissions in women but not in men. CONCLUSIONS: Suicide risk peaks in periods immediately after admission and discharge. The risk is particularly high in persons...
Thiago da Silva Domingos
Full Text Available OBJECTIVE To investigate the effectiveness of aromatherapy massage using the essential oils (0.5% of Lavandula angustifolia and Pelargonium graveolens for anxiety reduction in patients with personality disorders during psychiatric hospitalization. METHOD Uncontrolled clinical trial with 50 subjects submitted to six massages with aromatherapy, performed on alternate days, on the cervical and the posterior thoracic regions. Vital data (heart and respiratory rate were collected before and after each session and an anxiety scale (Trait Anxiety Inventory-State was applied at the beginning and end of the intervention. The results were statistically analyzed with the chi square test and paired t test. RESULTS There was a statistically significant decrease (p < 0.001 of the heart and respiratory mean rates after each intervention session, as well as in the inventory score. CONCLUSION Aromatherapy has demonstrated effectiveness in anxiety relief, considering the decrease of heart and respiratory rates in patients diagnosed with personality disorders during psychiatric hospitalization.
Isabella G. S. de Souza
Full Text Available OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs and a version for children (ChIPS. In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.OBJETIVO: O avanço em pesquisa em psiquiatria da infância e adolescência no Brasil depende da existência de instrumentos para a investigação de síndromes psiquiátricas adaptadas à Língua Portuguesa. Este artigo descreve um cuidadoso processo de tradução do Children´s Interview for Psychiatric Syndromes para o uso em pesquisa no Brasil. MÉTODOS: O Children´s Interview for Psychiatric Syndromes tem uma versão para pais (P-ChIPs e uma versão para as crianças (ChIPs. Nesse artigo, as seções do P-ChIPs referentes ao transtorno do déficit de aten
Maryam Vahidi; Mina Hosseinzadeh
Seclusion is one of the methods in controlling violent behavior of inpatients in psychiatric wards. In current descriptive analytic study, data collection instrument included the seclusion list of inpatients by considering individual, social and clinical characteristics in one of the psychiatry wards In the Razi teaching hospital of Tabriz in the first six months of 2012. Among 264 admitted patients, 24 patients (9.1%) had been secluded and a total of 29 isolated incidents w...
Majid Barekatain; Mohammad Reza Maracy; Razeyeh Hassannejad; Reihane Hosseini
Objectives. Readmission has a major role in the reduction of the quality of life and the increase in the years of lost life. The main objectives of this study were to answer to the following research questions. (a) What was the readmission rate? (b) What were the social, demographic, and clinical characteristics of patients admitted to the Psychiatric Emergency Service at Nour University Hospital, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran? (c) What were the effective...
Thiago da Silva Domingos; Eliana Mara Braga
OBJECTIVE To investigate the effectiveness of aromatherapy massage using the essential oils (0.5%) of Lavandula angustifolia and Pelargonium graveolens for anxiety reduction in patients with personality disorders during psychiatric hospitalization. METHOD Uncontrolled clinical trial with 50 subjects submitted to six massages with aromatherapy, performed on alternate days, on the cervical and the posterior thoracic regions. Vital data (heart and respiratory rate) were collected before and afte...
Becker, Sara J.; Nargiso, Jessica E.; Wolff, Jennifer C.; Uhl, Kristen M.; Simon, Valerie A.; Spirito, Anthony; Prinstein, Mitchell J.
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 psychiatrically hospitalized early adolescents. Youth (n = 108) between the ages of 12 and 15 years completed three assessments over 18 mont...
Amilton dos Santos Jr.
Full Text Available Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02. Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5% reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.
Petros, N; Foglia, E; Klamerus, E; Beards, S; Murray, R M; Bhattacharyya, S
Relapse in psychosis typically necessitates admission to hospital placing a significant financial burden on the health service. Exposure to childhood trauma is associated with an increased risk of psychosis, however, the extent to which this influences relapse is unclear. This report summarises current research investigating the influence of childhood trauma on relapse requiring psychiatric hospital admission for psychosis. Seven studies were included; two revealed a positive association between childhood trauma and relapse admission, two studies found a negative relationship and three found no significant difference. Inconsistent current evidence suggests a need for further research in this area. PMID:27151070
Krishnaram, Vaithiyam Devendran; Aravind, Vaithiyam Krishnaram; Vimala, A. Rupavathy
Majority of the published studies on suicide deal with identifying the sociodemographic and psychosocial aspects of suicide attempters and those who have completed suicide or to identify the characteristic differences between the two groups. There are very few studies focusing mainly or only on deliberate self harm. Most of these are hospital based studies or in a setting of general hospital psychiatry units. The present study is from Ram Psychiatry Hospital and Institute, a government licensed private psychiatric institute at Madurai, Tamil Nadu. It is a prospective study of individuals with self harm behavior mostly without the intention to kill, attending the psychiatry outpatient department of the hospital for the period of one year (January to December 2014) a total number of 140 cases are registered. Sociodemographic, clinical profiles with Axis I or Axis II diagnosis or otherwise, and the initiating or precipitating cause or mode of self-injury or self-harm are studied. The results are presented and discussed.
Lee, Myung-Soo; Park, Jong-Ik
Background A political movement towards building alternatives to long-term hospitalization of psychiatric patients in Korea has gained momentum. We aimed to provide sturdy foundation needed to formulate the most rational policy by review of caregiver’s opinion to the political alternatives under discussion for facilitating discharge of long-term stayed psychiatric patients in Korea. Discussion Caregivers in Korea, whose family members had been hospitalized longer than 6 months and all of whom...
non-peer-reviewed This study developed from a larger research project in the Clinical Therapies Department in the University of Limerick. The research project aims to document the Irish history of occupational therapy. In this study the researcher focused on the development of occupational therapy in St.Finan???s Psychiatric Hospital. The closure of St.Finan???s Psychiatric Hospital in 2012 and the release of its documentation to Kerry library archives provided this study with primary sour...
Full Text Available Abstract Background The PERSEO study (psychiatric emergency study and epidemiology is a naturalistic, observational clinical survey in Italian acute hospital psychiatric 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 and psychiatric diagnoses; and (ii to assess the clinical management, subjective wellbeing and attitudes toward medications. Methods A total of 62 SPDCs distributed throughout Italy participated in the study and 2521 patients were enrolled over the 5-month study period. Results Almost half of patients (46% showed an aggressive behaviour at admission to ward, but they engaged more commonly in verbal aggression (38%, than in aggression toward other people (20%. A total of 78% of patients had a psychiatric diagnosis at admission, most frequently schizophrenia (36%, followed by depression (16% and personality disorders (14%, and no relevant changes in the diagnoses pattern were observed during hospital stay. Benzodiazepines were the most commonly prescribed drugs, regardless of diagnosis, at all time points. Overall, up to 83% of patients were treated with neuroleptic drugs and up to 27% received more than one neuroleptic either during hospital stay or at discharge. Atypical and conventional antipsychotics were equally prescribed for schizophrenia (59 vs 65% during stay and 59 vs 60% at discharge, while atypical drugs were preferred in schizoaffective psychoses (72 vs 49% during stay and 70 vs 46% at discharge and depression (41 vs 32% during stay and 44 vs 25% at discharge. Atypical neuroleptics were slightly preferred to conventional ones at hospital discharge (52 vs 44%. Polypharmacy was in general widely used. Patient attitudes toward medications were on average positive and self
Pedro Gabriel Melo de Barros e Silva
Full Text Available ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.
Electricity demands in hospitals are characterized by their need for high quality, guaranteed supplies. The existence of captive electricity uses and the size and regularity of the electrical and heat loads required by hospitals are aspects that could well buttress the possibility of installing cogeneration plants fired by natural gas (CHP). The purpose of this paper is to estimate the CHP technical potential in Brazilian hospitals. Based on a classification of Brazilian hospitals by specific energy consumption indicators, this potential is assessed, taking into consideration gas fueled engines associated with absorption cooling systems. A potential figure of approximately 500 MWe was obtained, whose effective implementation runs up against the obstacles inherent to Brazil's hospital sector, listed at the end of this paper. Consequently, some actions are proposed for surmounting these barriers
Rudimar Antunes da Rocha
Full Text Available The article deals with the Hospital Accreditation as a quality parameter of hospitals in Brazil and the world. The focus was to identify how the hospitals of the host cities of the FIFA World Cup in 2014 are classified by the National Accreditation Organization (ONA and Joint Commission on Accreditation of Hospitals (JCI - the Brazilian Consortium for Accreditation (CBA. The Brazilian Manual of Accreditation establishes three stamps of hospital quality: Level 1: Accredited, Level 2: Fully Accredited and Level 3: Accredited with Excellence. From the methodological point of view the study was regarded as an exploratory approach, with a kind psychographic survey, with the intentional collection of data, ie the host cities. The research had a qualitative and quantitative treatment. Data were collected during March and April 2011 through the official websites of the ONA, JCI-CBA and FIFA on the Internet. It was concluded that the cities of Sao Paulo, Rio de Janeiro and Belo Horizonte are the best prepared in time for hospital accreditation by ONA and / or JCI-CBA. The hospitals of other offices need to create mechanisms to achieve a quality accreditation of types urgently. Only thus will avoid the negative image of the Brazilian health services to foreigners who, by bad luck, requiring medical and hospital during the World Cup 2014.
Increased security measures at high secure psychiatric hospitals can complicate hand hygiene. This audit assessed the availability of appropriate hand hygiene equipment and the practice of good hand hygiene at Broadmoor Hospital using the local hand hygiene policy as the standard for comparison. A data collection tool used to audit the hand hygiene equipment on 23 wards in the hospital showed that there were significant deficits in the supply of hand hygiene equipment on the wards. In addition, a staff survey was conducted using a questionnaire designed to assess awareness, training and hand decontamination practice among nursing staff. This survey identified a need to increase awareness of the hand hygiene policy and the appropriate timing of hand decontamination procedures. As a result of the audit, appropriate equipment was ordered and the duties of infection prevention link nurses on each ward were made more explicit; namely, to check and order equipment for hand hygiene as necessary, to conduct regular reminder sessions of the hand decontamination procedure and to raise awareness of hand hygiene policy. Posters were also placed on wards in patient areas to increase awareness of hand hygiene among patients, and alcohol gel dispensers were introduced into nursing stations. Similar audits may prove beneficial at other psychiatric hospitals. PMID:20304525
Full Text Available Ann Lykkegaard Soerensen,1,2 Marianne Lisby,3 Lars Peter Nielsen,4 Birgitte Klindt Poulsen,4 Jan Mainz5,6 1Faculty of Social Sciences and of Health Sciences, Aalborg University, Aalborg, Denmark; 2Department of Nursing, University College of Northern Denmark, Aalborg, Denmark; 3Research Centre of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; 4Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark; 5Aalborg Psychiatric University hospital, Aalborg, Denmark; 6Department for Health Services Research, University of Southern Denmark, Denmark Purpose: To investigate the frequency, type, and potential severity of errors in several stages of the medication process in an inpatient psychiatric setting. Methods: A cross-sectional study using three methods for detecting errors: (1 direct observation; (2 unannounced control visits in the wards collecting dispensed drugs; and (3 chart reviews. All errors, except errors in discharge summaries, were assessed for potential consequences by two clinical pharmacologists. Setting: Three psychiatric wards with adult patients at Aalborg University Hospital, Denmark, from January 2010–April 2010. The observational unit: The individual handling of medication (prescribing, dispensing, and administering. Results: In total, 189 errors were detected in 1,082 opportunities for error (17% of which 84/998 (8% were assessed as potentially harmful. The frequency of errors was: prescribing, 10/189 (5%; dispensing, 18/189 (10%; administration, 142/189 (75%; and discharge summaries, 19/189 (10%. The most common errors were omission of pro re nata dosing regime in computerized physician order entry, omission of dose, lack of identity control, and omission of drug. Conclusion: Errors throughout the medication process are common in psychiatric wards to an extent which resembles error rates in somatic care. Despite a substantial proportion of errors with potential to harm patients, very
Full Text Available The aim of the present study was to identify factors that are perceived by recovering psychiatric patients as contributing to their relapse. The participants were a convenient sample of out-patients at a psychiatric hospital in Mafikeng, north west South Africa. The sample consisted of 15 males and 15 females, aged 18 to GO years (mean age = 38.7 years. The research data was collected using a questionnaire and non-structured interview. The results showed that 43 percent of the patients attributed their relapse to inability to adhere to prescribed medical intervention. Patients also attributed relapse to lack of social support (20 percent, grief following the loss of a close family member (20 percent, and lack of employment (17 percent. It is recommended that a more integrated approach aimed at providing effective social support be considered in relapse prevention.
Cristina Amélia Luzio
Full Text Available The Brazilian psychiatric reform: historical and technical-supportive aspects of experiences carried out in the cities of São Paulo (capital, Santos and Campinas, in order to understand their material, social and political impacts, the progress in the process of breaking away from the psychiatric ward model, and the establishment of creative and productive groups, required to build up the psychosocial treatment in regard to mental health, as well as to evaluate the contribution that the SUS (Brazilian Public Health System had on the psychiatric reform in the mentioned cities. The research, which is the basis of this paper, is part of a thesis regarding mental health care, whereby the innovative projects implemented in those cities served as framework and basis for comparison to analyze mental health policy in small and medium-sized cities and towns in the state of São Paulo.
Walsh, D; Daly, A; Moran, R
Before the eighteenth century, there was limited response to the problem of psychiatric illness in Ireland as in many other countries. The asylums of the 1820s and 1830s were no sooner opened than they were overcrowded. A second wave of asylum building commenced in the second half of the nineteenth century continuing up to the early twentieth century. In 1966, the Report of the Commission on Mental Illness noted that the rate of psychiatric beds in Ireland per 1,000 was one of the highest in the world. The report called for a change in the policy of caring for the mentally ill in psychiatric hospitals to more community-based settings and in psychiatric units located in general hospital settings, along with a call for more research into mental illness. The result of the latter was the establishment of the first census of psychiatric patients resident in psychiatric hospitals. Thus began fifty years of census reporting and the subsequent establishment of the National Psychiatric Inpatient Reporting System (NPIRS). PMID:26667467
Luciana Burim Scomparini
Full Text Available OBJECTIVES: The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program. METHODS: In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse. RESULTS: The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation. CONCLUSION: All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse.
Di Lorenzo R
Full Text Available Rosaria Di Lorenzo,1 Nina Cimino,2 Elena Di Pietro,3 Gabriella Pollutri,4 Vittoria Neviani,5 Paola Ferri2 1Service of Psychiatric Diagnosis and Treatment, Department of Mental Health, AUSL Modena, Modena, 2School of Nursing, University of Modena and Reggio Emilia, 3School of Neuro-Psychiatry, 4School of Psychiatry, University of Modena and Reggio Emilia, 5 “The Medlar”, Villa Igea Hospital, Modena, Italy Background: Psychiatric emergencies of children and adolescents have greatly increased during the last years, but this phenomenon has not been studied in detail. The aim of this study was to analyze the correlation between acute psychiatric hospitalizations of adolescents and selected variables to highlight risk factors for psychiatric emergencies. Methods: This retrospective research was conducted in the acute psychiatric public ward, Service of Psychiatric Diagnosis and Treatment (SPDT, and in the residential facility for adolescents, “The Medlar”, located in Modena. The sample was constituted by all adolescent patients (n=101, age range 14–18 who had acute hospitalizations (n=140 in SPDT and had been successively transferred to “The Medlar” (n=83, from February 2, 2010 to January 31, 2015. From clinical charts, we extracted demographic and anamnestic characteristics of patients and clinical variables related to hospitalizations. Data were statistically analyzed. Results: Sixty-one percent of our patients lived with one divorced parent, with adoptive or immigrant family, or in institutions; 51% had experienced stressful events during childhood; 81% had a normal intellective level, but only 6% presented regular school performance. Parental psychiatric illness was negatively related, in a statistically significantly way, with onset age of adolescent mental disorders (coefficient -2.28, 95% confidence interval [CI]: -3.53 to 1.01, P<0.001, single linear regression; odds ratio: 4.39, 95% CI: 1.43–13.47, P<0.010, single logistic
Dov C. Goldenberg, MD, PhD; Gal M. Dini, MD, PhD; Max D. Pereira, MD, PhD; Augusto Gurgel, MD; Endrigo O. Bastos, MD; Purushottam Nagarkar, MD; Rolf Gemperli, MD, PhD; Lydia M. Ferreira, MD, PhD
Background: Soccer is the most popular sport in Brazil and a high incidence of related trauma is reported. Maxillofacial trauma can be quite common, sometimes requiring prolonged hospitalization and invasive procedures. To characterize soccer-related facial fractures needing surgery in 2 major Brazilian Centers. Methods: A retrospective review of trauma medical records from the Plastic Surgery Divisions at the Universidade Federal de São Paulo–Escola Paulista de Medicina and the Hospital das ...
Tramontina MY; Heineck I; Dos Santos L
Objectives: To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions (ADRs), drug interactions, and prescription of potentially hazardous medicines.Methods: A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as...
While the provisions of the highest courts concerning the involuntary commitment and treatment in psychiatric hospitals of people unable to give their consent are being implemented, in many federal states corresponding adjustments to the rules governing involuntary commitment in accordance with the mental health laws and laws on involuntary commitment are still pending. In states where new regulations do exist, legal experts express doubts that they conform to the Constitution and the UN Convention on the Rights of Persons with Disabilities. The DGPPN has formulated key parameters for involuntary commitment from a clinical perspective, which should be taken into account in the new regulations of the individual federal states. PMID:26868108
Full Text Available Background: A range of psychological disorders occur in women in the postpartum period apart from the traditional blues, postpartum depression and psychosis. These include obsession of infanticide, PTSD, morbid preoccupations regarding child birth and disorders of mother-infant relationships, though they are under emphasized. Methods: it is a cross-sectional study conducted in the tertiary maternity care hospital. A total of 152 study subjects were interviewed on MINI (Mini International Neuropsychiatric Inventory and GAF (Global Assessment of Functioning within 2 weeks after delivery. Results: The psychiatric morbidity was seen in 67 (44% of the study subjects. About 26% of subjects had Depressive disorder NOS. Obsessive harm to the child, Panic disorder, Social phobia were the other disorders identified. There were no cases of Mania, Bipolar disorder, psychosis, post traumatic stress disorder or substance use disorder diagnosed across the sample. The Global Assessment of Functioning (GAF score averaged 87.8. Statistically significant association was seen to be present between psychiatric illness and number of previous still births and dead children before this delivery (P = 0.045. Conclusions: The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Social phobia identified as a common association is a new finding and needs further replication. It needs a larger sample with a prospective assessment to generalize the findings of our study.
Trachtenberg, R L
When Robert L. Trachtenberg took over the executive directorship of the National Association of Private Psychiatric Hospitals some five months ago, he walked into a situation wherein several psychiatric specialty hospitals in Texas were under fire. "There were a lot of questions," Trachtenberg says, "and challenges to the credibility of psychiatric hospitals." He was referring to the Texas state investigation into abuses by personnel within psychiatric hospitals. Last year, the Texas Senate Interim Committee on Health and Human Services conducted an eight-month investigation into the conduct of the state's psychiatric hospitals after a newspaper article recounted the unconventional way in which a 14-year old boy was picked up and admitted to a psychiatric facility. After a number of public hearings, three private agencies overseeing Texas psychiatric hospitals adopted rules to prevent further problems in the areas of patient rights, fraudulent billing, patient recruitment and the admission and discharge process. The Senate Interim Committee, however, felt these rules needed to be codified into law and has drafted over 30 bills to be presented to the Texas legislature as omnibus legislation next January. Trachtenberg went to work to iron out methods to encourage better overseeing and state governance, as well as tackling the related issues of standards of care and managed care/utilization review. His background as Deputy Administrator of the Alcohol, Drug Abuse and Mental Health Administration within HHS provided him with a broad spectrum of knowledge about the field of psychiatry and its problems, and his vast experience in federal government--over 32 years of running domestic programs--enable him to have a keen sense of what can get done, and how. Health Systems REVIEW recently discussed the role of the NAPPH under its new leader, Bob Trachtenberg. What follows is an edited version of that conversation. PMID:10122848
Sripada, Rebecca K; Bowersox, Nicholas W; Ganoczy, Dara; Valenstein, Marcia; Pfeiffer, Paul N
The objective of this study was to assess whether the constructs of self-determination theory-autonomy, competence, and relatedness-are associated with adherence to outpatient follow-up appointments after psychiatric hospitalization. 242 individuals discharged from inpatient psychiatric treatment within the Veterans Health Administration completed surveys assessing self-determination theory constructs as well as measures of depression and barriers to treatment. Medical records were used to count the number of mental health visits and no-shows in the 14 weeks following discharge. Logistic regression models assessed the association between survey items assessing theory constructs and attendance at mental healthcare visits. In multivariate models, none of the self-determination theory factors predicted outpatient follow-up attendance. The constructs of self-determination theory as measured by a single self-report survey may not reliably predict adherence to post-hospital care. Need factors such as depression may be more strongly predictive of treatment adherence. PMID:26319610
Many therapeutic, diagnostic and prophylactic procedures used in hospitals are of potential genetic risk. An evaluation was made of genotoxic occupational risk in 42 workers from the Hospital de Clínicas de Porto Alegre, RS, Brazil, who had been occupationally exposed to lead (solder), ethylene oxide (sterilization area), antineoplastic drugs (nurses and pharmacists) or ionizing radiation. They were compared with 42 unexposed individuals. There was an increase in the frequency of binucleated ...
Full Text Available Zaid Demoz,1 Befikadu Legesse,1 Gebrehiwot Teklay,1 Birhanu Demeke,1 Tewodros Eyob,2 Zewdneh Shewamene,3 Mubarek Abera4 1Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, 2Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, 3Department of Pharmacology, School of Pharmacy, University of Gondar, Gondar, 4Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia Background: The degree to which an individual follows medical advice is a major concern in every medical specialty. Non-adherence to psychiatric treatment regimens has a profound impact on the disease course, relapse, future recovery, cost of health care, and the outcome for the patient. The aim of this study was to assess medication adherence and its correlates among psychiatric patients at Ayder Referral Hospital, Northern Ethiopia.Methods: A cross-sectional study was conducted from June to September 2013 at Ayder Referral Hospital, where 423 patients were selected by a systematic random sampling technique from all patients attending the psychiatric clinic at the hospital. Data were collected by trained data collectors through interview of the patients using a structured questionnaire. The collected data were entered into Epi Info version 7 and analyzed by Statistical Package for the Social Sciences version 16 software. Logistic regression was used to assess independent predictors of adherence. Results: A total of 387 patients completed the interview. Two hundred and sixteen (55.8% and 113 (29.2% were patients with a diagnosis of schizophrenia and mood disorder, respectively, while 35 (9% and 23 (5.9% had a diagnosis of drug addiction and autistic disorder. Two hundred and seven (71.6% patients were found to be adherent to their medication. When adherence rates were observed according to type of disorder, 60 (53.1%, 24 (68.6%, 149 (69%, and 18 (78.3% of patients
Vaithiyam Devendran Krishnaram
Full Text Available Majority of the published studies on suicide deal with identifying the sociodemographic and psychosocial aspects of suicide attempters and those who have completed suicide or to identify the characteristic differences between the two groups. There are very few studies focusing mainly or only on deliberate self harm. Most of these are hospital based studies or in a setting of general hospital psychiatry units. The present study is from Ram Psychiatry Hospital and Institute, a government licensed private psychiatric institute at Madurai, Tamil Nadu. It is a prospective study of individuals with self harm behavior mostly without the intention to kill, attending the psychiatry outpatient department of the hospital for the period of one year (January to December 2014 a total number of 140 cases are registered. Sociodemographic, clinical profiles with Axis I or Axis II diagnosis or otherwise, and the initiating or precipitating cause or mode of self-injury or self-harm are studied. The results are presented and discussed.
Blüml, Victor; Waldhör, Thomas; Kapusta, Nestor D.; Vyssoki, Benjamin
Background Recently, there has been a revived interest in the validity of the Penrose hypothesis, which was originally postulated over 75 years ago. It suggests an inverse relationship between the numbers of psychiatric hospital beds and the sizes of prison population. This study aims to investigate the association between psychiatric hospital beds and prison populations in a large sample of 26 European countries between 1993 and 2011. Methods The association between prison population sizes and numbers of psychiatric hospital beds was assessed by means of Spearman correlations and modeled by a mixed random coefficient regression model. Socioeconomic variables were considered as covariates. Data were retrieved from Eurostat, the statistical office of the European Union. Outcomes Mean Spearman correlation coefficients between psychiatric beds and prison population showed a significant negative association (-0.35; p = <0.01). However, in the mixed regression model including socioeconomic covariates there were no significant fixed parameter estimates. Meanwhile, the covariance estimates for the random coefficients psychiatric beds (σ2 = 0.75, p = <0.01) and year (σ2 = 0.0007, p = 0.03) yielded significant results. Interpretation These findings do not support the general validity of the Penrose hypothesis. Notably, the results of the mixed-model show a significant variation in the magnitude and direction of the association of psychiatric hospital bed numbers and the prison population sizes between countries. In this sense, our results challenge the prevalent opinion that a reduction of psychiatric beds subsequently leads to increasing incarcerations. These findings also work against the potential stigmatization of individuals suffering from mental disorders as criminals, which could be an unintentional byproduct of the Penrose hypothesis. PMID:26529102
Full Text Available The aim of the present investigation was to study the prevalence of psychiatric disorders in a sample of delinquent adolescents of both genders and to compare the prevalence between genders. A total of 116 adolescents (99 males and 17 females aged 12 to 19 on parole in the State of Rio de Janeiro were interviewed using the screening interview based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime (KSADS-PL. Data were collected between May 2002 and January 2003. Of 373 male and 58 female adolescents present in May 2002 in the largest institution that gives assistance to adolescents on parole in the city of Rio de Janeiro, 119 subjects were assessed (three of them refused to participate. Their average age was 16.5 years with no difference between genders. The screening interview was positive for psychopathology for most of the sample, with the frequencies of the suggested more prevalent psychiatric disorders being 54% for attention-deficit/hyperactivity disorder, 77% for conduct disorder, 41% for oppositional defiant disorder, 57% for anxiety disorder 57, 60% for depressive disorder 60, 63% for illicit drug abuse, and 58% for regular alcohol use. Internalizing disorders (depressive disorders, anxiety disorders and phobias were more prevalent in the female subsample. There was no significant difference in the prevalence of illicit drug abuse between genders. There were more male than female adolescents on parole and failure to comply with the sentence was significantly more frequent in females. The high prevalence of psychopathology suggested by this study indicates the need for psychiatric treatment as part of the prevention of juvenile delinquency or as part of the sentence. However, treatment had never been available for 93% of the sample in this study.
Full Text Available Abstract Background The paper reports on a study to evaluate the psychometric properties and cultural appropriateness of the Chinese translation of the Admission Experience Survey (AES. Methods The AES was translated into Chinese and back-translated. Content validity was established by focus groups and expert panel review. The Chinese version of the Admission Experience Survey (C-AES was administered to 135 consecutively recruited adult psychiatric patients in the Castle Peak Hospital (Hong Kong SAR, China within 48 hours of admission. Construct validity was assessed by comparing the scores from patients admitted voluntarily versus patients committed involuntarily, and those received physical or chemical restraint versus those who did not. The relationship between admission experience and psychopathology was examined by correlating C-AES scores with the Brief Psychiatric Rating Scale (BPRS scores. Results Spearman's item-to-total correlations of the C-AES ranged from 0.50 to 0.74. Three factors from the C-AES were extracted using factor analysis. Item 12 was omitted because of poor internal consistency and factor loading. The factor structure of the Process Exclusion Scale (C-PES corresponded to the English version, while some discrepancies were noted in the Perceived Coercion Scale (C-PCS and the Negative Pressure Scale (C-NPS. All subscales had good internal consistencies. Scores were significantly higher for patients either committed involuntarily or subjected to chemical or physical restrain, independent on severity of psychotic symptoms. Conclusion The Chinese AES is a psychometrically sound instrument assessing the three different aspects of the experience of admission, namely "negative pressure, "process exclusion" and "perceived coercion". The potential of C-AES in exploring subjective experience of psychiatric admission and effects on treatment adherence should be further explored.
Full Text Available Abstract Background Research on length of stay (LOS of psychiatric inpatients is an under-investigated issue. In this naturalistic study factors which affect LOS of two groups of patients were investigated, focusing on the impact on LOS of medical comorbidity severe enough to require referral. Methods Active medical comorbidity was quantified using referral as the criterion. The study sample consisted of 200 inpatients with the diagnosis of schizophrenia and 228 inpatients suffering from bipolar disorder (type I or II. Jonckheere and Mann–Whitney tests were used to estimate the influence of referrals on LOS, and regression analyses isolated variables associated with LOS separately for each group. Results Half of the patients needed one or more referrals for a non-psychiatric problem. The most common medical condition of patients with bipolar disorder was arterial hypertension. Inpatients with schizophrenia suffered mostly from an endocrine/metabolic disease - 12% of referrals were for Hashimoto’s thyroiditis. A positive linear trend was found between LOS and number of referrals; the effect was greater for schizophrenia patients. The effect of referrals on LOS was verified by regression in both groups. Overall, referred patients showed greater improvement in GAF compared to controls. Conclusions To our knowledge this was the first study to investigate physical comorbidity in psychiatric inpatients using the criterion of referral to medical subspecialties. Comorbidity severe enough to warrant referral is a significant determinant of hospital stay. This insight may prove useful in health care planning. The results show lack of effective community care in the case of schizophrenia and negative symptoms may be the cause of this. Our findings call for more attention to be paid to the general medical needs of inpatients with severe mental health and concurrent severe medical comorbidity.
Thaís Helena Piai-Morais
Full Text Available OBJECTIVE Evaluate and correlate individual, work-related and organizational factors that influence adherence to standard precautions among nursing professionals of psychiatric hospitals in São Paulo. METHOD An exploratory cross-sectional study conducted with 35 nursing professionals, using the assessment tool for adherence to standard precautions through the Likert scale, ranging from 1 to 5. RESULTS Knowledge of the precautions received a high score (4.69; adherence received (3.86 and obstacles (3.78, while intermediaries and the scales of organizational factors received low scores (2.61. There was a strong correlation between the magnitude adherence scale and the personal protective equipment availability (r = 0.643; p = 0.000. The training scale for prevention of HIV exposure (p = 0.007 was statistically different between the nurses and nursing assistants. CONCLUSION The organizational factors negatively contributed to adherence to standard precautions, indicating that psychiatric institutions lack safe working conditions, ongoing training and management actions to control infections.
Full Text Available Abstract Background There is a dearth of studies regarding chemical restraint in routine clinical psychiatric practice. There may be wide variations between different settings and countries. Methods A retrospective study on chemical restraint was performed in the 11-bed psychiatric ward of the General Hospital of Arta, in northwestern Greece. All admissions over a 2-year-period (from March 2008 to March 2010 were examined. Results Chemical restraint was applied in 33 cases (10.5% of total admissions. From a total of 82 injections, 22 involved a benzodiazepine and/or levomepromazine, whereas 60 injections involved an antipsychotic agent, almost exclusively haloperidol (96.7% of cases, usually in combination with a benzodiazepine (61.7% of cases. In 36.4% of cases the patient was further subjected to restraint or seclusion. Conclusions In our unit, clinicians prefer the combined antipsychotic/benzodiazepine regimen for the management of patients' acute agitation and violent behaviour. Conventional antipsychotics are administrated almost exclusively and in a significant proportion of cases further coercive measures are applied. Studies on the practice of chemical restraint should be regularly performed in clinical settings.
Chen, Wen-Ching; Hwu, Hai-Gwo; Kung, Shou-Mei; Chiu, Hsien-Jane; Wang, Jung-Der
Workplace violence, a possible cause of job stress, has recently become an important concern in occupational health. This study determined the prevalence of workplace violence and its risk factors for employees at a psychiatric hospital in Taiwan. A questionnaire developed by ILO/ICN/WHO/PSI was first translated and validated. It was then used to survey the prevalence of workplace violence in the last 12 months experienced by all nursing aides, nurses, and clerks at the hospital. Multiple logistic regression models were constructed to discover the determinants of violence. A total of 222 out of 231 surveyed workers completed a valid questionnaire. The one-year prevalence rates of physical violence (PV), verbal abuse, bullying/mobbing, sexual harassment, and racial harassment were 35.1, 50.9, 15.8, 9.5, and 4.5%, respectively. The prevalence of PV at this hospital was higher than that reported by other countries for the health sector. A high anxiety level was associated with the occurrence of PV. These results need to be corroborated by future investigation. A training program may be required for high risk groups to reduce workplace violence. PMID:18408350
Full Text Available Abstract Tuberculosis (TB is considered an occupational disease among health-care workers (HCWs. Direct contact with TB patients leads to an increased risk to become latently infected by Mycobacterium tuberculosis. The objective of this study is to estimate the prevalence of latent M. tuberculosis minfection among nursing professionals of a hospital in Rio Grande do Sul, Brazil, assessed by tuberculin skin test (TST. From November 2009 to May 2010, latent M. tuberculosis infection was assessed by TST in 55 nursing professionals. Epidemiological information was collected using a standardized questionnaire. A positive TST result (> or = 10 mm was observed in 47.3% of the HCWs tested. There was no significant difference in TST positivity when duration of employment or professional category (technician or nurse was evaluated. The results of this work reinforce the need for control measures to prevent latent M. tuberculosis infection among nursing professionals at the hospital where the study was conducted.
Full Text Available Seclusion is one of the methods in controlling violent behavior of inpatients in psychiatric wards. In current descriptive analytic study, data collection instrument included the seclusion list of inpatients by considering individual, social and clinical characteristics in one of the psychiatry wards In the Razi teaching hospital of Tabriz in the first six months of 2012. Among 264 admitted patients, 24 patients (9.1% had been secluded and a total of 29 isolated incidents were recorded. Most of secluded incidents occurred on weekdays (75.9%, first week of inpatient (87.7%, and during the evening shifts (48.3%. The results obtained in this study demonstrate that in 55.2% cases, the duration of isolation was two hours and the most common cause of seclusion was aggressive behaviors. Most of secluded patients (66.7% were diagnosed with mood disorders.
Munkner, Runa; Haastrup, Soeren; Joergensen, Torben;
The study examines how age, sex and substance use disorder are associated with the risk of committing a criminal offence. The study explicitly examines the risk after the first contact to the psychiatric hospital system and after the diagnosis of schizophrenia for those with no previous criminal...... record; the association between previous non-violent criminality and later violent criminality is also analysed. The study sample comprised 4619 individuals ever diagnosed with schizophrenia. All solved offences were accessible. Data were analysed using Cox's regression. Schizophrenic men had twice the...... risk of schizophrenic women of committing both violent and non-violent offences. A registered substance use disorder increased the risk 1.9- to 3.7-fold, depending on the starting point for the analyses, while increasing age on first contact or when diagnosed with schizophrenia diminished the risk...
Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars
We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients. PMID:26581019
Parshall Alice M
Full Text Available Abstract Background Evaluation of the referral, admission, treatment, and outcome of overseas patients admitted to a psychiatric hospital in central London. Ethical, legal and economic implications, and the involvement of consulates in the admission process, are discussed. Method Assessment and review of overseas patients admitted between 1 January 1999 and 31 December 1999. Non-parametric statistical tests were used, and relevant outcomes described. Results 19% of admissions were overseas patients. Mean age was 38 years. 90% were unattached; 84% were white, 71% from European countries. 45% spoke fluent English. Differences in socio-economic status between home country and England were found. 74% were unwell on arrival; 65% travelled to England as tourists. 65% of admissions came via the police. 32% had been ill for more than one year before admission; 68% had psychiatric history. 77% were admitted and 48% discharged under section of the Mental Health Act. 74% had psychotic disorders, all of them with positive symptoms. 55% showed little to moderate improvement in mental state; 10% were on Enhanced Care Programme Approach. Relatives of 48% of patients were contacted. The Hospital repatriated 52% of patients; the Mental Health Team followed up 13% of those discharged. The average length of admission was 43.4 days (range 1–365. Total cost of admissions was GBP350, 600 ($577, 490; average individual cost was GBP11, 116 (range GBP200-81, 000. Conclusions Mentally ill overseas individuals are a vulnerable group that need recognition by health organisations to adapt current practice to better serve their needs. The involvement of consulates needs further evaluation.
Fabiana Rossi Varallo; Helaine Carneiro Capucho; Cleópatra da Silva Planeta; Patrícia de Carvalho Mastroianni
OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to Decemb...
The assessment process can be integrated with treatment and evaluation for helping teenage suicide attempters and families in short term psychiatric hospitalization programs. The method is an extremely efficient way for the therapist to work within a given time constraint. During family assessment sufficient information can be gathered to…
Juliana Mika Kato
Full Text Available Objective: to analyze the epidemiology, clinical features and survival rate of patients undergoing orbital exenteration (OE in a tertiary referral hospital. Methods : we conducted a retrospective study of all patients undergoing OE at the Hospital das Clínicas, FMUSP between January 2007 and December 2012. We collected data records related to gender, age, origin, length of stay, duration of the disease, other treatments related to the disease, number of procedures outside of the face related to the disease, follow-up and histological diagnosis. Results : we treated 37 patients in the study period. The average survival in one year was 70%, in two years, 66.1%, and 58.3% in three years. There was no significant difference in the one-year survival related to histological diagnosis (p=0.15, days of hospitalization (p=0.17, gender (p=0.43, origin (p=0.78, disease duration (p=0.27 or the number of operations for the tumor (p=0.31. Mortality was higher in elderly patients (p=0.02. The average years of life lost was 33.9 in patients under 60 years, 14.7 in patients in the 61-80 years range and 11.3 in patients over 80 years. Conclusion : the present series of cases is significant in terms of prevalence of orbital exenteration; on the other hand, it shows one of the lowest survival rates in the literature. This suggests an urgent need for improved health care conditions to prevent deforming, radical resections.
Sharbel Weidner Maluf
Full Text Available Many therapeutic, diagnostic and prophylactic procedures used in hospitals are of potential genetic risk. An evaluation was made of genotoxic occupational risk in 42 workers from the Hospital de Clínicas de Porto Alegre, RS, Brazil, who had been occupationally exposed to lead (solder, ethylene oxide (sterilization area, antineoplastic drugs (nurses and pharmacists or ionizing radiation. They were compared with 42 unexposed individuals. There was an increase in the frequency of binucleated cytochalasin-blocked lymphocytes with micronuclei, though it was not significant (P = 0.058. The groups exposed to antineoplastic drugs and radiation had a significant increase in micronuclei frequency (P = 0.038 and P = 0.022, respectively. The high frequencies of dicentric bridges suggest the action of clastogenics in these two groups. These results suggest that the safety procedures adopted were very important to protect workers from exposure to mutagenic agents and should be improved in the radiological and chemotherapeutical areas.Vários procedimentos terapêuticos, diagnósticos e profiláticos usados em hospitais apresentam um risco genético. Para avaliar o risco genotóxico ocupacional, 42 trabalhadores do Hospital de Clínicas de Porto Alegre, RS, Brasil, ocupacionalmente expostos a chumbo (uso de soldas, óxido de etileno (área de esterilização, drogas antineoplásicas (enfermeiros e farmacêuticos e radiação ionizante foram comparados com 42 indivíduos não expostos. A análise de linfócitos binucleados apresentou um aumento estatisticamente não significativo (P = 0.058 na freqüência de micronúcleos. Quando analisados separadamente, os grupos expostos a drogas antineoplásicas e radiação ionizante apresentaram um aumento estatisticamente significativo (P = 0.038 e P = 0.0217, respectivamente na freqüência de micronúcleos. As freqüências de pontes dicêntricas e anomalias de fuso sugerem a ação de clastogênicos nestes dois
Reis Adriana O.
Full Text Available The emergence of vancomycin-resistant enterococci (VRE has been described recently in Brazil. This is in contrast to the USA and Europe, where the VRE appeared in the late 1980s. The progressive increase in VRE isolation poses important problems in the antimicrobial therapy of nosocomial infections. Treatment options and effective antimicrobial agents for VRE are often limited and the possibility of transfer of vancomycin genes to other Gram-positive microorganisms continues. In the search for antimicrobial agents for multiresistant Gram-positive cocci, compounds such as linezolid and quinupristin/dalfopristin have been evaluated. The present study was conducted to evaluate the in vitro activity of the oxazolidinone linezolid and 10 other antimicrobial agents, including quinupristin-dalfopristin, against multiresistant enterococci isolated in Brazilian hospitals. Thirty-three vancomycin resistant isolates (17 Enterococcus faecium and 16 E. faecalis, were analyzed. Strains were isolated from patients at São Paulo Hospital, Oswaldo Cruz Hospital, Hospital do Servidor Público Estadual, Santa Marcelina Hospital, Santa Casa de Misericórdia de São Paulo, and Hospital de Clínicas do Paraná. The samples were tested by a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS recommendations. All isolates were molecular typed using pulsed-field gel electrophoresis (PFGE. Linezolid was the most active compound against these multiresistant enterococci, showing 100% inhibition at the susceptible breakpoints. Quinupristin/dalfopristin and teicoplanin showed poor activity against both species. The molecular typing results suggest that there has been interhospital spread of vancomycin resistant E. faecium and E. faecalis among Brazilian hospitals. The results of this study indicate that linezolid is an appropriate therapeutic option for the treatment of vancomycin-resistant enterococci infections in Brazil.
Reis, A O; Cordeiro, J C; Machado, A M; Sader, H S
The emergence of vancomycin-resistant enterococci (VRE) has been described recently in Brazil. This is in contrast to the USA and Europe, where the VRE appeared in the late 1980s. The progressive increase in VRE isolation poses important problems in the antimicrobial therapy of nosocomial infections. Treatment options and effective antimicrobial agents for VRE are often limited and the possibility of transfer of vancomycin genes to other Gram-positive microorganisms continues. In the search for antimicrobial agents for multiresistant Gram-positive cocci, compounds such as linezolid and quinupristin/dalfopristin have been evaluated. The present study was conducted to evaluate the in vitro activity of the oxazolidinone linezolid and 10 other antimicrobial agents, including quinupristin-dalfopristin, against multiresistant enterococci isolated in Brazilian hospitals. Thirty-three vancomycin resistant isolates (17 Enterococcus faecium and 16 E. faecalis), were analyzed. Strains were isolated from patients at São Paulo Hospital, Oswaldo Cruz Hospital, Hospital do Servidor Público Estadual, Santa Marcelina Hospital, Santa Casa de Misericórdia de São Paulo, and Hospital de Clínicas do Paraná. The samples were tested by a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. All isolates were molecular typed using pulsed-field gel electrophoresis (PFGE). Linezolid was the most active compound against these multiresistant enterococci, showing 100% inhibition at the susceptible breakpoints. Quinupristin/dalfopristin and teicoplanin showed poor activity against both species. The molecular typing results suggest that there has been interhospital spread of vancomycin resistant E. faecium and E. faecalis among Brazilian hospitals. The results of this study indicate that linezolid is an appropriate therapeutic option for the treatment of vancomycin-resistant enterococci infections in Brazil. PMID:11779450
Fabiana Rossi Varallo
Full Text Available OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%, fatigue (12.3%, and chest pain (9.0%. Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases.
Henrique Borges Kappel
Full Text Available Introduction Insects have been described as mechanical vectors of nosocomial infections. Methods Non-biting flying insects were collected inside a pediatric ward and neonatal-intensive care unit (ICU of a Brazilian tertiary hospital. Results Most (86.4% of them were found to carry one or more species of bacteria on their external surfaces. The bacteria isolated were Gram-positive bacilli (68.2% or cocci (40.9%, and Gram-negative bacilli (18.2%. Conclusions Insects collected inside a hospital were carrying pathogenic bacteria; therefore, one must consider the possibility they may act as mechanical vectors of infections, in especially for debilitated or immune-compromised patients in the hospital environments where the insects were collected.
Guerra, Mariana; de Souza, Antônio Artur; Moreira, Douglas Rafael
This article describes a proposal for analyzing the performance of public Brazilian hospitals using financial and non-financial rates (i.e., operational rates), and thereby highlights the effectiveness (or otherwise) of the financial management of organizations in this study. A total of 72 hospitals in the Brazilian Unified Health Care System (in Portuguese, Sistema Unico de Saúde-SUS), were selected for accessibility and completeness of their data. Twenty-six organizations were used for the study sample, consisting of entities that had publicly disclosed financial statements for the period from 2008 (in particular, via the Internet) and whose operational data could be found in the SUS database. Our proposal, based on models using the method of Data Envelopment Analysis (DEA), was the construction of six initial models that were later compiled into a standard model. The relations between the rates that comprised the models were based on the variables and the notes of: Schuhmann, McCue and Nayar, Barnum and Kutzin, Younis, Younies, and Okojie, Marinho, Moreno, and Cavalini, and Ersoy, Kavuncubasi, Ozcan, and Harris II. We put forward an enhanced grant proposal applicable to Brazil aiming to (i) confirm or refute the rates that show the effectiveness or ineffectiveness of financial management of national hospitals; and (ii) determine the best performances, which could be used as a reference for future studies. Obtained results: (i) for all financial indicators considered, only one showed no significance in all models; and (ii) for operational indicators, the results were not relevant when the number of occupied beds was considered. Though the analysis was related to only services provided by SUS, we conclude that our study has great potential for analyzing the financial management performance of Brazilian hospitals in general, for the following reasons: (i) it shows the relationship of financial and operational rates that can be used to analyze the performance of
HUGO KARLING MORESCHI
Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.
Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina
Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…
Catarina Savastano; Elisa de Oliveira Silva; Lindyanne Lemos Gonçalves; Jéssica Maria Nery; Naiara Chaves Silva; Amanda Latercia Tranches Dias
Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the s...
CARIZA TEIXEIRA BOHRER; EDUARDO RAUPP DE VARGAS
This paper proposes a reflection to induce a better understanding of R&D in services, based on case studies carried out in Brazilian University Hospitals (UHs). The results show that the generation and increase of the stock of knowledge in services go beyond those reported in the material component. We also found that a diversity of actors contributed in an informal way to these dynamics. Concerning R&D funding, we noticed that service R&D is not always planned through a formal project. Then ...
Comtois, Katherine Anne; Carmel, Adam
The goals of this study were to (1) assess prevalence rates of borderline personality disorder (BPD) in public mental health patients and (2) compare research assessment rates to clinical record rates in those with and without a history of high utilization of inpatient psychiatric hospitalization. One hundred and sixty participants randomly selected from county mental health centers were fully assessed. Among the non-high utilizers, 10% met criteria for BPD on research diagnosis, 4.5% on clinical record diagnosis, and 1.5% on both. Among high utilizers, 42% met criteria for BPD on research diagnosis, 19% on clinical record diagnosis, and 19% on both. For the non-high utilizers, the sensitivity of the clinical record diagnosis (compared to the gold standard of the research diagnosis) was 15% and the specificity was 97%. For the high utilizer group, the sensitivity of the clinical record diagnosis was 45% and specificity was 100% indicating that there was never an incorrect clinical diagnosis of BPD among the high utilizers. Thus, while the specificity of the clinical record was high, the sensitivity of the clinical record diagnosis was quite low, and the clinical record greatly underestimated the prevalence of BPD in this sample. Further, since effective outpatient treatment has been developed for these expensive high utilizers with BPD, the under-recognition of BPD has significant implications for the planning of outpatient mental health services in public sector settings. PMID:24875431
Pfeiffer, Paul N; Bowersox, Nicholas; Birgenheir, Denis; Burgess, Jennifer; Forman, Jane; Valenstein, Marcia
Patient preferences and barriers to care may impact receipt of adequate mental health treatment following psychiatric hospitalization and could inform quality improvement initiatives. This study assessed preferences for a broad range of post-hospital services and barriers to counseling by surveying 291 patients and interviewing 25 patients who had recently been discharged from an inpatient psychiatric stay at one of the two Veterans Affairs Medical Centers. Individual counseling was the most frequently reported service that survey respondents preferred, but did not receive; whereas, open-ended survey responses and interviews also identified telephone follow-up "check-in" calls as a frequently preferred service. Difficulty with transportation was the most commonly cited barrier to counseling among survey respondents and in interviews; however, patients strongly preferred in-person counseling to telephone or internet-video alternatives. Increasing support from family and support from an individual Veteran peer were also perceived to be helpful in the majority of survey respondents. PMID:25779387
W.J.C. Van Rhyn; M.R. Gontsana
An exploratory study was conducted with the aim of discovering and describing experiences of psychiatric nursing students during clinical placement in a psychiatric unit. For the purpose of the study an unstructured interview was conducted with each participant during their first placement in a psychiatric unit to identify the factors experienced as stressful. The results indicated that all eight participants experienced average to high stress. Sources of stress identified included, among oth...
Ali Sahraian; Ahmad Ghanizadeh; Seyed Hamzeh Hashemi; Mohammad Reza Mohammadi; Laaya Ahmadzadeh
Objective: Violence imposed on wives by their inpatient psychiatric husbands has not been studied yet. The current study surveyed the rates and predictors of violence committed by inpatient psychiatric husbands towards their wives.Methods: A convenient sample of wives of 209 married male psychiatric inpatients completed a self-reported questionnaire. They were asked about physical, emotional, social and economic abuse.Results: More than 80% of the husbands socially abused their wives; 73.0% o...
Epaenetus A. Awuzu; Emmanuel Kaye; Patrick Vudriko
Various studies have reported that abuse of cannabis is a risk factor for psychosis. The aims of this study were to determine the prevalence of delta 9-tetrahydrocanabinol (Δ9-THC), a major metabolite of cannabis, in psychiatric patients in Uganda, and to assess the diagnostic capacity of two referral mental health hospitals to screen patients for exposure to cannabis in Uganda. Socio-demographic characteristics of the patients were collected through questionnaires and review of medical recor...
Wilkinson, M J B; Barczak, P.
The prevalence of psychiatric disorder in 100 patients attending their general practitioner was found to be 33% based on the criteria of the DSM-3 diagnostic system. Using the DSM-3 diagnosis as a yardstick, the performance of the hospital anxiety depression scale was compared with that of the general health questionnaire. Relative operating coefficient analysis showed good discrimination between `cases' and `non-cases' for both questionnaires, and the optimum threshold score was found to be ...
Full Text Available BACKGROUND Chronic pulmonary diseases are a global health problem and the number of patients being treated in primary care settings is increasing. The prevalence of a life-time diagnosis of asthma has increased in all age groups. There has been a dramatic shift in the conceptualization and treatment of asthma and COPD in the last 50 years. Psychiatric disorders, especially anxiety disorders, are very common in patients with asthma and COPD. Anxiety is also common in COPD and is related to some of the same factors described for asthma including the psychological response to the experience of breathlessness as well as side effects of beta-agonists. Since there is paucity of relevant data from Kashmir, this study was designed to find the co morbidity in patients of COPD and Asthma in a tertiary care teaching hospital in Srinagar, Kashmir. METHODS Sixty successive patients presents with history of thirty each of asthma and COPD who fulfilled inclusion and exclusion criteria were taken up for the study and administered the Hamilton depression rating scale (HAM-D and Hamilton Anxiety rating scale (HAM-A scales for evaluation of depressive disorder and anxiety disorder. Each patient was informed about the purpose of interview; his/her consent was obtained and strict confidentiality was ensured. General description, demographic data and psychiatric history were recorded using semi structured Proforma and HAM-A and HAM-D. RESULTS Out of sixty cases of COPD and Bronchial Asthma, 50% of the patients were in the age group of 66-80 followed by 35% in age group of 81-85 years. This could suggest that COPD and Bronchial Asthma is a problem of old age. There were predominantly more males (65% than females (35% in our study. Representations of gender, religion, family type and marital status have been found to be in accordance with socio-demographic profile of our country. Out of sixty cases of COPD and Bronchial Asthma, 35% of the patients were educated up to
Full Text Available Background and Objectives: Feasible interventions promoting tobacco cessation need to be implemented in psychiatric hospitals, where high proportions of patients are heavy smokers. This pilot study examined the feasibility of a new brief motivational intervention associating positive experiences with temporary smoking cessation. Methods: One-day interventions were proposed to 19 smokers hospitalized for severe mental disorders. The multicomponent intervention comprised a 25-hour tobacco cessation period, information about smoking, attending thermal baths and music therapy sessions, intensive group support and feedback sessions. Expired carbon monoxide was monitored and nicotine replacement was available. Patients were evaluated before, during and after the intervention. Results: Most participants were heavy smokers (68.4% and precontemplative about smoking cessation (52.6%. Rates of successful smoking abstinence were 78.9% after 10 hours and 47.4% at 25 hours; 15.8% stopped for 3 days or more. Median CO level decreased from 24 to 9 ppm. Patients reported high levels of general well-being and satisfaction during the abstinence day. Psychiatric condition did not deteriorate and frequency of withdrawal symptoms was low. 84% of patients used nicotine replacement. Significantly reduced cigarette consumption persisted for at least one week after the intervention. Conclusions: A brief motivational intervention based on the association between positive experience and temporary smoking abstinence is feasible in a psychiatric hospital. The reported positive experience calls for further development and validation of integrative interventions, which are currently lacking.
Adami, Fernando; Figueiredo, Francisco Winter dos Santos; Paiva, Laércio da Silva; de Sá, Thiago Hérick; Santos, Edige Felipe de Sousa; Martins, Bruno Luis; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos
Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults. PMID:27332892
Zahreddine, Nada; Hady, Rima Talaat; Chammai, Rabih; Kazour, François; Hachem, Dory; Richa, Sami
40 million female domestic workers worldwide experience the inhumane conditions associated with this unregulated occupation, a situation that induces psychiatric morbidities in many. The case in Lebanon is not any better where it is estimated that one foreign domestic worker (FDW) commits suicide weekly. 33 female FDW and 14 female Lebanese (control group, CG) were enrolled. Brief Psychotic Rating Scale (BPRS) and Clinical Global Impression (CGI) scales were administered on admission and discharge and socio-demographic, living conditions, mental health care data and phenomenological observations were collected. Sexual, physical, and verbal abuses were detected in FDW (12.5, 37.5, and 50.0 %. respectively). 66.7 % of them were diagnosed with brief psychotic episode. The mean duration of hospital stay (13.1 days) was significantly lower in the FDW group. The mean cumulative antipsychotic dose of the FDW was 337.1 mg of chlorpromazine equivalent and the mean BPRS total pre-score of FDW was 66.4 with a much improved state on the CGI global improvement scale, all of which were nonsignificantly different from the CG. Striking phenomenological findings among FDW were acute anorexia (39.4 %), nudity (30.3 %), catatonic features (21.2 %), and delusion of pregnancy (12.1 %). Inpatient FDW are more diagnosed with psychotic than affective disorders and receive approximately similar treatment as controls in spite of the trend to rapidly discharge and deport the worker to limit the costs. Both groups presented with similar severity, although the FDW had peculiar phenomenological observations. PMID:24370752
van Harten, Peter N.; Egberts, Toine C. G.; Pijl, Ysbrand J.; Wilting, Ingeborg; Tenback, Diederik E.
Objective. Constipation is a prevalent problem in patients with psychiatric disorders; it reduces quality of life and may lead to severe complications. The prevalence distribution of constipation across all psychiatric diagnoses in patients with severe mental illness (SMI) has hardly been studied. The aim of this study is to estimate the association between psychiatric disorders and constipation in SMI inpatients. Methods. The strength of the association between constipation (based on use of laxatives) and DSM-IV psychiatric diagnosis was studied in a cross-sectional study with “adjustment disorders” as the reference group. The association was analyzed using logistic regression. Results. Of the 4728 patients, 20.3% had constipation. In the stratum of patients older than 60 years, all psychiatric categories except for substance related disorders were significantly associated with a higher prevalence of constipation (odds ratios ranging from 3.38 to 6.52), whereas no significant associations were found in the stratum of patients between 18 and 60 years (odds ratios ranging from 1.00 to 2.03). Conclusion. In the elderly, all measured psychiatric diagnoses are strongly associated with an increased prevalence of constipation. Physicians should be extra alert for constipation in SMI patients, independent of specific psychiatric diagnoses. PMID:27034921
Results: Out of 200 respondents studied in the study 41.5 % were males and 58.5% were females. Maximum number of patients (31.5% studied were in the age group below the 30 years. 3.5% of respondents were in the age group above 70 years. Out of total 200 respondents in the study 74 % of the respondents are in compliance with recommended medicine whereas non-compliance was found in the 26% of studied population. Complications (13.46% ascending out by usage of psychiatric medicine can be attributed as one of the major case of treatment non-compliance in psychiatric patients, among the psychiatric patients. Accessibility of psychiatric medicine and Financial constrain was also one of the reasons behind the medicine non-compliance (7.69%. Patients with no insight to psychiatric disease also include a good percentage of (5.76 % of medicine non- compliance. Conclusions: Non-compliance is a dominant factor which causes possibly causes readmission in psychiatric wards. Compliance in psychiatric patients in general could be enhanced and improved by adequate intervention via patient counselling and patient medicinal care and education. [Int J Basic Clin Pharmacol 2014; 3(1.000: 220-224
Erlangsen, Annette; Mortensen, Preben Bo; Vach, Werner; Jeune, Bernhard
BACKGROUND: Very old people have higher suicide rates than the younger elderly population. Psychiatric disorders are known to have a strong association with suicide among elderly people. AIMS: To analyse the analyse the suicide risk associated with psychiatric hospitalisation among the very old....... CONCLUSIONS: The association between suicide and psychiatric hospitalisation is much weaker for the very old than for the old. Psychiatric disorders among very old people may be interacting with other disorders, may be underdiagnosed or treated in other healthcare settings....... (> or =80 years) compared with the middle-aged (50-64 years) and old (65-79 years) populations. METHOD: Individual-level data on the entire Danish population aged 50 years or over were analysed for the period 1994-1998. Relative suicide risks were calculated using event-history analysis. RESULTS: Among...
Cheng, Jason E; Shumway, Martha; Leary, Mark; Mangurian, Christina V
This case-control study identified patient-specific factors associated with the longest psychiatric inpatient lengths of stay (LOS) at a large urban county hospital. Subjects with LOS ≥ 60 days comprised the extended LOS (ELOS) case cohort. An equally-sized control cohort consisted of a random sample of inpatients with LOS ≤ 30 days. Chi square tests and t tests were conducted to determine differences between groups. Factors associated with ELOS included older age, cognitive impairment, higher number of medical conditions requiring medication, and violence during hospital stay. Initiatives focused on community placement of patients with these characteristics may reduce prolonged LOS at safety-net hospitals. PMID:26883829
Sheikh Shoib; Raheel Mushtaq; Mohammad Maqbool Dar; Javid Ahmad Mir; Tabindah Shah; Rameshwar Singh; Javid Ahmad; Syed Kyser
Background: Compliance with medication is decisive for treatment of the psychiatric disorders and is necessary for determining the outcome and prognoses of psychiatric patients. While the causes of poor compliance are multifactorial, the psychiatrist should be aware of such factors and may be able to implement interventions to address those factors. The objective of study was to find out the various medical and social reasons affecting treatment Compliance among patients suffering from psychi...
W.J.C. Van Rhyn
Full Text Available An exploratory study was conducted with the aim of discovering and describing experiences of psychiatric nursing students during clinical placement in a psychiatric unit. For the purpose of the study an unstructured interview was conducted with each participant during their first placement in a psychiatric unit to identify the factors experienced as stressful. The results indicated that all eight participants experienced average to high stress. Sources of stress identified included, among others, ineffective teaching and learning programmes, poor managerial governance of the service, detachment of professional nurses from their teaching role, poor relationships among staff, overreliance on the medical model of care and patient neglect. Psychiatric nursing students sampled indicated universal support for in-service education and training for professional nurses, attitude change of professional nurses towards students, support for student initiatives, student involvement in patient care and adequate allocation of resources for patient care and nurse training. The exploration and description of experiences of the psychiatric nursing students will help nurse educators plan clinical learning opportunities in such a way that they are less stressful, thus ensuring that psychiatric nursing students are equipped to utilise themselves as therapeutic instruments.
Siegel, Pamela; da Motta, Pedro Mourão Roxo; da Silva, Luis G; Stephan, Celso; Lima, Carmen Silvia Passos; de Barros, Nelson Filice
The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment. PMID:27078812
Bressan, R A; J. Gerolin; Mari, J. J.
The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (...
Maria Selma Nogueira Oliveira
Full Text Available Objective: To assess the sociodemographic and clinical profile of patients in psychiatric hospitalizations of voluntary inpatients (IPV and involuntary (IPI, in psychiatric hospitals of Fortaleza-CE, Brazil, under contract with the Unified Health System (SUS. Methods: A quantitative study, descriptive, cross-sectional and analytical. The sample comprised 393 patients, distributed among 253 IPV and 140 IPI, submitted to Psychiatry specialty treatment, in the year 2007. Results: For both patients, IPV and IPI, most were male: 185 (73.1% and 82 (58.6%; single: 181 (46.7% and 103 (26.5%; living in Fortaleza: 181 (71.5% and 95 (67.9%, respectively, and aged 20 to 60 years (mean age of 37 years. We observed significant difference between the type of hospital and patient gender (p = 0.003, which did not occur with marital status (p = 0.688 and origin (p = 0.95. The main symptom profiles which justified the clinical admission of these patients were the use of alcohol or drugs 70 (27.6%, changes in critical judgments 40 (28.6% and psychological distress 68 (26.9%. Family members were the main responsible for conducting these patients to the hospital. Conclusion: The results showed that patients on IPV and IPI, which joined in the study, had a socio-demographic and clinical profile characterized by: prevalence of male patients, from the capital Fortaleza, single, mean age of 37 years, having been brought to hospital by a relative, mainly due to alcohol use or drugs.
沈萍; 沈仲夏; 徐美英; 陈海勤; 金莉; 陈海支
目的 分析精神专科医院外科住院患者精神病共病的流行病学情况及特征.方法外科住院患者791例,对其中共患精神病者进行统计学分析.结果 791例患者中共患精神病59例,精神病前3位分别为精神分裂症、抑郁症、神经症;外科疾病前3位分别为骨折、脑外伤、肠梗阻.结论 精神专科医院外科住院患者精神病共病比例高,共患疾病有相关性.%Objective To study the cpidcmiological status and characteristics on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals. Method Take statistic analysis on patients with psychiatric comorbidity from 791 inpatients from surgery department. Result There arc 59 psychiatric comorbidity patients from 791 patients. The first three of psychosis arc schizophrenia, depression and neurosis and the first three surgical diseases arc fracture, brain injury and intestinal obstruction. Conclusion There is a high level of psychiatric comorbidity among inpatients from surgery department of psychiatric hospitals. There is correlation between comorbidity diseases.
Full Text Available Abstract Background The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. Methods The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC", "hospitalization in the psychiatry ward (HIPW", or "non-hospitalization (NH", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. Results The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS, general health performance (GAS, psychiatric symptoms (BPRS, and life events (LCU, while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. Conclusion There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a
Ruaño, Gualberto; Szarek, Bonnie L; Villagra, David; Gorowski, Krystyna; Kocherla, Mohan; Seip, Richard L; Goethe, John W; Schwartz, Harold I
Aim This study aimed to determine the effect of the CYP2D6 genotype on the length of hospitalization stay for patients treated for major depressive disorder. Methods A total of 149 inpatients with a diagnosis of major depressive disorder at the Institute of Living, Hartford Hospital (CT, USA), were genotyped to detect altered alleles in the CYP2D6 gene. Prospectively defined drug metabolism indices (metabolic reserve, metabolic alteration and allele alteration) were determined quantitatively and assessed for their relationship to length of hospitalization stay. Results Hospital stay was significantly longer in deficient CYP2D6 metabolizers (metabolic reserve <2) compared with functional or suprafunctional metabolizers (metabolic reserve ≥2; 7.8 vs 5.7 days, respectively; p = 0.002). Conclusion CYP2D6 enzymatic functional status significantly affected length of hospital stay, perhaps due to reduced efficacy or increased side effects of the medications metabolized by the CYP2D6 isoenzyme. Functional scoring of CYP2D6 alleles may have a substantial impact on the quality of care, patient satisfaction and the economics of psychiatric treatment. PMID:23734807
Lunsky, Yona; Gracey, Carolyn; Bradley, Elspeth
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…
Full Text Available Objective: Violence imposed on wives by their inpatient psychiatric husbands has not been studied yet. The current study surveyed the rates and predictors of violence committed by inpatient psychiatric husbands towards their wives.Methods: A convenient sample of wives of 209 married male psychiatric inpatients completed a self-reported questionnaire. They were asked about physical, emotional, social and economic abuse.Results: More than 80% of the husbands socially abused their wives; 73.0% of the wives had been regularly beaten by their husbands; the rate for humiliation was 77.2%; and only 14.1% of the wives reported that their sexual relationship with their husbands is with desire.onclusion: There is a dramatic high rate of different types of abuse toward wives by their inpatient psychiatric husbands. They are commonly victimized by their husbands. Moreover, different types of violence always co-occur. Future studies should consider this important issue which is unfortunately an ignored research area.
Chemali, Zeina N.; Borba, Christina PC; Henderson, Tanya E; Tesfaye, Markos
This paper presents the delivery of mental health care to a sample of women living in Jimma, rural Ethiopia, and their access to mental health services. A total of 226 psychiatric charts were reviewed for women seen at Jimma University Specialized Hospital. The mental health charts included documentation ranging from one paragraph to a full note. No psychiatric chart recorded medication status, detailed substance abuse history, or a history of violence. Rendering appropriate mental health car...
Barnett, Paul G.; Wong, Wynnie; Jeffers, Abra; Hall, Sharon M.; Prochaska, Judith J.
Objective We examined the cost-effectiveness of smoking cessation treatment for psychiatric inpatients. Method Smokers, regardless of intention to quit, were recruited during psychiatric hospitalization and randomized to receive stage-based smoking cessation services or usual aftercare. Smoking cessation services, quality of life, and biochemically-verified abstinence from cigarettes were assessed during 18-months of follow-up. Trial findings were combined with literature on changes in smoking status and the age and gender adjusted effect of smoking on health care cost, mortality, and quality of life in a Markov model of cost-effectiveness during a lifetime horizon. Results Among 223 smokers randomized between 2006 and 2008, the mean cost of smoking cessation services was $189 in the experimental treatment group and $37 in the usual care condition (p < 0.001). At the end of follow-up, 18.75% of the experimental group was abstinent from cigarettes, compared to 6.80% abstinence in the usual care group (p <0.05). The model projected that the intervention added $43 in lifetime cost and generated 0.101 additional Quality Adjusted Life Years (QALYs), an incremental cost-effectiveness ratio of $428 per QALY. Probabilistic sensitivity analysis found the experimental intervention was cost-effective against the acceptance criteria of $50,000/QALY in 99.0% of the replicates. Conclusions A cessation intervention for smokers identified in psychiatric hospitalization did not result in higher mental health care costs in the short-run and was highly cost-effective over the long-term. The stage-based intervention was a feasible and cost-effective way of addressing the high smoking prevalence in persons with serious mental illness. PMID:26528651
Hildenete Monteiro Fortes
Full Text Available Este artigo traça um perfil histórico das diferentes interpretações da loucura, permitindo vislumbrar a própria história da saúde mental, desde seu caráter mítico inicial até explicações racionais, passando pela tolerância ao diferente até sua caracterização como doença. Na condição de doença mental, passível de tratamento e possível cura, surgem os hospitais psiquiátricos, os quais se tornaram símbolos da exclusão e seqüestro da cidadania. As recorrentes denúncias de violência e desrespeito aos direitos humanos, a partir da década de 1970, impulsionaram a reforma deste modelo de assistência psiquiátrica, pautando-se na desinstitucionalização e no resgate da cidadania e do respeito à singularidade e subjetividade do doente mental. A partir disso, a legislação brasileira passou a garantir os direitos e deveres tanto dos doentes mentais como dos médicos que deles cuidam, garantindo o respeito à dignidade humana em toda sua essência, inclusive no que tange a autonomia do paciente com relação ao tratamento compulsório.This article outlines the history of the various interpretations of madness. This provides an insight into the history of mental health, from initial mythical explanations to more rational modern approaches, from the tolerance of difference to its characterization as disease. The idea of treatable and possibly curable mental illnesses led to the emergence of psychiatric hospitals, which became symbols of incarceration and exclusion from society. Recurrent reports of violence and human rights abuses have, since the 1970s, fuelled calls to reform this model of psychiatric care and led to greater emphasis on care in the community, civil rights, and respect for the subjective and uniquely personal nature of mental illness. As a result, Brazilian law now recognizes the rights and duties both of the mentally ill and of the doctors who care for them, thereby ensuring respect for full human dignity
O'Sullivan, S T
Deliberate and recurrent foreign body ingestion is a common problem among institutionalised patients. We review our experience with 36 cases of deliberate foreign body ingestion by prisoners or psychiatric patients, thirty of whom were institutionalised at the time of ingestion. Symptoms were frequently severe in the prison inmate group but, in contrast, psychiatric patients presented with few, if any, symptoms. A majority of objects pass spontaneously or remain in situ without complication. Twenty-four patients were discharged following initial evaluation and without specific treatment. Eight of these were reviewed electively and discharged within one week. Twelve patients were admitted for observation, seven of whom were discharged within 48 hrs. Upper gastrointestinal endoscopy was performed in four patients and an intragastric foreign body identified in two cases. Laparotomy was performed in two cases for unresolving mechanical intestinal obstruction. Management should be conservative when possible, with surgery indicated only for complications.
NORDGAARD, JULIE; REVSBECH, RASMUS; Sæbye, Ditte; Parnas, Josef
The use of structured psychiatric interviews performed by non-clinicians is frequent for research purposes and is becoming increasingly common in clini-cal practice. The validity of such interviews has rarely been evaluated empirically. In this study of a sample of 100 diagnostically heterogeneous, first-admitted inpatients, the results of an assessment with the Structured Clinical Interview for DSM-IV (SCID), yielding a DSM-IV diagnosis and performed by a trained non-clinic...
Douzenis, Athanassios; Seretis, Dionysios; Nika, Stella; Nikolaidou, Paraskevi; Papadopoulou, Athanassia; Rizos, Emmanouil N; Christodoulou, Christos; Tsopelas, Christos; Mitchell, Dominic; Lykouras, Lefteris
Background Research on length of stay (LOS) of psychiatric inpatients is an under-investigated issue. In this naturalistic study factors which affect LOS of two groups of patients were investigated, focusing on the impact on LOS of medical comorbidity severe enough to require referral. Methods Active medical comorbidity was quantified using referral as the criterion. The study sample consisted of 200 inpatients with the diagnosis of schizophrenia and 228 inpatients suffering from bipolar diso...
Andrea Cristina Coelho Scisleski
Full Text Available Este artigo analisa a internação psiquiátrica de jovens, tomando-a não a partir de uma perspectiva psicopatológica individual, mas de uma dimensão subjetivo-social com base nos percursos desses jovens até a internação. O estudo foi realizado no Centro Integrado de Atenção Psicossocial para crianças e adolescentes do Hospital Psiquiátrico São Pedro, na cidade de Porto Alegre, Rio Grande do Sul, Brasil, por meio de oficinas com os jovens que estavam em atendimento na internação deste serviço. Percebeu-se uma recorrência que marca o percurso desses jovens e expressa um determinado modo de funcionamento da rede de atenção até a internação, acarretando na produção de um certo perfil desses jovens: pobreza sócio-econômica, baixa escolaridade e uso de drogas. Outro aspecto importante é o papel da ordem judicial nos encaminhamentos à internação, que obedece tanto a uma lógica de punição aos jovens e aos serviços, como também, paradoxalmente, constitui-se numa estratégia de acesso aos serviços de saúde.This article analyzes psychiatric hospitalization of young patients from a contemporary social-subjective (rather than a psychopathological perspective, following the trajectory of these youth prior to their admission. The study was conducted at the Center for Comprehensive Psychosocial Care for Children and Adolescents, São Pedro Psychiatric Hospital, in the city of Porto Alegre, Rio Grande do Sul State, Brazil. Recurrent traits in the trajectory of these youth expressed how the health care network functioned with them prior to their hospitalization, with a consistent pattern of socioeconomic deprivation, low schooling, and drug use. Another key aspect was the role of the court system in referring them for hospitalization, adhering to a kind of logic that punished both the youth and the services and paradoxically formed a strategy for access to health services.
... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Special staff... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.62 Condition of participation: Special... the patients. (f) Standard: Social services. There must be a director of social services who...
... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Special medical record... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.61 Condition of participation: Special... stated by the patient and/or others significantly involved. (4) The social service records,...
Edenir I. Palmero
Full Text Available Abstract The identification of families at-risk for hereditary cancer is extremely important due to the prevention potential in those families. However, the number of Brazilian genetic services providing oncogenetic care is extremely low for the continental dimension of the country and its population. Therefore, at-risk patients do not receive appropriate assistance. This report describes the creation, structure and management of a cancer genetics service in a reference center for cancer prevention and treatment, the Barretos Cancer Hospital (BCH. The Oncogenetics Department (OD of BCH offers, free of charge, to all patients/relatives with clinical criteria, the possibility to perform i genetic counseling, ii preventive examinations and iii genetic testing with the best quality standards. The OD has a multidisciplinary team and is integrated with all specialties. The genetic counseling process consists (mostly of two visits. In 2014, 614 individuals (371 families were seen by the OD. To date, over 800 families were referred by the OD for genetic testing. The support provided by the Oncogenetics team is crucial to identify at-risk individuals and to develop preventive and personalized behaviors for each situation, not only to the upper-middle class population, but also to the people whose only possibility is the public health system.
Psychiatric disorders and psychiatric consultation in a general hospital: a case- control study Transtornos psiquiátricos e solicitações de interconsulta psiquiátrica em hospital geral: um estudo de caso controle
Sumaia Inaty Smaira
Full Text Available INTRODUCTION: Psychiatric consultation (PC has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence. METHODS: A case-control patient study was conducted (47 cases and 94 controls to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures, and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD-10 criteria. The Self Report Questionnaire (SRQ, the CAGE and Brief Psychiatric Rating Scale (BPRS were used as well as a specifically designed questionnaire to collect clinical and demographic data. RESULTS: Behavioral alterations, either of elation or of depression, were the main for requesting a PC ; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases, while anxiety, depressive and alcohol-related disorders were predominant in group II (controls. Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals. DISCUSSION: The SRQ and CAGE were quite useful in the screening
Full Text Available The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (ISI. There are nine Master's and Doctoral graduate programs dedicated to research in psychiatry, neuropsychiatry, psychobiology, and mental health in the country, seven being located in southern states. During the 5-year period, from 1998 to 2002, 186 students received their doctorate degree (37/year. The programs published 637 articles in journals indexed by ISI, the majority of them in journals with an impact factor higher than 2. The research advisors' productivity varied among graduate programs, ranging from 0.6 to 2.0 articles per year in ISI-indexed journals. Despite the substantial barriers faced by the Brazilian scientific community (mainly financial and writing difficulties, Brazil's scientific mental health production is on the rise. The number of articles published in ISI-indexed journals has doubled without a significant increase in the number of graduate theses, suggesting that there was an improvement in both the quality of the scientific production and the productivity of the graduate programs. Based on these data, it is reasonable to predict a tendency to an increase in production over the next few years.
Grimholt Tine K
Full Text Available Abstract Background Patients who self-poison have high repetition and high mortality rates. Therefore, appropriate follow-up is important. The aims of the present work were to study treatment received, satisfaction with health care services, and psychiatric symptoms after hospitalization for self-poisoning. Methods A cohort of patients who self-poisoned (n = 867 over a period of 1 year received a questionnaire 3 months after discharge. The Beck Depression Inventory (BDI, Beck Hopelessness Scale (BHS, and Generalized Self-Efficacy Scale (GSE were used. The participation rate was 28% (n = 242; mean age, 41 years; 66% females. Results Although only 14% of patients were registered without follow-up referrals at discharge, 41% reported no such measures. Overall, satisfaction with treatment was fairly good, although 29% of patients waited more than 3 weeks for their first appointment. A total of 22% reported repeated self-poisoning and 17% cutting. The mean BDI and BHS scores were 23.3 and 10.1, respectively (both moderate to severe. The GSE score was 25.2. BDI score was 25.6 among patients with suicide attempts, 24.9 for appeals, and 20.1 for substance-use-related poisonings. Conclusions Despite plans for follow-up, many patients reported that they did not receive any. The reported frequency of psychiatric symptoms and self-harm behavior indicate that a more active follow-up is needed.
Kitchen waste of a psychiatric hospital will be recycled in a 'Biorek' system supplied by Danish producer Bioscan A/S. Biorek stands for 'Biological recirculation with combined heat and power generation'. The unit has a filter in which residues are filtered and recirculated. A small volume of residues, much water and separated nutrients are produced as end products. [German] Es wird eine Anlage zur Verwertung von Kuechenabfaellen beschrieben. Der Verfahrensingenieur Peter Ackermann empfiehlt Biorek vom daenischen Hersteller Bioscan A/S. Biorek, das steht fuer 'Biologische Rezirkulation mit Kraft-Waerme-Produktion'. Vom Grundsatz her handelt es sich dabei um eine Biogasanlage mit einer kleinen, aber entscheidenden Besonderheit: Einer Filteranlage. Was bei herkoemmlichen Anlagen bereits als Reststoff den Reaktor verlaesst, wird beim Biorek-Verfahren gefiltert und zurueckgepumpt. Am Ende des Prozesses steht eine kleine Menge 'unverdaulicher' Reststoff, viel Wasser und separierte Naehrstoffe. (orig.)
Full Text Available Background: Psychiatric Nurses and nurses’ assistants working in an inpatient unit experience a significant number of critical cases. A small number of studies have explored which patients’ problems nurses perceive as ‘critical case or incident’ and particularly which interventions they choose. Aim: The aim of the research was 1. To identify the clinical problems that mental health nurses and assistant nurses characterize as critical 2. To report the main nursing interventions 3. To investigate the main person involved in the critical incident. Material-Method: Critical incident technique was used as a method of data collection. Content analysis was carried out in order nurses’ information to be categorized into subcategories. The sample consisted of 35 mental health nurses and nurses’ assistants who work in psychiatric acute inpatient wards.Results: Nurses identified ten types of critical incidents. They noted violence (verbal, physical by patients and psychotic symptoms to be the most critical situations. Nurses were the main person involved in these incidents. The study also described eight nursing interventions used by nurses when faced with critical events. Conclusions: The findings indicated that mental health nurses and assistant nurses working in acute inpatient wards are called to confront a variety of critical incidents in their every day practice. Further research is necessary to identify in-depth nursing interventions and decision-making used in these situations.
The meaning of articles on the main security measures concerned with placing the convict in a closed psychiatric unit is studied. Articles 93 & 94 section 1 of the penal code limit their application only as final measures--the ultima ratio. Art. 93 of the penal code pertains to the perpetrator of illegal actions in connection to their psychiatric illness, mental retardation, alcohol or other related substance addiction, along with a risk of the crime being committed once again, only when it will prevent the person from repeating the crime. The issues that need be considered are the following: psychic state of the perpetrator along with prediction of the risk of him repeating the act, but the liability evaluation and the degree of probability do not play any vital role. This is probably due to the fact that the measure described in art. 96 of the penal code has a limited time span (it cannot be any shorter than 3 months and longer than 2 years) and what is more; it can be applied instead of the punishment. Art. 94 section 1 of the penal code requires very precise evaluation of the risk of repetition in each case of a non-liable perpetrator guilty of conducting crime of serious social damage. This measure is not limited in time span, because it depends on the psychic state of the person under its influence. Henceforth it is considered as more restrictive. PMID:17068937
Govind S Bhogale
Full Text Available Context: The prevalence of psychiatric comorbidity in general hospital range from 20% to 60%. Presence of psychiatric morbidity compounds the disability and suffering in medical patients. There is a limited literature on the prevalence of psychiatric morbidity in patients admitted in the intensive care units (ICUs. Aims: The aim of the study was to estimate the prevalence and nature of comorbid psychiatric illness in the cases referred from ICUs. Settings and Design: Cross-sectional observational study. Materials and Methods: This study included all the consecutive patients referred from different ICUs to psychiatry department for consultation during the four-year period from January 1, 2000 to December 31, 2003, assessment was done by psychiatrist and diagnosis was made using ICD-10. Statistical Analysis: Descriptive statistics. Results: There were 309 (1.97% referrals from ICUs to psychiatry department during the period of study. Among the referred patients, diagnosis of organic mental disorders was the commonest psychiatric diagnosis present in 104 (33.65% patients followed by suicidal attempt in 101 (32.69%; anxiety disorders in 40 (12.94%; depressive disorders in 21 (6.8%; Psychotic illness in 10 (3.24%; other psychiatric illnesses in 28 (9.06%; and nil psychiatric illness in 5 (1.62% patients. Conclusion: Prevalence of psychiatric referrals from ICUs was low. This could be due to stigma and lack of awareness among physicians. There is increased need for recognition and treatment of comorbid psychiatric illness by the treating physicians which may help to decrease morbidity and overall cost of the treatment.
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.
Frederiksen, Julie Elisabeth Nordgaard; Revsbech, Rasmus; Sæbye, Ditte;
The use of structured psychiatric interviews performed by non-clinicians is frequent for research purposes and is becoming increasingly common in clini-cal practice. The validity of such interviews has rarely been evaluated empirically. In this study of a sample of 100 diagnostically heterogeneous......, first-admitted inpatients, the results of an assessment with the Structured Clinical Interview for DSM-IV (SCID), yielding a DSM-IV diagnosis and performed by a trained non-clinician, were compared with a consensus lifetime best diagnostic estimate (DSM-IV) by two experienced research clinicians, based...... on multiple sources of information, which included videotaped comprehensive semi-structured narrative interviews. The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by SCID were 19% and 100%, respectively. It is concluded that structured...
Fistein, Elizabeth C; Clare, Isabel C H; Redley, Marcus; Holland, Anthony J
The use of detention for psychiatric treatment is widespread and sometimes necessary. International human rights law requires a legal framework to safeguard the rights to liberty and personal integrity by preventing arbitrary detention. However, research suggests that extra-legal factors may influence decisions to detain. This article presents observational and interview data to describe how decisions to detain are made in practice in one jurisdiction (England and Wales) where a tension between policy and practice has been described. The analysis shows that practitioners mould the law into 'practical criteria' that appear to form a set of operational criteria for identifying cases to which the principle of soft paternalism may be applied. Most practitioners also appear willing, albeit often reluctantly, to depart from their usual reliance on the principle of soft paternalism and authorise detention of people with the capacity to refuse treatment, in order to prevent serious harm. We propose a potential resolution for the tension between policy and practice: two separate legal frameworks to authorise detention, one with a suitable test of capacity, used to enact soft paternalism, and the other to provide legal justification for detention for psychiatric treatment of the small number of people who retain decision-making capacity but nonetheless choose to place others at risk by refusing treatment. This separation of detention powers into two systems, according to the principle that justifies the use of detention would be intellectually coherent, consistent with human rights instruments and, being consistent with the apparent moral sentiments of practitioners, less prone to idiosyncratic interpretations in practice. PMID:27062108
Naiara Gajo Silva
la necesidad de la interconsulta de enfermería psiquiátrica en este hospital.This is a cross-sectional study that aimed to describe the psychiatric demand in a university hospital in the city of Cuiabá, state of Mato Grosso, Brazil, and to know the current situation of the service to this demand. The data were collected from the inpatient medical records in a university hospital, from June to August, 2009, in a total of 551 records. Despite being considered by the literature as unprepared, nursing is the professional category that most identifies the psychiatric demand in this hospital. The treatment plan to this demand was restricted to medication, nine evaluations of psychology and thirteen consultation-liaison psychiatric service, without a significant involvement of nursing. The approach of emotional and/or mental aspects results in the improvement in the quality of nursing care, and there is a need for the nurses to qualify for that. To make it happen, we propose a reflection on the need for the consultation-liaison psychiatric service in this hospital.
Full Text Available Suicide is one of the commonest psychiatric emergencies. According to WHO report, 1999 suicide was one of the top three leading causes of death among people aged 15-34 years in all countries. In recent years, attempted suicide has become the focus of research as it has been found to be the predictor of suicide. Psychiatric factors are one of the important determinants in attempted suicide. OBEJCTIVES The aim of the present study was to analyse the psychiatric factors in attempted suicide. METHODS The present study was conducted in the Department of Medicine and Department of Psychiatry, Gandhi Medical College and associated Hamidia Hospital Bhopal. Study based on the patients admitted in Medicine/Psychiatry ward or attending Out Patients Department with history of suicidal attempts, during the period December 2006 to November 2007. RESULTS Psychiatric disorders were present in 74.25%, while no psychiatric disorder was present in rest of 25.75%. CONCLUSION Major depressive disorder accounting for 34.69% cases, was the most common concurrent psychiatric illness among the study group.
Booth, Brenda M; Blow, Frederic C; Loveland Cook, Cynthia A
OBJECTIVE To measure the persistence of impaired health-related quality of life (HRQL) and psychological distress associated with co-occurring psychiatric and substance use disorders in a longitudinal sample of medically hospitalized male veterans. DESIGN A random sample followed observationally for 1 year after study enrollment. SETTING Inpatient medical and surgical wards at three university-affiliated Department of Veterans Affairs Medical Centers. PATIENTS/PARTICIPANTS A random sample of 1,007 admissions to medical and surgical inpatient services, excluding women and admissions for psychiatric reasons. A subset of participants (n = 736) was designated for longitudinal follow-up assessments at 3 and 12 months after study enrollment. This subset was selected to include all possible participants with study-administered psychiatric diagnoses (52%) frequency-matched by date of study enrollment to approximately equivalent numbers of participants without psychiatric diagnoses (48%). MEASUREMENTS AND MAIN RESULTS All participants were administered a computerized structured psychiatric diagnostic interview for 13 psychiatric (include substance use) disorders and received longitudinal assessments at 3 and 12 months on a multidimensional measure of HRQL, the SF-36, and a measure of psychological distress, the Symptom Checklist, 90-item version. On average, HRQL declined and psychological distress increased over time (P < .05). Psychiatric disorders were associated with significantly greater impairments in functioning and increased distress on all measures (P < .001) except physical functioning (P < .05). These results were replicated in the patients (n = 130) who received inpatient or outpatient mental health or substance abuse services. CONCLUSIONS General medical physicians need to evaluate the mental health status of their hospitalized and seriously ill patients. Effective mental health interventions can be initiated posthospitalization, either immediately in primary
Full Text Available Falls have been a major safety concern in view of its high incidences and potential detrimental consequences. This article described a systematic review about effectiveness of interventions for the assessment and prevention of falls in adult psychiatric patients conducted previously. These patients possessed unique fall-related risk factors such as altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, and polypharmacy that might warrant specific tailored fall prevention interventions. Following the systematic review, a care bundle for fall prevention in a tertiary psychiatric hospital would be implemented, taking into account these risk factors and evidence relating to fall prevention.
Full Text Available Background: Despite rapid movement in student research in recent years, there is still little evidence that shows the impact of students' activities on research productivity. In this RMP (Research Mentorship Program, we have tried to create a link between medical students with little experience and the professors in the field of medicine. This research was led by a group of medical students who are highly experienced in research. The aim of this study has been to evaluate the impact of the RMP on research productivity.Methods: The Research Mentorship Program began in July 2009 and the program continued for 6 months. After that initial period, the results were evaluated following another 18 months. Some of the interventions included: introducing the RMP to the students; student meetings of the RMP; meetings with the professors; designing a psychiatric history and mental status examination checklist; and research workshops.Results: In eleven semi years, the research productivity scores were evaluated, including eight semi years before interventions and 3 semi years after it. The results show a significant increase in the research productivity score after the RMP in comparison to the research productivity score before it (P-value=0.047. The mean RPS before the RMP was 16.56±7.30 and the score changed to 28.16±7.94 after the RMP.Conclusions: This study shows that with suitable interventions the student researcher’s have the potential to increase research productivity.
Jaeger, Matthias; Briner, David; Kawohl, Wolfram; Seifritz, Erich; Baumgartner-Nietlisbach, Gabriela
Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these facilities. The aim of the present study was to evaluate mental health, functional and social status of individuals living in community sheltered housing facilities. A cross-sectional survey of n=338 individuals in sheltered housing compared to a sample of patients at intake in acute inpatient psychiatry (n=619) concerning clinical and social variables was carried out in the catchment area of Zurich. Matched subsamples of individuals with schizophrenia (n=168) were compared concerning functioning and impairments on the Health of the Nation Outcome Scales (HoNOS). Individuals with schizophrenia in sheltered housing (25% of the residents) have significantly more problems concerning substance use, physical illness, psychopathological symptoms other than psychosis and depression, and relationships, daily activities and occupation than patients with schizophrenia at intake on an acute psychiatric ward. Community sheltered accommodation although conceptualized to prevent homelessness in the general population de facto serve as housing facilities for individuals with schizophrenia and other severe mental illness. PMID:26416587
Sørensen, Ann Lykkegaard; Mainz, Jan; Lisby, Marianne
-hospital patients (n=67), physicians prescribing drugs and ward staff (nurses and nurses assistants) dispensing and administering drugs. The study was carried out using 3 methods of investigation – an observational study, an unannounced control visit and an audit of medical records. Medication errors were evaluated......%), B) Electronic medical record (EMR): 245/251 (98%). Dispensing: 18/391 (5%). Administration: 142/340 (42%). Discharge summaries: 19/84 (23%). The most common errors were lack of documentation of informed consent in the EMR, omission of pro re nata (prn) dosing regime in the CPOE, omission of dose...... potentially harmful errors found in somatic hospital settings but tends to be less serious. Errors in the administration stage constituted almost a third of all errors detected in the study and it appears that bar-coded medication administration could reduce administration errors. Medical staff needs further...
Full Text Available Abstract Background Electroconvulsive therapy (ECT is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients. Methods This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan. Results We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009. The most common source of awareness was electronic and print media (38%, followed by relatives (24% and doctors (23%. Physical injuries (42% and neurological (12% and cognitive disturbances (11% were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%. Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001 and efficacy (p = 0.0001. Conclusion We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.
Pfeiffer, Ernst; Hansen, Berit; Korte, Alexander; Lehmkuhl, Ulrike
The paper presents--in the sense of clinical guidelines--reality of clinical care in a child and adolescence university hospital specialised on eating disorders. Need of a multimodal therapeutic approach is emphasized, including normalisation of weight and eating behaviour, nursing and pedagogical measures, individual, group and family therapy, completed by body therapy, art and music therapy and in case psychopharmacotherapy. Recommendations for overcoming weak spots are made. PMID:15918540
Reforma psiquiátrica brasileira: conhecimentos dos profissionais de saúde do serviço de atendimento móvel de urgência Reforma psiquiátrica brasileña: conocimientos de los profesionales de salud del servicio móvil de urgencia Brazilian psychiatric reform: knowledges of health professional of mobile service of urgency
tratamiento psicosocial, sus líneas de referencia a la necesidad de hospitalización para los pacientes psiquiátricos. El modelo centrado en los hospitales y diseñado por la psiquiatría clásica exclusiva sigue vivo en las ideas de estos profesionales como una referencia a la atención de urgencias psiquiátricas.Objective is to identify the knowledge of health professionals of Service of Mobile Emergency of Natal on the Brazilian Psychiatric Reform. Information was collected through semi-structured interviews with 24 health professionals stationed at the institution. The interviews were transcribed and submitted to the technique of thematic analysis revealed three categories of analysis: admission of the subject in crisis as social and family demands; Psychiatric Reform: legislation and reality in the SAMU-Natal, and the Brazilian Psychiatric Reform as a promoter of deinstitutionalization. The professionals showed misleading and reductionist understandings of the Brazilian Psychiatric Reform and, mostly, did not give credence to the current model of mental health care in guided psychosocial treatment, his lines referring to the need for hospitalization of psychiatric patients. In this sense, we realize that the hospital-centered model designed by classical psychiatry is still alive in the ideas of these professionals as a reference to the psychiatric emergency care.
Daffern, Michael; Day, Andrew; Cookson, Amy
Although interpersonal style is a defining feature of personality and personality disorder and is commonly identified as an important influence on aggressive behavior, treatment completion, and the development of an effective therapeutic alliance, it is rarely considered in practice guidelines for preventing, engaging, and managing patients at risk of aggression. In this article, the authors consider three potential applications of interpersonal theory to the care and management of patients at risk of aggression during hospitalization: (a) preventing aggression through theoretically grounded limit setting and de-escalation techniques, (b) developing and using interventions to alter problematic interpersonal styles, and (c) understanding therapeutic ruptures and difficulties establishing a therapeutic alliance. Interpersonal theory is proposed to offer a unifying framework that may assist development of intervention and management strategies that can help to reduce the occurrence of aggression in institutional settings. PMID:21518699
Wagoro, M C A; Othieno, C J; Musandu, J; Karani, A
To explore structure and process factors which influence patients' perception of quality inpatient psychiatric nursing care at Mathari hospital. This was a cross-sectional study of 236 inpatients selected by stratified random sampling. Competence to give consent was determined by a minimum score of 24 on Mini Mental State Examination. Patients were interviewed using a semi-structured questionnaire. Differences in proportions of variables were determined by calculating confidence interval and summary chi-squared statistics. P-values of < or =0.05 were considered significant. Majority of patients (87%) were aged 20-49 years with 43% having stayed in the ward for over a month. Structure factors related to patients' perception of care included physical environment, being happy with the way the ward looked was significantly related to satisfaction with care (chi(2) = 5.506, P = 0002). Process factors significantly related to patients' satisfaction with care included nurses providing patients with information on prescribed medicines (chi(2) = 10.50, P = 00012). Satisfaction with care was positively related to ability to recommend someone for admission in the same ward (chi(2) = 20.2, P = 00001). Structure and process factors identified as influencing patients' perception of care were physical environment and nurses' qualities that fit within the characteristics of Peplau's Interpersonal Relations Theory. PMID:18307654
Becker, Stephen P; Luebbe, Aaron M; Fite, Paula J; Stoppelbein, Laura; Greening, Leilani
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 psychiatrically hospitalized 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
Vallières-Noël, Marie-Michelle; Garçon, Schnell; Rosmus, Christina; Goulnik, Francoise; Lavoie-Tremblay, Mélanie
This qualitative study explored the experience and the needs for support of pediatric nurses caring for children with a mental health disorder hospitalized in non-psychiatric units in a health organization in Canada. Semi-structured interviews were conducted with 17 nurses. Content analysis revealed two main themes: (a) nurses are challenged by the lack of knowledge, the gap between access to mental health resources and the basic role of only ensuring safety. Amidst these barriers, nurses revealed their feelings of helplessness, frustration and injustice. (b) All participants voiced their willingness to break this powerlessness loop. They identified several strategies to support them: more training in mental health, better collaboration with the mental health team, etc. Further research is needed to evaluate the efficiency of these strategies to improve the delivery of care for children with a mental health disorder hospitalized in non-psychiatric units. PMID:26992867
Geoffroy, Pierre Alexis; Duhamel, Alain; Behal, Hélène; Zouitina-Lietaert, Nadia; Duthilleul, Julie; Marquette, Louise; Ducrocq, François; Vaiva, Guillaume; Rolland, Benjamin
Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known.We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists' confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45-38.67]; p IHM was "agitation" compared with "suicide" (OR = 11.44; 95% CI[3.38-38.78]; p IHM. PMID:27324574
Gilberto José Miranda
Full Text Available O Custeio Baseado em Atividades tem se mostrado como uma alternativa promissora para fazer frente à complexidade que caracteriza os custos hospitalares. Nos últimos dez anos, somente na Plataforma Lattes, foram encontrados mais de uma centena de estudos dessa natureza. Este trabalho tem como objetivo, conhecer, empiricamente, a utilização do Custeio ABC nos hospitais universitários e de ensino brasileiros e comparar os resultados, conforme as possibilidades, com as pesquisas realizadas nas maiores empresas brasileiras pelos autores: Khoury (1999, Beuren e Roedel (2002 e Azevedo, Santos e Pamplona (2004. Dos 115 questionários enviados aos hospitais universitários, 34 foram respondidos. O estudo levou a conclusões importantes, como: Os sistemas de custos atuais dos hospitais têm poucas condições de fornecer informações úteis à gestão; o Custeio ABC é bastante conhecido no ambiente, mas o número de usuários ainda é relativamente pequeno: apenas 15% da amostra; mas existe expectativa por parte de 44% dos hospitais com relação ao uso futuro da abordagem. As principais causas apresentadas para a não-utilização do Sistema ABC foram: (a o sistema utilizado atende às necessidades da organização e (b o Custeio Baseado em Atividades é muito complexo.The Cost Based Activity has been a promising alternative to deal with the complexity that characterizes hospital costs. In the last ten years, only in the Plataforma Lattes, more than a hundred studies of this nature had been found. This work aims to find out, empirically, the use of ABC Costing in Brazilian university hospitals and to compare the results, according to the possibilities, with the researches that have been made in the biggest Brazilian companies by the authors: Khoury (1999, Beuren and Roedel (2002 and Azevedo, Santos and Pamplona (2004. A hundred and fifteen questionnaires were sent to the university hospitals, 34 had been answered. The study relates important
Marcela Pimenta Muniz
Full Text Available O objetivo do estudo foi analisar a compreensão da equipe de enfermagem sobre os processos educativos vivenciados por ela em um hospital psiquiátrico. O percurso metodológico foi realizado à luz da Análise Institucional, através de grupo focal com a equipe de enfermagem e observação participante. Os participantes do grupo focal mencionam que é necessário que haja: tempo disponível para participar dos espaços educativos, mais investimento institucional, co-responsabilização da equipe multidisciplinar na formação dos profissionais de enfermagem. Apontam que cada aspecto temático requer um determinado dispositivo educativo. Concluímos que a organização das ações educativas para a equipe de enfermagem no HP em estudo deve ser co-construída por trabalhadores, portadores de sofrimento psíquico, familiares e gestores para a busca de processos de mudança no cuidado e de trabalho responsáveis. Necessita-se ponderar estratégias que vençam o medo ou a resistência às mudanças, sem apresentar como resposta o recrudescimento.
Full Text Available L’objectif de cet article est de montrer que la pénibilité du travail des soignants en hôpital psychiatrique est moins due à la dangerosité des patients qu’à l’impossibilité perçue de faire un travail de qualité. Nous tentons donc à travers les discours des personnels interrogés par entretiens d’analyser les difficultés ressenties. Nous développons l’idée que cette pénibilité est liée à l’inquiétude que suscitent les changements organisationnels en cours. Cette explication de la pénibilité s’apparente davantage à un choc des cultures qui rend le décalage entre travail prescrit et réel plus prégnant. La discussion nous permet d’envisager le cadre théorique de la psychopathologie pour comprendre les résultats obtenus. Ainsi, c’est sous l’angle de l’organisation du travail que nous mettons en évidence les problèmes de pénibilité des soignants en psychiatrie. Nous formulons l’hypothèse que l’impact des changements étudiés à l’hôpital psychiatrique n’est pas spécifique à ce secteur ; ils ont, cependant, un retentissement plus fort dans des situations de travail déjà porteuses de violence. En effet, le contexte de l’hôpital psychiatrique met en évidence l’exacerbation des problèmes organisationnels généraux soulevés.The aim of this article is to show that the difficult work of nursing staff in psychiatric hospitals is less the result of the dangerousness of patients than the perceived impossibility of doing quality work. Through interviews with the staff, we attempt to analyze the difficulties felt. We develop the idea that this difficulty is related to the worry caused by current organizational changes. This explanation of the difficulty is more like a culture clash that emphasizes the difference between the prescribed work and the actual work. The discussion allows us to consider the theoretical framework of psychopathology in order to understand the results obtained
Full Text Available Abstract Background This study compared 1-year risk of psychiatric hospitalization 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 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 psychiatric hospitalization 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.
Silva, Kesia Esther; Cayô, Rodrigo; Carvalhaes, Cecilia Godoy; Patussi Correia Sacchi, Flávia; Rodrigues-Costa, Fernanda; Ramos da Silva, Ana Carolina; Croda, Julio; Gales, Ana Cristina; Simionatto, Simone
We describe an outbreak caused by KPC-2- and IMP-10-producing Serratia marcescens isolates in a Brazilian teaching hospital. Tigecycline was the only active antimicrobial agent tested. The blaIMP-10 gene was located in a new class 1 integron, named In990, carried by a nonconjugative plasmid, in contrast to blaKPC-2. PMID:25878341
Records about the need for a psychiatric hospital in Istria date back to the early 19th century). This article presents the views on the issue expressed by advisors of the National Council of Istria more than half a century later. It starts with the session held on 15 March 1864 and follows the development of views the National Council held, from the motion to build a new mental hospital in at the feet of Monte Ghiro to the actual construction of the "Santorio Santorio" Provincial Hospital (still existing) at the hill of St Mihovil in Pula. The paper also investigates the reasons why the Council advisors abandoned the project of building the psychiatric hospital in Istria in favour of a home for the mentally ill in Trieste, where many Istrian patients were provided accommodation from as early as the end of the eighteenth century until the end of World War II. During the rule of the Habsburg Monarchy, many other cities of the Empire hospitalised mental patients from Istria, whose pitiful condition was reported by Matteo Campitelli at the session of the Istrian Provincial Parliament in 1886. PMID:24304106
Steinert, Tilman; Goebel, Rita; Rieger, Wolfgang
In three psychiatric hospitals in Baden-Wuerttemberg, Germany, a physician-nurse shared leadership model was implemented in 1997 by the hospital management. The whole hospital, departments, and single wards are led each by a leadership team consisting of a physician, psychologist or social worker and a nurse, being responsible for organization, staff, and budgets. The consequences for staff opinion in leadership positions were evaluated. All 165 leading staff members of all professional groups were anonymously interviewed with a questionnaire containing 45 items regarding their satisfaction with this new leadership model. The response rate was 79.4%. Overall, the leading staff members were satisfied with the shared leadership model both in their own clinical practice and in general. Non-medical staff members were significantly more in favour of several aspects of shared leadership than physicians, but even the latter reported to be generally satisfied. However, both professional groups estimated leading positions to be only modestly attractive. The results yield some evidence that the change from traditional leadership models to the physician-nurse shared leadership model may have advantages in the management of psychiatric hospitals. PMID:17064321
Filho, Jose Carlos Serufo; Grillo, Tania Moreira
The management requires a hospital organization to provision their costs/expenses with tools that approximate reality. The task of measuring productivity can be complex and uncertain, several methods are tested and the use of the DRG has been efficient, being used to assess the productivity through clinical outcomes. Cross-sectional study evaluated 145.710 hospitalizations in the period 2012-2014, using the DRG methodology for measuring productivity from the median length of hospitalization. When we group all hospitalizations in clinical (37.6%) and surgical (62.4%), multiple analyzes could be made according to this criterion. The DRG as a tool for prediction of hospital days is an effective alternative, thereby contributing to the control of productivity that directly influences the costs of hospital expenses and product and service quality.
Nakamura-Pereira, Marcos; Mendes-Silva, Wallace; Dias, Marcos Augusto Bastos; Reichenheim, Michael E; Lobato, Gustavo
This study aimed to investigate the performance of the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in identifying cases of maternal near miss in a hospital in Rio de Janeiro, Brazil, in 2008. Cases were identified by reviewing medical records of pregnant and postpartum women admitted to the hospital. The search for potential near miss events in the SIH-SUS database relied on a list of procedures and codes from the International Classification of Diseases, 10th revision (ICD-10) that were consistent with this diagnosis. The patient chart review identified 27 cases, while 70 potential occurrences of near miss were detected in the SIH-SUS database. However, only 5 of 70 were "true cases" of near miss according to the chart review, which corresponds to a sensitivity of 18.5% (95%CI: 6.3-38.1), specificity of 94.3% (95%CI: 92.8-95.6), area under the ROC of 0.56 (95%CI: 0.48-0.63), and positive predictive value of 10.1% (IC95%: 4.7-20.3). These findings suggest that SIH-SUS does not appear appropriate for monitoring maternal near miss. PMID:23843001
Pasquini, T.A.S.; H.D. Neder; Araújo-Junqueira, L.; De-Souza, D.A.
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high c...
Antonio Isidro-Filho; Tomás de Aquino Guimarães; Marcelo Gattermann Perin; Ricky C. Leung
Competencies mobilized by service providers form an element of hospital services insofar as scientific and technological procedures that are part of the service become tangible. In view of the fact that hospitals have adopted Information and Communication Technologies (ICT), it would be logical to assume that learning contributes towards acquiring competencies related to changes in hospitals resulting from the adoption of new technologies. This paper aims to analyze relationships between work...
Elizabete Rodrigues Coelho
Full Text Available OBJETIVO: Descrever o perfil dos internos suicidas do Instituto Psiquiátrico Forense (IPF de Porto Alegre em duas décadas. MÉTODO: Foi realizado um estudo retrospectivo dos registros dos internos com óbito por suicídio. Os dados foram analisados por meio da estatística descritiva. RESULTADOS: Dos 20 casos de suicídio, 70% cumpriam medida de segurança, 70% eram réus primários, 80% dos crimes era contra a pessoa; a maioria (45% dos suicídios foi cometida durante a madrugada e 40% dos casos ocorreram com internos que estavam de 1 a 9 anos na instituição; 90% eram do sexo masculino, 55% tinham idade entre 20 e 39 anos, 70% eram solteiros, 60% não tinham filhos, 85% eram naturais do interior do RS, 25% não tinham profissão, 84,2% tinham até o Ensino Fundamental; 55% dos casos tinham diagnóstico de esquizofrenia. Em 75% dos casos a morte ocorreu por enforcamento. CONCLUSÕES: Os dados apontam para o seguinte perfil: homem, solteiro, sem filhos, do interior do Estado, com baixa qualificação profissional e pouca escolaridade. Os fatores psicossociais encontrados foram transtorno mental grave, uso de drogas e/ou álcool, baixo suporte social e familiar e tentativas anteriores de suicídio.OBJECTIVE: To describe the profile of suicides inmates at a Forensic Psychiatric Institute in Porto Alegre from two decades. METHOD: It was a retrospective study of the inmates records with a history of death by suicide. The data were analyzed through descriptive statistics. RESULTS: There was a total of 20 cases of suicide, 70% were involuntary commitment, 70% were primary defendants, 80% of crimes against persons, the majority (45% of suicides were committed in the daybreak period and 40% of the cases occurred in inmates that were from 1 to 9 years in the institution. They also had the following characteristics: 90% were male, 55% were between 20 and 39 years old, 70% single, 60% childless man, 85% of the subjects were originally from small towns
Full Text Available 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.
Full Text Available Abstract 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 psychiatric hospitals 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.
Helio Roberto Hekis
Full Text Available Hospital portals that manage health related data are becoming increasingly popular since they play an important role to provide, acquire and exchange information to its users. This study aims to verify how the hospital portals are contributing to the expansion of users knowledge by the analysis of interactive features associated with three mechanisms of knowledge management: Knowledge Access (KA; Knowledge Creation (KC; and Knowledge Transfer (KT. The study is exploratory, descriptive and qualitative, classified as a survey, and involves the standardization of data collection instruments (questionnaires and interviews applied directly to people of a particular population to evaluate the knowledge management the portals present on the university hospitals from northeastern of Brazil. The results indicated that the proceeds of access to knowledge (AK prevailed over other confirming the results found on the Asians and Americans hospital portals.
Cabral Lucio M; de Souza Ana HA; Huf Gisele
Abstract Background Sildenafil is a cyclic guanosine monophosphate-specific phosphodiesterase-5 inhibitor used for treating pulmonary hypertension. Although the use of sildenafil in patients under 18 years old is off-label, this inhibitor has been widely prescribed for children treatment at hospitals in Brazil. In this work we evaluated the current practices in using sildenafil in the three main reference hospitals of Rio de Janeiro to design a clinical trial. Then we analyzed the content of ...
Full Text Available Competencies mobilized by service providers form an element of hospital services insofar as scientific and technological procedures that are part of the service become tangible. In view of the fact that hospitals have adopted Information and Communication Technologies (ICT, it would be logical to assume that learning contributes towards acquiring competencies related to changes in hospitals resulting from the adoption of new technologies. This paper aims to analyze relationships between workplace learning strategies and professional competencies after the adoption of innovations supported ICT in hospitals. Eleven interviews were carried out with professionals from three different hospitals and identifying the professional competencies resulting from innovations supported by ICT. This was followed by a cross-sectional survey involving 425 employees at the hospitals surveyed. The data analysis was undertaken by means of structural equation modeling (SEM. The results confirm the hypothesis and indicate that the performance of professional competences based on new ICT is determined by the way the respondents think, change and apply their knowledge, skills and attitudes in the workplace by use of new information and communication technologies.
K. Mendonça de Araujo
Full Text Available We analyzed the trends of scientific output of the University Hospital, Federal University of Rio de Janeiro. A total of 1420 publications were classified according to pattern and visibility. Most were non-research publications with domestic visibility. With time, there was a tendency to shift from non-research (or education-oriented publications with domestic visibility to research publications with international visibility. This change may reflect new academic attitudes within the institution concerning the objectives of the hospital and the establishment of scientific research activities. The emphasis of this University Hospital had been on the training of new physicians. However, more recently, the production of new knowledge has been incorporated as a new objective. The analysis of the scientific production of the most productive sectors of the hospital also showed that most are developing non-research studies devoted to the local public while a few of the sectors are carrying out research studies published in journals with international status. The dilemma of quality versus quantity and of education versus research-oriented publication seems, however, to continue to exist within the specialized sectors. The methodology described here to analyze the scientific production of a university hospital can be used as a tool to better understand the evolution of medical research in Brazil and also to help formulate public policies and new strategies to include research among the major objectives of University Hospitals.
Denilson Campos de Albuquerque
Full Text Available Background: Heart failure (HF is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%, dyslipidemia (36.7% and diabetes (34%. Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.
Memórias de idosos aposentados de um hospital psiquiátrico catarinense (1951-1971 Memorias del trabajo de ancianos jubilados de un hospital psiquiátrico (1951-1971 Memoirs of work retirees elderly from a psychiatric hospital (1951-1971
Ana Maria Espíndola Koerich
ía, hoy ancianos, tuvieron un papel fundamental en la asistencia de enfermería prestada a la clientela internada.This is a qualitative study of socio-historical approach that aimed to historicize the daily lives of nursing workers, elderly nowadays, in a psychiatric hospital in Santa Catarina state in the period between 1951 and 1971. Data were collected through semistructured interviews with six nursing staff using the method of oral history. The memory was used as the theoretical framework and the data were categorized on content analysis. The results showed the knowledge and practices of nursing staff, working conditions and relationships between professionals in the health care team. The results showed that the situation experienced by workers in this institution was congruent with the situation of Brazilian nursing, especially in psychiatric hospitals asylums. Moreover, these nursing workers, elderly people today, had a key role in nursing care to patients admitted.
K. S. Carvalho
Full Text Available
The hospital environment, especially surfaces, represents a secondary reservoir for pathogens such as Staphylococcus aureus. The present study was carried out at the Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU in Brazil, from January to August 2004, with the aim of qualitatively and quantitatively assessing the presence of S. aureus on surfaces touched by hands (bed rail, bedside table and door handle, on the floor and in the air, in wards where the patients were infected or not infected with this organism. Twenty-six wards with at least one infected patient and 26 wards with uninfected patients were investigated. Surfaces and air were sampled during bed making, by means of sterile 10cm2 adhesive tapes and 90mm-diameter exposed culture plates, respectively. Cultures were carried out on Egg Yolk Salt Agar, containing 7.5% NaCl and 1% egg yolk, and colonies identified by lecithinase and coagulase tests and Gram stain. About 50% of the wards were S. aureus contaminated, without significant differences between the groups (46.1% in the infected patient wards versus 53.8% in controls; the correlation between counts of the pathogen on the surfaces and in the air was 66.7%. In spite of the fact that these bacteria were frequently present in the assessed wards, the microbial density was low (less than 1 CFU/cm2. The association between environmental contamination and the epidemiology of S. aureus nosocomial infections is complex and thus further investigations are needed to reach a better understanding of this relationship. Keywords: environmental contamination; nosocomial infections; Staphylococcus aureus.
Matheus F. Oliveira
Full Text Available Normal pressure hydrocephalus (NPH is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant
Pasquini, T.A.S. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Neder, H.D. [Instituto de Economia, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Araújo-Junqueira, L. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); De-Souza, D.A. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Departamento de Clínica Médica e Curso de Nutrição, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil)
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.
Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed
Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866
Tairacan Augusto Pereira da Fonseca
Full Text Available Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB, bank machine keyboard buttons (BMKB, restroom surfaces, and the employee biometric time clock system (EBTCS, in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients.
Lara Stefânia Netto de Oliveira LEÃO-VASCONCELOS; Lima, Ana Beatriz Mori; COSTA, Dayane de Melo; Larissa Oliveira ROCHA-VILEFORT; de OLIVEIRA, Ana Claúdia Alves; GONÇALVES, Nádia Ferreira; VIEIRA, José Daniel Gonçalves; PRADO-PALOS, Marinésia Aparecida
The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and suppor...
Mendonça de Araujo K.; Mourão P.A.S.; Leta J.
We analyzed the trends of scientific output of the University Hospital, Federal University of Rio de Janeiro. A total of 1420 publications were classified according to pattern and visibility. Most were non-research publications with domestic visibility. With time, there was a tendency to shift from non-research (or education-oriented) publications with domestic visibility to research publications with international visibility. This change may reflect new academic attitudes within the institut...
Guimarães Márcia Aparecida
Full Text Available Nosocomial infections are an important cause of morbidity and mortality all over the world. It has been shown that appropriate environmental hygienic and disinfection practices can be very helpful to hospital infection control. The purpose of this study was to evaluate the bactericidal activity of some disinfectants against antibiotic-susceptible and antibiotic-resistant hospital bacterial isolates. The susceptibility of 27 clinical isolates to disinfectants and antibiotics was determined by the Association of Official Analytical Chemist?s (AOAC Use-Dilution method and by the Kirby-Bauer method, respectively. All strains tested were susceptible to sodium hypochlorite, glutaraldehyde and to the association quaternary ammonium - formaldehyde - ethyl alcohol disinfectants. However, the susceptibility of strains to phenol and to one quaternary ammonium compound was variable. Among twenty-one antibiotic-multiresistant strains (methicillin-resistant staphylococci, Enterococcus spp, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae, Serratia marcescens and Escherichia coli eleven (52% and eight (38% strains were resistant to the quaternary ammonium and phenol compounds, respectively. Among six isolates that demonstrated susceptibility to antibiotics (staphylococci, Enterococcus spp, P. mirabilis, E. cloacae and E. coli two strains (33% showed resistance to these disinfectants. The results demonstrated the lack of correlation between antibiotic-susceptibility and susceptibility to disinfectants in hospital strains.
Seyed Hamzeh Hosseini
Full Text Available (Received 17 Mar, 2008; Accepted 15 Mar, 2008 Abstract Background and purpose: One of the important problems in diagnosis and treatment of psychiatric disorders is its accompaniment with substance abuse.In addition to substance abuse symptoms which are present in all addicts, in psychiatric patients it cause special problems in main diagnosis , slow reaction to therapy and even non effectiveness of the therapy and also poor prognosis.Considering its different prevalence in studies and also considering the point that a similar work has never been done in Iran, this study is designed to find out the abundancy of disorders and pattern and type of substances used by the referred patients to psychiatric clinic of zare hospital.Materials and methods: In this descriptive research study , 782 referrals to psychiatric clinic of zare hospital in a period of one year were evaluated D. S.M. IV interview.The self made Questionnaire which is filed by a psychologist and then referred to a psychiatric for the diagnosis of the disease, includes the time of Commencement, amount and type of substance used.Results: The results obtained, showed that 79.1% were men , 20.9% were women, 54.4% were urban and 45.5% were from rural areas. 4.8% were referred for substance – withdrawal and 95.2% for psychiatry problems. and also the 28% were smokers, 68.4% never smoked and 3.8% were smokers in the past. 12.7% were substance abuse at persent 3.3% had a history if substance abuse in the past and 84% had no history of substance abuse ever. Substance dependency and nondependency were 8.6% and 91.4% respectively. The percentages for the first consumed substance were as follow:60.8 opium, 6.4 alcohal, 26.4 hashish, 4 heroin and 2.4 other substances. From psychiatry diagnostic point of view 28.7% suffered from schizophrenia , 41% had mood disorders, 14% had personality disorders and 4% suffered from anxiety. There has been a statistically significant relationship between the
Mirza Ghazanfar Baig
The factors such as social support from family and friends, the stay of the study group with parents or in-laws, and duration of pre-separation, the study proved that there is no significant difference exists on the marital quality of the study group based on these factors. Conclusions: The numbers of females who were separated from their spouses are more likely to have psychiatric illnesses due the additional work load of looking after the children and managing the household activities. The study also found that the females staying with their parents after the separation from their spouses were less likely to have a severe psychiatric morbidity as they felt comfortable due the cooperation from their parents. [Int J Res Med Sci 2015; 3(8.000: 2086-2092
Silveria, P V; Nishioka, S de A
A retrospective survey of 473 cases of snake bite admitted to a Brazilian teaching hospital from 1984 to 1990 revealed 91 cases of bite without envenoming and/or caused by non-venomous snakes. In 17 of these cases the snake was identified, and one patient was bitten by a snake-like reptile (Amphisbaena mertensii). In 43 cases diagnosis was made on clinical grounds (fang marks in the absence of signs of envenoming). The other 30 cases were of patients who complained of being bitten but who did not show any sign of envenoming or fang mark. Most cases occurred in men (66;73%), in the 10-19 years age group (26;29%), in the lower limbs (51/74;69%), between 6 A. M. and 2 P.M. (49;61%) and in the month of April (16;18%). One patient bitten by Philodryas olfersii developed severe local pain, swelling and redness at the site of the bite, with normal clotting time. The patient bitten by Drymarcon corais was misdiagnosed as being bitten by a snake of the genus Bothrops, was given the specific antivenom, and developed anaphylaxis. One patient bitten by Sibynomorphus mikanii presented prolonged clotting time, and was also given antivenom as a case of Bothrops bite. Correct identification of venomous snakes by physicians is necessary to provide correct treatment to victims of snake bite, avoiding unnecessary distress to the patient, and overprescription of antivenom, which may eventually cause severe untoward effects. PMID:1342117
Michelle Dowd; Diane Vickers; Joaquim Rosario; Stephanie Peck Peterson; T. F. McLaughlin
The purpose of the research was to carry out a component analysis of assisted reading. A third grade student with a reading deficit who was attending an impatient psychiatric classroom setting was the participant. Data were collected from the student's oral reading. The measures gathered were percent correct, errors per minute, and the percent of comprehension questions correctly answered from the passages from the classroom reading text. The component analysis of assisted reading was evalua...
Keite da Silva Nogueira
Full Text Available INTRODUCTION: Epidemiological data on the prevalence of extended-spectrum β-lactamases (ESBLs are scarce in Brazil despite the fact that these data are essential for empirical treatment and control measures. The objective of this study was to evaluate the prevalence of different ESBLs by type and distribution in a tertiary hospital in southern Brazil. METHODS: We evaluated 1,827 enterobacterial isolates between August 2003 and March 2008 isolated from patients at a tertiary hospital. Samples were identified using a Vitek automated system and were confirmed by biochemical testing. The identified ESBL strains were characterized by phenotypic methods, polymerase chain reaction (PCR, and sequencing. Genetic similarities were evaluated by pulsed-field gel electrophoresis. RESULTS: It was 390 (21.3% ESBL-producing strains, which expressed the ESBLs CTX-M (292, SHV (84, CTX and SHV (10, TEM (2, and PER (2. CONCLUSIONS: The prevalence of ESBL-expressing strains was high, especially in Klebsiella pneumoniae and Enterobacter spp. CTX-M was the predominant type of ESBL observed, and its genetic variability indicates a polyclonal distribution.
Lilian Andreia Fleck Reinato
Full Text Available OBJECTIVE: to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil. METHOD: a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT: of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2% of the individuals, resistance to oxacillin being evidenced in 10 (21.8% participants. CONCLUSION: the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population.
Serviço de Emergência Psiquiátrica em hospital geral: estudo retrospectivo Servicio de emergencia psiquiátrica en hospital general: estudio retrospectivo Emergency psychiatric service in general hospitals: a retrospective study
Fernando Sérgio Pereira de Sousa
SEPHG, 43,45% de tales pacientes fueron derivados al CAPS-ad. Se desprende de los resultados cuán imprescindibles son los servicios de salud mental.The Emergency Psychiatric Service in General Hospitals (SEPHG, acronym in Portuguese is a service included in the psychiatric reform movement. The purpose of the present study was to characterize patients with psychological distress treated at the Dr. Estevam SEPHG, located in Sobral, Ceará state. This exploratory study was performed using documental analyses with a quantitative approach, and involved 191 clients treated at the referred SEPHG from January to December 2007. Data collection was performed using a client register book, which contained information obtained from the patients' medical record. There was a predominance of male patients (70.15%, aged 30-49 years (48.71% and single (74.86%. Most patients were from the city of Sobral (69.64%. In 42.40% of cases, the diagnosis was of alcohol use/abuse. Most clients (66.50% sought the service voluntarily. After being evaluated at the SEPHG, 43.45% of patients were referred to the local Center for Psychosocial Care -Alcohol and other Drugs. The results emphasize the importance of mental health.
Zetin, Mark; Warren, Stacey; Lanssens, Ed; Tominaga, Doris
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 t...
Daniela Oliveira Melo
Full Text Available This study proposes to measure frequency and to characterize the profile of potential drug interactions (pDDI in a general medicine ward of a teaching hospital. Data about identification and clinical status of patients were extracted from medical records between March to August 2006. The occurrence of pDDI was analyzed using the database monographs Micromedex® DrugReax® System. From 5,336 prescriptions with two or more drugs, 3,097 (58.0% contained pDDI. The frequency of major and well document pDDI was 26.5%. Among 647 patients, 432 (66.8% were exposed to at least one pDDI and 283 (43.7% to major pDDI. The multivariate analysis identified that factors related to higher rates of major pDDI were the same age (p< 0.0001, length of stay (p< 0.0001, prevalence of hypertension [OR=3.42 (p< 0.0001] and diabetes mellitus [OR=2.1 (p< 0.0001], cardiovascular diseases (p< 0.0001 and the number of prescribed drugs (Spearman’s correlation=0.640622, p< 0.0001. Between major pDDI, the main risk was hemorrhage (50.3%, the most frequent major pDDI involved combination of anticoagulants and antiplatelet drugs. Among moderate pDDI, 3,866 (90.8% involved medicines for the treatment of chronic non-communicable diseases, mainly hypertension. In HU-USP, the profile of pDDI was similar among adults and elderly (the most frequent pDDI and major pDDI were same, the difference was only the frequency in either group. The efforts of the clinical pharmacists should be directed to elderly patients with cardiovascular compromise, mainly in use of anticoagulants and antiplatelet drugs. Furthermore, hospital managers should increase the integration between levels of health care to promote safety patient after discharge.Keywords: Drug interactions. Aged. Internal Medicine. Hospitals, University. RESUMOInterações medicamentosas potenciais em um hospital escolar brasileiro: diferenças relacionadas à idade?O estudo tem por objetivo descrever o perfil de intera
The art of taking care of the insane developed and solidified at the Hospital Saint-Jean-de-Dieu after a School of Nurses was created there in 1912. Founded by the Sisters of Providence, this new school participated in the transformation of the asylum into a regular hospital. The archives of the Sisters of Providence and the monthly magazine La garde-malade canadienne-française allow us to analyze the discourse of nursing leaders, which was based on the importance of professional training. Scientific discoveries and new technologies were at the heart of the care process at Saint-Jean-de-Dieu, where students were introduced to a technical, as well as a spiritual, education. This article first considers the marginal status of psychiatric nursing training within the larger nurses' professionalization movement. In a second step, it describes the socio-religious context between 1912 and 1962 within which the School of Nurses of the Hospital Saint-Jean-de-Dieu evolved. PMID:21560368
Felipe Filardi da Rocha
Full Text Available OBJETIVO: Avaliar a produção científica brasileira, no ano de 2006, nas 40 revistas de psiquiatria com maior fator de impacto (FI segundo o Journal of Citation Report (JCR, 2006. MÉTODOS: Do total de 94 periódicos, selecionamos todos os artigos com FI acima da média (n = 40. Avaliamos, entre estes artigos, quantos apresentavam pelo menos um autor brasileiro, quantos eram compostos por equipe exclusivamente brasileira ou tinham pelo menos o primeiro autor e/ou o autor sênior filiado à instituição nacional. Avaliamos também a respectiva distribuição das publicações por estados, de acordo com a instituição de filiação do(s autor(es. RESULTADOS: Entre 7.996 artigos avaliados, 96 (1,2% tinham pelo menos um autor com afiliação em instituição brasileira e oito tinham autor sênior brasileiro, sendo excluídas as 59 publicações compostas exclusivamente por pesquisadores brasileiros. Ao se determinar a distribuição, por estados, da instituição de pesquisa na qual está(ão vinculado(s o(s autor(res brasileiro(s, São Paulo, com 46 publicações (47,91%, ficou na primeira posição, com predominância absoluta do eixo Sudeste-Sul (98,95%. CONCLUSÃO: Apesar das publicações brasileiras em psiquiatria terem apresentado aparente crescimento quantitativo e qualitativo, a produção científica da área é ainda pequena e altamente concentrada em alguns poucos estados.OBJECTIVE: The Brazilian scientific production published in 2006 in the twenty psychiatric journals with high impact factor (IF according to the Journal of Citation Report (JCR, 2006, was evaluated. METHODS: All articles from 94 journals with an IF higher than the average (n = 40 were selected. We assessed the articles that had at least one author affiliated to a Brazilian institution as well as those with only Brazilian authors or a first/senior author belonging to a Brazilian institution. Secondly, the distribution of the author(s by state was determined. RESULTS
Aljamir Duarte Chedid
Full Text Available RACIONAL: A diverticulite cecal é uma condição rara, especialmente em populações ocidentais. Sua importância reside no fato de fazer parte do diagnóstico diferencial da apendicite aguda e do carcinoma ulcerado de ceco. CASUÍSTICA E MÉTODOS: Apresenta-se a experiência de um hospital geral do sul do Brasil no tratamento da diverticulite cecal. Descrevem-se quatro casos de divertículo único inflamado de ceco. Um destes teve diagnóstico pré-operatório através de tomografia computadorizada de abdome, tendo o paciente tratado clinicamente com remissão do quadro de diverticulite. Os outros três pacientes foram submetidos a colectomia direita com íleo-transverso anastomose. RESULTADOS: A mortalidade foi nula e nos casos operados não houve complicações pós-operatórias. Quando se consegue obter diagnóstico pré-operatório, pode-se optar por manejo clínico. CONCLUSÃO: Recomendamos laparotomia exploradora quando não há certeza diagnóstica. Preconizamos manejo cirúrgico radical quando o diagnóstico é efetuado através de laparotomia.BACKGROUND: Cecal diverticulitis is a rare condition, specially in western people. Its importance concerns of being part of the differential diagnosis of acute appendicitis and ulcerated cecal carcinoma. AIM: To present the experience of southern Brazilian general hospital in the treatment of cecal diverticulitis. MATERIAL AND METHODS: We present four cases of single inflamed cecal diverticulum. One was diagnosed by pre-operatively computer tomography and was treated medically without complications. The other three cases were diagnosed during operation and treated by right hemicolectomy and ileotransverse anastomosis. RESULTS:There were no deaths or complications. When cecal diverticulitis is pre-operatively diagnosed it may be treated medically. We preclude laparotomy when the diagnosis is uncertain. CONCLUSION: We recommend radical surgical management when the diagnosis is made during operation.
目的：探讨跌倒风险管理对预防住院精神病患者跌倒及减轻跌倒造成伤害的影响。方法：将2011年7月至2013年7月的4647例精神病患者作为观察组，运用跌倒风险管理理念和方法，并与作为对照组的2009年6月至2011年6月的4504例精神病患者进行比较。结果：两组患者跌倒Ⅰ级、Ⅱ级、Ⅲ级伤害程度、无伤害跌倒事件上报率、跌倒风险管理依从性比较，差异有统计学意义；两组跌倒发生率比较，差异无统计学意义；观察组无护理投诉及护理纠纷，对照组有1例因为跌倒引起纠纷，通过经济赔偿解决。结论：对住院精神病患者进行跌倒风险管理，既可提高护理人员的质量意识、风险意识及防范跌倒风险的能力，又能促进患者参与预防跌倒管理，有效降低和减轻跌倒造成的严重伤害，提高护理质量，保障患者安全。%Objective:To explore the effect of fall risk management in preventing falling of hospitalized psychiatric patients and reducing the damage impact of falling. Methods:Totally 4647 psychiatric patients hospitalized from July in 2011 to July in 2013 were participated as observation group, while psychiatric patients hospitalized from June in 2009 to June in 2011 as control group. Risk management methods were used in observation group. Results:The damage degree in grade I, II, III between two groups had signiifcant difference (P0.05), however, the reporting rate about no hurt fall event between two groups had signiifcant difference (X2=12.392, P<0.001). Patients’ compliance of fall risk management between two groups had signiifcant difference (P<0.01). There was no complaint and nursing dispute in observation group, while there was one case of fall-related nursing dispute in control group, resolved through economic compensation. Conclusion:Fall risk management of hospitalized psychiatric patients can promote the quality awareness and risk awareness
Paulo E Marchiori
Full Text Available OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, São Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5 + 13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV, herpes simplex virus 1 (HSV1, Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.
Lara Stefânia Netto de Oliveira LEÃO-VASCONCELOS
Full Text Available The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs. The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7% were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%. The highest rates of resistance were observed for β-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC β-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC β-lactamases.
Bráulio Matias de Carvalho
Full Text Available Infection with both Human Immunodeficiency Virus (HIV and Mycobacterium tuberculosis is currently the world's leading cause of death due to infectious agents. We evaluated factors related to the development of tuberculosis (TB in HIV-infected patients who were being treated at an infectious diseases hospital in Fortaleza, Ceará, Brazil. From January 2004 to December 2005, we made an epidemiological study through the analysis of the medical records of 171 patients, who were diagnosed as having both HIV and tuberculosis. Among these co-infected patients, most (81%, p=0.0006 were male. Co-infection was more frequent (87.8% among patients over 40 years of age and those with lower educational levels (less than eight years of schooling. Forty-one percent of the patients in the study had not had a smear culture test for acid-fast bacilli (AFB. CD4 cell counts were lower than 200 cells/µL in 71.9% of the patients, the mean being 169 cells/µL. This type of data is important for establishing strategies to improve the control of tuberculosis in HIV-infected patients.
José Luiz Rodrigues Leles
Full Text Available BACKGROUND: Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries. OBJECTIVE: The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil. MATERIAL AND METHODS: A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76% male, with a mean age of 25.5±15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods. RESULTS: The main causes of trauma were traffic accidents (45.7% and physical assaults (24.3%, and differences in etiological factors were identified according to gender (p<0.001. The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01, physical assaults (p<0.001, falls (p<0.001 and sport injuries (p<0.01. In the multinomial logistic regression analysis (R² = 0.233; p<0.05, age was associated with injury in traffic accidents and falls (p<0.01, sports-related accidents were associated with males (p<0.05, and alcohol consumption with assaults and traffic accidents (p<0.001. Facial soft tissue lesions were found in 98% of patients and facial fractures in 51%. CONCLUSIONS: The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.
Flávia Alves Ferreira Rossini
Full Text Available INTRODUCTION: Vancomycin-resistant enterococci (VRE can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs, who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7% colonized and 11 (7.3% infected. Seventy-three percent were cared for in non-ICUs (p = 0.028. Infection was more frequent in patients with a central-line (p = 0.043, mechanical ventilation (p = 0.013, urinary catheter (p = 0.049, or surgical drain (p = 0.049. Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%, 31 (20.7%, 24 (16%, and 24 (16% patients, respectively. Death was more frequent in infected (73% than in colonized (17% patients (p < 0.001. After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001. CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.
Objective:To investigate the clinical features of mental patients in our hospital worker medical insurance and analyze the coping strategies.Method:93 mental patients on the state of July 22,2013 were investigated and analyzed with our own questionnaire.Result:Our hospital psychiatric patients with hospital worker medical insurance accounted for the majority of(41.9%). Male was also higher than female,the difference was statistically significant (P<0.05). Schizophrenia patients were the main(92.5%). Before admission the patients were hospitalized several times. So far they had the long course and they were older,too. Most of the patients had somatic diseases,so they must have the needs of a variety of psychiatric drugs and improving drug somatic disease treatment. It was a recession without self injury,wounding and the most dangerous patients had themselves harm or hurt others.Conclusion:The mental patients with hospital worker medical insurance are to return to the community rehabilitation,for long-term hospitalization. We will strengthen the doctor-patient communication and update the concept,on mental health law.%目的：了解本院职工医保住院精神病患者的临床特点，分析应对策略。方法：用自编调查表对本院2013年7月22日住院状态的93例精神病患者进行调查分析。结果：本院职工医保住院精神病患者占多数，为41.9%；男性高于女性，差异有统计学意义（P<0.05）；精神分裂症为主（92.5%）；入院前曾多次住院治疗；目前病程长、年龄大、多伴有躯体疾病、需要多种精神病药物及改善躯体疾病的药物联合治疗、呈衰退状态而无自伤、伤人及有自伤、伤人危险的患者居多。结论：职工医保长期住院的精神病患者，应对照精神卫生法，加强医患沟通，更新理念，回归社区康复。
目的 分析住院精神病患者服药依从性的影响因素,从而提出干预措施.方法 通过与病人、家属及其他病友交流以及对病人进行观察,对89例服药依从性差的住院患者进行分析.结果 影响住院精神病患者服药依从性的原因很多,在89例被调查者中,对疾病无正确认识23例(占25.84％),害怕出现药物副反应17例(占19.10％),受幻觉妄想内容的影响15例(占16.85％),认为自己病好了没有必要再服药11例(占12.36％),对医护人员不信任7例(占7.86％),经济因素7例(占7.86％),家属对病人支持不良6例(占6.74％),企图积存药物自杀3例(占3.37％).结论 影响住院精神病患者服药依从性的原因,有病人个人的因素、医护人员的因素和其他因素(经济因素、家属的态度)等.%Objective To analyze the influencing factors of hospitalized psychiatric patients with poor medication compliance, and propose interventions. Methods With the method of communication with the patients, families and other patient as well as observation,to analyze 89 hospitalized psychiatric patients with poor medication compliance. Results There were many factors influenced hospitalized psychiatric patients' compliance. In 89 patients ,23 cases (25. 84% )were in no correct understanding of the disease, 17 cases (19. 10%)were in fear of adverse drug reactions, 15 cases (16. 85%) were influenced by the content of delusions hallucinations, 11 cases (12. 36%)thought their disease was cured and didn't need to serve further,7 cases (7. 86%)mistrust health care,7 cases (7. 86%) were influenced by economic factors,6 cases (6. 74%)were in poor family support,3 cases (3. 37%)were attempt to accumulate drug to suicide. Conclusion The influencing factors of medication compliance for psychiatric patients due mainly to patient factors,medical factors and other factors (economic factors,and the family's attitude),etc.
A liaison approach to psychiatric consultation increases the patient population who can benefit from psychiatric assessment during hospitalization for medical or surgical conditions. It also broadens the scope of the psychiatric investigation of the individual patient. The meaning of the illness to the patient, and the patient's present methods of adapting to his or her illness are important considerations. Unconscious concerns, which interfere with the patient's compliance to medical treatme...
Balassiano, Ilana T; dos Santos-Filho, Joaquim; Vital-Brazil, Juliana M; Nouér, Simone A; Souza, Claudia R C; Brazier, Jon S; Ferreira, Eliane de O; Domingues, Regina M C P
Clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. Recently, the rates of C. difficile infection (CDI) have increased worldwide, but in Brazil few data about this situation and the incidence of clonal types of C. difficile exist. This study aimed to isolate and characterize C. difficile strains from samples obtained of a university hospital (HUCFF) in Rio de Janeiro city, Brazil. CDI was identified by ELISA in 27.1% of HUCFF-in-patients enrolled in the study, and the bacterium was recovered from eight of these fecal samples. All strains, except one, presented tcdA and tcdB genes and presented neither the cdtA and cdtB genes nor any significant deletions in the tcdC gene. All strains were sensitive to metronidazole, vancomycin and moxifloxacin, and resistant to clindamycin, ciprofloxacin and levofloxacin. PCR-ribotyping and PFGE revealed four different clonal types among the isolates. The Brazilian PCR-ribotype 133 accounted for 50% of strains isolated, and PCR-ribotype 233 strains were obtained from 25% of the in-patients. The prevalence and resurgence of the Brazilian PCR-ribotype 133 among the hospitalized patients of HUCFF was established, and cross-infection of different patients associated to the same PCR-ribotypes was detected. Our results emphasize the importance of the diagnosis and control of CDI in order to prevent the emergence of specific clones that can lead to C. difficile-associated outbreaks in Brazilian hospitals. PMID:20623188
Full Text Available Um dos obstáculos atuais à Reforma Psiquiátrica é a ausência de uma rede assistencial ágil, flexível e resolutiva. A proposta de saída dos usuários do hospital de forma planejada e assistida é uma estratégia fundamental no processo de desinstitucionalização, no sentido de evitar o tão acentuado fenômeno da reinternação. Tal situação está relacionada à falta de uma rede de atenção extra-hospitalar, bem como de suporte e acompanhamento do usuário por parte da equipe técnica em parceria com as famílias. Com base nisso, realizou-se uma investigação em um hospital psiquiátrico do município de Natal, visando a avaliar o processo de implantação e o funcionamento do Projeto de Alta-Assistida atualmente em curso nessa instituição. Este trabalho objetiva discutir os resultados dessa investigação.One of the current obstacles to the psychiatric reform is the absence of an agile, flexible and problem-solving welfare network. The proposed removal of users from the hospital in a planned and assisted is a key strategy in the process of deinstitutionalization, in order to avoid the phenomenon of so marked rehospitalization. This situation is related to the lack of a network of care outside hospitals, as well as supporting and monitoring of the user by the technical team in partnership with families. On this basis, there was an investigation into a psychiatric hospital in the city of Natal, to evaluate the process of deployment and operation of the Project for Assisted Discharge currently in progress at that institution. This work discusses the results of this research.
Dike, Charles C; Nicholson, Elizabeth; Young, John L
Patients in a forensic psychiatric facility often require escorted transport to medical facilities for investigations or treatments of physical health ailments. Transporting these patients presents significant safety and custody challenges because of the nature of patients housed in forensic psychiatric facilities. A significant proportion of these patients may be transfers from the Department of Corrections (DOC) under legal mandates for psychiatric evaluation and treatment better provided in a hospital setting, and most of them will return to the DOC. Although departments of correction have protocols for escorting these potentially dangerous individuals, it is unclear whether receiving psychiatric hospitals have established procedures for maintaining the safety of others and custody of these individuals during transportation outside the hospital facility. The literature is sparse on precautions to be observed when transporting dangerous forensic psychiatric patients, including those with high escape risk. In this article, we describe one forensic inpatient facility's procedure for determining the appropriate level needed to transport these individuals outside of the forensic facility. We also describe the risk assessment procedure for determining level of transport. These are quality improvement measures resulting from a critical review of an incident of escape from the forensic facility several years ago. PMID:26668224
Guacira Corrêa de Matos
Full Text Available A albumina humana é freqüentemente usada sem que haja correspondência entre suas propriedades farmacológicas e as doenças. Este é um estudo das prescrições de albumina humana em um hospital da rede pública no Rio de Janeiro, Brasil, com ênfase no grau de adesão das mesmas a protocolos de tratamento. As informações foram extraídas dos registros do Serviço de Farmácia e dos prontuários médicos de 99 pacientes adultos, que receberam, entre março e agosto de 2001, 1.475 unidades de albumina humana, solicitadas em 498 prescrições. A análise de confiabilidade das informações sobre indicação terapêutica resultou num kappa de 0,79 (IC95%: 0,72-0,85. As indicações terapêuticas foram avaliadas como apropriadas, inapropriadas ou controversas, com base em quatro protocolos de países diferentes. Do total de prescrições, 33,1% foram consideradas apropriadas, 61,8% inapropriadas, 4,6% controversas e 0,4% indeteminadas. Identificaram-se dois casos suspeitos de reações adversas. A proporção de prescrições inapropriadas é preocupante, dado o elevado custo do produto e o seu potencial para causar reações adversas. A implantação das diretrizes nacionais expressas no protocolo da ANVISA é estratégica para a promoção do uso racional da albumina humana em hospitais.Human albumin is frequently used without regard for the relationship between its pharmacological properties and the respective disease. We investigated the prescription of human albumin in a Brazilian public hospital with emphasis on adherence to international guidelines. Data were gathered from pharmacy and medical records. From March to August 2001, 99 patients (> 15 years received 1,475 units of human albumin, ordered in 498 prescriptions. The reason for prescribing human albumin was independently collected from medical records by two health professionals, and agreement was assessed by kappa statistics (95%CI: 0.72-0.85. According to different guidelines
徐东; 费立鹏; 许德广; 邵贵忠; 曾闽风
Objective: To compare the attitudes of doctors and nurses from different psychiatric hospitals on mental illness and its stigma experienced by mentally ill patients and their family members. Methods: A questionnaire was administered to 102 doctors and 116 nurses from three psychiatric hospitals in Beijing with different mean lengths of admission and different proportions of chronic patients. Results: There was relatively little difference in the attitudes of nurses among the three hospitals, but doctors from the three centers differed significantly in their beliefs about the social worth of psychiatric patients, patients' level of violence and the need to restrict patients' social activities, as well as the effect of stigma on patients and their family members. These differences among physicians remained after adjusting for gender, age and level of education; this suggests that their attitudes were related to the types of patients they treated.Conclusion: The attitudes of doctors and to a lesser extent nurses on mental illness are affected by the duration of illness and level of social disability of the psychiatric patients they treat.
Full Text Available OBJETIVO: Avaliar a produção científica brasileira, no ano de 2005, nas 20 revistas de psiquiatria com maior fator de impacto (FI segundo o Journal of Citation Report (JCR, 2004. MÉTODOS: Do total de 90 periódicos com FI variando de 11,207 até 0,13, selecionamos todos os artigos dos periódicos com FI acima do percentil 75 (n = 20. Avaliamos, entre esses artigos, quantos apresentavam pelo menos um autor brasileiro, quantos eram compostos por equipe exclusivamente brasileira ou tinham pelo menos o primeiro autor e/ou o autor sênior filiado à instituição nacional. Avaliamos também a respectiva distribuição das publicações por estados de acordo com a instituição de filiação do(s autor(es. RESULTADOS: Entre 4.859 artigos avaliados, 54 (1,11% tinham pelo menos um autor com afiliação a instituição brasileira e 22 tinham autor sênior brasileiro, excluindo-se as 32 publicações compostas exclusivamente por pesquisadores brasileiros. Ao se determinar a distribuição, por estados, da instituição de pesquisa à qual está(ão vinculado(s o(s autor(res brasileiro(s, São Paulo, com 34 publicações (55,73%, ficou na primeira posição, com predominância absoluta do eixo Sudeste-Sul (96,72%. CONCLUSÃO: Apesar de as publicações brasileiras em psiquiatria terem apresentado aparente crescimento quantitativo e qualitativo, a produção científica da área é ainda pequena e altamente concentrada em alguns poucos estados.OBJECTIVE: We evaluated the Brazilian scientific production published in the year 2005 in the twenty psychiatric periodicals with high impact factor (IF according to Journal of Citation Report (JCR, 2004. METHODS: From 90 periodicals with IF ranging from 11,207 to 0,13, we selected all articles from periodicals with IF higher than percentile 75 (n = 20. We assessed which articles had at least one author affiliated to a Brazilian institution as well as articles that had only Brazilian authors or first/senior author