Powell, Emilie S; Khare, Rahul K; Venkatesh, Arjun K; Van Roo, Ben D; Adams, James G; Reinhardt, Gilles
Patient crowding and boarding in Emergency Departments (EDs) impair the quality of care as well as patient safety and satisfaction. Improved timing of inpatient discharges could positively affect ED boarding, and this hypothesis can be tested with computer modeling. Modeling enables analysis of the impact of inpatient discharge timing on ED boarding. Three policies were tested: a sensitivity analysis on shifting the timing of current discharge practices earlier; discharging 75% of inpatients by 12:00 noon; and discharging all inpatients between 8:00 a.m. and 4:00 p.m. A cross-sectional computer modeling analysis was conducted of inpatient admissions and discharges on weekdays in September 2007. A model of patient flow streams into and out of inpatient beds with an output of ED admitted patient boarding hours was created to analyze the three policies. A mean of 38.8 ED patients, 22.7 surgical patients, and 19.5 intensive care unit transfers were admitted to inpatient beds, and 81.1 inpatients were discharged daily on September 2007 weekdays: 70.5%, 85.6%, 82.8%, and 88.0%, respectively, occurred between noon and midnight. In the model base case, total daily admitted patient boarding hours were 77.0 per day; the sensitivity analysis showed that shifting the peak inpatient discharge time 4h earlier eliminated ED boarding, and discharging 75% of inpatients by noon and discharging all inpatients between 8:00 a.m. and 4:00 p.m. both decreased boarding hours to 3.0. Timing of inpatient discharges had an impact on the need to board admitted patients. This model demonstrates the potential to reduce or eliminate ED boarding by improving inpatient discharge timing in anticipation of the daily surge in ED demand for inpatient beds. Copyright © 2012 Elsevier Inc. All rights reserved.
Fortescue, Elizabeth B; Kaushal, Rainu; Landrigan, Christopher P; McKenna, Kathryn J; Clapp, Margaret D; Federico, Frank; Goldmann, Donald A; Bates, David W
Medication errors in pediatric inpatients occur at similar rates as in adults but have 3 times the potential to cause harm. Error prevention strategies in this setting remain largely untested. The objective of this study was to classify the major types of medication errors in pediatric inpatients and to determine which strategies might most effectively prevent them. A prospective cohort study was conducted of 1020 patients who were admitted to 2 academic medical centers during a 6-week period in April and May 1999. Medication errors were characterized by subtype. Physician raters evaluated error prevention strategies and identified those that might be most effective in preventing errors. Of 10 778 medication orders reviewed, 616 contained errors. Of these, 120 (19.5%) were classified as potentially harmful, including 115 potential adverse drug events (18.7%) and 5 preventable adverse drug events (0.8%). Most errors occurred at the ordering stage (74%) and involved errors in dosing (28%), route (18%), or frequency (9%). Three interventions might have prevented most potentially harmful errors: 1) computerized physician order entry with clinical decision support systems (76%); 2) ward-based clinical pharmacists (81%); and 3) improved communication among physicians, nurses, and pharmacists (86%). Interrater reliability of error prevention strategy assignment was good (agreement: 0.92; kappa: 0.82). Of the assessed interventions, computerized physician order entry with clinical decision support systems; ward-based clinical pharmacists; and improved communication among physicians, nurses, and pharmacists had the greatest potential to reduce medication errors in pediatric inpatients. Development, implementation, and assessment of such interventions in the pediatric inpatient setting are needed.
Wren, Sherry M; Martin, Molinda; Yoon, Jung K; Bech, Fritz
Postoperative pneumonia can lead to increased morbidity, length of hospital stay, and costs. Pneumonia-prevention programs have been successfully implemented in ICU settings, but no program exists for surgical ward patients. A pilot prevention program was designed and implemented based on literature review. The program consisted of education of physicians and ward staff and a standardized postoperative electronic order set consisting of incentive spirometer, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation. Quarterly staff meetings discussed the results of and compliance with the program. The intervention commenced in April 2007. Baseline incidence of inpatient ward pneumonia was calculated from the National Surgical Quality Improvement Program database for fiscal year (FY) 2006 and FY 2007. Postintervention incidence was calculated in the same manner from FY 2007 through FY 2008. Any patient who contracted pneumonia in the ICU was excluded from analysis. There was a significant decrease in ward pneumonia incidence from 0.78% in the preintervention group compared with 0.18% in the postintervention group (p = 0.006), representing an 81% decrease in incidence from 2006 to 2008. The pneumonia-prevention program was very successful in diminishing postoperative pneumonia on the surgical ward. There was a highly statistically significant 4-fold decrease in pneumonia incidence after program implementation. The interventions were not costly but did require ongoing communication and cooperation between physician and nursing leadership to achieve compliance with the measures. This program has great potential for dissemination to hospital surgical wards and could decrease inpatient postoperative pneumonias. Published by Elsevier Inc.
Maxwell M. Lodenyo
Full Text Available Background: Among many Kenyan rural communities, access to in-patient healthcare services is seriously constrained. It is important to understand who has ready access to the facilities and services offered and what factors prevent those who do not from doing so.Aim: To identify factors affecting time of access of in-patient healthcare services at a rural district hospital in Kenya.Setting: Webuye District hospital in Western Kenya.Methods: A cross-sectional, comparative, hospital-based survey among 398 in-patients using an interviewer-administered questionnaire. Results were analysed using SPSS V.12.01.Results: The median age of the respondents, majority of whom were female respondents(55%, was 24 years. Median time of presentation to the hospital after onset of illness was 12.5 days. Two hundred and forty seven patients (62% presented to the hospital within 2 weeks of onset of illness, while 151 (38% presented after 2 weeks or more. Ten-year increase in age, perception of a supernatural cause of illness, having an illness that was considered bearable and belief in the effectiveness of treatment offered in-hospital were significant predictors for waiting more than 2 weeks to present at the hospital.Conclusion: Ten-year increment in age, perception of a supernatural cause of illness(predisposing factors, having an illness that is considered bearable and belief in the effectiveness of treatment offered in-hospital (need factors affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.
Felton, Brent M; Reisdorff, Earl J; Krone, Christopher N; Laskaris, Gus A
This was a point-prevalence study designed to quantify the magnitude of emergency department (ED) overcrowding and inpatient boarding. Every ED in Michigan was surveyed at a single point in time on a Monday evening. Given the high patient volumes on Monday evenings, the effect on inpatient boarding the next morning was also reviewed. All 134 EDs within the state of Michigan were contacted and surveyed on Monday evening, March 16, 2009, over a single hour and again the following morning. Questions included data on annual census, bed number, number of admitted patients within the ED, ambulance diversion, and ED length of stay. Data were obtained from 109 of the 134 (81%) hospitals on Monday evening and 99 (74%) on Tuesday morning. There was no difference in annual visits or ED size between participating and nonparticipating EDs. Forty-seven percent of EDs were boarding inpatients on Monday evening, compared with 30% on Tuesday morning. The mean estimated boarding times were 3.7 hours (Monday evening) and 7.2 hours (Tuesday morning). Twenty-four percent of respondents met the definition of overcrowded during sampling times. There was a significant relationship between inpatient boarding and ED overcrowding (p boarding inpatients, while 24% were operating beyond capacity. On the following morning (Tuesday), EDs had fewer boarded inpatients than on Monday evening. However, these boarded inpatients remained in the ED for a significantly longer duration. © 2011 by the Society for Academic Emergency Medicine.
Buri, Caroline; Moggi, Franz; Giovanoli, Anna; Strik, Werner
In randomized controlled trials with high internal validity, pharmacotherapy using acamprosate, naltrexone, and, to a somewhat lesser extent, disulfiram has proved effective in preventing relapse in patients with alcohol use disorders (AUD). There remains, however, a paucity of studies with sufficient external validity in which the effectiveness of pharmacotherapy in clinical practice is investigated. This study aimed to make a contribution to close this gap in research. In this naturalistic, prospective study, a comparison on indices of substance use, psychiatric symptoms, and treatment service utilization was carried out using samples of 92 patients who received pharmacotherapy and 323 patients who did not receive pharmacotherapy following discharge from 12 residential AUD programmes (index stay). Patients that received pharmacotherapy were more likely to use alcohol during the index stay and at the 1-year follow-up. Moreover, this patient group more readily utilized treatment services during a 2-year period prior to and a 1-year period following index stay than patients who were not given pharmacotherapy. Nevertheless, when pharmacotherapy was prescribed before first post-treatment alcohol use, it was associated with delay of alcohol use, fewer relapses, and a reduced need for inpatient treatment. In many cases, however, medication was not prescribed until alcohol use and relapse had occurred. The length of time to first alcohol use was longer, and the cumulative abstinence rate higher, for disulfiram than for acamprosate, the latter being generally prescribed for more severely alcohol-dependent patients. There is a need for further studies to probe the reasons why medication for relapse prevention is not prescribed upon discharge from residential treatment and for less severely alcohol-dependent patients.
Skidmore, Elizabeth R.; Whyte, Ellen M.; Butters, Meryl A.; Terhorst, Lauren; Reynolds, Charles F.
Objective Apathy, or lack of motivation for goal-directed activities, contributes to reduced engagement in and benefit from rehabilitation, impeding recovery from stroke. We examined the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke. Design Secondary analysis of randomized controlled trial. Setting Acute inpatient rehabilitation. Participants Participants with acute stroke who exhibited cognitive impairments (Quick Executive Interview Scores ≥ 3) and were admitted for inpatient rehabilitation were randomized to receive strategy training (n=15, one session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (n=15, same dose). Methods Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following and responding). Main Outcome Measurements Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 and 6 months. Data were analyzed with repeated measures fixed-effects models. Results Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission (strategy training, M=25.79, SD=7.62; reflective listening, M=25.18, SD=4.40). A significant group by time interaction (F2,28 =3.61, p =.040) indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large (d=−0.99, t28=−2.64, p=.013) at month 3, and moderate to large at month 6 (d=−0.70, t28=−1.86, p=.073). Conclusion Strategy training shows promise as an adjunct to usual rehabilitation
Neuderth, S; Lukasczik, M; Musekamp, G; Gerlich, C; Saupe-Heide, M; Löbmann, R; Vogel, H
There so far is no standardized program for external quality assurance in inpatient parent-child prevention and rehabilitation in Germany. Therefore, instruments and methods of external quality assurance were developed and evaluated on behalf of the federal-level health insurance institutions. On the level of structure quality, a modular questionnaire for assessing structural features of rehabilitation/prevention centers, basic and allocation criteria as well as a checklist for visitations were developed. Structural data were collected in a nationwide survey of parent-child prevention and rehabilitation centers. Process and outcome quality data were collected in n=38 centers. Process quality was assessed using multiple methods (process-related structural features, case-related routine documentation, and incident-related patient questionnaires). Outcome quality was measured via patient questionnaires (n=1 799 patients). We used a multi-level modelling approach by adjusting relevant confounders on institutional and patient levels. The methods, instruments and analyzing procedures developed for measuring quality on the level of structure, processes and outcomes were adjusted in cooperation with all relevant stakeholders. Results are exemplarily presented for all quality assurance tools. For most of the risk-adjusted outcome parameters, we found no significant differences between institutions. For the first time, a comprehensive, standardized and generally applicable set of methods and instruments for routine use in comparative quality measurement of inpatient parent-child prevention and rehabilitation is available. However, it should be considered that the very heterogeneous field of family-oriented measures can not be covered entirely by an external quality assurance program. Therefore, methods and instruments have to be adapted continuously to the specifics of this area of health care and to new developments. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Single-room ward design has previously been associated with increased risk of inpatient falls and adverse outcomes. However, following quality initiatives, the incidence of inpatient falls has shown a sustained reduction. Benefits have also been observed in the reduction of hip fractures. However, one-year mortality trends have not been reported. The aim of this observational study is to report the trends in one-year mortality rates before and after implementing quality-improvement initiatives to prevent inpatient falls over the last 5 years (2012–2016. This retrospective observational study was conducted for all patients who had sustained an inpatient fall between January 2012 and December 2016. All the incident reports in DATIX patient-safety software which were completed for each inpatient fall were studied, and the clinical information was extracted from Clinical Work Station software. Mortality data were collected on all patients for a minimum of one year following the discharge from the hospital. The results show that 95% patients were admitted from their own homes; 1704 patients had experienced 3408 incidents of an inpatient fall over 5 years. The mean age of females (82.61 ± 10.34 years was significantly higher than males (79.36 ± 10.14 years. Mean falls/patient = 2.0 ± 2.16, range 1–33. Mean hospital stay was 45.43 ± 41.42 days. Mean hospital stay to the first fall was 14.5 ± 20.79 days, and mean days to first fall prior to discharge was 30.8 ± 34.33 days. The results showed a significant and sustained reduction in the incidence of inpatient falls. There was a downward trend in the incidence of hip fractures over the last two years. There was no significant difference in the inpatient and 30-day mortality rate over the last five years. However, mortality trends appear to show a significant downward trend in both six-month and one-year mortality rates over the last two years following the implementation of quality initiatives
Maynard, Greg; Jenkins, Ian H; Merli, Geno J
Hospital-associated nonsurgical venous thromboembolism (VTE) is an important problem addressed by new guidelines from the American College of Physicians (ACP) and American College of Chest Physicians (AT9). Narrative review and critique. Both guidelines discount asymptomatic VTE outcomes and caution against overprophylaxis, but have different methodologies and estimates of risk/benefit. Guideline complexity and lack of consensus on VTE risk assessment contribute to an implementation gap. Methods to estimate prophylaxis benefit have significant limitations because major trials included mostly screening-detected events. AT9 relies on a single Italian cohort study to conclude that those with a Padua score ≥4 have a very high VTE risk, whereas patients with a score AT9 includes the Padua model and Caprini point-based system for nonsurgical inpatients and surgical inpatients, respectively, but there is no evidence they are more effective than simpler risk-assessment models. New VTE prevention guidelines provide varied guidance on important issues including risk assessment. If Padua is used, a threshold of 3, as well as 4, should be considered. Simpler VTE risk-assessment models may be superior to complicated point-based models in environments without sophisticated clinical decision support. © 2013 Society of Hospital Medicine.
Bhansali, P.; Birch, S.; Campbell, J.K.; Agrawal, D.; Hoffner, W.; Manicone, P.; Shah, K.; Krieger, E.; Ottolini, M.
OBJECTIVE: Family-centered rounds (FCR) have become increasingly prevalent in pediatric hospital settings. The objective of our study was to describe time use and discrete events during pediatric inpatient rounds by using a FCR model. METHODS: We conducted a prospective observational study at
Maxwell M. Lodenyo
Conclusion: Ten-year increment in age, perception of a supernatural cause of illness(predisposing factors, having an illness that is considered bearable and belief in the effectiveness of treatment offered in-hospital (need factors affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.
Latimer, Sharon; Chaboyer, Wendy; Gillespie, Brigid
Pressure injuries are a patient safety issue. Despite the suite of prevention strategies, sustained reductions in pressure injury prevalence rates have not been achieved. Generally, nurses are usually responsible for assessing patients' pressure injury risk, and then implementing appropriate prevention strategies. The study aim was to describe five planned and implemented pressure injury prevention strategies (risk assessment, management plan, support surface, repositioning, and education), and determine if a relationship existed between the planning and implementation of support surfaces and regular repositioning. An observational study collecting data using chart audits and semi-structured observations. Data were analysed using descriptive and inferential statistics. This study was set in four medical units across two Australian metropolitan hospitals. The sample comprised adult medical inpatients with reduced mobility. A subsample of participants assessed at pressure injury risk on admission was drawn from this sample. Participants were aged ≥18 years, had a hospital length of stay of ≥3 days prior to recruitment, provided an informed consent, and had reduced mobility. There was suboptimal planning and implementation of pressure injury prevention strategies for the sample and subsample. There was a significant relationship between planned and implemented support surfaces at both hospitals; however, no relationship existed between the planned and implemented of regular repositioning at either site. The planning and implementation of pressure injury strategies is haphazard. Patients received support surfaces; however, gaps exist in pressure injury risk assessment, management planning, regular repositioning, and patient education.
Manongi, Rachel; Mtei, Frank; Mtove, George; Nadjm, Behzad; Muro, Florida; Alegana, Victor; Noor, Abdisalan M; Todd, Jim; Reyburn, Hugh
To investigate the association, if any, between child mortality and distance to the nearest hospital. The study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates and child mortality rates in the catchment population using inpatient deaths as the numerator. Three thousand hundred and eleven children under the age of 5 years were included of whom 4.6% died; 2307 were admitted from time between admission and death. Assuming uniform mortality in the catchment population, the predicted number of deaths not benefiting from hospital admission prior to death increased by 21.4% per hour of travel time to hospital. If the same admission and death rates that were found at <3 h from the hospital applied to the whole catchment population and if hospital care conferred a 30% survival benefit compared to home care, then 10.3% of childhood deaths due to febrile illness in the catchment population would have been averted. The mortality impact of poor access to hospital care in areas of high paediatric mortality is likely to be substantial although uncertainty over the mortality benefit of inpatient care is the largest constraint in making an accurate estimate. © 2014 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Otero, Paula; Leyton, Andrea; Mariani, Gonzalo; Ceriani Cernadas, José María
The objective of this study was to assess the prevalence and characteristics of medication errors in pediatric and neonatal inpatients and to measure the impact of interventions to reduce medication errors. A preintervention and postintervention cross-sectional study was conducted of a sample of prescriptions that were ordered by physicians and medications that were administered by nurses to patients at the NICU, PICU, and general pediatric settings at the Hospital Italiano de Buenos Aires Department of Pediatrics in 2002 and 2004. Number and type of errors, time shift on which they occurred, and whether they had any kind of adverse event on the patient were recorded. Medication errors were stratified according to physicians' and nurses' status. Several interventions, including incorporating a positive safety culture without a punitive management of errors and specific prescribing and drug-administration recommendations were implemented between the 2 phases of the study. A total of 590 prescriptions and 1174 drug administrations for 95 patients in the first phase of the study and 1144 prescriptions with 1588 drug administrations for 92 patients in the second phase were evaluated. The prevalence of medication error rate in the second phase was 7.3% (199 of 2732) and 11.4% (201 of 1764) in the first phase. The risk difference was -4.1%. The development of a program mainly centered on the promotion of a cultural change in the approach to medical errors can effectively diminish medication errors in neonates and children.
Andrew, Rachel E; Lauria, Alexis; Puleo, Frances J; Berg, Arthur; Stewart, David B
Despite data suggesting safety and efficacy in ulcerative colitis patients treated with inpatient infliximab, prior studies did not focus on patients with extensive colitis, the group at highest risk for requiring surgery. This was a single center, retrospective study (2008-2015) of consecutive patients who required admission because of severe extensive ulcerative colitis defined by preoperative symptoms and computed tomography scans and postoperative histology. Patients admitted for high-dose steroids were compared with steroid refractory inpatients provided with one or two infusions of infliximab. The primary study outcome was colectomy rates; secondary outcomes included mean length of stay and 60-d complication rates. A total of 174 patients required admission with steroids for extensive ulcerative colitis. Of these, 19 (10%) also received infliximab. Among the subjects treated with infliximab, 15 (78%) required total colectomy during that admission versus 81 (52%) who received steroids alone (P = 0.03). Postoperative readmission rates, surgical-site infections, return to the operating room, and all-complication rates were similar between the cohorts (P > 0.05). For steroid refractory extensive ulcerative colitis, inpatient infliximab did not lower colectomy rates or increase postoperative complications compared with patients treated with steroids alone. Copyright © 2017 Elsevier Inc. All rights reserved.
[External quality assurance in inpatient medical rehabilitation and prevention centers for mothers, fathers and children: comparative outcome quality analyses across rehabilitation/prevention centers].
Lukasczik, M; Gerlich, C; Musekamp, G; Saupe-Heide, M; Löbmann, R; Vogel, H; Neuderth, S
To date, there are no programs for external quality assurance for inpatient prevention and rehabilitation programs for mothers, fathers and children. Instruments for outcome quality assessment were evaluated with the goal of determining their ability to document differences between prevention/rehabilitation centers in quality-relevant outcome parameters. Referring to the ICF, relevant outcome variables were specified and operationalized using established questionnaires. Data from 45 inpatient prevention and rehabilitation centers for mothers, fathers and children were analyzed using multilevel modeling with risk adjustment. Intra-class correlations were computed to determine in which parameters differences between institutions could be found. The percentage of variability accounted for by patient vs. institution characteristics was computed while statistically controlling for relevant confounders. For prevention centers, substantial variation on the institutional level was found in 9 out of 15 parameters. Almost all institutions did not deviate significantly from the grand mean of the respective parameter. For rehabilitation centers, significant variability was found in 2 out of 10 parameters. The differences between most institutions remained within a range of expectable variability. The results imply that comparative analyses across hospitals are better suited to identify institutions with low quality rather than establish quality-based rankings of institutions. © Georg Thieme Verlag KG Stuttgart · New York.
Qiu, Shanshan; Chinnam, Ratna Babu; Murat, Alper; Batarse, Bassam; Neemuchwala, Hakimuddin; Jordan, Will
Emergency departments (ED) in hospitals are experiencing severe crowding and prolonged patient waiting times. A significant contributing factor is boarding delays where admitted patients are held in ED (occupying critical resources) until an inpatient bed is identified and readied in the admit wards. Recent research has suggested that if the hospital admissions of ED patients can be predicted during triage or soon after, then bed requests and preparations can be triggered early on to reduce patient boarding time. We propose a cost sensitive bed reservation policy that recommends optimal bed reservation times for patients. The policy relies on a classifier that estimates the probability that the ED patient will be admitted using the patient information collected and readily available at triage or right after. The policy is cost sensitive in that it accounts for costs associated with patient admission prediction misclassification as well as costs associated with incorrectly selecting the reservation time. Results from testing the proposed bed reservation policy using data from a VA Medical Center are very promising and suggest significant cost saving opportunities and reduced patient boarding times.
Yamamoto, J Jay; Malatestinic, Bill; Lehman, Angela; Juneja, Rattan
The objective of this project was to improve the timing of inpatient insulin administration related to meal delivery and the scheduling of radiology tests by Lean Six Sigma method. A multidisciplinary hospital team and a Six Sigma team from a pharmaceutical manufacturer collaborated to evaluate food delivery and radiology scheduling processes related to the timing of insulin administration. Key factors leading to problems within each system were addressed to improve the efficiency of each process while improving the timeliness of glucose testing and insulin administration. Standardizing the food delivery schedule and utilizing scorecards to track on-time meal deliveries to the floor enabled nursing to more accurately administer insulin in coordination with the delivery of meals. Increasing communication and restricting the scheduling of inpatient procedures during mealtimes reduced disruptions to insulin administration. Data at 6 months postimplementation demonstrated that the institution met goals for most primary outcome metrics including increasing on-time meal delivery and the proportion of patients taking insulin scheduled for radiology tests during appropriate times. By implementing the recommendations identified via Lean Six Sigma, this collaborative effort improved the timing of inpatient insulin administration related to meal delivery and radiology testing.
Uccello, R., & Lachenmeyer, J. (1998, November). Behavioral treatment of body dysmorphic disorder . Poster presented at the annual meeting of the...TITLE: Pilot Trial of Inpatient Cognitive Therapy for the Prevention of Suicide in Military Personnel with Acute Stress Disorder or Post-Traumatic...Stress Disorder PRINCIPAL INVESTIGATOR: Marjan G. Holloway, Ph.D
Chen, Yu-Yi; Tsai, Meng-Lin
The occurrence of a medication error can threaten patient safety. The medication administration process is complex and cumbersome, and nursing staffs are prone to error when they are tired. Proper Information Technology (IT) can assist the nurse in correct medication administration. We review a recent proposal regarding a leading-edge solution to enhance inpatient medication safety by using RFID technology. The proof mechanism is the kernel concept in their design and worth studying to develop a well-designed grouping-proof scheme. Other RFID grouping-proof protocols could be similarly applied in administering physician orders. We improve on the weaknesses of previous works and develop a reading-order independent RFID grouping-proof scheme in this paper. In our scheme, tags are queried and verified under the direct control of the authorized reader without connecting to the back-end database server. Immediate verification in our design makes this application more portable and efficient and critical security issues have been analyzed by the threat model. Our scheme is suitable for the safe drug administration scenario and the drug package scenario in a hospital environment to enhance inpatient medication safety. It automatically checks for correct drug unit-dose and appropriate inpatient treatments. Copyright © 2013. Published by Elsevier Ireland Ltd.
Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian
Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.
Zimmermann, Peter; Kowalski, Jens; Niggemeier-Groben, Angelika; Sauer, Melanie; Leonhardt, Robert; Ströhle, Andreas
Since 1999, the German Armed Forces (Bundeswehr) have been conducting 3-weeks preventive treatment programs aimed at psychological resource-strengthening in soldiers returning from deployment. Five hundred participants of these programs received the Posttraumatic Stress Scale 10 (PTSS-10) before and after treatment and the rehabilitation assessment questionnaire of the German statutory pension insurance body. Sixty control group subjects received the PTSS-10 twice in an interval of 4-5 months without therapeutic interventions. Comparison of pre- and post-treatment PTSS-10 results in the covariance analysis showed an effect of the initial PTSS-10-stress-levels and rank category, not of the intervention. On average, the treatment program received 'very good' to 'excellent' overall ratings in the rehabilitation questionnaire. The acceptance of sports and movement therapy was significantly above average, whereas that of individual and group counselling was below. The results of this pilot study suggest a high acceptance of the post-deployment preventive program. Effectiveness in terms of psychometric improvement cannot be proven at this point.
Castilla, Jesús; Martínez-Baz, Iván; Navascués, Ana; Casado, Itziar; Aguinaga, Aitziber; Díaz-González, Jorge; Delfrade, Josu; Guevara, Marcela; Ezpeleta, Carmen
IntroductionWe compared trivalent inactivated influenza vaccine effectiveness (VE) in preventing outpatient and inpatient influenza cases in Navarre, Spain. Methods: During seasons 2010/11 to 2015/16, community-dwelling patients with influenza-like illness aged 50 years or older were tested for influenza when attended by sentinel general practitioners or admitted to hospitals. The test-negative design was used to estimate and compare the VE by healthcare setting. Results: We compared 1,242 laboratory-confirmed influenza cases (557 outpatient and 685 inpatient cases) and 1,641 test-negative controls. Influenza VE was 34% (95% confidence interval (CI): 6 to 54) in outpatients and 32% (95% CI: 15 to 45) in inpatients. VE in outpatients and inpatients was, respectively, 41% (95% CI: -1 to 65) and 36% (95% CI: 12 to 53) against A(H1N1)pdm09, 5% (95% CI: -58 to 43) and 22% (95% CI: -9 to 44) against A(H3N2), and 49% (95% CI, 6 to 73) and 37% (95% CI: 2 to 59) against influenza B. Trivalent inactivated influenza vaccine was not associated with a different probability of hospitalisation among influenza cases, apart from a 54% (95% CI: 10 to 76) reduction in hospitalisation of influenza A(H3N2) cases. Conclusions: On average, influenza VE was moderate and similar in preventing outpatient and inpatient influenza cases over six influenza seasons in patients above 50 years of age. In some instances of low VE, vaccination may still reduce the risk of hospitalisation in older adults with vaccine failure.
Yakov, Svetlana; Birur, Badari; Bearden, Melissa F; Aguilar, Barbara; Ghelani, Kinjal J; Fargason, Rachel E
Impaired sensory gating in patients with acute mental illness predisposes to overstimulation and behavioral dyscontrol. Explore use of sensory reduction interventions on a high-acuity inpatient milieu to reduce high assault/restraint rates. A multidisciplinary team using failure mode and effect analysis to explore high restraint use between 4:00 p.m. and 7:00 p.m. observed patient/staff overstimulation contributed to behavioral escalations. The team implemented sensory reduction/integration improvements over a 5-month period to prevent excessive restraint use. Restraint rates dropped immediately following light and sound reduction interventions and by 72% at 11 months postimplementation. Mann-Whitney statistics for unpaired 6-month comparisons, 1-year pre- and postintervention showed significant reductions: Assault rates (median pre = 1.37, post = 0.18, U = 4, p = .02); Restraint rates (median pre = 0.50, post = 0.06, U = 0, p = .002). Sensory reduction during a high-stress time period on a high-acuity psychiatric unit was associated with a reduction in assaults and restraints.
The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors
Dijkgraaf Marcel G
Full Text Available Abstract Background The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established. However, given the substantial incidence of preventable ADEs in Dutch hospitals found in recent studies, appears warranted. Therefore, "Ward-Oriented Pharmacy", an on-ward service tailored to the Dutch hospital setting, will be developed. This service will consist of multifaceted interventions implemented in the Internal Medicine wards by hospital pharmacists. The effect of this service on preventable ADEs in elderly inpatients will be measured. Elderly patients are at high risk for ADEs due to multi-morbidity, concomitant disabilities and polypharmacy. Most studies on the incidence and preventability of ADEs in elderly patients have been conducted in the outpatient setting or on admission to a hospital, and fewer in the inpatient setting. Moreover, recognition of ADEs by the treating physicians is challenging in elderly patients because their disease presentation is often atypical and complex. Detailed information about the performance of the treating physicians in ADE recognition is scarce. Methods/Design The design is a multi-centre, interrupted time series study. Patients of 65 years or older, consecutively admitted to Internal Medicine wards will be included. After a pre-measurement, a Ward-Oriented Pharmacy service will be introduced and the effect of this service will be assessed during a post-measurement. The primary outcome measures are the ADE prevalence on admission and ADE incidence during hospital stay. These outcomes will be assessed using structured
Lavin, Jennifer M; Schroeder, James W; Thompson, Dana M
The traditional practice model for pediatric otolaryngologists at high-volume academic centers is to simultaneously balance outpatient care responsibilities with those of the inpatient service, emergency department, and ambulatory care clinics. This model leads to challenges with care coordination, timeliness of nonemergency operative care, and consistent participation in care and consultation at the attending surgeon level. The "surgeon on service" (SOS) model-where faculty members rotate to manage the inpatient service in lieu of outpatient responsibilities-has been described as one method to address this conundrum. The operational and economic feasibility of the SOS model has been demonstrated; however, its impact on care coordination, time from consultation to surgical care, and length of stay (LOS) have not been evaluated. To determine the impact of the SOS model on the quality principles of timeliness and efficiency of tracheostomy tube placement and to determine if the SOS model is fiscally feasible in an academic pediatric otolaryngology practice. Medical record review of patients undergoing tracheostomy in a pediatric academic medical center and survey of their treating physician trainees, comparing the 6-month SOS pilot phase (postimplementation, January-June 2016) with the 6-month preimplementation period (January-June 2015). Implementation of the SOS model. Time to tracheostomy, frequency of successful coordination of tracheostomy with gastrostomy tube placement, total LOS, productivity measured in work relative value units, and responses to trainee surveys. Of the 41 patients included in the study (24 boys and 17 girls; mean age, 3 years; range, 3 months to 17 years), 15 were treated before SOS implementation, and 26 after. Also included were 21 trainees. Before SOS implementation, median time to tracheostomy was 7 days (range, 2-20 days); after SOS implementation, it was 4 days (range, 1-10 days) (difference between the medians, before to after, -3
Full Text Available Objectives: The relative merits of hub and spoke models of service delivery are often debated, but accessing data on how they may benefit service delivery can be difficult, and may hinder the adoption of a model which can benefit the health community. Our aim was to provide objective data that would either support or refute one potential benefit of service redesign, namely the effect on turnaround times within the acute hospital. Design and methods: Data on turnaround times for sequential requests containing creatinine as a request item received from inpatient locations at two acute hospitals were extracted from the laboratory computer system. Monthly data was collected for a period of 5 months prior to and the same 5 month period following the service redesign. Data was subjected to statistical process control (SPC analysis. Results: There was a statistically significant reduction (P<0.05 in the average turnaround time of at least 29% for routine requests and 22% for urgent requests, accompanied by a statistically significant reduction (P<0.05 in upper control limits of least 46% â improving the predictability of result availability and reducing the 95% confidence interval for turnaround times. Conclusions: Adoption of a âhub and spokeâ model has the potential to support laboratories in improving both urgent and non-urgent turnaround times in a cost-efficient manner within acute hospitals, and reduce the variability in turnaround time. Keywords: Laboratory organisation, Turnaround time, Efficiency
Saupe-Heide, M; Gerlich, C; Lukasczik, M; Musekamp, G; Neuderth, S; Vogel, H
As required by German law, inpatient institutions offering prevention and rehabilitation measures for mothers, fathers and children are obliged to implement external quality assurance measures. In 2 pilot projects funded by the German federal association of health insurance funds, external quality assurance procedures for in-hospital prevention and rehabilitation of mothers and fathers were analyzed with the aim of developing a set of instruments for the description of structural characteristics in this area of health care and to evaluate its appropriateness. Concerning structure-related quality, the project included a) designing and evaluating a questionnaire, b) the definition of assessment criteria for subsequent comparative data analyses, and c) the description and documentation of the current state in the field of rehabilitation and prevention for mothers, fathers and children. To document structural quality comprehensively, a modular questionnaire was developed and tested in a survey of 115 inpatient prevention and rehabilitation institutions for mothers, fathers and children. Involving an expert panel, preliminary basic and selection criteria were defined in order to assure a conducive assessment with regard to structural attributes. The majority of institutions had provider agreements for both prevention and rehabilitation. Measures for mothers/fathers with children were predominant; only 7 institutions exclusively treated mothers and fathers. Institution sizes varied strongly. Major indications included psychosomatics, dermatology, and pneumology. Overall, structural conditions of the institutions showed a high standard. Potential for development was found with regard to some aspects of the conceptual framework of institutional practice and the implementation of the International Classification of Functioning, Disability and Health (ICF) in diagnostics. In this article, the degrees of fulfillment with relation to the structural dimensions are presented
Inpatient violence constitutes a major concern for staff, patients, and administrators. Violence can cause physical injury and psychological trauma. Although violence presents a challenge to inpatient clinicians, it should not be viewed as inevitable. By looking at history of violence, in addition to clinical and other historical factors, clinicians can identify which patients present the most risk of exhibiting violent behavior and whether the violence would most likely flow from psychosis, impulsivity, or predatory characteristics. With that information, clinicians can provide environmental and treatment modifications to lessen the likelihood of violence. Copyright © 2016 Elsevier Inc. All rights reserved.
Seel, Ronald T; Corrigan, John D; Dijkers, Marcel P; Barrett, Ryan S; Bogner, Jennifer; Smout, Randall J; Garmoe, William; Horn, Susan D
To describe patients' level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and to evaluate how age, injury severity, cognitive impairment, and time are associated with effort. Prospective, multicenter, longitudinal cohort study. Acute TBI rehabilitation programs. Patients (N=1946) receiving 138,555 therapy sessions. Not applicable. Effort in rehabilitation sessions rated on the Rehabilitation Intensity of Therapy Scale, FIM, Comprehensive Severity Index brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS). The Rehabilitation Intensity of Therapy Scale effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean Rehabilitation Intensity of Therapy Scale ratings for patients' therapy sessions were higher in the discharge week than in the admission week (Prehabilitation, differences in effort ratings (Prehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort (Prehabilitation setting using the Rehabilitation Intensity of Therapy Scale. Patients who sustain TBI show varying levels of effort in rehabilitation therapy sessions, with effort tending to increase over the stay. PTA and agitated behavior are primary risk factors that substantially reduce patient effort in therapies. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Leone, Rita Marie; Adams, Rachel Joy
The purpose of this article is to review a quality improvement project aimed to examine how nurse leaders in an inpatient rehabilitation (IPR) unit can reduce the number of patient falls by implementing multiple fall prevention interventions and sustain their results by promoting a strong culture of safety on the unit. A retrospective review of IPR fall rates was performed. Quarterly fall rates were then compared with implementation dates of fall prevention interventions (safety huddles, signage, and hourly rounding). Culture of safety scores were also examined to assess the effect of an enhanced culture of safety on the sustainability of lowered fall rates. The largest decrease in fall rate was noted after initial revitalization efforts of the IPR unit's culture of safety concurrently with hourly rounding. Fall rates rise and fall despite multiple fall prevention interventions and encouraging a positive shift in the culture of safety. Physical injuries following a fall can reduce mobility and increase morbidity. Costs associated with falls negatively impact costs and reimbursement. Employing evidence-based fall prevention strategies are then of critical importance to nurse leaders as falls remain an ongoing serious adverse event. © 2015 Association of Rehabilitation Nurses.
Wagar, Elizabeth A; Phipps, Ron; Del Guidice, Robert; Middleton, Lavinia P; Bingham, John; Prejean, Cheryl; Johnson-Hamilton, Martha; Philip, Pheba; Le, Ngoc Han; Muses, Waheed
Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services. To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders. The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement. After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%. Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.
Widner, Aimee; Nobles, Delores L; Faulk, Clinton; Vos, Paul; Ramsey, Keith M
To determine how the implementation of a methicillin-resistant Staphylococcus aureus (MRSA) control program in an inpatient rehabilitation facility (IRF) affects MRSA health care-associated infections (MRSA-HAIs). A retrospective chart review. IRF affiliated with Vidant Medical Center, an 861-bed, acute-care teaching hospital for The Brody School of Medicine at East Carolina University. Seventy-nine adult patients in the IRF who developed a MRSA-HAI from February 2005 through January 2011. Both the acute care hospital and the affiliated inpatient rehabilitation unit began screening 100% of admissions for MRSA nasal carriage, with decolonization of positive carriers, starting in February 2007. Yearly rates of MRSA-HAI per 1000 patient-days were compared in the IRF before and after the intervention. The weighted mean monthly infection rate before the intervention (February 2005 through January 2007) was 1.0714 per 1000 patient days compared with 0.6557 per 1000 patient days after the intervention (February 2007 through January 2011). The decreased infection rates after the intervention were statistically significant (P = .0315). The implementation of an all-admissions MRSA screening program with decolonization of positive carriers in an IRF affiliated with an acute care hospital resulted in decreased MRSA-HAI rates in the IRF. When developing surveillance guidelines for MRSA, IRFs should be cognizant of infection rate trends and of the affiliated hospital's scope of policies and practices for infection prevention and control. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Williams, M; Cardona-Morrell, M; Stevens, P; Bey, J; Smith Glasgow, M E
Research indicates up to one-third of rapid response team calls relate to end-of-life symptoms. The CriSTAL criteria were developed as a screening tool to identify high risk of death within three months. The primary purpose of this pilot study was to investigate the timing of palliative care referrals in patients receiving rapid response team services, and patients' CriSTAL criteria score on admission. The potential feasibility of using the CriSTAL tool to stimulate earlier Palliative Care Team (PCT) referral served as an underlying goal, and investigation of a relationship between specific CriSTAL criteria and the prediction of in-hospital death was a secondary objective. A retrospective chart review of rapid response calls made in 2015 was used to identify patient risk of death on admission based on the CriSTAL criteria. The presence and timing of PCT referral as well as patient survival status to hospital discharge were documented for comparison. A sample of 183 charts from 584 inpatients involved in over 600 RRT events recorded in 2015. The study was undertaken in a 676-bed teaching hospital in the Midwestern U.S. Ninety-one patients died during the hospital stay while 92 patients from the 493 individuals who survived were randomly selected for full analysis. Applying CriSTAL criteria to the 141 individuals aged 50 years or older indicated that frailty (OR=1.43, 95%CI 1.08-1.89, p=0.012), being a male (OR=3.14; 95%CI 1.40-7.05, p=0.006), and the presence of two or more comorbidities (OR=3.71, 95%CI 1.67-8.24, p=0.001) were the most significant predictors of in-hospital death after adjusting for age. A CriSTAL score of 6 was the optimal cut-off for high-risk of in-hospital death. Palliative care consultations within the high-risk population occurred for 45.2% of the deceased and 40.4% of the survivors. Consultation often occurred within two days of the RRT event and many patients (46.8%) died within one day of the consultation. A positive relationship was found
LTC Geoffrey Grammer , M.D., Chief of Inpatient Psychiatry at WRNMMC. Dr. Holloway remains the overall study PI. We received initial approval to...WRNMMC inpatient psychiatry for availability for site PI, Dr. Grammer . On March 9, 2013, the clinical coordinator attended the WRNMMC IRB Research...Dr. Geoffrey Grammer (Chief of Inpatient Psychiatry) and Major Robert Duprey (Acting Chief of Psychiatric Nursing Service). During these meetings, we
French, Amanda N; Ashby, Regan S; Morgan, Ian G; Rose, Kathryn A
Recent epidemiological evidence suggests that children who spend more time outdoors are less likely to be, or to become myopic, irrespective of how much near work they do, or whether their parents are myopic. It is currently uncertain if time outdoors also blocks progression of myopia. It has been suggested that the mechanism of the protective effect of time outdoors involves light-stimulated release of dopamine from the retina, since increased dopamine release appears to inhibit increased axial elongation, which is the structural basis of myopia. This hypothesis has been supported by animal experiments which have replicated the protective effects of bright light against the development of myopia under laboratory conditions, and have shown that the effect is, at least in part, mediated by dopamine, since the D2-dopamine antagonist spiperone reduces the protective effect. There are some inconsistencies in the evidence, most notably the limited inhibition by bright light under laboratory conditions of lens-induced myopia in monkeys, but other proposed mechanisms possibly associated with time outdoors such as relaxed accommodation, more uniform dioptric space, increased pupil constriction, exposure to UV light, changes in the spectral composition of visible light, or increased physical activity have little epidemiological or experimental support. Irrespective of the mechanisms involved, clinical trials are now underway to reduce the development of myopia in children by increasing the amount of time they spend outdoors. These trials would benefit from more precise definition of thresholds for protection in terms of intensity and duration of light exposures. These can be investigated in animal experiments in appropriate models, and can also be determined in epidemiological studies, although more precise measurement of exposures than those currently provided by questionnaires is desirable. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Abstract Background Timely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program. Methods A total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120 were formed according to the three OAI subgroups: short (less than 20 days, moderate (between 20 and 40 days or long (over 40 days; maximum of 70 days OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM, absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores were evaluated to test for differences between the three OAI subgroups. Results Analysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972 and discharge (P = 0.083–0.367 FIM scores, absolute (P = 0
Conclusion: The treatment of tinea capitis is simple and effective. Timely identification and treatment are essential to prevent the formation of a cicatricial alopecia, often disturbing for the patient.
Raveendranathan, D; Chandra, P S; Chaturvedi, S K
OBJECTIVE. Violence in psychiatric wards results in serious consequences and there is need for research to assess it in various settings to enable improvements in safety within psychiatric facilities. This study aimed to assess the inpatient violence from victims' perspective, in settings where family members accompanied patients during inpatient stay and played a significant role in caregiving. METHODS. A total of 100 consecutive incidents of inpatient violence were examined. Family members present at the time of the incident were interviewed to assess putative causes and behaviour prior to the incident. RESULTS. Bipolar spectrum disorder was the most common diagnosis. Family members were the targets of violence in 70% of the incidents and 81% were provoked episodes. Also, 76% of the patients were identified by family member to be irritable just prior to the episode. As preventive measures, family members suggested a need for more staff, more sedation, and improved communication. CONCLUSIONS. The capability of family members to identify behaviour patterns of patients prior to the episode might help decrease the severity and consequence of violence. It is essential to provide culture-specific interventions to the family, which could enable them in handling violence and give better care for the patient.
Nolte, S; Mierke, A; Fischer, H F; Rose, M
Significant life events such as severe health status changes or intensive medical treatment often trigger response shifts in individuals that may hamper the comparison of measurements over time. Drawing from the Oort model, this study aims at detecting response shift at the item level in psychosomatic inpatients and evaluating its impact on the validity of comparing repeated measurements. Complete pretest and posttest data were available from 1188 patients who had filled out the ICD-10 Symptom Rating (ISR) scale at admission and discharge, on average 24 days after intake. Reconceptualization, reprioritization, and recalibration response shifts were explored applying tests of measurement invariance. In the item-level approach, all model parameters were constrained to be equal between pretest and posttest. If non-invariance was detected, these were linked to the different types of response shift. When constraining across-occasion model parameters, model fit worsened as indicated by a significant Satorra-Bentler Chi-square difference test suggesting potential presence of response shifts. A close examination revealed presence of two types of response shift, i.e., (non)uniform recalibration and both higher- and lower-level reconceptualization response shifts leading to four model adjustments. Our analyses suggest that psychosomatic inpatients experienced some response shifts during their hospital stay. According to the hierarchy of measurement invariance, however, only one of the detected non-invariances is critical for unbiased mean comparisons over time, which did not have a substantial impact on estimating change. Hence, the use of the ISR can be recommended for outcomes assessment in clinical routine, as change score estimates do not seem hampered by response shift effects.
Prevention of obstetric fistula should include universal access to maternity care, recognition and timely correction of abnormal progress of labour and punctilious attention to bladder care to avoid post-partum urinary retention. Key words: Obstetric fistula, Risk factors, Pathophysiology, Post-partum urinary retention ...
Mernyi, Lena; Hölzle, Patricia; Hamann, Johannes
Objective People with mental diseases have a high risk of unemployment and they have only limited access to the labor market. The return to work is often associated with fears.The present study aims to provide an overview of the number of hospitalized psychiatric patients with permanent employment. Moreover it should give an insight into the process of return to work, the experiences patients gain and the support they receive. Methods In the participating clinics we measured the number of patients with permanent employment. The main inclusion criteria for further survey were the status of permanent employment and age between 18 and 65. The participating patients were interviewed on two occasions, at the time of inclusion and 3 months after the patient was discharged. The questions addressed working conditions, job satisfaction and the process of return-to-work. For statistical analysis, descriptive statistics (frequencies, means, standard deviations) were used. Results Only 21 % of n = 815 inpatients of the participating hospitals were permanently employed. Many patients did not return to work after being discharged. In many cases the interviewed patients saw a connection between their job and their current episode of illness. In this context patients reported unsatisfying workplace conditions such as long working hours, bad work organization and social conflicts. Conclusions For mentally ill patients, the employment rate in the primary labor market is devastating low. After psychiatric inpatient treatment patients are at high risk to lose their jobs. In order to prevent this development, work-related stress factors should be discussed with inpatients at an early stage and support should be provided during the return-to-work-process. © Georg Thieme Verlag KG Stuttgart · New York.
Graudins, Linda V; Ingram, Catherine; Smith, Brodie T; Ewing, Wendy J; Vandevreede, Melita
Omitting time-critical medications leads to delays in treatment and may result in patient harm. Published studies show that omission of prescribed medication doses is common. Although most are inconsequential, up to 86% of omitted medications place patients at some risk of harm. Funding was obtained to develop a medication safety package to facilitate decreasing omitted dose incidents by audit, education and feedback. A panel of nursing and pharmacy hospital staff in Victoria, Australia, reviewed existing audit tools and published studies to develop a critical medication list and audit tool. The tool, definitions and instructions were tested in 11 rural, urban and teaching hospitals. Qualitative feedback was sought to refine the tool using a Plan-Do-Study-Act model. An educational presentation was developed using reported incidents. Staff in 11 hospitals tested the audit tool in 321 patients receiving 17 361 doses of medication. Feedback indicated audit data were useful for informing improvements in practice and for accreditation. The educational material consists of the User Guide, plus a presentation for nursing staff illustrated by six cases with questions, with instructions on how to decrease harm from omitted doses by ensuring correct documentation and prioritising time-critical medications. A medication safety package using standard definitions and a critical medication list was successfully tested. It is now used by nursing and pharmacy staff across the state. Several interstate hospitals are using the tools as part of their hospital medication safety programmes. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
Background: Pneumococcal vaccination (PV) is important as Streptococcus pneumoniae accounts for one third of all hospitalizations for community-acquired pneumonia. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia and more than 50,000 people died from the disease. The Centers for Disease Control and Prevention recommend that…
Establishing the effectiveness, cost-effectiveness and student experience of a Simulation-based education Training program On the Prevention of Falls (STOP-Falls) among hospitalised inpatients: a protocol for a randomised controlled trial.
Williams, Cylie; Bowles, Kelly-Ann; Kiegaldie, Debra; Maloney, Stephen; Nestel, Debra; Kaplonyi, Jessica; Haines, Terry
Simulation-based education (SBE) is now commonly used across health professional disciplines to teach a range of skills. The evidence base supporting the effectiveness of this approach for improving patient health outcomes is relatively narrow, focused mainly on the development of procedural skills. However, there are other simulation approaches used to support non-procedure specific skills that are in need of further investigation. This cluster, cross-over randomised controlled trial with a concurrent economic evaluation (cost per fall prevented) trial will evaluate the effectiveness, cost-effectiveness and student experience of health professional students undertaking simulation training for the prevention of falls among hospitalised inpatients. This research will target the students within the established undergraduate student placements of Monash University medicine, nursing and allied health across Peninsula Health acute and subacute inpatient wards. The intervention will train the students in how to provide the Safe Recovery program, the only single intervention approach demonstrated to reduce falls in hospitals. This will involve redevelopment of the Safe Recovery program into a one-to-many participant SBE program, so that groups of students learn the communication skills and falls prevention knowledge necessary for delivery of the program. The primary outcome of this research will be patient falls across participating inpatient wards, with secondary outcomes including student satisfaction with the SBE and knowledge gain, ward-level practice change and cost of acute/rehabilitation care for each patient measured using clinical costing data. The Human Research Ethics Committees of Peninsula Health (LRR/15/PH/11) and Monash University (CF15/3523-2015001384) have approved this research. The participant information and consent forms provide information on privacy, storage of results and dissemination. Registration of this trial has been completed with the
Rodrigues, Daniel Francisco Santos; Nunes, Carla
The economic crisis has placed Portugal in a situation of budgetary constraints with repercussions on mental health, since 2009. This study analyses the association between economic crisis and the inpatient profile of major depression in the working-age population in Portuguese National Health System hospitals. This was an observational, descriptive and cross-sectional study. An individual analysis of hospitalisation and an ecological analysis at district level, were performed before 2008 and during the crisis (2013). Data on the hospitalisation episodes, working-age population and psychiatric inpatient beds were analysed. An increase in hospitalisation rates for major depression were observed, and across country, high spatial variations were perceived: districts with lower rates of urbanisation and population density had higher hospitalisation rates for major depression. Hospitalisation rates were positively influenced by the available inpatient beds. The results for 2013 were more critical (higher hospitalisation rates, less beds). Further research is needed to understand all patterns, considering other individual and contextual information.
Bosch, Xavier; Sanclemente-Ansó, Carmen; Escoda, Ona; Monclús, Esther; Franco-Vanegas, Jonathan; Moreno, Pedro; Guerra-García, Mar; Guasch, Neus; López-Soto, Alfons
Mainly because of the diversity of clinical presentations, diagnostic delays in lymphoma can be excessive. The time spent in primary care before referral to the specialist may be relatively short compared with the interval between hospital appointment and diagnosis. Although studies have examined the diagnostic intervals and referral patterns of patients with lymphoma, the time to diagnosis of outpatient compared to inpatient settings and the costs incurred are unknown. We performed a retrospective study at two academic hospitals to evaluate the time to diagnosis and associated costs of hospital-based outpatient diagnostic clinics or conventional hospitalization in four representative lymphoma subtypes. The frequency, clinical and prognostic features of each lymphoma subtype and the activities of the two settings were analyzed. The costs incurred during the evaluation were compared by microcosting analysis. A total of 1779 patients diagnosed between 2006 and 2016 with classical Hodgkin, large B-cell, follicular, and mature nodal peripheral T-cell lymphomas were identified. Clinically aggressive subtypes including large B-cell and peripheral T-cell lymphomas were more commonly diagnosed in inpatients than in outpatients (39.1 vs 31.2% and 18.9 vs 13.5%, respectively). For each lymphoma subtype, inpatients were older and more likely than outpatients to have systemic symptoms, worse performance status, more advanced Ann Arbor stages, and high-risk prognostic scores. The admission time for diagnosis (i.e. from admission to excisional biopsy) of inpatients was significantly shorter than the time to diagnosis of outpatients (12.3 [3.3] vs 16.2 [2.7] days; P cost of €4039.56 (513.02) per inpatient and of €1408.48 (197.32) per outpatient, or a difference of €2631.08 per patient. Although diagnosis of lymphoma was quicker with hospitalization, the outpatient approach seems to be cost-effective and not detrimental. Despite the considerable savings with the latter
J. N. Seheult
Full Text Available Background. Poor inpatient glycaemic control has a prevalence exceeding 30% and results in increased length of stay and higher rates of hospital complications and inpatient mortality. The aim of this study was to improve inpatient glycaemic control by developing an alert system to process point-of-care blood glucose (POC-BG results. Methods. Microsoft Excel Macros were developed for the processing of daily glucometry data downloaded from the Cobas IT database. Alerts were generated according to ward location for any value less than 4 mmol/L (hypoglycaemia or greater than 15 mmol/L (moderate-severe hyperglycaemia. The Diabetes Team provided a weekday consult service for patients flagged on the daily reports. This system was implemented for a 60-day period. Results. There was a statistically significant 20% reduction in the percentage of hyperglycaemic patient-day weighted values >15 mmol/L compared to the preimplementation period without a significant change in the percentage of hypoglycaemic values. The time-to-next-reading after a dysglycaemic POC-BG result was reduced by 14% and the time-to-normalization of a dysglycaemic result was reduced from 10.2 hours to 8.4 hours. Conclusion. The alert system reduced the percentage of hyperglycaemic patient-day weighted glucose values and the time-to-normalization of blood glucose.
Seheult, J N; Pazderska, A; Gaffney, P; Fogarty, J; Sherlock, M; Gibney, J; Boran, G
Background. Poor inpatient glycaemic control has a prevalence exceeding 30% and results in increased length of stay and higher rates of hospital complications and inpatient mortality. The aim of this study was to improve inpatient glycaemic control by developing an alert system to process point-of-care blood glucose (POC-BG) results. Methods. Microsoft Excel Macros were developed for the processing of daily glucometry data downloaded from the Cobas IT database. Alerts were generated according to ward location for any value less than 4 mmol/L (hypoglycaemia) or greater than 15 mmol/L (moderate-severe hyperglycaemia). The Diabetes Team provided a weekday consult service for patients flagged on the daily reports. This system was implemented for a 60-day period. Results. There was a statistically significant 20% reduction in the percentage of hyperglycaemic patient-day weighted values >15 mmol/L compared to the preimplementation period without a significant change in the percentage of hypoglycaemic values. The time-to-next-reading after a dysglycaemic POC-BG result was reduced by 14% and the time-to-normalization of a dysglycaemic result was reduced from 10.2 hours to 8.4 hours. Conclusion. The alert system reduced the percentage of hyperglycaemic patient-day weighted glucose values and the time-to-normalization of blood glucose.
A systematic nurse-led approach to withdrawal risk screening, prevention and treatment among inpatients with an alcohol use disorder in an ear, nose, throat and jaw surgery department-A formative evaluation.
Leuenberger, Deborah Linda; Fierz, Katharina; Hinck, Andreas; Bodmer, Daniel; Hasemann, Wolfgang
Among patients with head and neck cancer comorbid alcohol use disorder is frequent which contributes to higher risk of developing perioperative alcohol withdrawal syndrome/delirium or delirium due to medical conditions. Although guidelines emphasize prevention and treatment of alcohol withdrawal in hospitalized patients, a validated systematic approach for management of these patients is still lacking. Our aim was to formatively evaluate our newly developed systematic approach in view of nurses' adherence to screening patients for regular alcohol consumption and managing their withdrawal symptoms using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised. We conducted a formative evaluation to improve the project's design and performance and used a retrospective chart review in a consecutive sample of all adult inpatients with head and neck cancer being assigned for surgery in a university hospital. Our bundle of interventions consisted of nurses' screenings for regular alcohol consumption, withdrawal risk assessment, offering patients a substitution therapy, nurses' assessments of withdrawal symptoms and symptom oriented withdrawal management. Proximate endpoints were analyzed descriptively at each component of the bundle in terms of frequencies and severity of withdrawal symptoms, frequencies of nurses' and doctors' screenings and nurses' assessments performed as required. Between 2013 and 2014, 87 inpatients met inclusion criteria and screenings by doctors/ nurses revealed 49 alcohol consumers, where six screenings were omitted by nurses and six by doctors. Twenty-one consumers were at risk and six of them developed an alcohol withdrawal syndrome. None of the 87 showed an alcohol withdrawal delirium, but five developed a delirium due to medical conditions. Nurses correctly conducted all preventive elements of the intervention bundle in 14 (58%) patients at risk but overall, only performed 50% of the required assessments. Although nurses safely
U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...
This podcast delivers a diabetes prevention message tailored for Asian Americans. Created: 11/1/2007 by National Diabetes Education Program (NDEP), a joint program of the Centers for Disease Control and Prevention and the National Institutes of Health. Date Released: 11/21/2007.
McDonald, Deborah Dillon; Ambrose, Margaret; Morey, Barbara
Hispanic adults experience significant pain, but little is known about their pain during hospitalization. The purpose of this research was to describe Hispanic inpatients' pain intensity and compare their pain intensity with that of non-Hispanic patients. A post hoc descriptive design was used to examine 1,466 Hispanic inpatients' medical records (63.2% English speakers) and 12,977 non-Hispanic inpatients' medical records from one hospital for 2012. Mean documented pain intensity was mild for both Hispanic and non-Hispanic inpatients. Pain intensity was greater for English-speaking Hispanic patients than Spanish speakers. The odds of being documented with moderate or greater pain intensity decreased 30% for Spanish-speaking patients. Greater pain intensity documented for English-speaking Hispanic inpatients suggests underreporting of pain intensity by Spanish-speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioners' language(s). © The Author(s) 2014.
Ravndal, Edle; Amundsen, Ellen J
Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance. Two hundred and seventy-six drug users who had been admitted to 11 inpatient facilities in Norway, were followed prospectively after discharge from treatment during an 8-year period (1998-2006). The following instruments were used: EuropASI, SCL-25 and MCMI II. Information on deaths and causes of death were obtained from the National Death Register. A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses. There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. The elevated risk of dying from overdose within the first 4 weeks of leaving medication-free inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Preventing cancer by reducing exposure to carcinogens is the only way to reduce the frequency of cancers in the population. We discuss the current situation of cancer prevention in France in the order of importance as measured by the risk, demonstrating the recent reversal of the national anti-tobacco policy, the large benefit that could be expected from a reduction in alcohol consumption, the low coverage of the population for papillomavirus and hepatitis B virus vaccinations. Copyright © 2015 Société Françise du Cancer. Publié par Elsevier Masson SAS. Tous droits réservés. Published by Elsevier Masson SAS. All rights reserved.
Hightower, Rebecca E
Since the publication of the first analysis of Medicare payment error rates in 1998, the Office of Inspector General and the Centers for Medicare & Medicaid Services have focused resources on Medicare payment error prevention programs, now referred to as the Hospital Payment Monitoring Program. The purpose of the Hospital Payment Monitoring Program is to educate providers of Medicare Part A services in strategies to improve medical record documentation and decrease the potential for payment errors through appropriate claims completion. Although the payment error rates by state (and dollars paid in error) have decreased significantly, opportunities for improvement remain as demonstrated in this study of nine hospitals with a high proportion of short-term admissions over time. Previous studies by the Quality Improvement Organization had focused on inpatient stays of 1 day or less, a primary target due to the large amount of Medicare dollars spent on these admissions. Random review of Louisiana Medicare admissions revealed persistent medical record documentation and process issues regardless of length of stay as well as the opportunity for significant future savings to the Medicare Trust Fund. The purpose of this study was to determine whether opportunities for improvement in reduction of payment error continue to exist for inpatient admissions of greater than 1 day, despite focused education provided by Louisiana Health Care Review, the Louisiana Medicare Quality Improvement Organization, from 1999 to 2005, and to work individually with the nine selected hospitals to assist them in reducing the number of unnecessary short-term admissions and billing errors in each hospital by a minimum of 50% by the end of the study period. Inpatient Short-Term Acute Care Hospitals. A sample of claims for short-term stays (defined as an inpatient admission with a length of stay of 3 days or less excluding deaths, interim bills for those still a patient and those who left against
Efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health-related quality of life in a low-education cohort: a randomized controlled study.
Mayer-Berger, Wolfgang; Simic, Dusan; Mahmoodzad, Jawad; Burtscher, Ralph; Kohlmeyer, Martin; Schwitalla, Birgitta; Redaèlli, Marcus
The aim of this study was to evaluate the efficacy of a long-term secondary prevention programme following inpatient cardiovascular rehabilitation on cardiovascular risk and health-related quality of life in a cohort of middle-aged (≤58 years) coronary artery disease (CAD) patients of low educational level compared to usual care. The study included 600 patients with CAD, with 271 in the intervention group (IG) and 329 in the control group (CG). The average age was nearly 50 years in both groups, nearly 90% were male, and 77% had less than 10 years of school education. No significant differences existed between the groups at baseline. Both groups had a 3-week comprehensive cardiovascular inpatient rehabilitation programme at the beginning, the intervention consisted of one further rehabilitation session in hospital after 6 months and regular telephone reminders over a period of 36 months. Analyses were conducted on an intention-to-treat basis. To evaluate the individual risk level, we used the PROCAM score and intima-media thickness (IMT) was measured at the common carotid artery on both sides following international standards. Health-related quality of life was assessed with the EUROQOL and HADS. Patients in the IG showed better 3-year risk profile outcomes. The PROCAM score increased by 3.0 (IG) and by 3.7 (CG) from the beginning to after 3 years (p > 0.05 intention-to-treat). The average IMT increased by 0.04 mm in the CG and was reduced by 0.03 mm in the IG (p = 0.014 for the difference). The IG had a significant improvement in health-related quality of life. Mortality, myocardial infarction, and stroke were not different although 'other cardiac events' (cardiac surgery or intervention) were significantly lower in the IG than the CG patients (p risk was pronounced in the high-risk subgroup (PROCAM 10-year risk 10-40%).
Bekmezian, Arpi; Chung, Paul J
This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission. This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression. Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01). Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.
Spence, J David; Yi, Qilong; Hankey, Graeme J
B vitamin therapy lowers plasma total homocysteine concentrations, and might be a beneficial intervention for stroke prevention; however, cyanocobalamin (a form of vitamin B12) can accelerate decline in renal function and increase the risk of cardiovascular events in patients with impaired renal function. Although early trials did not show benefit in reduction of stroke, these results might have been due to harm in participants with impaired renal function. In patients with diabetic nephropathy, cyanocobalamin is harmful, whereas B vitamins appear to reduce cardiovascular events in study participants with normal renal function. Our meta-analysis of individual patient data from two large trials of B vitamin therapy (VISP and VITATOPS) indicates that patients with impaired renal function who are exposed to high-dose cyanocobalamin do not benefit from therapy with B vitamins for the prevention of stroke (risk ratio 1·04, 95% CI 0·84-1·27), however, patients with normal renal function who are not exposed to high-dose cyanocobalamin benefit significantly from this treatment (0.78, 0·67-0·90; interaction p=0·03). The potential benefits of B vitamin therapy with folic acid and methylcobalamin or hydroxycobalamin, instead of cyanocobalamin, to lower homocysteine concentrations in people at high risk of stroke warrant further investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.
Basin, David; Debois, Søren; Hildebrandt, Thomas
We present a system model, an enforcement mechanism, and a policy language for the proactive enforcement of timed provisions and obligations. Our approach improves upon existing formalisms in two ways: (1) we exploit the target system's existing functionality to avert policy violations proactively......, rather than compensate for them reactively, and, (2) instead of requiring the manual specification of remedial actions in the policy, we automatically deduce required actions directly from the policy. As a policy language, we employ timed dynamic condition response (DCR) processes. DCR primitives...
Irving, L M; Seidner, A L; Burling, T A; Thomas, R G; Brenner, G F
Attitudes about quitting cigarette smoking were assessed at admission to a substance abuse treatment program for homeless veterans. The majority were interested in quitting smoking, believed that inpatient drug/alcohol treatment was the best time to quit, and that quitting would not threaten their sobriety. Using cluster analysis, four subgroups of inpatients with different levels of interest, confidence, and motivation regarding quitting smoking were identified. Our inpatients' positive attitudes about quitting smoking stand in contrast with previously reported attitudes of many health professionals, and suggest that inpatient treatment could be an opportune time to provide stop-smoking interventions. Findings also suggest that different treatment approaches may be needed for subgroups of inpatients with varying attitudes about quitting.
McKechnie, Duncan; Fisher, Murray J; Pryor, Julie
To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. Falls are the most frequently recorded patient safety incident in the inpatient context. However, higher rates of falls are reported in rehabilitation settings compared to acute care settings. In the rehabilitation setting, patients with a traumatic brain injury have been identified as at a high risk of falling. However to date, research into the nature of falls involving this patient population is limited. Five-year retrospective cohort study design. Falls data from an inpatient traumatic brain injury rehabilitation unit were retrieved from the NSW Ministry of Health Incident Information Management System and patient clinical notes; nursing shift data were retrieved from the local rostering system. The fall rate was 5·18 per 1000 patient bed days. Over a 24-hour period falls (n = 103) occurred in a trimodal pattern. The median fall free period after admission was 14 days and 22% of traumatic brain injury patients had at least one fall. 53% of falls occurred in the patient's bedroom and 57% were attributed to loss of balance. At time of fall, 93% of fallers had impaired mobility and 85% required assistance for transfers. Falls within inpatient traumatic brain injury rehabilitation are a significant and complex clinical issue. While many patients continued to be at risk of falling several months after admission, a repeat faller's first fall occurred earlier in their admission than a single faller's. Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient's risk of falling is not static and in fact, may increase over time. © 2015 John Wiley & Sons Ltd.
Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D
Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.
Hou, Wen-Hsuan; Kang, Chun-Mei; Ho, Mu-Hsing; Kuo, Jessie Ming-Chuan; Chen, Hsiao-Lien; Chang, Wen-Yin
To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Secondary data analysis. A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely
Biesbroeck, Lauren K; Shinohara, Michi M
Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.
Mishra, Alita; Otgonsuren, Munkhzul; Venkatesan, Chapy; Afendy, Mariam; Erario, Madeline; Younossi, Zobair M
Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA METHODS: Five cycles of Nationwide Inpatient Sample (NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS(®) v.9.3 was used for statistical analysis. From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100,000 discharges (2005) to 99 per 100,000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) (P inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges. There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Kontaxakis, Vassilis; Havaki-Kontaxaki, Beata; Margariti, Maria; Stamouli, Sophia; Kollias, Costas; Christodoulou, George
Schizophrenia has been associated with a high rate of suicide. This study investigates the prevalence of suicidal ideation in a population of inpatients with acute schizophrenia, together with the clinical parameters associated with suicidal thoughts. We assessed 93 schizophrenia patients. We matched subjects for age and sex and compared subjects with and without suicidal thoughts. We performed stepwise multiple regression analysis to assess the association between specific clinical symptoms and suicidal ideation. Of the patients, 20.4% reported suicidal thoughts during the last 15 days. Severity of depressive symptoms, motor retardation, guilt feelings, pathological guilt, and self-depreciation predicted the patients' suicidal ideation. Suicidal thoughts are frequent among inpatients with acute schizophrenia. Prevention of suicidal behaviour should include helping patients improve their self-esteem and reducing depression and guilt feelings.
Yen, Yi-Chung; Lo, Nai-Wei; Wu, Tzong-Chen
Medication error can easily cause serious health damage to inpatients in hospital. Consequently, the whole society has to spend huge amount of extra resources for additional therapies and medication on those affected inpatients. In order to prevent medication errors, secure inpatient medication administration system is required in a hospital. Using RFID technology, such administration system provides automated medication verification for inpatient's medicine doses and generates corresponding medication evidence, which may be audited later for medical dispute. Recently, Peris-Lopez et al. (Int. J. Med. Inform., 2011) proposed an IS-RFID system to enhance inpatient medication safety. Nevertheless, IS-RFID system does not detect the denial of proof attack efficiently and the generated medication evidence cannot defend against counterfeit evidence generated from the hospital. That is, the hospital possesses enough privilege from the design of IS-RFID system to modify generated medication evidence whenever it is necessary. Hence, we design two lightweight RFID-based solutions for secure inpatient medication administration, one for online verification environment and the other for offline validation situation, to achieve system security on evidence generation and provide early detection on denial of proof attack.
... Error processing SSI file About Heart Disease & Stroke Prevention Heart disease and stroke are an epidemic in ... secondhand smoke. Barriers to Effective Heart Disease & Stroke Prevention Many people with key risk factors for heart ...
Bousardt, A.M.C.; Hoogendoorn, A.W.; Noorthoorn, E.O.; Hummelen, J.W.; Nijman, H.L.I.
Background: Empirical knowledge of 'predictors' of physical inpatient aggression may provide staff with tools to prevent aggression or minimise its consequences. Aim: To test the value of a self-reported measure of impulsivity for predicting inpatient aggression. Methods: Self-report measures of
DeWitt, Elizabeth S; Triedman, John K; Cecchin, Frank; Mah, Doug Y; Abrams, Dominic J; Walsh, Edward P; Gauvreau, Kimberlee; Alexander, Mark E
Implantable cardioverter defibrillators (ICDs) used to prevent sudden cardiac arrest in children not only provide appropriate therapy in 25% of patients but also result in a significant incidence of inappropriate shocks and other device complications. ICDs placed for secondary prevention have higher rates of appropriate therapy than those placed for primary prevention. Pediatric patients with primary prevention ICDs were studied to determine time-dependent incidence of appropriate use and adverse events. A total of 140 patients aged prevention were retrospectively identified. Demographics and times to first appropriate shock; adverse events (including inappropriate shock, lead failure, reintervention, and complication); generator replacement and follow-up were noted. During mean follow-up of 4 years, appropriate shock occurred in 19% patients and first adverse event (excluding death/transplant) occurred in 36%. Risk of death or transplant was ≈1% per year and was not related to receiving appropriate therapy. Conditional survival analysis showed rates of appropriate therapy and adverse events decrease soon after implantation, but adverse events are more frequent than appropriate therapy throughout follow-up. Primary prevention ICDs were associated with appropriate therapy in 19% and adverse event in 36% in this cohort. The incidence of both first appropriate therapy and device-related adverse events decreased during longer periods of follow-up after implantation. This suggests that indications for continued device therapy in pediatric primary prevention ICD patients might be reconsidered after a period of nonuse. © 2014 American Heart Association, Inc.
Full Text Available Background: This study examined the tendency and suicidal behavior rates of Chinese adult inpatients with different types of mental disorders from 2010 to 2015. The aim was to provide some interesting clues for further studies. Methods: Adult patients with mental disorders who were hospitalized in Beijing Anding hospital from 1 January 2010 to 31 December 2015 were included. Chi-square tests were used to compare the difference among inpatients with mental disorders by gender and year. Frequency, trend and suicidal behavior rates of inpatients with mental disorders were graphed. Results: A total of 17,244 psychiatric adult inpatients were included in our study. About 53.2% of the inpatients had mood disorders, followed by schizophrenia, which accounted for 34.6%. The proportion of female inpatients with mental disorders was larger than that of males (52.6% to 47.4%. Of the total, 3296 psychiatric inpatients were recognized as having suicidal behaviors. The rate of suicidal behavior among all inpatients was 19.1%, and it varied over the years. The suicidal behavior rate of female inpatients with mood disorders was much higher than that of the corresponding male inpatients. Conclusions: The presence of suicidal behavior varied among people with different types of mental disorders. For each type of mental illness, identifying the risk of specific suicide behavior would help tailor-make preventive efforts accordingly.
Full Text Available About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way. Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor. When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.
Nienke Verstegen; Vivienne de Vogel; Michiel de Vries Robbé; Martijn Helmerhorst
Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be
Yao, Xiaoxi; Dembe, Allard E; Wickizer, Thomas; Lu, Bo
Regular use of recommended preventive health services can promote good health and prevent disease. However, individuals may forgo obtaining preventive care when they are busy with competing activities and commitments. This study examined whether time pressure related to work obligations creates barriers to obtaining needed preventive health services. Data from the 2002-2010 Medical Expenditure Panel Survey (MEPS) were used to measure the work hours of 61,034 employees (including 27,910 females) and their use of five preventive health services (flu vaccinations, routine check-ups, dental check-ups, mammograms and Pap smear). Multivariable logistic regression analyses were performed to test the association between working hours and use of each of those five services. Individuals working long hours (>60 per week) were significantly less likely to obtain dental check-ups (OR=0.81, 95% CI: 0.72-0.91) and mammograms (OR=0.47, 95% CI: 0.31-0.73). Working 51-60 h weekly was associated with less likelihood of receiving Pap smear (OR=0.67, 95% CI: 0.46-0.96). No association was found for flu vaccination. Time pressure from work might create barriers for people to receive particular preventive health services, such as breast cancer screening, cervical cancer screening and dental check-ups. Health practitioners should be aware of this particular source of barriers to care. Copyright © 2015 Elsevier Inc. All rights reserved.
Goljar, Nika; Globokar, Daniel; Puzić, Nataša; Kopitar, Natalija; Vrabič, Maja; Ivanovski, Matic; Vidmar, Gaj
To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients. A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010-2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006-2014 period to evaluate effectiveness of fall-risk reduction measures. The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and non-extreme FIM score (55-101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014. The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention. Implications for Rehabilitation Recognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards. Assessing the fall risk is a team tasks and combines information from various sources. Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient.
Kim, Byung Wook; Cheung, Hwan
It cannot be denied that in the practice of radiological medicine or technology in Korea, patient care, the most fundamental aspect of medicine, has not received as much emphasis as the technical aspect has. This is also the case with the curriculum of the vocational colleges which train radiological technologists. But this is certainly wrong when we think of the fact that hospital itself exists for the patient, and medicine has developed for his well-being. This situation may be attributed to the health facilities which were grossly inadequate to handle the explosive health demand resulting from the development of the Korean economy, and the health policy of the government preoccupied with facility expansion. But Korea seems to have reached the stage demanding greater attention to improvement of the quality of medical care through, among other things, re-evaluation of the fundamental stance and re-establishment of values of the medical profession. This study, with focus on the attitude of technologists, considered various procedures of patient care involving means of patient transport used and the time required for handing of individual cases, as reflected in the results of independent investigation and in the questionnaire answered by in-patients of the Seoul National University Hospital who used the services of its Diagnostic Radiology Department
Karatas, Bahtiyar Can; Jóhannsson, Hjörtur; Nielsen, Arne Hejde
. The software platform receives phasor measurement unit (PMU) data at a high repetition rate for full system observability. The PMU data serves as input for methods capable of analyzing the steady state torque balance for each individual generator and to determine available power reserves and possible remedial...... actions. The capabilities of the software platform were demonstrated by testing the methods on the Nordic32 test system and the results show that the methods can determine an active power re-dispatch and apply the countermeasures in realtime and prevent aperiodic rotor angle instability.......This paper presents an innovative approach to apply wide-area control actions in real-time and prevent emerging instability. A software platform has been further developed, which utilizes Real Time Digital Simulator (RTDS) technology to prevent scenarios leading to power system instability...
Background Preterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns. Results Inpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed. Conclusions Whilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care
Bernaards, C.M.; Jans, M.P.; Heuvel, S.G. van den; Hendriksen, I.J.; Houtman, I.L.; Bongers, P.M.
Aims: To investigate the longitudinal relation between strenuous leisure time physical activity and psychological complaints (depression and emotional exhaustion) in a Dutch working population in order to find evidence For the preventive role of physical activity in the development of psychological
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Bates, Nathaniel A; McPherson, April L; Rao, Marepalli B; Myer, Gregory D; Hewett, Timothy E
The purpose of this epidemiologic study was to quantify the incidence, expense, and concomitant injuries for anterior cruciate ligament reconstruction (ACLR) procedures in the USA from 2003 to 2011 that required an inpatient stay. It was hypothesized that the relative reported rates of concomitant knee injuries would be greater with the MCL and menisci compared to all other concomitant knee injuries. The National Inpatient Sample from 2003 to 2011 was retrospectively sampled using ICD-9-CM codes to identify ACLR patients and to extrapolate national averages. Between the years of 2003-2011, an average of 9,037 ± 1,728 inpatient hospitalization included ACLRs, of which 4,252 ± 1,824 were primarily due to the ACLR. Inpatient visits primarily due to ACLR involved an average hospitalization of 1.7 ± 0.2 days and cost $30,118 ± 9,066 per patient. Knee injuries that were commonly reported along with inpatient ACLRs included medial meniscus damage (18.1 %), lateral meniscus damage (16.8 %), collateral ligament repairs (12.3 %), and medial collateral ligament strains (6.9 %). Prevalence of meniscus injuries was consistent across years, but MCL-related injuries increased over time. ACLR-related inpatient hospitalizations account for approximately 7.1 % of the total ACLRs performed annually in the USA. Inpatient ACLR procedures continue to decrease in frequency; however, the mean cost per patient increased. Meniscus and collateral ligament injuries were the most commonly reported concomitant knee injuries. The clinical relevance of this investigation is that it informs, on a large clinical cohort of patients, the current state of incidence and expense for ACLR surgeries in an inpatient setting. Prognostic, retrospective study, Level II.
Quality of care in the context of inpatient neurology is the standard of performance by neurologists and the hospital system as measured against ideal models of care. There are growing regulatory pressures to define health care value through concrete quantifiable metrics linked to reimbursement. Theoretical models of quality acknowledge its multimodal character with quantitative and qualitative dimensions. For example, the Donabedian model distils quality as a phenomenon of three interconnected domains, structure-process-outcome, with each domain mutually influential. The actual measurement of quality may be implicit, as in peer review in morbidity and mortality rounds, or explicit, in which criteria are prespecified and systemized before assessment. As a practical contribution, in this article a set of candidate quality indicators for inpatient neurology based on an updated review of treatment guidelines is proposed. These quality indicators may serve as an initial blueprint for explicit quality metrics long overdue for inpatient neurology. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Rüsch, Nicolas; Schiel, Sarah; Corrigan, Patrick W; Leihener, Florian; Jacob, Gitta A; Olschewski, Manfred; Lieb, Klaus; Bohus, Martin
Inpatient dialectical behavior therapy (DBT) is an effective treatment for borderline personality disorder (BPD), but often treatment is ended prematurely and predictors of dropout are poorly understood. We, therefore, studied predictors of dropout among 60 women with BPD during inpatient DBT. Non-completers had higher experiential avoidance and trait anxiety at baseline, but fewer life-time suicide attempts than completers. There was a trend for more anger-hostility and perceived stigma among non-completers. Experiential avoidance and anxiety may be associated with dropout in inpatient DBT. Low life-time suicidality and high anger could reflect a subtype at risk for discontinuation of inpatient treatment.
Halken, S; Høst, A
, breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....
Seakey Atsu K
Full Text Available Abstract Background Whiles awaiting for the arrival of an effective and affordable malaria vaccine, there is a need to make use of the available control tools to reduce malaria risk, especially in children under five years and pregnant women. Intermittent preventive treatment (IPT has recently been accepted as an important component of the malaria control strategy. This study explored the potential of a strategy of intermittent preventive treatment for children (IPTC and timely treatment of malaria-related febrile illness in the home in reducing the parasite prevalence and malaria morbidity in young children in a coastal village in Ghana. Methods The study combined home-based delivery of IPTC among six to 60 months old and home treatment of suspected febrile malaria illness within 24 hours. All children between six and 60 months of age received intermittent preventive treatment using amodiaquine and artesunate, delivered by community assistants every four months (three times in 12 months. Malaria parasite prevalence surveys were conducted before the first and after the third dose of IPTC. Results Parasite prevalence was reduced from 25% to 3% (p Conclusion The evaluation result indicates that IPTC given three times in a year combined with timely treatment of febrile malaria illness, impacts significantly on the parasite prevalence. The marked reduction in the parasite prevalence with this strategy points to the potential for reducing malaria-related childhood morbidity and mortality, and this should be explored by control programme managers.
Richards, John R.; Ozery, Gal; Notash, Mark; Sokolove, Peter E.; Derlet, Robert W.; Panacek, Edward A.
Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS). Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42%) patients preferred to be boarded in an inpatient hallway, 33 (33%) preferred the ED hallway, and 24 (24%) had no preference. Mean (±SD) NEDOCS (range 0–200) was 136 ± 46 for patients preferring inpatient boarding, 112 ± 39 for ED boarding, and 119 ± 43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded. PMID:22235374
Richards, John R; Ozery, Gal; Notash, Mark; Sokolove, Peter E; Derlet, Robert W; Panacek, Edward A
Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS). Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42%) patients preferred to be boarded in an inpatient hallway, 33 (33%) preferred the ED hallway, and 24 (24%) had no preference. Mean (±SD) NEDOCS (range 0-200) was 136 ± 46 for patients preferring inpatient boarding, 112 ± 39 for ED boarding, and 119 ± 43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.
John R. Richards
Full Text Available Objective. The boarding of patients in Emergency Department (ED hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS. Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42% patients preferred to be boarded in an inpatient hallway, 33 (33% preferred the ED hallway, and 24 (24% had no preference. Mean (±SD NEDOCS (range 0–200 was 136±46 for patients preferring inpatient boarding, 112±39 for ED boarding, and 119±43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.
U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare...
... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient... any period of incapacity as defined in § 825.113(b), or any subsequent treatment in connection with...
Tattersall, Laura C; Reed, Matthew J
The management and risk stratification of patients with syncope in the Emergency Department (ED) has been the emphasis of much recent research, however little is known about inpatient management especially in the UK. The aim of this study was to examine the inpatient management of patients with syncope admitted to hospital from a UK ED. This was a single centre prospective observational cohort study, recruiting patients with syncope admitted to hospital from a UK ED. Inpatient management was examined focusing on length of stay and investigations undertaken. Between 3 March 2007 and 22 July 2008, 540 patients presenting with syncope to the ED of the Royal Infirmary of Edinburgh, UK were admitted and enrolled. Median and mean length of stay was 1 day (IQR 1-4) and 6.3 days (SD 15.5). In all, 392 (73%) patients were admitted to General/Acute Medicine, 39 (7%) to Cardiology, 35 (7%) to Medicine of the Elderly, 33 (6%) to surgical specialities and the rest to other specialities. A diagnosis was finally made in 342 (63%) patients including 33 (85%) of the 39 admitted to Cardiology and 239 (61%) of the 392 patients admitted to General/Acute Medicine. The use of diagnostic tests varied between specialities with more intensive investigation undertaken in patients admitted to Cardiology. The current approach to the inpatient management of syncope is speciality dependent. Standardised diagnostic pathways may improve diagnostic yield and cost effectiveness.
Koopmans Raymond TCM
Full Text Available Abstract Background Patients in hospitals and nursing homes are at risk of the development of, often preventable, adverse events (AEs, which threaten patient safety. Guidelines for prevention of many types of AEs are available, however, compliance with these guidelines appears to be lacking. Besides general barriers that inhibit implementation, this non-compliance is associated with the large number of guidelines competing for attention. As implementation of a guideline is time-consuming, it is difficult for organisations to implement all available guidelines. Another problem is lack of feedback about performance using quality indicators of guideline based care and lack of a recognisable, unambiguous system for implementation. A program that allows organisations to implement multiple guidelines simultaneously may facilitate guideline use and thus improve patient safety. The aim of this study is to develop and test such an integral patient safety program that addresses several AEs simultaneously in hospitals and nursing homes. This paper reports the design of this study. Methods and design The patient safety program addresses three AEs: pressure ulcers, falls and urinary tract infections. It consists of bundles and outcome and process indicators based on the existing evidence based guidelines. In addition it includes a multifaceted tailored implementation strategy: education, patient involvement, and a computerized registration and feedback system. The patient safety program was tested in a cluster randomised trial on ten hospital wards and ten nursing home wards. The baseline period was three months followed by the implementation of the patient safety program for fourteen months. Subsequently the follow-up period was nine months. Primary outcome measure was the incidence of AEs on every ward. Secondary outcome measures were the utilization of preventive interventions and the knowledge of nurses regarding the three topics. Randomisation took
Full Text Available Servicing is applied periodically in practice with the aim of restoring the system state and prolonging the lifetime. It is generally seen as an imperfect maintenance action which has a chief influence on the maintenance strategy. In order to model the maintenance effect of servicing, this study analyzes the deterioration characteristics of system under scheduled servicing. And then the deterioration model is established from the failure mechanism by compound Poisson process. On the basis of the system damage value and failure mechanism, the failure rate refresh factor is proposed to describe the maintenance effect of servicing. A maintenance strategy is developed which combines the benefits of scheduled servicing and preventive maintenance. Then the optimization model is given to determine the optimal servicing period and preventive maintenance time, with an objective to minimize the system expected life-cycle cost per unit time and a constraint on system survival probability for the duration of mission time. Subject to mission time, it can control the ability of accomplishing the mission at any time so as to ensure the high dependability. An example of water pump rotor relating to scheduled servicing is introduced to illustrate the failure rate refresh factor and the proposed maintenance strategy. Compared with traditional methods, the numerical results show that the failure rate refresh factor can describe the maintenance effect of servicing more intuitively and objectively. It also demonstrates that this maintenance strategy can prolong the lifetime, reduce the total lifetime maintenance cost and guarantee the dependability of system.
Alemdaroğlu, Ebru; Özbudak, Sibel Demir; Mandiroğlu, Sibel; Biçer, Seda Alakoç; Özgirgin, Neşe; Uçan, Halil
Inpatient falls are of significant concern. The aim of this prospective study was to determine the predictors of inpatient falls among children with cerebral palsy in a rehabilitation hospital. A total of 93 patients with cerebral palsy were assessed based on history, physical findings, the Selective Motor Control Test, the Gross Motor Functional Classification System, the Berg Balance Scale and the Manual Ability Classification System. Previous history of falls/frequent falls, and any falls which occurred during hospitalization, were recorded. Of all 93 patients, 25 (27%) fell and 68 (73%) did not fall. The mean age of the fallers (6.3±2.0 years) was lower than that of the non-fallers (8.1±3.9 years). Behavioral problems according to the mother's statement (OR 26.454), not being able to maintain a long sitting position (OR 10.807), ability to balance on knees without support (OR 9.810), a history of frequent falls (OR 4.893) and a negative Thomas test (OR 4.192 fold) were found to increase the risk of inpatient falls. In these children with cerebral palsy, behavioral problems according to the mother's statement, a history of frequent falls, not being able to maintain a long sitting position, a negative Thomas test, and able to balance on knees without support were associated with the risk of inpatient falls. Children with cerebral palsy may experience inpatient falls. Further studies are required in order to develop prevention programs. For patients diagnosed with cerebral palsy, these results may help identify possible inpatient fallers on hospital admission. Copyright © 2016 Elsevier Inc. All rights reserved.
Doyle, E.K.; Jardine, A.K.S.
The use of various maintenance optimization techniques at Bruce has lead to cost effective preventive maintenance applications for complex systems. As previously reported at ICONE 6 in New Orleans, 1996, several innovative practices reduced Reliability Centered Maintenance costs while maintaining the accuracy of the analysis. The optimization strategy has undergone further evolution and at the present an Integrated Maintenance Program (IMP) is in place where an Expert Panel consisting of all players/experts proceed through each system in a disciplined fashion and reach agreement on all items under a rigorous time frame. It is well known that there are essentially 3 maintenance based actions that can flow from a Maintenance Optimization Analysis: condition based maintenance, time based maintenance and time based discard. The present effort deals with time based discard decisions. Maintenance data from the Remote On-Power Fuel Changing System was used. (author)
DiStefano, Lindsay J; Marshall, Stephen W; Padua, Darin A; Peck, Karen Y; Beutler, Anthony I; de la Motte, Sarah J; Frank, Barnett S; Martinez, Jessica C; Cameron, Kenneth L
Knowledge is limited regarding how long improvements in biomechanics remain after completion of a lower extremity injury prevention program. To evaluate the effects of an injury prevention program on movement technique and peak vertical ground-reaction forces (VGRF) over time compared with a standard warm-up (SWU) program. Controlled laboratory study. A total of 1104 incoming freshmen (age range, 17-22 years) at a military academy in the United States volunteered to participate. Participants were cluster-randomized by military company to either the Dynamic Integrated Movement Enhancement (DIME) injury prevention program or SWU. A random subsample of participants completed a standardized jump-landing task at each time point: immediately before the intervention (PRE), immediately after (POST), and 2 (POST2M), 4 (POST4M), 6 (POST6M), and 8 months (POST8M) after the intervention. VGRF data collected during the jump-landing task were normalized to body weight (%BW). The Landing Error Scoring System (LESS) was used to evaluate movement technique during the jump landing. The change scores (Δ) for each variable (LESS, VGRF) between the group's average value at PRE and each time point were calculated. Separate univariate analyses of variance were performed to evaluate group differences. The results showed a greater decrease in mean (±SD) VGRF in the DIME group compared with the SWU group at all retention time points: POST2M (SWU [Δ%BW], -0.13 ± 0.82; DIME, -0.62 ± 0.91; P = .001), POST4M (SWU, -0.15 ± 0.98; DIME,-0.46 ± 0.64; P = .04), POST6M (SWU, -0.04 ± 0.96; DIME, -0.53 ± 0.83; P = .004), and POST8M (SWU, 0.38 ± 0.95; DIME, -0.11 ± 0.98; P = .003), but there was not a significant improvement in the DIME group between PRE and POST8M (Δ%BW, -0.11 ± 0.98). No group differences in Δ LESS were observed. The study findings demonstrated that an injury prevention program performed as a warm-up can reduce vertical ground-reaction forces compared with a standard
Jit, Mark; Aveyard, Paul; Barton, Pelham; Meads, Catherine A
School-based smoking prevention programmes may delay the age of smoking initiation, but do not appear to achieve lasting reductions in smoking prevalence beyond school-leaving age. We explored whether delaying the age at which someone initiates smoking may have life-time benefits by increasing the likelihood of quitting in later life. Data from the General Household Survey of Great Britain were used in a logistic regression model to examine the association between age at which someone initiates regular smoking and the probability that the person will quit smoking later in life. The effect of confounding variables (sex, ethnicity, socio-economic class, education and geographical location) was taken into account. The predicted relationship was used in a cohort model to estimate the life-time reduction in smoking prevalence and all-cause mortality of a school-based smoking prevention programme. Age of regular smoking initiation was associated strongly with the probability of quitting later in life (coefficient -0.103, P < 0.001). The strength of the association was slightly reduced but still significant when confounding variables were included (coefficient -0.075, P < 0.001). An intervention that delays smoking initiation without decreasing smoking prevalence at age 18 may reduce adult smoking prevalence by 0.13-0.32% (depending on age) and all-cause mortality by 0.09% over the life-time of the sample. School-based smoking prevention programmes have potential for a beneficial effect over the life-time of the participants even if they have no apparent effect at school-leaving age.
Kumar, Navin L; Perencevich, Molly L; Trier, Jerry S
Inpatient training is a key component of gastroenterology (GI) fellowship programs nationwide, yet little is known about perceptions of the inpatient training experience. To compare the content, objectives and quality of the inpatient training experience as perceived by program directors (PD) and fellows in US ACGME-accredited GI fellowship programs. We conducted a nationwide, online-based survey of GI PDs and fellows at the conclusion of the 2016 academic year. We queried participants about (1) the current models of inpatient training, (2) the content, objectives, and quality of the inpatient training experience, and (3) the frequency and quality of educational activities on the inpatient service. We analyzed five-point Likert items and rank assessments as continuous variables by an independent t test and compared proportions using the Chi-square test. Survey response rate was 48.4% (75/155) for PDs and a total of 194 fellows completed the survey, with both groups reporting the general GI consult team (>90%) as the primary model of inpatient training. PDs and fellows agreed on the ranking of all queried responsibilities of the inpatient fellow to develop during the inpatient service. However, fellows indicated that attendings spent less time teaching and provided less formal feedback than that perceived by PDs (p training experience (p training experience.
Bowers, Len; Banda, Tumi; Nijman, Henk
The literature on inpatient suicides was systematically reviewed. English, German, and Dutch articles were identified by means of the electronic databases PsycInfo, Cochrane, Medline, EMBASE psychiatry, CINAHL, and British Nursing Index. In total, 98 articles covering almost 15,000 suicides were reviewed and analyzed. Rates and demographic features connected to suicides varied substantially between articles, suggesting distinct subgroups of patients committing suicide (e.g., depressed vs. schizophrenic patients) with their own suicide determinants and patterns. Early in the admission is clearly a high-risk period for suicide, but risk declines more slowly for patients with schizophrenia. Suicide rates were found to be associated with admission numbers, and as expected, previous suicidal behavior was found to be a robust predictor of future suicide. The methods used for suicide are linked to availability of means. Timing and location of suicides seem to be associated with absence of support, supervision, and the presence of family conflict. Although there is a strong notion that suicides cluster in time, clear statistical evidence for this is lacking. For prevention of suicides, staff need to engage with patients' family problems, and reduce absconding without locking the door. Future research should take into account the heterogeneous subgroups of patients who commit suicide, with case-control studies addressing these separately.
Burra, Tara A.; Hwang, Stephen W.; Rourke, Sean B.; Stergiopoulos, Vicky
This study examines differences in services available at the time of discharge for homeless and housed psychiatric inpatients. Participants diagnosed with schizophrenia or schizoaffective disorder were recruited from a general hospital psychiatric inpatient unit. Thirty homeless individuals and 21 housed controls (matched for diagnosis, gender,…
Lapid, M I; Drake, M T; Geske, J R; Mundis, C B; Hegard, T L; Kung, S; Frye, M A
This study investigated the rate of hypovitaminosis D in psychogeriatric inpatients and explored whether any associations exist between vitamin D levels, cognitive function, and psychiatric diagnoses. Retrospective medical record review from November 2000 through November 2010. Geriatric psychiatric ward of an academic tertiary care hospital. Psychiatric inpatients aged 65 years or older. MEASUREMENTS AND ANALYSIS METHODS: Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at admission. Associations between 25(OH)D levels, Mini-Mental State Examination (MMSE) scores were analyzed using Spearman correlations, and psychiatric diagnoses were analyzed using logistic regression models and Fisher's exact tests. In 141 subjects (mean age, 77.8 years; 86 [61%] female; 135 [96%] white), the most frequent diagnoses were major depressive disorder in 81 patients (57%), dementia in 38 (27%), delirium in 13 (9%), anxiety in 12 (8.5%), and bipolar disorder in 11 (8%). Mean MMSE score was 24±6.4 (range, 3-30). Forty-three subjects (30.4%) had mild to moderate vitamin D deficiency [25(OH)D, 10-24 ng/mL], and 6 (4.2%) had severe deficiency [25(OH)D D was common in elderly psychiatric inpatients. No associations were found between vitamin D levels and global cognitive function or psychiatric diagnoses.
Marsh, Patrick J; Odlaug, Brian L; Thomarios, Nick; Davis, Andrew A; Buchanan, Stephanie N; Meyer, Craig S; Grant, Jon E
The goal of the present study was to examine the prevalence of paraphilias in an adult inpatient psychiatric population. One hundred twelve consecutive, voluntarily admitted, adult male psychiatric inpatients were administered the Structured Clinical Interview for DSM-IV, Sexual Disorders Module, Male Version, to assess the rates of DSM-IV paraphilias. Fifteen patients (13.4%) reported symptoms consistent with at least one lifetime DSM-IV paraphilia. The most common paraphilias were voyeurism (n = 9 [8.0%]), exhibitionism (n = 6 [5.4%]), and sexual masochism (n = 3 [2.7%]). Patients who screened positive for a paraphilia had significantly more psychiatric hospitalizations (P = .006) and, on a trend level, were more likely to have attempted suicide. In addition, patients with paraphilias were significantly more likely to report having been sexually abused than patients without a paraphilia (P = paraphilia. Paraphilias appear to be more common in adult male psychiatric inpatients than previously estimated. The study also demonstrated that these disorders were not screened for by the treating physician and thus may go untreated. Further, larger-scale studies are necessary in order to further examine the rates of these disorders in the general population.
Betsie van Gaal; Theo van Achterberg; Marlies Hulscher; George F Borm; Joke Mintjes; Raymond TCM Koopmans; Lisette Schoonhoven
Patients in hospitals and nursing homes are at risk of the development of, often preventable, adverse events (AEs), which threaten patient safety. Guidelines for prevention of many types of AEs are available, however, compliance with these guidelines appears to be lacking. Besides general barriers
Gaal, H.G.I. van; Schoonhoven, L.; Hulscher, M.E.J.L.; Mintjes, J.A.; Borm, G.F.; Koopmans, R.T.C.M.; Achterberg, T. van
BACKGROUND: Patients in hospitals and nursing homes are at risk of the development of, often preventable, adverse events (AEs), which threaten patient safety. Guidelines for prevention of many types of AEs are available, however, compliance with these guidelines appears to be lacking. Besides
Rossi, Anthony M; Eviatar, Joseph; Green, Jeremy B; Anolik, Robert; Eidelman, Michael; Keaney, Terrence C; Narurkar, Vic; Jones, Derek; Kolodziejczyk, Julia; Drinkwater, Adrienne; Gallagher, Conor J
Men are a growing patient population in aesthetic medicine and are increasingly seeking minimally invasive cosmetic procedures. To examine differences in the timing of facial aging and in the prevalence of preventive facial aging behaviors in men by race/ethnicity. Men aged 18 to 75 years in the United States, Canada, United Kingdom, and Australia rated their features using photonumeric rating scales for 10 facial aging characteristics. Impact of race/ethnicity (Caucasian, black, Asian, Hispanic) on severity of each feature was assessed. Subjects also reported the frequency of dermatologic facial product use. The study included 819 men. Glabellar lines, crow's feet lines, and nasolabial folds showed the greatest change with age. Caucasian men reported more severe signs of aging and earlier onset, by 10 to 20 years, compared with Asian, Hispanic, and, particularly, black men. In all racial/ethnic groups, most men did not regularly engage in basic, antiaging preventive behaviors, such as use of sunscreen. Findings from this study conducted in a globally diverse sample may guide clinical discussions with men about the prevention and treatment of signs of facial aging, to help men of all races/ethnicities achieve their desired aesthetic outcomes.
Lai, Tzu-Hsien; Wang, Shuu-Jiun
Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.
Li, Yan; Hu, Xiao-Xia; Fu, Li; Chen, Jing; Lu, Li-He; Liu, Xiang; Xu, Zhe; Zhou, Li; Wang, Zhi-Ping; Zhang, Xi; Ou, Zhi-Jun; Ou, Jing-Song
Cold cardioplegia is used to induce heart arrest during cardiac surgery. However, endothelial function may be compromised after this procedure. Accordingly, interventions such as adenosine, that mimic the effects of preconditioning, may minimize endothelial injury. Herein, we investigated whether adenosine prevents cold-induced injury to the endothelium. Cultured human cardiac microvascular endothelial cells were treated with adenosine for different durations. Phosphorylation and expression of endothelial nitric oxide synthase (eNOS), p38MAPK, ERK1/2, and p70S6K6 were measured along with nitric oxide (NO) production using diaminofluorescein-2 diacetate (DAF-2DA) probe. Cold-induced injury by hypothermia to 4°C for 45 minutes to mimic conditions of cold cardioplegia during open heart surgery was induced in human cardiac microvascular endothelial cells. Under basal conditions, adenosine stimulated NO production, eNOS phosphorylation at serine 1177 from 5 minutes to 4 hours and inhibited eNOS phosphorylation at threonine 495 from 5 minutes to 6 hours, but increased phosphorylation of ERK1/2, p38MAPK, and p70S6K only after exposure for 5 minutes. Cold-induced injury inhibited NO production and the phosphorylation of the different enzymes. Importantly, adenosine prevented these effects of hypothermic injury. Our data demonstrated that adenosine prevents hypothermic injury to the endothelium by activating ERK1/2, eNOS, p70S6K, and p38MAPK signaling pathways at early time points. These findings also indicated that 5 minutes after administration of adenosine or release of adenosine is an important time window for cardioprotection during cardiac surgery.
This education-focused paper presents a discussion of possible data sources used in patient safety issues specific to fall reduction in hospital inpatient care settings. Although hospitals and clinicians in the USA have been implored to improve care and reduce events that harm patients (falls), studies to date have failed to clearly address the facility system-level factors for falls. Making meaningful approaches to modify risk factors is clearly overdue. Discursive paper. Possible data sources for answering patient fall-related research questions in hospital settings are categorised as: (1) archived hospital data, (2) surveys of patients/families/clinicians, (3) interviews and focus groups of patients/families/clinicians, (4) publicly available data sets and (5) published legal cases. The complexities of research in fall prevention are illustrated using the conceptual models. Examples were included to illustrate the use of these data sources. Data-related issues include: (1) unit of analysis, (2) computer data processing capabilities, (3) merging data sets from different sources and (4) data abstraction, aggregation and data analytic techniques. The trend to use multiple data sources to answer research questions is gradually emerging. To demonstrate effective fall prevention efforts across hospitals, publicly available data sets can be reliable sources for analyses to inform policymakers about meaningful fall prevention programmes that result in positive outcomes. Challenges to develop and evaluate any interventions to eliminate risk factors for falls often relate to selecting feasible interventions and whether staff members accept the interventions and adhere to adopting the intervention. Using multiple data sources with time factors to cross-validate the sufficiency of nurses' knowledge with their practice patterns may be more productive. This need further supports the importance of this paper about possible data sources used in the research on patient safety
Full Text Available Αs technologies and communications develop, more sabotaging attacks occur including phishing attacks which jeopardize users' security and critical information like their passwords and credentials. Several solutions have been proposed for existing dangers. One of which is the use of one-time passwords. This issue has remained as a main challenge and requires more extensive research. In this research, we have focused on one-time password combinations and we also have proposed solutions based on behavioral patterns which lead to significant optimizations while tending the simplicity for users. Efficiency of the proposed method has been measured through defining scenarios, modeling and simulations based on a prevention rate index. In addition, complexity coefficient of the proposed method showing the probability of unpredictability of passwords for attackers has been calculated. Ultimately, a descriptive comparison has shown that the proposed method is superior to some of the existing methods.
Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian
Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Mannitol for the prevention of cisplatin-induced nephrotoxicity: A retrospective comparison of hydration plus mannitol versus hydration alone in inpatient and outpatient regimens at a large academic medical center.
Williams, Robert P; Ferlas, Brandon W; Morales, Paul C; Kurtzweil, Andy J
Background Cisplatin-induced nephrotoxicity is a dose limiting adverse effect that occurs in nearly one-third of patients. Mannitol administration has been used as a means to negate this toxicity. Data regarding the efficacy of mannitol use in this context are conflicting and limited. Objective The aim of this study is to evaluate the effect of mannitol on renal function and describe the incidence of cisplatin-induced nephrotoxicity. Methods This study is a quasi-experimental retrospective analysis approved by the Institutional Review Board of inpatient and outpatient adults receiving cisplatin doses ≥40 mg/m 2 . The primary outcome was mean change in serum creatinine from baseline. Secondary outcomes included incidences of various grades of nephrotoxicity. Results A total of 313 patients (95 treated with mannitol and 218 without) were evaluated. The average increase in serum creatinine (mg/dL) was lower in patients who received mannitol versus those who did not (0.30 vs. 0.47; 95% confidence interval for difference, 0.03 to 0.31; P = 0.02). Grade 2 or higher nephrotoxicity occurred less frequently in patients who received mannitol versus those who did not (8% vs. 17%; P = 0.04). Non-gynecologic regimens and those who received doses ≥70 mg/m 2 of cisplatin had lower rates of grade 2 or higher nephrotoxicity with mannitol (6% vs. 23%; P = 0.001, and 7% vs. 22%; P = 0.03, respectively). Conclusion The use of mannitol reduces the incidence and severity of nephrotoxicity in patients treated with cisplatin. The results of the study suggest mannitol may be most effective when used with non-gynecologic regimens and with cisplatin doses ≥70 mg/m 2 .
Taketomi, Shuji; Inui, Hiroshi; Yamagami, Ryota; Kawaguchi, Kohei; Nakazato, Keiu; Kono, Kenichi; Kawata, Manabu; Nakagawa, Takumi; Tanaka, Sakae
The purpose of this study was to analyze the association between the prevalence of meniscal and chondral lesions and the timing of surgery in patients undergoing primary anterior cruciate ligament (ACL) reconstruction to determine a safe time for surgery. This retrospective study involved 226 patients (91 females and 135 males; median age, 29 years) undergoing primary ACL reconstruction. Time interval from ACL injury to surgery (median, 4 months; range, 1-420 months) and concomitant meniscal and cartilage lesions in ACL reconstruction were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine the precise threshold interval to surgery to prevent meniscal or cartilage lesions. The risk of lesion occurrence after each cutoff period was determined using odds ratio (OR). The incidences of medial meniscus (MM), lateral meniscus (LM), and cartilage lesions were 43.8%, 32.7%, and 27.4%, respectively. ROC analysis revealed that patients who waited for more than 6, 4, and 5 months for ACL reconstruction had a significantly greater risk of associated MM, LM, and chondral lesions, respectively. Patients who underwent ACL reconstruction ≥7 months after injury had OR of 4.1 (p lesion as compared with those who underwent reconstruction within 6 months. Similarly, patients who underwent ACL reconstruction ≥5 months after injury had OR of 1.9 (p = 0.023) for the presence of LM lesion as compared with those who underwent reconstruction within 4 months, and patients who underwent ACL reconstruction ≥6 months after injury had OR of 2.9 (p lesion as compared with those who underwent reconstruction within 6 months. ACL reconstruction should be performed within approximately 6 months after the injury to prevent associated meniscal or chondral lesions. Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
Luboz, Vincent; Bailet, Mathieu; Boichon Grivot, Christelle; Rochette, Michel; Diot, Bruno; Bucki, Marek; Payan, Yohan
Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily set-up. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.
Hermans, Sabine M.; Grant, Alison D.; Chihota, Violet; Lewis, James J.; Vynnycky, Emilia; Churchyard, Gavin J.; Fielding, Katherine L.
The durability of isoniazid preventive therapy (IPT) in preventing tuberculosis (TB) is limited in high-prevalence settings. The underlying mechanism (reactivation of persistent latent TB or reinfection) is not known. We aimed to investigate the timing of TB incidence during and after IPT and
Gheorghe, Maria; Brouwer, Werner B F; van Baal, Pieter H M
This article explores the implications of the relation between quality of life (QoL) and time to death (TTD) for economic evaluations of preventive interventions. By using health survey data on QoL for the general Dutch population linked to the mortality registry, we quantify the magnitude of this relationship. For addressing specific features of the nonstandard QoL distribution such as boundness, skewness, and heteroscedasticity, we modeled QoL using a generalized additive model for location, scale, and shape (GAMLSS) with a β inflated outcome distribution. Our empirical results indicate that QoL decreases when approaching death, suggesting that there is a strong relationship between TTD and QoL. Predictions of different regression models revealed that ignoring this relationship results in an underestimation of the quality-adjusted life year (QALY) gains for preventive interventions. The underestimation ranged between 3% and 7% and depended on age, the number of years gained from the intervention, and the discount rate used. © The Author(s) 2014.
Jenmalm, M C; Duchén, K
The increasing allergy prevalence in affluent countries may be caused by reduced microbial stimulation and a decreased dietary ω-3/ω-6 long-chain polyunsaturated fatty acid (LCPUFA) ratio, resulting in an abnormal postnatal immune maturation. The timing of allergy-preventive probiotic and ω-3 LCPUFA interventions is critical, as early-life events occurring during critical windows of immune vulnerability can have long-term impact on immune development. The maternal dietary and microbial environment during pregnancy may programme the immune development of the child. Prenatal environmental exposures may alter gene expression via epigenetic mechanisms, aiming to induce physiological adaptations to the anticipated postnatal environment, but potentially also increasing disease susceptibility in the offspring if exposures are mismatched. Although the importance of fetal programming mostly has been studied in cardiovascular and metabolic disease, this hypothesis is also very attractive in the context of environmentally influenced immune-mediated diseases. This review focuses on how prenatal, perinatal or postnatal ω-3 LCPUFA interventions regulate childhood immune and allergy development, and if synergistic effects may be obtained by simultaneous probiotic supplementation. We propose that combined pre- and postnatal preventive measures may be most efficacious. Increasing knowledge on the immunomodulatory effects of prenatal, perinatal and postnatal interventions will help to direct future strategies to combat the allergy epidemic. © 2012 Blackwell Publishing Ltd.
Lin, Shi-Kwang; Hung, Tsui-Mei; Liao, Ya-Tang; Lee, Wen-Chung; Tsai, Shang-Ying; Chen, Chiao-Chicy; Kuo, Chian-Jue
This study aimed at estimating the protective effect of suicide precautions and clinical risk factors for inpatient suicides. A standardized precaution system was implemented in a large psychiatric center on January 1, 1996. A consecutive series of 33,121 admissions from 1998 to 2008 constituted the post-implementation cohort and 13,515 admissions from 1985 to 1995 constituted the pre-implementation cohort as comparison group. Inpatient suicides were identified via record linkage with national mortality database. For each of 41 inpatient suicides, four controls were randomly selected based on a nested case-control study. A standardized chart review process was employed to collate clinical information for each study subject. Risk and protective factors for inpatient suicides was estimated by conditional logistic regression. The findings showed that, among subjects with shorter lengths of stay, those admitted in post-implementation era had a significantly lower adjusted risk ratio (0.157, p=0.048) for inpatient suicides. Three depression-related symptoms elevated the risk for inpatient suicides: depressed mood (adjusted risk ratio=2.11, P=0.002), loss of energy (adjusted risk ratio=1.99, P=0.018), and psychomotor retardation (adjusted risk ratio=1.67, P=0.066; with marginal statistical significance). Suicide precautions have protective effect against inpatient suicides. A better assessment and prevention efforts is needed, particularly for those with depression-related symptoms. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Rockette-Wagner, Bonny; Storti, Kristi L; Dabelea, Dana; Edelstein, Sharon; Florez, Hermes; Franks, Paul W; Montez, Maria G; Pomeroy, Jeremy; Kriska, Andrea M
This study aims to determine if evidence exists for a lasting effect of the Diabetes Prevention Program (DPP) lifestyle intervention on activity levels by comparing objectively collected activity data between the DPP Outcome Study (DPPOS) cohort and adults from the National Health and Nutrition Examination Survey (NHANES; 2003-2006). Average minutes/day of light and moderate to vigorous physical activity (MVPA) and sedentary behavior from ActiGraph accelerometers (collected 2010-2012) were examined (2013-2014) for comparable DPPOS and NHANES subgroups by age, sex, and diabetes status. Longitudinal questionnaire data on leisure activity, collected yearly from DPP baseline to the time of accelerometer measurement (1996-2010; 11.9-year mean follow-up), were also examined to provide support for a long-term intervention effect. Average minutes/day of accelerometer-derived MVPA was higher in all DPPOS subgroups versus NHANES subgroups of similar age/sex/diabetes status; with values as much as twice as high in some DPPOS subgroups. Longitudinal questionnaire data from DPP/DPPOS showed a maintained increase of 1.24 MET hours/week (p=0.026) of leisure activity in DPPOS participants from all original study arms between DPP baseline and accelerometer recording. There were no consistent differences between comparable DPPOS and NHANES subgroups for accelerometer-derived sedentary or light-intensity activity minutes/day. More than 10 years after the start of DPP, DPPOS participants performed more accelerometer-measured MVPA than similar adults from NHANES. Longitudinal questionnaire data support the accelerometer-based findings by suggesting that leisure activity levels at the time of accelerometer recording remained higher than DPP baseline levels. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.
Gormican, Erin K; Hussein, Zahra S
Screening, brief intervention, and referral to treatment (SBIRT) is an important and effective strategy among injury prevention measures aimed at reducing risky alcohol use (). The trauma patient population is at significant risk for alcohol-related trauma recidivism () and is therefore a priority group in which to implement SBIRT. Vancouver General Hospital (VGH) implemented SBIRT on its 2 inpatient trauma units in the fall of 2014. The alcohol use disorders screening test (AUDIT-C) was chosen as the screening tool for nurses to complete with new patients. A brief intervention was conducted by the trauma social workers in the cases where a patient scored positive on the AUDIT-C. To evaluate the implementation and effectiveness of SBIRT on the 2 inpatient trauma units at VGH and to provide recommendations for improvement, a telephone survey of past trauma patients and a review of the screening process were undertaken in May 2016. Patient follow-up was conducted via a telephone survey. Of the 79 patients who met the follow-up criteria, a total of 19 were successfully contacted. Results from the survey showed that the majority of patients did not recall being screened with the AUDIT-C and were either unsure or did not recall receiving a brief intervention by the social worker. Despite these findings, a rescreening with the AUDIT-C tool revealed that 68% of patients who participated in the survey had a lower score than when they were inpatients. Recommendations for improvement include optimizing the timing of SBIRT with trauma inpatients and implementing a follow-up system. The literature suggests that following up with patients to provide an SBIRT "booster" increases the effectiveness of brief interventions (C. ).
Tanner, Amanda E.; Secor-Turner, Molly; Garwick, Ann; Sieving, Renee; Rush, Kayci
Introduction Evaluating interventions for reducing unintended adolescent pregnancy is necessary to ensure quality and efficacy. The purpose of this study was to examine core case management practices and processes for engaging high-risk girls in Prime Time, an intensive multi-component intervention from the perspectives of intervention program staff. Method Structured individual interviews were conducted with the entire Prime Time program staff (N=7) to assess successes and challenges in engaging adolescent girls at high risk for early pregnancy recruited from school and community clinics. Results Program staff described different capacities of adolescents to engage with the program (easy, middle and difficult connecting adolescents) and provided specific recommendations for working with different connectors. Discussion Findings from this study support the notion that preventive interventions with vulnerable groups of adolescents must pay careful attention to strategies for establishing trusting youth-adult relationships. The ability of staff (e.g., case managers, nurses) to engage with adolescents is a crucial step in improving health outcomes. The identified strategies are useful in helping adolescents build skills, motivations and supports needed for healthy behavior change. PMID:22726710
Johnson, Janet; Brennan, Mary; Musil, Carol M; Fitzpatrick, Joyce J
Nurse practitioners (NPs) deliver a wide array of healthcare services in a variety of settings. The purpose of this study was to examine the practice patterns and organizational commitment of inpatient NPs. A quantitative design was used with a convenience sample (n = 183) of NPs who attended the American Association of Nurse Practitioners (AANP) national conference. The NPs were asked to complete a demographic questionnaire, the Practice Patterns of Acute Nurse Practitioners tool and the Organizational Commitment Questionnaire. Over 85% of inpatient practice time consists of direct and indirect patient care activities. The remaining nonclinical activities of education, research, and administration were less evident in the NP's workweek. This indicates that the major role of inpatient NPs continues to be management of acutely ill patients. Moderate commitment was noted in the Organizational Commitment Questionnaire. Supportive hospital/nursing leadership should acknowledge the value of the clinical and nonclinical roles of inpatient NPs as they can contribute to the operational effectiveness of their organization. By fostering the organizational commitment behaviors of identification, loyalty, and involvement, management can reap the benefits of these professionally dedicated providers. ©2015 American Association of Nurse Practitioners.
Vlierberghe, Leen Van; Braet, Caroline; Goossens, Lien; Rosseel, Yves; Mels, Saskia
This study aimed to investigate whether psychological disorders and symptom severity hamper weight loss in obese adolescents and explored the effect of evidence-based adolescent obesity treatment on psychological disorders and symptom severity. Participants were 66 adolescents admitted for a 10-month obesity treatment programme. At the start of treatment both clinical interviews and self-report questionnaires were administered. Weight loss was registered at several time points. Half of the sample was invited to complete questionnaires and be interviewed once again at the end of the programme. Baseline degree of overweight was the strongest predictor of weight loss. The presence of at least one psychological disorder appeared a negative predictor of weight loss after four months. At post-test, a decrease in eating, shape and weight concern and binge eating episodes was demonstrated. A similar trend was found for internalizing symptoms. All eating disorders resolved, but a substantial number of adolescents still suffered from psychological disorders at the end of treatment. During inpatient obesity treatment, youngsters who are more severely obese lose most weight. In girls and in adolescents suffering from psychological disorders, long-term care should be the aim to prevent an experience of failure. From a psychological health perspective, the inclusion of psychotherapy during inpatient obesity treatment for adolescents suffering from psychiatric disorders is worth considering. All together, the findings of this study demonstrate the importance of adopting both a medical and a psychological perspective on obesity (treatment) in youth.
Fraser, Sarah J; Chapman, Justin J; Brown, Wendy J; Whiteford, Harvey A; Burton, Nicola W
The life expectancy of adults with mental illness is worse than that of the general population and is largely due to poor physical health status. Physical activity has been consistently recommended for the prevention and management of many chronic physical health conditions and can also have benefits for mental health. This cross sectional study assessed the attitudes towards and preferences for physical activity among inpatient adults with mental illness, and differences by distress and gender. Self-report questionnaires were completed by 101 patients. Findings indicated that inpatient adults with mental illness are interested in doing physical activity while in hospital, primarily to maintain good physical health and improve emotional wellbeing. Fewer than half of participants agreed that physical activity has benefits for serious mental illness. Participants indicated a preference for walking and physical activity that can be done alone, at a fixed time and with a set routine and format. Major barriers were fatigue and lack of motivation. Females were more likely than males to prefer activities done with others of the same gender (P = 0.001) and at the same level of ability (P mental illness. © 2015 Australian College of Mental Health Nurses Inc.
Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service. ©2017 Frontline Medical Communications.
Status migrainosus is defined by the international classification of headache disorders (ICHD) criteria as a debilitating migraine lasting more then 72 hours. The epidemiology of status migrainosus is still unknown in adult and children, and frequently underdiagnosed. Children and adolescents often end up in the emergency room with an intractable headache that failed outpatient therapy. Six to seven percent of these children do not respond to acute infusion therapy and require hospitalization. It is imperative that more aggressive therapy is considered when patients are affected by a severe intractable headache to prevent further disability and returning the child to baseline activity. Multiple therapies are available for adults and children. Studies for acute therapy in the emergency room are available in adults and pediatric groups. Small studies are available for inpatient therapy in children and, along with available therapies for children and adolescents, are described in this review. A review of the literature shows growing evidence regarding the use of dihydroergotamine intravenously once patients are hospitalized. Effectiveness and safety have been proven in the last decades in adults and small studies in the pediatric populations. © 2015 American Headache Society.
The term 'psychosomatic' has many connotations, be it in the sense of a general biopsychosocial concept in medicine as outlined in the ICF (International Classification of Functioning, Disability and Health) of the World Health Organization, a holistic and person-centered view of the patient beyond the illness, the treatment of somatoform or somatic disorders, or special psychotherapeutic approaches. In Germany, there are also about 25,000 inpatient beds in 'psychosomatic rehabilitation hospitals', which treat approximately 5/1,000 inhabitants in the working age population per year. These institutions give an example of how to translate the theoretical concepts of psychosomatic medicine and of the ICF into clinical practice. 'Psychosomatic rehabilitation' aims at the prevention, treatment and compensation of chronic illness by a biopsychosocial approach. This includes a multilevel psychosomatic assessment and a multidimensional treatment focus including the reduction of symptoms, the training of capacities, the coping with chronic illness and impairment, the restoration of well-being and normal life, and the occupational reintegration including the search for a workplace, which allows work in spite of impairment. Scientific studies have shown that the psychological status, the motivation to work, the number of days on sickness leave and occupational reintegration can be improved, and that the system pays for the patients themselves, but also pension and health insurance companies. © 2014 S. Karger AG, Basel.
Westert Gert P
Full Text Available Abstract Background Hospital inpatient complications are one of a number of adverse health care outcomes. Reducing complications has been identified as an approach to improving care and saving resources as part of the health care reform efforts in the United States. An objective of this study was to describe the Potentially Preventable Complications software developed as a tool for evaluating hospital inpatient outcomes. Additional objectives included demonstration of the use of this software to evaluate the connection between health care outcomes and expenses in United States administrative data at the state and local levels and the use of the software to plan and implement interventions to reduce hospital complications in one U.S. metropolitan area. Methods The study described the Potentially Preventable Complications software as a tool for evaluating these inpatient hospital outcomes. Through administrative hospital charge data from California and Maryland and through cost data from three hospitals in Syracuse, New York, expenses for patients with and without complications were compared. These comparisons were based on patients in the same All Patients Refined Diagnosis Related Groups and severity of illness categories. This analysis included tests of statistical significance. In addition, the study included a planning process for use of the Potentially Preventable Complications software in three Syracuse hospitals to plan and implement reductions in hospital inpatient complications. The use of the PPC software in cost comparisons and reduction of complications included tests of statistical significance. Results The study demonstrated that Potentially Preventable Complications were associated with significantly increased cost in administrative data from the United States in California and Maryland and in actual cost data from the hospitals of Syracuse, New York. The implementation of interventions in the Syracuse hospitals was associated with
Full Text Available Coal seam water injection is widely used to prevent rockbursts in coal mines, and the duration of water injection is an important parameter related to the effectiveness of rockburst prevention, making it of practical importance to optimize the effective water injection duration. This paper presents the test results of the mechanical properties and pore structure of samples with different soaking time, obtained from a working face where rockburst occurred. Soaking time changes the mechanical properties of samples, and this time effect differs with the coal size (from centimeter to nanometer size. Results of numerical simulation and on-site tests in the Changgouyu coal mine demonstrated that water injection can effectively soften coal bodies and release or transfer stresses, and the time effect of water injection on rock prevention and control is apparent.
Hellen Cristina de Almeida Abreu
Full Text Available OBJECTIVE To estimate the incidence and predicting factors associated with falls among older inpatients. METHODS Prospective cohort study conducted in clinical units of three hospitals in Cuiaba, MT, Midwestern Brazil, from March to August 2013. In this study, 221 inpatients aged 60 or over were followed until hospital discharge, death, or fall. The method of incidence density was used to calculate incidence rates. Bivariate analysis was performed by Chi-square test, and multiple analysis was performed by Cox regression. RESULTS The incidence of falls was 12.6 per 1,000 patients/day. Predicting factors for falls during hospitalization were: low educational level (RR = 2.48; 95%CI 1.17;5.25, polypharmacy (RR = 4.42; 95%CI 1.77;11.05, visual impairment (RR = 2.06; 95%CI 1.01;4.23, gait and balance impairment (RR = 2.95; 95%CI 1.22;7.14, urinary incontinence (RR = 5.67; 95%CI 2.58;12.44 and use of laxatives (RR = 4.21; 95%CI 1.15;15.39 and antipsychotics (RR = 4.10; 95%CI 1.38;12.13. CONCLUSIONS The incidence of falls of older inpatients is high. Predicting factors found for falls were low education level, polypharmacy, visual impairment, gait and balance impairment, urinary incontinence and use of laxatives and antipsychotics. Measures to prevent falls in hospitals are needed to reduce the incidence of this event.
Full Text Available Current reforms of mental health and substance abuse services (MHS emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources and indicators of service need (mental health index, education, single household, and alcohol sales correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years. The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.
Cunningham, Peter; Sabik, Lindsay M; Bonakdar Tehrani, Ali
The Affordable Care Act is expected to profoundly affect inpatient hospital utilization, both as a result of expansions in insurance coverage as well as payment and delivery system reforms. The objective of this study is to examine changes in inpatient utilization between 2010 and 2013 in California, following a Medicaid expansion and implementation of the Delivery System Reform Incentive Payment program. Findings show that between 2010 and 2013: (a) the overall number of inpatient admissions increased, mainly because an increase in Medicaid admissions exceeded the decrease in uninsured admissions; (b) the number of preventable admissions did not change; (c) preventable admissions decreased at safety net hospitals that received Delivery System Reform Incentive Payment funds relative to other safety net hospitals. The results suggest that delivery system reforms may help offset the upward pressures on utilization and costs due to coverage expansions.
Vartika Mehta; Deepak Punetha; Vishwanath Bijalwan
This paper report discusses a theft prevention system, which can prevent the theft and also can be track the object. This system is capable to tracking the vehicle as well as theft prevention. An R.F. module is use to exchange the information regarding vehicle and owner of the vehicle with police control room or SOS services. The vehicle can be track with the help of R.F. receiver. A DTMF based fuel lock has been attached in this system. A cell phone with SIM card has been attached with DTMF ...
Michael Ranniery Garcia Ribeiro
Full Text Available Purpose. To evaluate the mineral ion loss of root dentine after treatment with 2% chlorhexidine solution (CHX and to compare its yield and flexural strength (fs after exposure to calcium hydroxide [Ca(OH2]. Materials and Methods. Dentine bars (DB were made from 90 roots of bovine incisors and randomized into three groups: GControl: distilled/deionized water (DDW, GNaOCl: 2.5% sodium hypochlorite + 17% EDTA, and GCHX: CHX + DDW. The release of phosphate (PO4 and calcium (Ca ions was measured by spectrophotometry. The DB were exposed to Ca(OH2 paste for 0, 30, 90, and 180 days. DB were subjected to the three-point bending test to obtain yield and fs values. The fracture patterns were evaluated (20x. Data were analyzed using Kruskal-Wallis and Dunn’s post hoc tests or one- and two-way ANOVA followed by Tukey’s post hoc test (α=0.05. Results. GCHX showed lower PO43- and Ca2+ ionic release than GNaOCl (pGNaOCl in all periods (p<0.001, except for yield strength values on 90 days (p=0.791. A larger frequency of vertical fractures was observed in GNaOCl and that of oblique fractures in GCHX (p<0.05. Conclusions. CHX prevented PO43- and Ca2+ loss and showed a tendency to preserve the yield and fs of root dentine over time following exposure to Ca(OH2 paste.
Allen, C. Christopher; And Others
Explored construct validity of computer-assisted battery of neuropsychological tests with 82 psychiatric inpatients and 89 normal volunteers. Principal components analysis of inpatients scores revealed simple reaction time, response accuracy, visuomotor skill, and complex processing and memory components. Found similar factorial structure in…
Bergin, Patrick F; Psaradellis, Telly; Krosin, Michael T; Wild, Jason R; Stone, Marcus B; Musapatika, Dana; Weber, Timothy G
Operative treatment of calcaneus fractures is associated with the risk of early wound complications. Though accepted practice dictates surgery should be delayed until soft tissues recover from the initial traumatic insult, optimal timing of surgery has not been delineated. A retrospective chart and radiographic review at a level I trauma center was performed to determine if an aggressive inpatient soft tissue management protocol designed to decrease the time delay from injury to surgery is effective at reducing complications. Ninety-seven patients (17 female, 80 male; mean age, 39.7±14.0 years) with 102 calcaneus fractures treated between October 1995 and January 2005 were identified. Differences in complication rates and quality of reduction between the inpatient and outpatient treatment groups were analyzed. Quality of reduction was determined by measuring postoperative Bohler's angle and posterior facet articular step-off. Mean time from injury to surgery was 6.2 days for the inpatient group and 10.8 days for the outpatient group (pfractures is a feasible treatment option when a patient is kept in the hospital that offers a reduction in postoperative wound complications while enabling surgery 4 days earlier on average.
Zarrabi, Homa; Khalkhali, Mohammadrasoul; Hamidi, Azam; Ahmadi, Reza; Zavarmousavi, Maryam
Over the past few years, methamphetamine-induced psychosis (MIP) has increased in Iran, accounting for a significant percentage of psychiatry hospital admissions. The present study was conducted with an aim to investigate clinical symptoms, and course and treatment methods of MIP inpatients in Shafa Psychiatry Hospital in northern Iran. Participants were 152 MIP inpatients. Brief Psychiatric Rating Scale (BPRS) subscales of suspiciousness, unusual thought content; hallucinations and hostility were used to measure psychiatric symptoms. Data regarding suicide and homicide and violence were also obtained through interviews with the inpatients and their family. Based on their lengths of recovery time, the inpatients were categorized into 3 clinical groups. These inpatients received their usual treatments and were monitored for their psychiatric symptoms and clinical course of illness. The data were analyzed by descriptive statistics. The most frequent psychiatric symptoms were violence (75.6 %), intimate partner violence (61.2 %), delusions of persecution (85.5 %), delusions of reference (38.5 %), delusions of grandiosity (32.9 %), delusions of infidelity (30.2 %), auditory hallucinations (51.3 %), visual hallucinations (18.4 %), suicidal thoughts (14.5 %), homicidal thoughts (3.9 %), suicide attempts (10.5 %) and homicide attempts (0.7 %). Recovery from psychotic symptoms in 31.6 % of the inpatients took more than one month. 46.1% of the inpatients were treated with Risperidone and 37.5 % with Olanzapine. Persecutory delusion and auditory hallucination were the most frequent persistent psychotic symptoms. 20.8 % of the inpatients with duration of psychosis more than one month were treated with electroconvulsive therapy (ECT) along with antipsychotics. All forms of violence are highly frequent in MIP inpatients. Our finding agrees with many other studies suggesting that recovery from MIP can take more than a month. Initial promising findings were found regarding the
U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...
U.S. Department of Health & Human Services — This file contains case level data for inpatient psychiatric stays and is derived from 2011 MEDPAR data file and the latest available provider specific file. The...
Bergamasco, Ellen Cristina; da Cruz, Diná de Almeida Lopes Monteiro
Sleep disturbances and deprivation are common stressors in inpatients. Nurses must be able to notice undesirable effects of sleep disturbances on the patient's responses to health problems, and to implement interventions to help them achieve the best possible quality of sleep. This article discusses the relevance of sleep-related nursing diagnoses for inpatients of medical-surgical wards, and presents a synthesis of the tools available in literature to assess sleep.
Leitner, Maya; Burstein, Brett; Agostino, Holly
The medical stabilization of adolescent patients with restrictive eating disorders can be associated with refeeding syndrome, a potentially fatal complication preceded by refeeding hypophosphatemia (RH). Whether RH can be prevented by routine prophylactic phosphate supplementation has not been previously examined. This study sought to determine the safety and efficacy of a refeeding strategy that incorporates prophylactic phosphate supplementation to prevent RH. Retrospective chart data were collected for patients aged younger than 18 years with restrictive eating disorders admitted to a tertiary pediatric inpatient ward between January 2011 and December 2014. All patients were refed with a standardized protocol that included prophylactic oral phosphate supplementation (1.0 ± .2 mmol/kg/day). During the 4-year study period, 75 admissions (70 patients) were included for analysis. The mean age and percent median body mass index of included patients were 15.3 years and 83.5%, respectively. Seven out of 75 (9%) had percent median body mass index of 20%. All patients were normophosphatemic at the time of admission (mean serum phosphate 1.24 ± .2 mmol/L). Serial laboratory evaluation revealed that all supplemented patients maintained serum phosphate levels >1.0 mmol/L during the initial 7 days of refeeding. Eleven patients became mildly hyperphosphatemic (range 1.81-2.17 mmol/L) with no associated clinical consequences. Additional analysis of 11 patients presenting with hypophosphatemia before refeeding revealed that with supplementation, phosphate values normalized by Day 1, and this group experienced no further RH episodes during initial refeeding. Prophylactic oral phosphate supplementation appears safe, and no episodes of RH occurred in patients with restrictive eating disorders undergoing inpatient refeeding. Copyright © 2015 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Background: Knowledge of the common causes of death in a particular locality is important. This would help in planning interventions aimed at preventing and adequately managing such diseases to reduce mortality. Aims: To document the common disease conditions which cause mortality in adult surgical in-patients and ...
van de Glind, Esther M. M.; Willems, Hanna C.; Eslami, Saeid; Abu-Hanna, Ameen; Lems, Willem F.; Hooft, Lotty; de Rooij, Sophia E.; Black, Dennis M.; van Munster, Barbara C.
For physicians dealing with patients with a limited life expectancy, knowing the time to benefit (TTB) of preventive medication is essential to support treatment decisions. The aim of this study was to investigate the usefulness of statistical process control (SPC) for determining the TTB in
Full Text Available This paper report discusses a theft prevention system, which can prevent the theft and also can be track the object. This system is capable to tracking the vehicle as well as theft prevention. An R.F. module is use to exchange the information regarding vehicle and owner of the vehicle with police control room or SOS services. The vehicle can be track with the help of R.F. receiver. A DTMF based fuel lock has been attached in this system. A cell phone with SIM card has been attached with DTMF IC. The fuel flow in the vehicle can be controlled by give a call to this cell phone. This system has been controlled by a microcontroller which can make the system cost effective, low power consumption, effective and reliable.
O'Brien, Amy; McCormack, Julie; Hoiles, Kimberley J; Watson, Hunna J; Anderson, Rebecca A; Hay, Phillipa; Egan, Sarah J
There are few evidence-based guidelines for inpatient pediatric eating disorders. The aim was to gain perspectives from those providing and receiving inpatient pediatric eating disorder care on the essential components treatment. A modified Delphi technique was used to develop consensus-based opinions. Participants (N = 74) were recruited for three panels: clinicians (n = 24), carers (n = 31), and patients (n = 19), who endorsed three rounds of statements online. A total of 167 statements were rated, 79 were accepted and reached a consensus level of at least 75% across all panels, and 87 were rejected. All agreed that families should be involved in treatment, and thatpsychological therapy be offered in specialist inpatient units. Areas of disagreement included that patients expressed a desire for autonomy in sessions being available without carers, and that weight gain should be gradual and admissions longer, in contrast to carers and clinicians. Carers endorsed that legal frameworks should be used to retain patients if required, and that inpatients are supervised at all times, in contrast to patients and clinicians. Clinicians endorsed that food access should be restricted outside meal times, in contrast to patients and carers. The findings indicate areas of consensus in admission criteria, and that families should be involved in treatment, family involvement in treatment, while there was disagreement across groups on topics including weight goals and nutrition management. Perspectives from patients, carers, and clinicians may be useful to consider during future revisions of best practice guidelines. © 2018 Wiley Periodicals, Inc.
Page, Andrew C; Hooke, Geoff R
The effectiveness among inpatients with depression of a modified cognitive behavior therapy (CBT) program was examined. A group of 300 inpatient admissions with a primary diagnosis of depression attending a private psychiatric clinic were assessed at the beginning and end of a two-week CBT program. The effectiveness of the treatment was demonstrated by improvements on the Beck depression inventory (BDI), the health of the nation outcome scales, locus of control of behaviour scale, and the global assessment of function. The changes on the BDI for patients with depression were benchmarked against estimates generated from published studies. The degree of change in a two-week period for inpatients with depression was similar to that observed in efficacy studies of CBT that typically run over a more extended time. Implications for integrating CBT with inpatient services are discussed.
Lin, Richard J; Reid, M Carrington; Liu, Lydia L; Chused, Amy E; Evans, Arthur T
The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers. © The Author(s) 2014.
Full Text Available Background and Design: To determine the clinical and etiological features of inpatients with acute urticaria and angioedema and to assess the need for laboratory tests. Material and Methods: We recruited 105 patients with acute urticaria and angioedema who were admitted to our inpatient unit. The lesions and the characteristics of the patients were analyzed. Routine diagnostic tests including complete blood count, thyroid function tests, hepatitis panel, stool parasite, total IgE levels, cultures, erythrocyte sedimentation rate, C-reactive protein, anti-nuclear antibody, and posterior anterior lung X-ray were ordered. A psychiatric consultation was obtained, when needed. The results were analyzed with SPSS 15.0 statistical software.Results: Among 105 patients, 28 (26.7% had urticaria, 7 (6.7% had angioedema, and 70 (66.7% suffered from both urticaria and angioedema. The most common accompanying symptoms were itching (91.4% and burning (34.3%. The most common systemic symptoms were fatigue (15.2% and headache (12.4%. The lesions usually appeared in the evening hours (24.8%. Twenty-five patients were waking up due to itching during the night. Some lesions were associated with physical activities. Systemic diseases accompanied the lesions in 12 patients (11%. In terms of etiological factors, 33 patients (22.5% had infections. Food- related lesions were encountered in 14 (13% patients. Thirty patients (28.5% had history of medication use. Stress was detected in 37.1% of the patients; anxiety was diagnosed in 3% of patients. The stool was positive for parasites in 10 (9% patients. Conclusion: Acute urticaria is a benign disorder. Although the underlying cause of urticaria can not always be identified, infections and medications are the most common causes. A comprehensive and detailed history is very important to discover the underlying cause. The diagnostic tests should be ordered according to the patient’s history. Conducting diagnostic tests
Emilio Jorge Ayos
Full Text Available Any crime prevention strategy implies, explicitly or implicitly, the question about what crime is, the causes of it and how to avert it. In this paper we will focus on set, thru criminological theories, the “concepts” that have been renewal to build different answers to such questions, particularly on crime prevention’s policies in contemporary Argentina. We suggest three axes: first, the criminal positivist sociology of Enrico Ferri, particularly his idea of “ penalties equivalent,”; second, the discussion about crime prevention in the “Chicago School”, specially on Thrasher Frederich’s work; and finally, “multi-agency intervention” idea of the left realist criminology, especially Jock Young, Roger Matthews and John Lea. Such productions have in common the fact that the three have specifically discussed the issue of “crime prevention” on their work. The selection criteria and comparison axis emerges from a broader investigation, which aimed to analyze the modes of way that the association between crime and living conditions is addressed on the social crime prevention policies in Argentina, during the first decade of the new century. Three comparatives dimensions were analyzed: the way social policies appears on crime prevention strategies; the ways the target populations are delimited; and last, the ways the intervention territories are defined, building an specific idea of territory.
Pietrobelli, Angelo; Agosti, Massimo; Zuccotti, Gianvincenzo
Growth and development are key characteristics of childhood and sensitive markers of health and adequate nutrition. The first 1000 days of life-conception through 24 months of age-represent a fundamental period for development and thus the prevention of childhood obesity and its adverse consequences is mandatory. There are many growth drivers during this complex phase of life, such as nutrition, genetic and epigenetic factors, and hormonal regulation. The challenge thus involves maximizing the potential for normal growth without increasing the risk of associated disorders. The Mediterranean Nutrition Group (MeNu Group), a group of researchers of the Mediterranean Region, in this Special Issue titled "Prevent Obesity in the First 1000 Days", presented results that advanced the science of obesity risk factors in early life, coming both from animal model studies and studies in humans. In the future, early-life intervention designs for the prevention of pediatric obesity will need to look at different strategies, and the MeNu Group is available for guidance regarding an appropriate conceptual framework to accomplish either prevention or treatment strategies to tackle pediatric obesity.
Full Text Available Growth and development are key characteristics of childhood and sensitive markers of health and adequate nutrition. The first 1000 days of life—conception through 24 months of age—represent a fundamental period for development and thus the prevention of childhood obesity and its adverse consequences is mandatory. There are many growth drivers during this complex phase of life, such as nutrition, genetic and epigenetic factors, and hormonal regulation. The challenge thus involves maximizing the potential for normal growth without increasing the risk of associated disorders. The Mediterranean Nutrition Group (MeNu Group, a group of researchers of the Mediterranean Region, in this Special Issue titled “Prevent Obesity in the First 1000 Days”, presented results that advanced the science of obesity risk factors in early life, coming both from animal model studies and studies in humans. In the future, early-life intervention designs for the prevention of pediatric obesity will need to look at different strategies, and the MeNu Group is available for guidance regarding an appropriate conceptual framework to accomplish either prevention or treatment strategies to tackle pediatric obesity.
Özcanhan, Mehmet Hilal; Dalkılıç, Gökhan; Utku, Semih
Reliable sources report that errors in drug administration are increasing the number of harmed or killed inpatients, during healthcare. This development is in contradiction to patient safety norms. A correctly designed hospital-wide ubiquitous system, using advanced inpatient identification and matching techniques, should provide correct medicine and dosage at the right time. Researchers are still making grouping proof protocol proposals based on the EPC Global Class 1 Generation 2 ver. 1.2 standard tags, for drug administration. Analyses show that such protocols make medication unsecure and hence fail to guarantee inpatient safety. Thus, the original goal of patient safety still remains. In this paper, a very recent proposal (EKATE) upgraded by a cryptographic function is shown to fall short of expectations. Then, an alternative proposal IMS-NFC which uses a more suitable and newer technology; namely Near Field Communication (NFC), is described. The proposed protocol has the additional support of stronger security primitives and it is compliant to ISO communication and security standards. Unlike previous works, the proposal is a complete ubiquitous system that guarantees full patient safety; and it is based on off-the-shelf, new technology products available in every corner of the world. To prove the claims the performance, cost, security and scope of IMS-NFC are compared with previous proposals. Evaluation shows that the proposed system has stronger security, increased patient safety and equal efficiency, at little extra cost.
Gambadauro, Pietro; Magos, Adam
Conventional audit of surgical records through review of surgical results provides useful knowledge but hardly helps identify the technical reasons lying behind specific outcomes or complications. Surgical teams not only need to know that a complication might happen but also how and when it is most likely to happen. Functional awareness is therefore needed to prevent complications, know how to deal with them, and improve overall surgical performance. The authors wish to argue that the systematic recording and reviewing of surgical videos, a "surgical black box," might improve surgical care, help prevent complications, and allow accident analysis. A possible strategy to test this hypothesis is presented and discussed. Recording and reviewing surgical interventions, apart from helping us achieve functional awareness and increasing the safety profile of our performance, allows us also to effectively share our experience with colleagues. The authors believe that those potential implications make this hypothesis worth testing.
Full Text Available Inpatient care for children has been considered to play an important role and to be influential in Russian healthcare system. However, a long lasting extensive development of health care system lacking sufficient finance and recourses has created a gap between the healthcare structure and capacity to provide healthcare and the needs of qualitative healthcare in the population. High number of limited ability hospitals without appropriate recourse base has already had its's day as a stage of inpatients care development. These hospitals could not provide a base for modern technology implementation and provision of present day high b quality medical care. Moreover, the current mechanism of financing «the hospital bed» but the patient has hampered medical care intensification and implementation of new technologies through loss of result orientation in medical specialists. Elaboration of efficacious means to optimize inpatient care would allow to control the rates assessing TH children's health in the country's population and to promote medical, social and economic efficacy of the inpatient care system.Key words: inpatient care, healthcare quality.
Grant, Jon E; Levine, Laura; Kim, Daniel; Potenza, Marc N
The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.
Full Text Available Abstract Background Incident reporting is the most common method for detecting adverse events in a hospital. However, under-reporting or non-reporting and delay in submission of reports are problems that prevent early detection of serious adverse events. The aim of this study was to determine whether it is possible to promptly detect serious injuries after inpatient falls by using a natural language processing method and to determine which data source is the most suitable for this purpose. Methods We tried to detect adverse events from narrative text data of electronic medical records by using a natural language processing method. We made syntactic category decision rules to detect inpatient falls from text data in electronic medical records. We compared how often the true fall events were recorded in various sources of data including progress notes, discharge summaries, image order entries and incident reports. We applied the rules to these data sources and compared F-measures to detect falls between these data sources with reference to the results of a manual chart review. The lag time between event occurrence and data submission and the degree of injury were compared. Results We made 170 syntactic rules to detect inpatient falls by using a natural language processing method. Information on true fall events was most frequently recorded in progress notes (100%, incident reports (65.0% and image order entries (12.5%. However, F-measure to detect falls using the rules was poor when using progress notes (0.12 and discharge summaries (0.24 compared with that when using incident reports (1.00 and image order entries (0.91. Since the results suggested that incident reports and image order entries were possible data sources for prompt detection of serious falls, we focused on a comparison of falls found by incident reports and image order entries. Injury caused by falls found by image order entries was significantly more severe than falls detected by
Häfner, Alexander; Stock, Armin; Pinneker, Lydia; Ströhle, Sabine
The purpose of this study was to examine the effects of a short-term time management training programme on perceived control of time and perceived stress. The sample of 177 freshmen was randomly assigned to a time management training (n?=?89) and an active control group (CG) (n?=?88). We expected that an increase in external demands during the…
Madsen, Trine; Agerbo, Esben; Mortensen, Preben B
admission until patient discharge or inpatient suicide over a 10-year study period from 1997 through 2006. By using survival analysis techniques, this study was the first to take the inpatient time at risk into account in the estimation of the suicide rate and the predictors of suicide among hospital......-admitted psychiatric patients. RESULTS: Among 126,382 psychiatric inpatients aged 14 years or older, 279 suicides occurred. The risk of inpatient suicide was high: 860 suicides per 100,000 inpatient years. Of those individuals who completed suicide, 50% died within 18 days of admission. The inpatient suicide rate...... education (HR = 0.41; 95% CI, 0.29-0.60) or those with vocational training (HR = 0.54; 95% CI, 0.39-0.77). Having a personality disorder as a secondary diagnosis (all psychiatric diagnoses were made according to ICD-10) raised the risk of suicide (HR = 1.60; 95% CI, 1.01-2.53), as did having recent contact...
Afifi, Ladan; Shinkai, Kanade
Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service. ©2017 Frontline Medical Communications.
Sabine I B Steinke
Full Text Available Treatment modalities of chronic plaque psoriasis have dramatically changed over the past ten years with a still continuing shift from inpatient to outpatient treatment. This development is mainly caused by outpatient availability of highly efficient and relatively well-tolerated systemic treatments, in particular BioLogicals. In addition, inpatient treatment is time- and cost-intense, conflicting with the actual burst of health expenses and with patient preferences. Nevertheless, inpatient treatment with dithranol and UV light still is a major mainstay of psoriasis treatment in Germany. The current study aims at comparing the total costs of inpatient treatment and outpatient follow-up to mere outpatient therapy with different modalities (topical treatment, phototherapy, classic systemic therapy or BioLogicals over a period of 12 months. To this end, a retrospective cost-of-illness study was conducted on 120 patients treated at the University Medical Centre Mannheim between 2005 and 2006. Inpatient therapy caused significantly higher direct medical, indirect and total annual costs than outpatient treatment (13,042 € versus 2,984 €. Its strong influence on cost levels was confirmed by regression analysis, with total costs rising by 104.3% in case of inpatient treatment. Patients receiving BioLogicals produced the overall highest costs, whereas outpatient treatment with classic systemic antipsoriatic medications was less cost-intense than other alternatives.
Kim, Sun Moon; Shu, Aimee D.; Long, Jin; Montez-Rath, Maria E.; Leonard, Mary B.; Norton, Jeffrey A.; Chertow, Glenn M.
Parathyroidectomy is the only curative therapy for patients with primary hyperparathyroidism. However, the incidence, correlates and consequences of parathyroidectomy for primary hyperparathyroidism across the entire US population are unknown. We evaluated temporal trends in rates of inpatient parathyroidectomy for primary hyperparathyroidism, and associated in-hospital mortality, length of stay, and costs. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) from 2002–2011. Parathyroidectomies for primary hyperparathyroidism were identified using International Classification of Diseases, Ninth Revision codes. Unadjusted and age- and sex- adjusted rates of inpatient parathyroidectomy for primary hyperparathyroidism were derived from the NIS and the annual US Census. We estimated 109,583 parathyroidectomies for primary hyperparathyroidism between 2002 and 2011. More than half (55.4%) of patients were younger than age 65, and more than three-quarters (76.8%) were female. The overall rate of inpatient parathyroidectomy was 32.3 cases per million person-years. The adjusted rate decreased from 2004 (48.3 cases/million person-years) to 2007 (31.7 cases/million person-years) and was sustained thereafter. Although inpatient parathyroidectomy rates declined over time across all geographic regions, a steeper decline was observed in the South compared to other regions. Overall in-hospital mortality rates were 0.08%: 0.02% in patients younger than 65 years and 0.14% in patients 65 years and older. Inpatient parathyroidectomy rates for primary hyperparathyroidism have declined in recent years. PMID:27529699
Eum, Regina S; Seel, Ronald T; Goldstein, Richard; Brown, Allen W; Watanabe, Thomas K; Zasler, Nathan D; Roth, Elliot J; Zafonte, Ross D; Glenn, Mel B
Risk factors contributing to institutionalization after inpatient rehabilitation for people with traumatic brain injury (TBI) have not been well studied and need to be better understood to guide clinicians during rehabilitation. We aimed to develop a prognostic model that could be used at admission to inpatient rehabilitation facilities to predict discharge disposition. The model could be used to provide the interdisciplinary team with information regarding aspects of patients' functioning and/or their living situation that need particular attention during inpatient rehabilitation if institutionalization is to be avoided. The study population included 7219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from 2002-2012 who had not been institutionalized prior to injury. Based on institutionalization predictors in other populations, we hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was used, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay. C-statistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management (adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair transfers (OR, 0.81 [95% CI, 0.83-0.93]), and comprehension (OR, 0.78 [95% CI, 0.68, 0.89]) at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment in age was associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29, 1.48) and living alone was associated with a 2.34 times higher risk (95% CI, 1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model
Ridolfi, Danielle R; Vander Wal, Jillion S
The purpose of this study was to assess the effectiveness of a body image dissatisfaction prevention session that provided information on body image and media literacy to college women. Participants were 81 undergraduates who were randomly assigned to attend either a body image intervention or a control intervention. Participants completed measures at pre- and post-intervention and at 4-week follow-up. The body image group improved significantly more than the control group on body shape concerns, but not on the other outcome variables. Efficacious interventions capable of reaching large numbers of women are necessary to help dispel the "normative discontent" prevalent today.
Florian, Mihai; Sørensen, John Dalsgaard
of information on the blades structural health to the decision maker. Further, inspections of the blades are often performed in connection with service. In light of the obtained information, a preventive type of maintenance becomes feasible, with the potential of predicting the blades remaining life to support O......&M decisions for avoiding major failure events. The present paper presents a fracture mechanics based model for estimating the remaining life of a wind turbine blade, focusing on the crack propagation in the blades adhesive joints. A generic crack propagation model is built in Matlab based on a Paris law...
Evidence based guidelines are effective in reducing incidence of venous thromboembolism (VTE) which is associated with morbidly, mortality and economic burden. This study aimed to identify the proportion of inpatients who had a VTE risk assessment (RA) performed and who received thromboprophylaxis (TP), in Cork University Hospital. There was no structured RA tool at the time; information was obtained from medical and drug charts to ascertain if a RA was performed. Patients were then RA by researchers and stratified as per NICE guidelines and the proportion who received TP was calculated. One thousand and nineteen inpatients were screened. Risk was documented in 24% of cases. TP was prescribed in 43.2% of inpatients. Following application of a RA tool >80% were at high risk of VTE with low risk of bleeding with TP prescription in 46.3% of inpatients. A national collaborative effort should be encouraged to develop a standardized approach for safe RA of inpatients and prescription of TP for prevention of HAT
Full Text Available Objective: The aim of this report was to establish a profile of patients with borderline personality disorder (BPD admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year. Methods: A retrospective record review was conducted to investigate the prevalence, demographics, reasons for admission, treatment, length of stay and follow-up of a group of inpatients during 2010 with a diagnosis of BPD, based on DSM-IV-TR diagnostic criteria, allocated on discharge. Results: Considering evidence retrospectively, the quality of the BPD diagnosis allocated appeared adequate. Statistical analysis revealed findings mainly in keeping with other reports, for example, that patients with BPD are above-average users of resources who make significantly more use of emergency services and that they generally do not adhere well to their scheduled outpatient follow-up arrangements. The longer average length of inpatient stay of this group with BPD, however, exceeded the typically brief period generally recommended for acute inpatient containment and emergency intervention. Conclusion: Implementation of targeted prevention and early intervention strategies, based on systematised programmes such as dialectical behavioural therapy and mentalisation based therapy, may be useful in addressing these problems experienced with integrating the in- and outpatient management of BPD. Keywords: Borderline personality; inpatient; acute
Full Text Available Abstract Background Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. Methods We carried out a national clinical survey based on a 10-year (1997-2006 sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. Results There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70% occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Conclusion Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.
Venerito, Marino; Vasapolli, Riccardo; Malfertheiner, Peter
Helicobacter pylori (H. pylori) is a Gram negative spiraliform bacterium that is commonly found in the stomach. H. pylori infection is still one of the world's most frequent infections, present in the stomachs of approximately one-half of the world's people. H. pylori infection is etiologically linked to histologic chronic active gastritis, peptic ulcer disease, and primary B-cell gastric lymphoma (gastric MALT lymphoma) and represents the major risk factor for the development of sporadic non-cardia gastric cancer (GC) of both intestinal and diffuse type. Studies that have examined the impact of GC prevention through H. pylori eradication have shown mixed results, but recent data suggest that prevention is only efficacious in patients without intestinal metaplasia or dysplasia. This indicates that, like in Barrett's esophagus, we need better clinical risk markers to indicate which patients are at greatest risk of developing cancer to guide clinical strategies. Furthermore, recent epidemiological data have suggested a possible contribution of H. pylori in modifying the risk of developing other gastrointestinal malignancies (including esophageal, pancreatic, hepatocellular, and colorectal cancer), although mechanistically these associations remain unexplained. We review clinically relevant aspects of H. pylori infection in the context of GC development as well as studies that have examined the impact of eradication on GC development and, lastly, discuss these recent epidemiological studies connecting H. pylori infection to extragastric gastrointestinal malignancies.
Meyer, Christian; Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A
Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.
Way, Bruce B; Smith, Hal; Sawyer, Don
To examine inpatients discharged from a forensic psychiatric hospital to a civil hospital at the completion of their correctional sentence. Extract information from a patient database. About 20% of the discharges from the New York State forensic hospital that serves mentally ill state prison inmates, Central New York Psychiatric Center (CNYPC), are transferred to a civil psychiatric hospital; the remainder are returned to a correctional setting. Although their diagnoses, Global Assessment of Functioning scores, and number of prior inpatient admissions are similar, CNYPC transfers stay 1(1/2) times as long in their civil hospital admission as other civil hospital admissions. If total inpatient hospitalization before release to the community at large is considered (CNYPC plus the subsequent civil hospital), the stay is about 2(1/2) times as long. Fifty-two percent of the CNYPC transfers had been incarcerated for violent offenses and 28% are re-hospitalized within 12 months after release from the civil hospital. Longer lengths of stay in the civil hospital for these CNYPC transfers do not seem to be related to psychiatric functioning. Instead, it may be related to being harder to place in a community setting. All these CNYPC transfers have prison histories, many have a violent offense history, and all have been geographically remote from their home communities for a long time periods. As a result, the social support networks of CNYPC transfers may be weaker than those of other civil inpatients. The families and neighborhood agencies of CNYPC transfers are probably less willing to accept them on their return than those of other civil patients.Enhanced discharge planning and support services targeted specially for correctional transfers to a civil psychiatric inpatient environment should be considered. These type of service may reduce inpatient length of stay and thereby allow the inpatient resources to be used by other patients. Copyright 2004 John Wiley & Sons, Ltd.
Full Text Available Abstract Background The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. Methods Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. Results The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of
Sharma, Priyank; Kovarik, Carrie L; Lipoff, Jules B
Many hospitals have limited inpatient dermatology consultation access. Most dermatologists are outpatient-based and may find the distance and time to complete inpatient consultations prohibitive. Teledermatology may improve access to inpatient dermatology care by reducing barriers of distance and time. We conducted a prospective two-phase pilot study at two academic hospitals comparing time needed to complete inpatient consultations after resident dermatologists initially evaluated patients, called average handling time (AHT), and time needed to respond to the primary team, called time to response (TTR), with and without teledermatology with surveys to capture changes in dermatologist opinion on teledermatology. Teledermatology was only used in the study phase, and patients were seen in-person in both study phases. Teledermatology alone sufficiently answered consultations in 10 of 25 study consultations. The mean AHT in the study phase (sAHT) was 26.9 min compared to the baseline phase (bAHT) of 43.5 min, a 16.6 min reduction (p = 0.004). The 10 study cases where teledermatology alone was sufficient had mean study TTR (sTTR) of 273.3 min compared to a baseline TTR (bTTR) of 405.7 min, a 132.4 min reduction (p = 0.032). Teledermatology reduces the time required for an attending dermatologist to respond and the time required for a primary team to receive a response for an inpatient dermatology consultation in a subset of cases. These findings suggest teledermatology can be used as a tool to improve access to inpatient dermatology care. © The Author(s) 2015.
Park, Subin; Kim, Jae-Won; Kim, Bung-Nyun; Bae, Jeong-Hoon; Shin, Min-Sup; Yoo, Hee-Jeong
Objective We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea. Methods The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office. Results Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge. Conclusion These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide. PMID:25670943
U.S. Department of Health & Human Services — The State Inpatient Databases (SID) contain the universe of hospital inpatient discharge abstracts in States participating in HCUP that release their data through...
Full Text Available Objective. Wireless capsule endoscopy (WCE is commonly used to directly visualize the small bowel. Opioids have variably been linked with incomplete studies and prolonged transit times in heterogeneous cohorts. We aimed to investigate the effect of opioid use on WCE for inpatient and outpatient cohorts. Methods. We performed a retrospective review of patients receiving WCE at our institution from April 2010 to March 2013. Demographic data, medical history, and WCE details were collected. Transit times were compared by log-rank analysis. Multivariable logistic regression and Cox proportional hazard models were utilized. Results. We performed 314 outpatient and 280 inpatient WCE that met study criteria. In the outpatient cohort, gastric transit time (GTT was not significantly different between opioid and nonopioid users. Completion rates were similar as well (88% and 87%, P=0.91. In the inpatient cohort, GTT was significantly longer in patients receiving opioids than in patients not receiving opioids (44 versus 23 min, P=0.04, but completion rates were similar (71% versus 75%, P=0.31. Conclusion. Opioid use within 24 hours of WCE did not significantly affect completion rates for inpatients or outpatients. GTT was prolonged in inpatients receiving opioids but not in outpatients.
Kleinman, Bryan; Stanich, Peter P.; Betkerur, Kavita; Porter, Kyle; Meyer, Marty M.
Objective. Wireless capsule endoscopy (WCE) is commonly used to directly visualize the small bowel. Opioids have variably been linked with incomplete studies and prolonged transit times in heterogeneous cohorts. We aimed to investigate the effect of opioid use on WCE for inpatient and outpatient cohorts. Methods. We performed a retrospective review of patients receiving WCE at our institution from April 2010 to March 2013. Demographic data, medical history, and WCE details were collected. Transit times were compared by log-rank analysis. Multivariable logistic regression and Cox proportional hazard models were utilized. Results. We performed 314 outpatient and 280 inpatient WCE that met study criteria. In the outpatient cohort, gastric transit time (GTT) was not significantly different between opioid and nonopioid users. Completion rates were similar as well (88% and 87%, P = 0.91). In the inpatient cohort, GTT was significantly longer in patients receiving opioids than in patients not receiving opioids (44 versus 23 min, P = 0.04), but completion rates were similar (71% versus 75%, P = 0.31). Conclusion. Opioid use within 24 hours of WCE did not significantly affect completion rates for inpatients or outpatients. GTT was prolonged in inpatients receiving opioids but not in outpatients. PMID:25214757
Magni, Guido; And Others
Administered two scales for the evaluation of depression to two groups of medical inpatients: adults (N=201) and geriatric subjects (N=178). Results confirmed a high presence of depressive symptoms among patients with medical problems, particularly among geriatric subjects. Factors most predictive of depressive symptoms are identified. (JAC)
Müller, Astrid; Rein, Katharina; Kollei, Ines; Jacobi, Andrea; Rotter, Andrea; Schütz, Patricia; Hillemacher, Thomas; de Zwaan, Martina
The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition to intermittent explosive disorder, pyromania, kleptomania, pathological gambling, and trichotillomania, the proposed ICDs not otherwise specified were assessed, including compulsive buying, nonparaphilic compulsive sexual behavior, pathological internet use, and pathological skin picking. Based on the SCID-ICD, a lifetime ICD rate of 23.5% and a current ICD rate of 18.8% were found. The most frequent ICDs were pathological skin picking (lifetime 7.3%, current 6.8%), compulsive buying (lifetime 6.8%, current 6.0%), and intermittent explosive disorder (lifetime 5.6%, current 3.4%). In contrast, referring to admission diagnoses taken from patients' charts only 3.8% of the inpatients were diagnosed with any current ICD. Individuals with comorbid ICD were significantly younger and had more admission diagnoses other than ICD. The results suggest high rates of ICDs among psychiatric inpatients that remain to be under-diagnosed in clinical routine. 2011 Elsevier Ireland Ltd. All rights reserved.
Jain, Umang; Salgado, Christopher; Mioton, Lauren; Rambachan, Aksharananda
Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; Pplastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations. PMID:24665418
Nijman, H.; Bowers, L.; Oud, N.; Jansen, G.
Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this "Perceptions of Prevalence Of Aggression Scale" (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff
However, professionals who are part of a multi-professional team need to be suitably skilled and prepared to meet the needs of the adolescent. Professionals working in therapy programmes for adolescents should have certain personal attributes that make them suitable for working with adolescents. An adolescent inpatient ...
Full Text Available Purpose: compare indicators of testing tourist skiers at different stages of the preparatory period to ski sports hike of third grade. Determine the effectiveness of training programs created to the tourists Categorical ski sports to prevent injuries and accidents in a limited time. Material: The study involved 13 people aged from 21 to 65 (4 women and 9 men with different experiences of hiking trails and various levels of total tourist preparedness. Results: The test results obtained before beginning the process of preparation are treated upon its completion, and immediately after passing categorical hike. In practice, the effectiveness of the proposed training programs of tourists to ski sports tours is proved. Conclusions : The created program can be recommended to tourist clubs, associations and organizations as the base in preparation for ski sports campaigns for the prevention of accidents and injuries.
Full Text Available Out of the total wind turbine failure events, blade damage accounts for a substantial part, with some studies estimating it at around 23%. Current operation and maintenance (O&M practices typically make use of corrective type maintenance as the basic approach, implying high costs for repair and replacement activities as well as large revenue losses, mainly in the case of offshore wind farms. The recent development and evolution of condition monitoring techniques, as well as the fact that an increasing number of installed turbines are equipped with online monitoring systems, offers a large amount of information on the blades structural health to the decision maker. Further, inspections of the blades are often performed in connection with service. In light of the obtained information, a preventive type of maintenance becomes feasible, with the potential of predicting the blades remaining life to support O&M decisions for avoiding major failure events. The present paper presents a fracture mechanics based model for estimating the remaining life of a wind turbine blade, focusing on the crack propagation in the blades adhesive joints. A generic crack propagation model is built in Matlab based on a Paris law approach. The model is used within a risk-based maintenance decision framework to optimize maintenance planning for the blades lifetime.
Full Text Available Global increases in obesity have led public health experts to declare this disease a pandemic. Although prevalent in all ages, the dire consequences associated with maternal obesity have a pronounced impact on the long-term health of their children as a result of the intergenerational effects of developmental programming. Previously, fetal under-nutrition has been linked to the predisposition to pediatric obesity explained by the adiposity rebound and ‘catch-up’ growth that occurs when a child born to a nutrient deprived mother is exposed to the obesogenic environment of present day. Given the recent increase in maternal overweight/obesity (OW/OB our attention has shifted from nutrient restriction to overabundance and excess during pregnancy. Consideration must now be given to interventions that could mitigate pregravid body mass index (BMI, attenuate gestational weight gain (GWG and reduce postpartum weight retention (PPWR in an attempt to prevent the downstream signaling of pediatric obesity and halt the intergenerational cycle of weight related disease currently plaguing our world. Thus, this paper will briefly review current research that best highlights the proposed mechanisms responsible for the development of child OW/OB and related sequalae (e.g. type II diabetes (T2D and cardiovascular disease (CVD resulting from maternal obesity.
Full Text Available Global increases in obesity have led public health experts to declare this disease a pandemic. Although prevalent in all ages, the dire consequences associated with maternal obesity have a pronounced impact on the long-term health of their children as a result of the intergenerational effects of developmental programming. Previously, fetal under-nutrition has been linked to the predisposition to pediatric obesity explained by the adiposity rebound and ‘catch-up’ growth that occurs when a child born to a nutrient deprived mother is exposed to the obesogenic environment of present day. Given the recent increase in maternal overweight/obesity (OW/OB our attention has shifted from nutrient restriction to overabundance and excess during pregnancy. Consideration must now be given to interventions that could mitigate pregravid body mass index (BMI, attenuate gestational weight gain (GWG and reduce postpartum weight retention (PPWR in an attempt to prevent the downstream signaling of pediatric obesity and halt the intergenerational cycle of weight related disease currently plaguing our world. Thus, this paper will briefly review current research that best highlights the proposed mechanisms responsible for the development of child OW/OB and related sequalae (e.g. type II diabetes (T2D and cardiovascular disease (CVD resulting from maternal obesity.
Rishoej, Rikke Mie; Almarsdóttir, Anna Birna; Christesen, Henrik Thybo
The aim was to describe medication errors (MEs) in hospitalized children reported to the national mandatory reporting and learning system, the Danish Patient Safety Database (DPSD). MEs were extracted from DPSD from the 5-year period of 2010–2014. We included reports from public hospitals...... on patients aged 0–17 years and categorized by reporters as medication-related. Reports from psychiatric wards and outpatient clinics were excluded. A ME was defined as any medication-related error occurring in the medication process whether harmful or not. MEs were categorized as harmful if they resulted...... in actual harm or interventions to prevent harm. MEs were further categorized according to occurrence in the medication process, type of error, and the medicines involved. A total of 2071 MEs including 487 harmful MEs were identified. Most MEs occurred during prescribing (40.8%), followed by dispensing (38...
Rhea, Sarah; Ising, Amy; Fleischauer, Aaron T; Deyneka, Lana; Vaughan-Batten, Heather; Waller, Anna
Timely public health interventions reduce heat-related illnesses (HRIs). HRI emergency department (ED) visit data provide near real-time morbidity information to local and state public health practitioners and may be useful in directing HRI prevention efforts. This study examined statewide HRI ED visits in North Carolina (NC) from 2008-2010 by age group, month, ED disposition, chief complaint, and triage notes. The mean number of HRI ED visits per day was compared to the maximum daily temperature. The percentage of HRI ED visits to all ED visits was highest in June (0.25%). 15-18 year-olds had the highest percentage of HRI visits and were often seen for sports-related heat exposures. Work-related HRI ED visits were more common than other causes in 19-45 year-olds. Individuals ≥65 years were more likely admitted to the hospital than younger individuals. The mean daily number of HRI ED visits increased by 1.4 for each 1°F (degree Fahrenheit) increase from 90°F to 98°F and by 15.8 for each 1°F increase from 98°F to 100°F. Results indicate that HRI prevention efforts in NC should be emphasized in early summer and targeted to adolescents involved in organized sports, young adults with outdoor occupations, and seniors. At a maximum daily temperature of 98°F, there was a substantial increase in the average daily number of HRI ED visits. ED visit data provide timely, sentinel HRI information. Analysis of this near real-time morbidity data may assist local and state public health practitioners in identification of HRI prevention strategies that are especially relevant to their jurisdictions.
cost PC , the inspection cost IC and an expected variable cost EVC [2, 32]. These costs are a function of quality and reliability. The lifecycle...expected variable cost EVC is a function of the time- dependent reliability which is used to estimate the expected present value of repairing and/or
Hatcher, Daniel W.; FitzSimons, Crystal Weedall; Turley, Jill R.
One in three children in this country is overweight or obese. One in five children lives in food-insecure households that struggle to put food on the table. Both problems affect millions of children. Both can occur in the same child at the same time. Both are linked to poor academic performance, behavior problems, and high rates of school…
Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L
Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK). Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare.
Full Text Available Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020, previous percutaneous coronary intervention (PCI (OR, 2.69; CI, 1.21-5.97; P=0.015, hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001, bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046, American Society of Anesthesiologists (ASA class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004, and obesity (body mass index ≥30 (OR, 1.43; CI, 1.09-1.88, P=0.011 to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.
West, Emily; Pasman, H Roeline; Galesloot, Cilia; Lokker, Martine Elizabeth; Onwuteaka-Philipsen, Bregje
Ten percent of non-sudden deaths in the Netherlands occur in inpatient hospice facilities. To investigate differences between patients who are admitted to inpatient hospice care or not following application, how diagnoses compare to the national population, characteristics of application, and associations with being admitted to inpatient hospice care or not. Data from a database representing over 25% of inpatient hospice facilities in the Netherlands were analysed. The study period spanned the years 2007-2012. Multivariate regression analyses were performed to study associations between demographic and application characteristics, and admittance. Ten thousand two hundred fifty-four patients were included. 84.1% of patients applying for inpatient hospice care had cancer compared to 37.0% of deaths nationally. 52.4% of applicants resided in hospital at the time of admission. Most frequent reasons for application were the wish to die in an inpatient hospice facility (70.5%), needing intensive care or support (52.2 ), relieving caregivers (41.4%) and needing pain/symptom control (39.9%). Living alone (OR 1.68, 95% CI 1.46-1.94), having cancer (OR 1.40, 95% CI 1.11-1.76), relieving caregivers (OR 1.18, 95% CI 1.01-1.38), needing pain/symptom control (OR1.72, 95% CI 1.46-2.03) wanting inpatient hospice care until death (vs respite care) (OR 3.59, 95% CI 2.11-6.10), wanting to be admitted as soon as possible (OR 1.64, 95% CI 1.42-1.88), and being referred by a primary care professional (OR 1.36, 95% CI 1.17-1.59) were positively associated with being admitted. Wishing to die in an inpatient hospice facility was negatively associated with being admitted (OR 0.85, 95% CI 0.72-1.00). This study suggests that when applying for inpatient hospice care, patients who seem most urgently in need of inpatient hospice care are more frequently admitted. However, non-cancer patients seem to be an under-represented population. Staff should consider application based on need for
... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital tests. 441.12 Section 441.12... General Provisions § 441.12 Inpatient hospital tests. Except in an emergency situation (see § 440.170(e)(1) of this chapter for definition), FFP is not available in expenditures for inpatient hospital tests...
Scherrer, B; Andrieu, S; Ousset, P J; Berrut, G; Dartigues, J F; Dubois, B; Pasquier, F; Piette, F; Robert, P; Touchon, J; Garnier, P; Mathiex-Fortunet, H; Vellas, B
Time-to-event analysis is frequently used in medical research to investigate potential disease-modifying treatments in neurodegenerative diseases. Potential treatment effects are generally evaluated using the logrank test, which has optimal power and sensitivity when the treatment effect (hazard ratio) is constant over time. However, there is generally no prior information as to how the hazard ratio for the event of interest actually evolves. In these cases, the logrank test is not necessarily the most appropriate to use. When the hazard ratio is expected to decrease or increase over time, alternative statistical tests such as the Fleming-Harrington test, provide a better sensitivity. An example of this comes from a large, five-year randomised, placebo-controlled prevention trial (GuidAge) in 2854 community-based subjects making spontaneous memory complaints to their family physicians, which evaluated whether treatment with EGb761 can modify the risk of developing AD. The primary outcome measure was the time to conversion from memory complaint to Alzheimer's type dementia. Although there was no significant difference in the hazard function of conversion between the two treatment groups according to the preplanned logrank test, a significant treatment-by-time interaction for the incidence of AD was observed in a protocol-specified subgroup analysis, suggesting that the hazard ratio is not constant over time. For this reason, additional post hoc analyses were performed using the Fleming-Harrington test to evaluate whether there was a signal of a late effect of EGb761. Applying the Fleming-Harrington test, the hazard function for conversion to dementia in the placebo group was significantly different from that in the EGb761 treatment group (p = 0.0054), suggesting a late effect of EGb761. Since this was a post hoc analysis, no definitive conclusions can be drawn as to the effectiveness of the treatment. This post hoc analysis illustrates the interest of performing
Medrano, María José; Alcalde-Cabero, Enrique; Ortíz, Cristina; Galán, Iñaki
To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain. Ecological time series analysis, 1982-2009. All public and private hospitals in Spain. General population. Incident coronary disease hospitalisation as derived from official hospital discharge data. Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units. Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (pstress on excessive body weight prevention.
Shah Nita H.
Full Text Available Economic production quantity (EPQ model has been analyzed for trended demand, and units in inventory are subject to constant rate. The system allows rework of imperfect units, and preventive maintenance time is random. A search method is used to study the model. The proposed methodology is validated by a numerical example. The sensitivity analysis is carried out to determine the critical model parameters. It is observed that the rate of change of demand, and the deterioration rate have a significant impact on the decision variables and the total cost of an inventory system. The model is highly sensitive to the production and demand rate.
SAF, HACI HASAN
The modernism-based 20th century politics which has been affecting the communities for long periods of time uncontrollably, has turned that communities into risk societies in the 21st century. And it has been one of the major problems of the goverments to control and monitor the social outbursts and movements in those risk societies. In this work; through the the example of the coup attempt of July 15th which gained momentum and turned out to be a major&...
Debes, Amanda K; Ali, Mohammad; Azman, Andrew S; Yunus, Mohammad; Sack, David A
: Cholera remains a serious public health threat in Asia, Africa and in parts of the Americas. Three World health Organization (WHO) pre-qualified oral cholera vaccines are now available but their supply is limited, so current supplies must be administered strategically. This requires an improved understanding of disease transmission and control strategies. : We used demographics and disease surveillance data collected from 1991 to 2000 in Matlab, Bangladesh, to estimate the spatial and temporal extent of the zone of increased risk around cholera cases. Specifically, we compare the cholera incidence among individuals living close to cholera cases with that among individuals living close to those without medically-attended cholera in this rural endemic setting. : Those living within 50 m of a confirmed cholera case had 36 times (95% confidence interval: 23-56) the risk of becoming a cholera case in the first 3 days (after case presentation) compared with risk elsewhere in the community. The relative risk gradually declined in space and time, but remained significantly high up to 450 me away within 3 days of case presentation, and up to 150 m away within 23 days from the date of presentation of the case. : These findings suggest that, if conducted rapidly, vaccinating individuals living close to a case (ring vaccination) could be an efficient and effective strategy to target vaccine to a high-risk population in an endemic setting. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association
Lanzillo, Elizabeth C.; Esposito, Erika C.; Santee, Angela C.; Nock, Matthew K.; Auerbach, Randy P.
Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N = 106; 82.1 % female) and inpatient (N = 174; 75.9 % female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6–12 months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury. PMID:27761783
Mackeen, A Dhanya; Packard, Roger E; Ota, Erika; Berghella, Vincenzo; Baxter, Jason K
Given the continued rise in cesarean birth rate and the increased risk of surgical site infections after cesarean birth compared with vaginal birth, effective interventions must be established for prevention of surgical site infections. Prophylactic intravenous (IV) antibiotic administration 60 minutes prior to skin incision is recommended for abdominal gynecologic surgery; however, administration of prophylactic antibiotics has traditionally been withheld until after neonatal umbilical cord clamping during cesarean delivery due to the concern for potential transfer of antibiotics to the neonate. To compare the effects of cesarean antibiotic prophylaxis administered preoperatively versus after neonatal cord clamp on postoperative infectious complications for both the mother and the neonate. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2014) and reference lists of retrieved papers. Randomized controlled trials (RCTs) comparing maternal and neonatal outcomes following prophylactic antibiotics administered prior to skin incision versus after neonatal cord clamping during cesarean delivery. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCT and trials using a cross-over design were not eligible for inclusion in this review. Studies published in abstract form only were eligible for inclusion if sufficient information was available in the report. At least two review authors independently assessed the studies for inclusion, assessed risk of bias, abstracted data and checked entries for accuracy. We assessed the quality of evidence using the GRADE approach. We included 10 studies (12 trial reports) from which 5041 women contributed data for the primary outcome. The overall risk of bias was low.When comparing prophylactic intravenous (IV) antibiotic administration in women undergoing cesarean delivery, there was a reduction in composite maternal infectious morbidity (risk ratio (RR) 0.57, 95% confidence
Day, E; Ison, J; Strang, J
There are a complex range of variables that can influence the course and subjective severity of opioid withdrawal. There is a growing evidence for the effectiveness of a range of medically-supported detoxification strategies, but little attention has been paid to the influence of the setting in which the process takes place. To evaluate the effectiveness of any inpatient opioid detoxification programme when compared with all other time-limited detoxification programmes on the level of completion of detoxification, the intensity and duration of withdrawal symptoms, the nature and incidence of adverse effects, the level of engagement in further treatment post-detoxification, and the rates of relapse post-detoxification. Electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 3, 2004); MEDLINE (January 1966-March 2004); EMBASE (January 1988-March 2004); PsycInfo (January 1967-March 2004); CINAHL (January 1982-March 2004). In addition the Current Contents, Biological Abstracts, Science Citation Index and Social Sciences Index were searched. Randomised controlled clinical trials comparing inpatient opioid detoxification (any drug or psychosocial therapy) with other time-limited detoxification programmes (including residential units that are not staffed 24 hours per day, day-care facilities where the patient is not resident for 24 hours per day, and outpatient or ambulatory programmes, and using any drug or psychosocial therapy). All abstracts were independently inspected by two reviewers (ED & JI) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria. Only one study met the inclusion criteria. This did not explicitly report the number of participants in each group that successfully completed the detoxification process, but the published data allowed us to deduce that 7 out of 10 (70%) in the inpatient detoxification group were opioid-free on discharge
Deisenhammer, Eberhard A; Behrndt, Elisa-Marie; Kemmler, Georg; Haring, Christian; Miller, Carl
Time of in-patient treatment and the first weeks after hospital discharge have repeatedly been described as periods of increased suicide risk. This study compared demographic, clinical and suicide related factors between in-patient, post-discharge and not recently hospitalized suicides. Suicide data from the Tyrol Suicide Register were linked with registers of three psychiatric hospitals in the state of Tyrol, Austria. Suicide cases then were categorized as in-patient suicides, post-discharge suicides (suicide within 12weeks after discharge) or never/not within 12weeks before death hospitalized suicides. Data were collected between 2004 and 2011. Of the total of 711 cases, 30 were in-patient, 89 post-discharge and 592 not recently hospitalized suicides. The three groups differed with regard to male-to-female ratio (lower in both hospitalized groups), marital status, suicide method used (jumping in in-patients, hanging in not recently hospitalized suicides), history of attempted suicide and suicide threats (highest in in-patients) and whether suicides had been in psychiatric or general practitioner treatment shortly before death. In most variables with significant differences there was a gradual increase/decrease with post-discharge suicides taking the middle place between the two other groups. The three suicide populations differed in a number of variables. Varying factors appear to influence suicide risk and choice of method differently in in-patient, post-discharge and not hospitalized suicides. Copyright © 2016 Elsevier Inc. All rights reserved.
Noordin, S.; Masri, B. A.
Objective: To compare the pattern of adult inpatient orthopaedic injuries admitted at three Vancouver hospitals following one of the worst winter snowstorms in the region with the preceding control winter period. Methods: The surveillance study was conducted at the University of British Columbia, Vancouver, Canada, 2007 to 2010. Inpatient adult admissions for orthopaedic injuries at three hospitals were recorded, including age, gender, anatomic location of injury, type of fracture (open or closed), fixation method (internal versus external fixation), and length of acute care hospital stay. Comparisons between admissions during this weather pattern and admission during a previous winter with minimal snow were made. SPSS 19 was used for statistical analysis. Results: Of the 511 patients admitted under Orthopaedic trauma service during the significant winter snowstorms of December 2008 - January 2009, 100 (19.6%) (CI: 16.2%-23.2%) were due to ice and snow, whereas in the preceding mild winter only 18 of 415 (4.3%) (CI: 2.5%-6.8%) cases were related to snow (p<0.05). Ankle and wrist fractures were the most frequent injuries during the index snow storm period (p<0.05). At all the three institutions, 97 (96.5%) fractures were closed during the snowstorm as opposed to 17 (95%) during the control winter period. Internal fixation in 06 (89%) fractures as opposed to external fixation in 12 (11%) patients was the predominant mode of fixation across the board during both time periods. Conclusion: The study demonstrated a significantly higher inpatient orthopaedic trauma volume during the snowstorm more rigorous prospective studies need to be designed to gain further insight to solving these problems from a public health perspective. (author)
Aquilina, T; Thompson, S M; Metcalfe, K H M; Hughes, H; Sinclair, L; Batt, F
To examine older inpatients' experiences with medical student education, their views on future interactions, and to seek their opinion on the most important curricular topics related to geriatric medicine. The study involved 112 non-confused inpatients older than 65 years of age, who completed a uniformed questionnaire on the day of their discharge from a teaching hospital. The mean age was 81 years, with equal number of male and female participants. 57% interacted with the students during their admission, the majority being interviewed and examined. Almost all (92%) of these patients described their experience as positive, some described it as time-consuming (23%), repetitive (19%) and tiresome (9%). 92% of all participants agreed that the older patients should be part of medical students' education. Dementia, cardiac conditions, cancer, arthritis, isolation/loneliness were highlighted as the most important topics to teach medical students related to geriatric medicine, while patience and listening were listed as important skills. They suggested practical, easily implemented advice for the improvement of the interaction between students and older patients; including allowing more time for interactions and for students to speak louder. Older patients felt positively about their interactions with medical students, and believed that older patients should be involved in medical student education. As well as medical conditions such as dementia, cardiac disease and cancer, these patients highlighted isolation and loneliness as important topics for undergraduate geriatric medical education, implying that students should learn about broader aspects of older patients' health and wellbeing.
Fathi-Ashtiani, Ali; Ahmadi, Ahmad; Ghobari-Bonab, Bagher; Azizi, Mohammed Parsa; Saheb-Alzamani, Sayeh Moosavi
The current study was conducted to examine the effect of cognitive behavior therapy on the reduction postpartum mood disorder and increasing the self-esteem of at-risk Iranian mothers. In this quasi-experimental study, 135 at-risk mothers were selected from the population by means of cluster sampling and randomly assigned into one of two groups: Intervention (n = 64), or control (n = 71). The control group received usual medical care, and the intervention group received an eight sessions' cognitive behavior program during pregnancy. Assessments were administered at two time points (pretest at the beginning of the third trimester and posttest at 2 weeks postpartum). Beck anxiety, beck depression, Edinburgh postpartum depression, (PPD) Coopersmith self-esteem, and religious attitude questionnaire were used to collect data. The mean age of participants was 25.8 ± 3.7 years. One-third of them had either bachelor or higher degrees in education (33%). About two-third of participants were unemployment with similar distribution in both the groups (intervention = 80%, control = 83%). The majority (70%) of the participants had cesarean section deliveries. There were no statistically significant differences respects to sociodemographic characteristics between the control and intervention groups (P > 0.05). The multivariate analysis of covariance results showed that the average scores of PPD were reduced significantly in the intervention group (P self-esteem increased from 29.09 (SE = 3.51) to 31.81 (SE = 2.76), no change was statistically significant in comparison to the control group. According to the findings of the present study, cognitive behavior intervention is effective in reducing PPD in at-risk mothers.
Thomsen, Christoffer; Starkopf, Liis; Hastrup, Lene Halling
PURPOSE: Reducing the use of coercion among patients with mental disorders has long been a political priority. However, risk factors for coercive measures have primarily been investigated in smaller studies. To reduce the use of coercion, it is crucial to identify people at risk which we aim to do...... in this first large-scale study. METHODS: A cohort study was conducted among all psychiatric inpatients in Denmark, following 112,233 individuals during 1999-2014. Data from Danish registers were analysed using logistic regression for repeated measures. RESULTS: 24,594 inpatients were exposed to a coercive...... measure (21.9%). Clinical characteristics were the foremost predictors of coercion and patients with organic mental disorder had the highest increased risk of being subjected to a coercive measure (OR = 5.56; 95% CI = 5.04, 6.14). The risk of coercion was the highest in the first admission and decreased...
Fletcher, Teresa M; Markley, Laura A; Nelson, Dana; Crane, Stephen S; Fitzgibbon, James J
To assess patient outcomes and describe demographic data of pregnant adolescents admitted to an inpatient child and adolescent psychiatric unit, as well as to determine if it is safe to continue to admit pregnant adolescents to such a unit. A descriptive retrospective chart review conducted at a free-standing pediatric hospital in northeast Ohio of all pregnant adolescents aged 13 to 17 years admitted to the inpatient child and adolescent psychiatric unit from July 2005 to April 2013. Data collection included details on demographic, pregnancy status, and psychiatric diagnoses. Eighteen pregnant adolescents were admitted to the psychiatric unit during the time frame. Sixteen of those were in the first trimester of pregnancy. Pregnancy was found to be a contributing factor to the adolescent's suicidal ideation and admission in 11 of the cases. Admission to an inpatient psychiatric facility did not lead to adverse effects in pregnancy. Pregnant adolescents did not have negative pregnancy outcomes related to admission to an inpatient psychiatric unit. Results of this study suggest that it is safe to continue to admit uncomplicated pregnant adolescents in their first trimester to an inpatient child and adolescent psychiatric unit for an acute stay. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Hase, J; Hartmann, T; Oppermann, H; Wahl, G
The aim of this study is to present data concerning children's participation in the German preventive medical examinations for children ("U2" to "U8") in accordance with sections 26 and 92 of the German Social Code (Book V) as retrospectively recorded by the Public Health Service ("Öffentlicher Gesundheitsdienst") of the German Province of Saxony-Anhalt during school entry medical examinations. Also we wanted to analyse the additional variables recorded per child in the areas of social factors, diagnostic findings and levels of therapeutic care in connection with their degree of participation in the preventive medical examinations. The statistical analysis of 73 628 anonymised data sets from the health monitoring system of the German Province of Saxony-Anhalt that were collected by the 14 health authorities in Saxony-Anhalt during school entry medical examinations between 2008 and 2012. An analysis of the data for 20 variables per child was performed with regard to the influence of their degree of participation in the U2 to U8 medical examinations using differences in frequency in the examination groups and checking the significance of these differences by means of the chi-squared test. 99-96% of children in Saxony-Anhalt underwent the 5 preventive medical examinations U2-U6. As the children get older, the participation rates decrease (U2=98.7% down to U8=88.5%). By the time the school entry medical examinations are carried out (at an average age of 63 months), 83% of the children have -undergone all 7 preventive medical examinations for children, while 0.4% have not -undergone one single "U" examination. A child's gender has no influence on its parents' decision as to whether or not it should undergo the examinations. The results also reveal that children who attend day care -facilities are significantly more likely to have undergone all of the U examinations (84.8%) than children who are cared for at home (55.1%). The retrospective comprehensive collection of
Tyler, Amy; McLeod, Lisa; Beaty, Brenda; Juarez-Colunga, Elizabeth; Birkholz, Meghan; Hyman, Daniel; Kempe, Allison; Todd, James; Dempsey, Amanda F
Croup is a clinical diagnosis, and the available evidence suggests that, except in rare cases, ancillary testing, such as radiologic imaging, is not helpful. Given the paucity of inpatient-specific evidence for croup care, we hypothesized that there would be marked variability in the use of not routinely indicated resources (NRIRs). Our primary study objective was to describe the variation and predictors of variation in the use of NRIRs. This was a retrospective cohort study that used the Pediatric Health Information System database of generally healthy inpatients with croup aged 6 months to 15 years who were admitted between January 1, 2012 and September 30, 2014. We measured variability in the use of NRIRs: chest and lateral neck radiographs, viral testing, parenteral steroids, and antibiotics. Risk-adjusted analysis was used to compare resource utilization adjusted for hospital-specific effects and average case mix. The cohort included 26 hospitals and 6236 patients with a median age of 18 months. Nine percent of patients required intensive care services, and 3% had a 30-day readmission for croup. We found marked variability in adjusted and unadjusted utilization across hospitals for all resources. In the risk-adjusted analysis, hospital-specific effects rather than patient characteristics were the main predictor of variability in the use of NRIRs. We observed an up to fivefold difference in NRIR utilization attributable to hospital-level practice variability in inpatient croup care. This study highlights a need for inpatient-specific evidence and quality-improvement interventions to reduce unnecessary utilization and to improve patient outcomes. Copyright © 2017 by the American Academy of Pediatrics.
Evans, R W; Ruff, R M; Braff, D L; Ainsworth, T L
MMPI (Form R) profiles of psychiatric inpatients (N = 45) meeting DSM-III criteria for borderline personality disorder were compared with chronic schizophrenic inpatients (N = 48) and with inpatients with acute psychotic illness (N = 20). Profile shape was similar among the three groups, although the borderline sample showed significantly higher elevations on four of the 10 clinical scales--Depression, Hysteria, Psychopathic Deviate, and Psychasthenia--when compared to the chronic schizophrenic cohorts. The borderline sample showed only one significant deviation on the clinical scales when compared to the acute psychotic sample as evidenced by a higher elevation on the Psychopathic Deviate scale. Clinically, the borderline MMPI responses suggest features of irritability, hostility, and resentfulness. On the validity scales, the borderline sample showed a significantly lower score on the L scale when compared to both comparison groups, although all of the groups' L scale scores were within conventional limits. While significant differences between groups did not emerge on the F scale, the borderline sample attained a clinically elevated score suggestive of weakened ego defenses and unconventional thinking. Analysis was also performed of a composite measure of psychoticism probability (the Goldberg Index) between groups. While the borderline and acute psychotic samples showed Goldberg indices suggestive of increasing likelihood for psychotic illness, the chronic schizophrenic group yielded a Goldberg Index significantly greater than both of the other groups, thus confirming the validity of the hypothesis. Finally, the MMPI borderline profiles were also compared to previously published norms of borderline outpatients and veteran borderline inpatients.(ABSTRACT TRUNCATED AT 250 WORDS)
Kreisel, Stefan H; Blahak, Christian; Bäzner, Hansjörg; Hennerici, Michael G
Causal experimental evidence that physical activity prevents disability in older people is sparse. Being physically active has nonetheless been shown to be associated with disability-free survival in observational studies. Observational studies are, however, prone to bias introduced by time-dependent confounding. Time-dependent confounding occurs when an exposure (e.g. being physically active at some time-point) potentially affects the future status of a confounder (such as depression sometime later), and both variables have an effect on latter outcome (i.e. disability). "Conventional" analysis with e.g. Cox-regression is the mainstay when analyzing longitudinal observational studies. Unfortunately, it does not provide unbiased estimates in the presence of time-dependent confounding. Marginal structural models (MSM) - a relatively new class of causal models - have the potential to adequately account for time-dependent confounding. Here we analyze the effect of older people being physically active on disability, in a large long-term observational study. We address time-dependent confounding by using marginal structural models and provide a non-technical practical demonstration of how to implement this type of modeling. Data is from 639 elderly individuals ascertained in the European multi-center Leukoaraiosis and Disability study (LADIS), followed-up yearly over a period of three years. We estimated the effect of self-reported physical activity on the probability to transit to instrumental disability in the presence of a large set of potential confounders. We compare the results of "conventional" modeling approaches to those estimated using marginal structural models, highlighting discrepancies. A "conventional" Cox-regression-like adjustment for salient baseline confounders signals a significant risk reduction under physical activity for later instrumental disability (OR 0.62, 95% CI 0.44-0.90). However, given MSM estimation, the effect is attenuated towards null
Kullberg, Anna; Sharp, Lena; Johansson, Hemming; Bergenmar, Mia
This prospective pilot study aimed to investigate patients' perception of information exchange and its associations with patient satisfaction, participation and safety at inpatient oncology wards. Consecutive patients with cancer who spent ≥3 days at an oncological inpatient ward at the Department of Oncology, Karolinska University Hospital during the study period (March-August 2013) were invited to respond to EORTC-INPATSAT32 measuring patient satisfaction and a study specific questionnaire. Data on changes in medication and fall risk assessments was collected from the patients' electronic health records. A total of 104 patients (58%) participated in the study. Patients rated doctors' and nurses' information provision lower than their technical and interpersonal skills, and 13% considered the information exchange "excellent". Changes in medication were registered for 83% of participating patients, which 56% of the patients were aware of. Fall risk assessment was registered for 73% of responding patients, and 39% reported having discussed risk of falling during the hospital stay. The Downton Fall Risk Index scores were not associated with actual falls or fall prevention actions. Deficits were found on information exchange and information provision between health care professionals and patients. This might have a negative impact on known patient safety risks such as medication errors and falls. More effective strategies to perform fall risk assessments in an oncological inpatient setting are needed. Further studies evaluating interventions to improve participation and information exchange are necessary to increase patient satisfaction, participation and safety in oncological inpatient care. Copyright © 2014 Elsevier Ltd. All rights reserved.
Wen, Timothy; Attenello, Frank J; Wu, Brian; Ng, Alvin; Cen, Steven Y; Mack, William J
Prior studies examining the impact of the "July effect" on in-hospital mortality rates have generated variable results. In 2008, the Centers for Medicare & Medicaid Services published a series of high-cost, high-volume, nonreimbursable hospital-acquired complications (HACs). These events were believed to be preventable and indicate deficiencies in healthcare delivery. The present study aims to investigate the impact of July admissions on patient safety in a national sample using the HACs as a metric. Discharge data were collected from all admissions recorded in the Nationwide Inpatient Sample database from 2008 to 2011. HAC incidence was evaluated as a function of admission month, adjusting for demographic and hospital factors in multivariable analysis. The outcome measures were HAC occurrence, prolonged length of stay (LOS), and higher inpatient costs. A total of 143,019,381 inpatient admissions were recorded, with an overall HAC occurrence of 4.7%. July admissions accounted for 7.6% of the total number of inpatient admissions. July admissions experienced a 6% increase in likelihood of HAC occurrence (odds ratio = 1.06, 95% confidence interval: 1.06-1.07, P organization structure distinct from traditional quality measures, requiring novel transition protocols dedicated to improving HACs. © 2015 Society of Hospital Medicine.
Bellanti, Dawn; Sakallaris, Bonnie R.
In order to understand a patient’s healing experience it is essential to understand the elements that they, the patient, believes contributed to their healing. Previous research has focused on symptom reducers or contributors through environment such as stress. A person’s experience of healing happens over time not instantaneous. Therefore, in this study, the interviews with patients happened after forty-eight hours of hospitalization. This mixed methods study describes the experiences of seventeen inpatients from two healthcare systems using a phenomenological approach combined with evidence based design evaluation methods to document the setting. The qualitative data was analyzed first for reoccurring themes then further explored and defined through quantitative environmental observations. The seventeen patients defined healing as “getting better/well.” Seventy three statements were recorded about contributors and detractors to healing in the physical environment. Three primary themes emerged from the data as positive influencers of a healing experience: being cared for, being comfortable and experiencing something familiar or like home. These results demonstrate that patients perceive their inpatient healing experience through a supported environment. PMID:28725848
Lorissa MacAllister PhD, AIA
Full Text Available In order to understand a patient’s healing experience it is essential to understand the elements that they, the patient, believes contributed to their healing. Previous research has focused on symptom reducers or contributors through environment such as stress. A person’s experience of healing happens over time not instantaneous. Therefore, in this study, the interviews with patients happened after forty-eight hours of hospitalization. This mixed methods study describes the experiences of seventeen inpatients from two healthcare systems using a phenomenological approach combined with evidence based design evaluation methods to document the setting. The qualitative data was analyzed first for reoccurring themes then further explored and defined through quantitative environmental observations. The seventeen patients defined healing as “getting better/well.” Seventy three statements were recorded about contributors and detractors to healing in the physical environment. Three primary themes emerged from the data as positive influencers of a healing experience: being cared for, being comfortable and experiencing something familiar or like home. These results demonstrate that patients perceive their inpatient healing experience through a supported environment.
Kimhy, David; Vakhrusheva, Julia; Liu, Ying; Wang, Yuanjia
Mobile electronic devices (i.e., PDAs, cellphones) have been used successfully as part of research studies of individuals with severe mental illness living in the community. More recently, efforts have been made to incorporate such technologies into outpatient treatments. However, few attempts have been made to date to employ such mobile devices among hospitalized psychiatric patients. In this article, we evaluate the potential use of such devices in inpatient psychiatric settings using 33 hospitalized patients with schizophrenia. Employing an Experience Sampling Method approach, we provide support for the feasibility of using such devices, along with examples of potentially clinically-relevant information that can be obtained using such technologies, including assessment of fluctuations in the severity of psychotic symptoms and negative mood in relation to social context, unit location, and time of day. Following these examples, we discuss issues related to the potential use of mobile electronic devices by patients hospitalized at inpatient psychiatric settings including issues related to patients' compliance, assessment schedules, questionnaire development, confidentiality issues, as well as selection of appropriate software/hardware. Finally, we delineate some issues and areas of inquiry requiring additional research and development. Copyright © 2014 Elsevier B.V. All rights reserved.
Kaufman, Darren S
Effective care of each patient throughout a hospital admission involves executing a specific set of tasks to produce a favorable outcome within an appropriate time frame. The ProjectRounds methodology, which can be implemented using widely available software, incorporates the principles of project management in planning and control hospital inpatient care. It consists of four stages--clinical assessment, planning, scheduling, and tracking. OVERVIEW OF PROJECTROUNDS AND EXAMPLE: As an example, a 68-year-old-man is admitted with pneumonia. In clinical assessment, the admitting physician uses an assessment tool that prompts her to list all the patient's clinical issues, define the conditions that need to be met to discharge the patient, highlight special problems, and list any consultations, diagnostic tests, and procedures that are planned. In planning, the work breakdown structure--a tabulation of all the tasks in the "project" (the admission)--is created. In scheduling, a project schedule is generated, and in tracking, the clinical team evaluates and monitors the project's course. During interdisciplinary clinical rounds, the progress of the patient's hospital care can be tracked and quantified by employing the percent complete method. Tracking can be used as a "dashboard," providing a concise summary of the care that needs to be and has been rendered to the patient. Applying the tenets of project management can optimize the process of providing health care to hospital inpatients.
James, Anthony; Clacey, Joe; Seagroatt, Valerie; Goldacre, Michael
Background: Adolescence is a time of very rapid change not only in physical but also psychological development. During the teenage years there is a reported rise in the prevalence of psychiatric disorders. The aim of this study was to investigate age- and sex-specific National Health Service (NHS) hospital inpatient admission rates for psychiatric…
Mirkowski, Magdalena; Pereira, Shelialah; Janzen, Shannon; Mehta, Swati; Meyer, Matthew; McClure, Andrew; Speechley, Mark; Teasell, Robert
To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke. A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates. Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8 ± 23.6 versus 72.9 ± 20.3; p availability explained 1.3% of additional variance, with the final model explaining 41.3% of total variance for functional ability at discharge (F (5,174) = 26.21, p availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke. The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.
Kocher, Walter M.
Pollution prevention (P2) opportunities and Greening the Government (GtG) activities, including the development of the Real-Time Environmental Monitoring System (RTEMS), are currently under development at the NASA Glenn Research Center. The RTEMS project entails the ongoing development of a monitoring system which includes sensors, instruments, computer hardware and software, plus a data telemetry system.Professor Kocher has been directing the RTEMS project for more than 3 years, and the implementation of the prototype system at GRC will be a major portion of his summer effort. This prototype will provide mulitmedia environmental monitoring and control capabilities, although water quality and air emissions will be the immediate issues addressed this summer. Applications beyond those currently identified for environmental purposes will also be explored.
Luciano Passamani Diogo
Full Text Available Introduction: Contrast induced nephropathy (CIN is one of the complications of the use of intravascular contrast agents, being defined as a reduction of the glomerular filtration rate caused by the iodinated contrast. Most CIN data derive from the cardiovascular literature, which identified as the most consistent risk factors pre-existing chronic renal insufficiency and diabetes mellitus. However, these studies limit their conclusions to a more specific patient population. Computerized tomography as a cause of CIN has been studied less often. Objective: To report on the incidence of computerized tomography contrast induced nephropathy (CIN in an inpatient population of a tertiary general hospital, identifying potentially avoidable risk factors. Methods: We performed a prospective cohort study with inpatients admitted at a tertiary hospital requiring contrast-induced CT. The primary outcome was the development of CIN, measure by the alteration of serum creatinine or glomerular filtration rate in 48 or 72 hours. Through clinical interview, we verified possible risk factors and preventive measures instituted by the medical team and their association with development of CIN. Results: Of a total of 410 patients, 35 (8.5% developed CIN. There was a positive correlation between CIN and the presence of diabetes mellitus (OR = 2.15; 95%CI 1.35-4.06; p = 0.02, heart failure (OR = 2.23; 95%CI 1.18-8.8; p = 0.022, and renal failure (OR = 3.36; 95%CI 1.57- 7.17; p = 0.002 Conclusion: Incidence of CIN varies according to the population. Diabetes mellitus, heart failure and renal failure were independent risk factors for the development of CT-associated CIN. Further studies are needed to better understand and treat CT-associated CIN.
Liu, Xuejuan; Wang, Binrong
Purpose: We deal with the problem of the joint determination of optimal economic production quantity (EPQ) and optimal preventive maintenance (PM) for a system that can produce multiple products alternately. The objective is to find the optimal number of production cycles and the PM policy simultaneously by minimizing the cost model. Design/methodology/approach: Considering the products go through the system in a sequence and a complete run of all products forms a production cycle. In each cycle, beyond production time we also consider some reserve time for maintenance and setup, shortage and overproduction may occur. We study the integrated problem based on two PM policies, and explain the situation with the other PM policies. The delay – time concept is used to model PM decisions. Findings: Using the integrated EPQ and PM model, we can calculate the optimal production planning and PM schedule simultaneously, especially we consider multiple products in each production cycle, which is more practical and economic than previous works. Originality/value: In modern companies, the production planning and maintenance schedule share the same system, and traditional research about two activities is separated, that always generate conflicts, such as inadequate or excessive maintenance, and shortages, etc., so we develop the integrated EPQ and PM model to avoid these undesirable effects.
Liu, Xuejuan; Wang, Binrong
Purpose: We deal with the problem of the joint determination of optimal economic production quantity (EPQ) and optimal preventive maintenance (PM) for a system that can produce multiple products alternately. The objective is to find the optimal number of production cycles and the PM policy simultaneously by minimizing the cost model. Design/methodology/approach: Considering the products go through the system in a sequence and a complete run of all products forms a production cycle. In each cycle, beyond production time we also consider some reserve time for maintenance and setup, shortage and overproduction may occur. We study the integrated problem based on two PM policies, and explain the situation with the other PM policies. The delay – time concept is used to model PM decisions. Findings: Using the integrated EPQ and PM model, we can calculate the optimal production planning and PM schedule simultaneously, especially we consider multiple products in each production cycle, which is more practical and economic than previous works. Originality/value: In modern companies, the production planning and maintenance schedule share the same system, and traditional research about two activities is separated, that always generate conflicts, such as inadequate or excessive maintenance, and shortages, etc., so we develop the integrated EPQ and PM model to avoid these undesirable effects.
Olfson, M; Mechanic, D; Hansell, S; Boyer, C A; Walkup, J
The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge. Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. Sociodemographic and clinical characteristics associated with homelessness were identified using likelihood ratio chi square analysis and logistic regression. Twenty patients (7.6 percent) reported an episode of homelessness during the follow-up period. Patients who had a drug use disorder at hospital discharge were significantly more likely to report becoming homeless than those without a drug use disorder. Patients with a total score above 40 on the Brief Psychiatric Rating Scale (BPRS) at hospital discharge were more likely to report becoming homeless than patients with lower scores, as were those with Global Assessment Scores less than 43. Twelve of 30 patients with a drug use disorder, a BPRS score above 40, and a GAS score less than 43 at hospital discharge reported becoming homeless. The combination of a drug use disorder, persistent psychiatric symptoms, and impaired global functioning at the time of hospital discharge poses a substantial short-term risk of homelessness among patients with schizophrenia. Patients who fit this profile may be candidates for community-based programs that are specifically aimed at preventing homelessness among patients with severe mental illness.
Wong, Hannah J; Caesar, Michael; Bandali, Salim; Agnew, James; Abrams, Howard
Effective and timely communication of information is essential for quality patient care. Information and communication technology tools have the potential to transform and enable health care processes to be more accurate, timely, and integrated. This study describes the development, implementation, and evaluation of an electronic whiteboard in a General Internal Medicine (GIM) inpatient unit of an acute care hospital. The development, implementation, and evaluation of the inpatient whiteboard included scope discussions, workflow analyses, communication and training, and issues and enhancement reporting, all managed through a central project team. Evaluation of the whiteboard was two-fold: a survey given to allied health, nursing and physician disciplines (n=120), and an audit performed on whiteboard usage. The whiteboard displays relevant, real-time patient information, in a single, highly visible, user-friendly display. With a quick glance at the whiteboard, one can get an accurate snapshot view of the current patient activity in the unit. Approximately 71% of survey participants believed that the whiteboard improves and standardizes communication within the care team. Further, approximately 62% of the participants agreed that the whiteboard saves them time when searching for information on a patient and their care plan. In addition, the whiteboard has had an impact on the work practices of many GIM care providers, and it along with its users has acted together as agents for positive change. Whiteboard utilization has significantly increased since its implementation. The success of the whiteboard is in part due to overall change management methodologies through collaborative development throughout the project development lifecycle and subsequent continuous improvement initiatives. The multidisciplinary care team embraced the tool, took ownership of it, and tailored it to meet their needs.
Full Text Available Background: Studies at the macro level (such as longer-term interventions showed that physical activity impacts positively on cognitive-emotional processes of patients with mental disorders. However, research focusing on the immediate impact of acute bouts of exercise (micro level are missing. The aim of the present study was therefore to investigate whether and to what extent single bouts of moderately intense exercise can influence dimensions of psychological functioning in inpatients with mental disorders.Method: 129 inpatients (mean age: 38.16 years; 50.4% females took part and completed a questionnaire both immediately before and immediately after exercising. Thirty inpatients completed the questionnaires a second time in the same week. The questionnaire covered socio-demographic and illness-related information. Further, the questionnaire asked about current psychological states such as mood, rumination, social interactions, and attention, tiredness, and physical strengths as a proxy of physiological states.Results: Psychological states improved from pre- to post-session. Improvements were observed for mood, social interactions, attention, and physical strengths. Likewise, rumination and tiredness decreased. Mood, rumination, and tiredness further improved, when patients completed the questionnaires the second time in the same week.Conclusion: At micro level, single bouts of exercise impacted positively on cognitive-emotional processes such as mood, rumination, attention and social interactions, and physiological states of tiredness and physical strengths among inpatients with mental disorders. In addition, further improvements were observed, if patients participated in physical activities a second time.
Hoffman, Jeanne M.; Brown, Elena Donoso; Chan, Leighton; Dikmen, Sureyya; Temkin, Nancy; Bell, Kathleen R.
Objective To evaluate the impact of Medicare’s inpatient rehabilitation facility (IRF) prospective payment system (PPS) on use of inpatient rehabilitation for individuals with traumatic brain injury (TBI). Design Retrospective cohort study of patients with TBI. Setting One hundred twenty-three level I and II trauma centers across the U.S. who contributed data to the National Trauma Data Bank. Participants Patients (N = 135,842) with TBI and an Abbreviated Injury Score of the head of 2 or greater admitted to trauma centers between 1995 and 2004. Interventions None. Main Outcome Measure Discharge location: IRF, skilled nursing facility, home, and other hospitals. Results Compared with inpatient rehabilitation admissions before IRF PPS came into effect, demographic characteristics of admitted patients changed. Those admitted to acute care trauma centers after PPS was enacted (January 2002) were older and nonwhite. No differences were found in rates of injury between men and women. Over time, there was a significant drop in the percent of patients being discharged to inpatient rehabilitation, which varied by region, but was found across all insurance types. In a logistic regression, after controlling for patient characteristics (age, sex, race), injury characteristics (cause, severity), insurance type, and facility, the odds of being discharged to an IRF after a TBI decreased 16% after Medicare’s IRF PPS system was enacted. Conclusions The enactment of the Medicare PPS appears to be associated with a reduction in the chance that patients receive inpatient rehabilitation treatment after a TBI. The impact of these changes on the cost, quality of care, and patient outcome is unknown and should be addressed in future studies. PMID:22840827
Hunsaker Amanda E
Full Text Available Abstract Background Stroke victims are at relatively high risk for injurious falls. The purpose of this study was to document longitudinal fall patterns following inpatient rehabilitation for first-time stroke survivors. Methods Participants (n = 231 were recruited at the end of their rehab stay and interviewed monthly via telephone for 1 to 32 months regarding fall incidents. Analyses were conducted on: total reports of falls by month over time for first-time and repeat fallers, the incidence of falling in any given month; and factors differing between fallers and non fallers. Results The largest percentage of participants (14% reported falling in the first month post-discharge. After month five, less than 10% of the sample reported falling, bar months 15 (10.4% and 23 (13.2%. From months one to nine, the percentage of those reporting one fall with and without a prior fall were similar. After month nine, the number of individuals who reported a single fall with a fall history was twice as high compared to those without a prior fall who reported falling. In both cases the percentages were small. A very small subset of the population emerged who fell multiple times each month, most of whom had a prior fall history. At least a third of the sample reported a loss of balance each month. Few factors differed significantly between fallers and non-fallers in months one to six. Conclusion Longitudinal data suggest that falls most likely linked to first time strokes occur in the first six months post discharge, particularly month one. Data routinely available at discharge does not distinguish fallers from non-fallers. Once a fall incident has occurred however, preventive intervention is warranted.
Full Text Available Objective: To determine the prevalence of occult hearing loss in elderly inpatients, to evaluate feasibility of opportunistic hearing screening and to determine subsequent provision of hearing aids. Materials and methods: Subjects (>65 years were recruited from five elderly care wards. Hearing loss was detected by a ward-based hearing screen comprising patient-reported assessment of hearing disability and a whisper test. Subjects failing the whisper test or reporting hearing difficulties were offered formal audiological assessment. Results: Screening was performed on 51 patients aged between 70 and 95 years. Of the patients, 21 (41% reported hearing loss and 16 (31% failed the whisper test. A total of 37 patients (73% were referred for audiological assessment with 17 (33% found to have aidable hearing loss and 11 were fitted with hearing aids (22%. Discussion: This study highlights the high prevalence of occult hearing loss in elderly inpatients. Easy two-step screening can accurately identify patients with undiagnosed deafness resulting in significant proportions receiving hearing aids. Key sentences Approximately 14% of the elderly population use hearing aids despite a reported prevalence of deafness in up to 55%. The use of hearing aids is associated with an improvement in physical, emotional, mental and social well-being. An easy screening test for hearing loss consists of patient-reported hearing loss and a whisper test. Opportunistic screening of elderly inpatients resulted in referral of 73% of screened patients for formal audiology. Of the screened patients, 22% were provided with hearing aids.
Schneider, Florian; Kaplan, Vladimir; Rodak, Roksana; Battegay, Edouard; Holzer, Barbara
To validate the estimates of the prevalence of multimorbidity based on administrative hospital discharge data, with medical records and chart reviews as benchmarks. Retrospective cohort study. Medical division of a tertiary care teaching hospital. A total of 170 medical inpatients admitted from the emergency unit in January 2009. The prevalence of multimorbidity for three different definitions (≥2 diagnoses, ≥2 diagnoses from different ICD-10 chapters, and ≥2 medical conditions as defined by Charlson/Deyo) and three different data sources (administrative data, chart reviews, and medical records). The prevalence of multimorbidity in medical inpatients derived from administrative data, chart reviews and medical records was very high and concurred for the different definitions of multimorbidity (≥2 diagnoses: 96.5%, 95.3%, and 92.9% [p = 0.32], ≥2 diagnoses from different ICD-10 chapters: 86.5%, 90.0%, and 85.9% [p = 0.46], and ≥2 medical conditions as defined by Charlson/Deyo: 48.2%, 50.0%, and 46.5% [p = 0.81]). The agreement of rating of multimorbidity for administrative data and chart reviews and administrative data and medical records was 94.1% and 93.0% (kappa statistics 0.47) for ≥2 diagnoses; 86.0% and 86.5% (kappa statistics 0.52) for ≥2 diagnoses from different ICD-10 chapters; and 82.9% and 85.3% (kappa statistics 0.69) for ≥2 medical conditions as defined by Charlson/Deyo. Estimates of the prevalence of multimorbidity in medical inpatients based on administrative data, chart reviews and medical records were very high and congruent for the different definitions of multimorbidity. Agreement for rating multimorbidity based on the different data sources was moderate to good. Administrative hospital discharge data are a valid source for exploring the burden of multimorbidity in hospital settings.
S. Mekdad; F. Sakr; Y. Asiri
Depression is very common among ill geriatric inpatients and could be a major factor responsible for delayed recovery, hospitalization and increased health care utilization. Study the prevalence of depression in geriatric cardiac inpatients. Determine the relationships between depression and hospitalization. A cross sectional study included 200 geriatrics (⩾65 years) inpatients in cardiac wards at King Fahad Medical City from 20th of March 2015 to 29th of April 2015. We employed the modified ...
van de Glind, Esther M M; Willems, Hanna C; Eslami, Saeid; Abu-Hanna, Ameen; Lems, Willem F; Hooft, Lotty; de Rooij, Sophia E; Black, Dennis M; van Munster, Barbara C
For physicians dealing with patients with a limited life expectancy, knowing the time to benefit (TTB) of preventive medication is essential to support treatment decisions. The aim of this study was to investigate the usefulness of statistical process control (SPC) for determining the TTB in relation to fracture risk with alendronate versus placebo in postmenopausal women. We performed a post hoc analysis of the Fracture Intervention Trial (FIT), a randomized, controlled trial that investigated the effect of alendronate versus placebo on fracture risk in postmenopausal women. We used SPC, a statistical method used for monitoring processes for quality control, to determine if and when the intervention group benefited significantly more than the control group. SPC discriminated between the normal variations over time in the numbers of fractures in both groups and the variations that were attributable to alendronate. The TTB was defined as the time point from which the cumulative difference in the number of clinical fractures remained greater than the upper control limit on the SPC chart. For the total group, the TTB was defined as 11 months. For patients aged ≥70 years, the TTB was 8 months [absolute risk reduction (ARR) = 1.4%]; for patients aged <70 years, it was 19 months (ARR = 0.7%). SPC is a clear and understandable graphical method to determine the TTB. Its main advantage is that there is no need to define a prespecified time point, as is the case in traditional survival analyses. Prescribing alendronate to patients who are aged ≥70 years is useful because the TTB shows that they will benefit after 8 months. Investigators should report the TTB to simplify clinical decision making.
Sieving, Renee E.; McMorris, Barbara J.; Beckman, Kara J.; Pettingell, Sandra L.; Secor-Turner, Molly; Kugler, Kari; Garwick, Ann W.; Resnick, Michael D.; Bearinger, Linda H.
Purpose Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. This paper examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention. Methods Randomized controlled trial with 253 girls ages 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention employed a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months following enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time. Results At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception and dual contraceptive methods with their most recent partner than did the control group. The intervention group also reported greater stress management skills with trends towards higher levels of pro-social connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use. Conclusions Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth. PMID:21783050
Li, Keliang; Li, Jinrang
To compare the advantages and disadvantages of real time recurrent laryngeal nerve (RLN) monitoring and conventional exposure during thyroid operation by Meta analysis. The published articles of randomized controlled clinical trials were searched in data bases to compare the therapeutic outcomes of using real-time RLN monitoring and conventional exposure in thyroid surgery. The quality of the searched original studies was assessed and the outcomes which are in line with the requirements were analyzed. Six articles met the inclusion criteria, which contained 12,646 RLN in total. There were 5,535 cases in the RLN monitoring group and 7,111 cases in the conventional exposure group. The results of Meta analysis showed that: the transient injury rate of the RLN in the monitoring group (OR=0.60, 95% CI=0.49-0.73, Pinjury rate of the RLN in two groups had no statistical difference (OR=0.90, 95 % CI= 0.57-1.40, P>0.05). The RLN identification rate also had no statistical difference between the two groups (OR=9.79, 95% CI=0.17-548. 64, P>0.05). The transient injury rate of the RLN is lower in the monitoring group than that in conventional exposure group, but the permanent injury rate and the RLN identification rate had no statistical difference between the two groups. The intraoperative nerve monitoring was useful in the prevention of the RLN injury in thyroid surgery.
Berdot, Sarah; Gillaizeau, Florence; Caruba, Thibaut; Prognon, Patrice; Durieux, Pierre; Sabatier, Brigitte
Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications.
Berdot, Sarah; Gillaizeau, Florence; Caruba, Thibaut; Prognon, Patrice; Durieux, Pierre; Sabatier, Brigitte
Context Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. Objectives We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. Data Sources Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. Study Selection Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. Data Extraction Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. Results Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. Conclusions Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications. PMID:23818992
Full Text Available CONTEXT: Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. OBJECTIVES: We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. DATA SOURCES: Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. STUDY SELECTION: Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. DATA EXTRACTION: Two reviewers (senior pharmacists independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given, and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR, according to their study design. RESULTS: Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46. The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. CONCLUSIONS: Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE, numerator and types of errors is essential for further publications.
Liu, Yachuan; Chen, Shanen; Xu, Jian; Liu, Xiaojian; Wu, Yongsheng; Zhou, Lin; Cheng, Jinquan; Ma, Hanwu; Zheng, Jing; Lin, Denan; Zhang, Li; Chen, Lili
Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to analyze associations between six air pollutants (namely SO₂, CO, NO₂, O₃, PM 10 , and PM 2.5 ) and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m³ increase in air pollutant concentration ranged from 0.48% (O₃ at lag 2) to 11.48% (SO₂ with 2-day moving average); for overall inpatient visits ranged from 0.73% (O₃ at lag 7) to 17.13% (SO₂ with 8-day moving average). Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits.
Full Text Available Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China. Generalized additive model was employed to analyze associations between six air pollutants (namely SO2, CO, NO2, O3, PM10, and PM2.5 and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m3 increase in air pollutant concentration ranged from 0.48% (O3 at lag 2 to 11.48% (SO2 with 2-day moving average; for overall inpatient visits ranged from 0.73% (O3 at lag 7 to 17.13% (SO2 with 8-day moving average. Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits.
Liu, Yachuan; Chen, Shanen; Xu, Jian; Liu, Xiaojian; Wu, Yongsheng; Zhou, Lin; Cheng, Jinquan; Ma, Hanwu; Zheng, Jing; Lin, Denan; Zhang, Li; Chen, Lili
Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to analyze associations between six air pollutants (namely SO2, CO, NO2, O3, PM10, and PM2.5) and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m3 increase in air pollutant concentration ranged from 0.48% (O3 at lag 2) to 11.48% (SO2 with 2-day moving average); for overall inpatient visits ranged from 0.73% (O3 at lag 7) to 17.13% (SO2 with 8-day moving average). Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits. PMID:29360738
Hopkins, J E; Loeb, S J; Fick, D M
To provide efficient and effective inpatient mental health services, it is imperative to not only ascertain if service users are satisfied with the care received from nurses, but also the degree to which initial expectations are being met. Ten reports of primary research on service users' experiences, perceptions and expectations of inpatient mental health care were examined to understand what service users' expect of inpatient mental health care and the implications for nursing practice. The World Health Organization's description of responsiveness to service users' non-medical expectations of care was used as a framework for retrieving literature and organizing the research outcomes. Responsiveness includes seven categories of healthcare performance ranging from respect for the dignity of the person, to adequacy of amenities, and choice of provider. Service users expect to form interpersonal relationships with nurses; however, non-clinical responsibilities serve as barriers which consume considerable available nursing time that otherwise could be spent developing therapeutic relationships. In addition, inpatient programming ideas are identified for the provision of better services. Hospitals' expectations of mental health nurses will need to be reconsidered if these nurses are to provide the time and resources necessary to meet current service users' expectations.
Medel-Herrero, Alvaro; Gomez-Beneyto, Manuel
Little is published about the impact of the 2008 economic crisis on mental health services in Spain. An interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. Age-adjusted psychiatric (ICD9 290-319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15-24 years old and to a less extend for inpatients aged 25-34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15-34 years old inpatients were unaffected. Psychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.
Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore
In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of Euro 1,009,095.35. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.
Parente, Joana; Pereira, Mário G; Tonini, Marj
The present study focuses on the dependence of the space-time permutation scan statistics (STPSS) (1) on the input database's characteristics and (2) on the use of this methodology to assess changes on the fire regime due to different type of climate and fire management activities. Based on the very strong relationship between weather and the fire incidence in Portugal, the detected clusters will be interpreted in terms of the atmospheric conditions. Apart from being the country most affected by the fires in the European context, Portugal meets all the conditions required to carry out this study, namely: (i) two long and comprehensive official datasets, i.e. the Portuguese Rural Fire Database (PRFD) and the National Mapping Burnt Areas (NMBA), respectively based on ground and satellite measurements; (ii) the two types of climate (Csb in the north and Csa in the south) that characterizes the Mediterranean basin regions most affected by the fires also divide the mainland Portuguese area; and, (iii) the national plan for the defence of forest against fires was approved a decade ago and it is now reasonable to assess its impacts. Results confirmed (1) the influence of the dataset's characteristics on the detected clusters, (2) the existence of two different fire regimes in the country promoted by the different types of climate, (3) the positive impacts of the fire prevention policy decisions and (4) the ability of the STPSS to correctly identify clusters, regarding their number, location, and space-time size in spite of eventual space and/or time splits of the datasets. Finally, the role of the weather on days when clustered fires were active was confirmed for the classes of small, medium and large fires. Copyright © 2016 Elsevier B.V. All rights reserved.
Dobrohotoff, John T; Llewellyn-Jones, Robert H
In many parts of the world the provision of psychogeriatric inpatient units (PGUs) remains limited. More units will be required over coming decades given rapid population aging. Medline (1950-2010), psycINFO (1806-2009), EMBASE (1980-2009) and CINAHL (1982-2009) were searched for papers about PGU design. Selected non-peer reviewed literature such as government reports and unpublished academic dissertations were also reviewed. Data were also obtained from the literature related to general adult psychiatry inpatient units where there was limited information from studies of units designed for older people. Over 200 papers were reviewed and 130 were included. There are few good quality studies to guide the design of acute PGUs and much of the existing literature is based on opinion and anecdote or, at best, based on observational studies. Randomized controlled studies comparing different designs and assessing outcomes are virtually non-existent. Several studies have identified violence and trauma resulting from hospitalization as significant problems with current acute PGU care. Despite its limitations the available literature provides useful guidance on how PGU design can optimize patient and staff safety and improve clinical outcomes. There are significant problems with current acute PGUs, and patient mix on existing units is an important issue. Future research should examine patient and staff perceptions of different PGU ward environments, the relationship between ward design and clinical outcomes, the effects of segregating patients with challenging behaviors in dementia and the benefits or otherwise of gender segregation.
Alberto J Caban-Martinez
Full Text Available Physical activity has been shown to be beneficial at improving health in some medical conditions and in preventing injury. Epidemiologic studies suggest that physical activity is one factor associated with a decreased risk for slips and falls in the older (≥ 65 years adult population. While the risk of slips and falls is generally lower in younger than in older adults; little is known of the relative contribution of physical activity in preventing slips and falls in younger adults. We examined whether engagement in leisure-time physical activity (LTPA was protective of slips and falls among a younger/middle-aged (≤ 50 years old working population.475 workers from 36 limited-service restaurants in six states in the U.S. were recruited to participate in a prospective cohort study of workplace slipping. Information on LTPA was collected at the time of enrollment. Participants reported their slip experience and work hours weekly for up to 12 weeks. We investigated the association between the rate of slipping and the rate of major slipping (i.e., slips that resulted in a fall and/or injury and LTPA for workers 50 years of age and younger (n = 433, range 18-50 years old using a multivariable negative binomial generalized estimating equation model.The rate of major slips among workers who engaged in moderate (Adjusted Rate Ratio (RR = 0.65; 95% Confidence Interval (CI = [0.18-2.44] and vigorous (RR = 0.64; 95%CI = [0.18-2.26] LTPA, while non-significant, were approximately one-third lower than the rate of major slips among less active workers.While not statistically significant, the results suggest a potential association between engagement in moderate and vigorous LTPA and the rate of major slips in younger adults. Additional studies that examine the role of occupational and non-occupational physical activity on the risk of slips, trips and falls among younger and middle aged adults appear warranted.
Ko, Wen-Tsai; Chiou, Shin-Yan; Lu, Erl-Huei; Chang, Henry Ker-Chang
RFID technology is increasingly used in applications that require tracking, identification, and authentication. It attaches RFID-readable tags to objects for identification and execution of specific RFID-enabled applications. Recently, research has focused on the use of grouping-proofs for preserving privacy in RFID applications, wherein a proof of two or more tags must be simultaneously scanned. In 2010, a privacy-preserving grouping proof protocol for RFID based on ECC in public-key cryptosystem was proposed but was shown to be vulnerable to tracking attacks. A proposed enhancement protocol was also shown to have defects which prevented proper execution. In 2012, Lin et al. proposed a more efficient RFID ECC-based grouping proof protocol to promote inpatient medication safety. However, we found this protocol is also vulnerable to tracking and impersonation attacks. We then propose a secure privacy-preserving RFID grouping proof protocol for inpatient medication safety and demonstrate its resistance to such attacks.
Osborne, Patricia J; Jimenez-Torres, Gladys Janice; Landa, Yulia; Mahoney, Jane; Madan, Alok
Individuals with serious mental illness (SMI) experience significant comorbid chronic pain (CP). Little is known about CP management in psychiatric inpatient settings. To address this gap in clinical practice, the authors developed CP management group psychotherapy for adult inpatients with SMI. In this report, the authors highlight (1) the theoretical underpinnings of and execution of the psychotherapy group, (2) the characteristics of participants in the pilot phase of the group, and (3) outcomes of group participants. Data were collected from 16 participants in the pain management psychotherapy group. The mean number of groups attended was two (SD = 1.7). Participants endorsed pain across five regions of the body with high pain intensity and severity. Improvements in depression, anxiety, somatic, and emotional regulation symptoms were evidenced during the course of treatment. CP group psychotherapy may be an effective modality to disseminate "best practices" and prevent diagnostic overshadowing for SMI patients.
Howard, Patricia B; El-Mallakh, Peggy; Kay Rayens, Mary; Clark, James J
This study, conducted at two public-sector psychiatric hospitals in a south-eastern state, investigated satisfaction with inpatient services and treatment outcomes among 204 hospitalized mental health consumers. A simple survey design with nonrandom sampling technique was used; instruments included the KY-CSI, the 21-item MHSIP Consumer Survey, and the CSQ-8. Respondents reported satisfaction with time available to be with other patients, staff availability, and their degree of comfort talking to staff. Areas of dissatisfaction included lack of client input into treatment planning, lack of family involvement, and lack of medication education. Providers are encouraged to include clients in all phases of treatment planning and to continue to evaluate consumer perspectives of quality services.
Drozd, Edward M; Maier, Jan; Hales, Jan F; Thomas, Frederick G
The inpatient psychiatric facility prospective payment system (IPF-PPS), provides per diem payments for psychiatric hospitals and units, including 17 comorbid condition payment adjustors that cover 11 percent of patients. This study identifies an alternative set of 16 adjustors identifying three times as many high-cost patients and evaluates the improved predictive power in log per diem cost regression models. A model using the IPF-PPS adjustors achieved 8.8 percent of the feasible improvement from a no-adjustor baseline, while the alternative adjustors achieved 22.1 percent of the feasible improvement. The current adjustors may therefore be too restrictive, resulting in systematic over- or underpayment for many patients.
The influence of the vaccination rate among inpatients and hospital personnel on the risk of influenza outbreaks in long-term medical and care hospital was investigated. Vaccination rates and the annual number of influenza cases were analyzed from 2003/2004 to 2008/ 2009. During the first three influenza seasons, vaccination among inpatients was low-45.4% in 2003/4, 49.7% in 2004/5, and 57.5% in 2005/6. Minor influenza outbreaks accounted for 22 patients in 2003/4, 10 in 2004/5, and 10 in 2005/6. During the next three seasons, vaccination was higher than in the previous years, at follows: 65.8% in 2006/7, 65.6% in 2007/8, and 72.0% in 2008/9. This improvement apparently accounted for the absence of outbreaks during these seasons, with patients numbering 0 in 2006/7 and 2 each in 2007/8 and 2008/9. A strong negative correlation thus exist between inpatient vaccination rates and the number of influenza patients (r = -0.903, p = 0.014). The vaccination rate among hospital personnel was high at 79.3%-91.2% throughout the study, and no correlation was seen between hospital personnel vaccination and the number of influenza patients (r = 0.379, p = 0.459). No correlation was seen, either, between the number of influenza patients and national influenza occurrence (r = - 0.146, p = 0.783). This results thus indicate that a high vaccination rate among hospital personnel is not enough to prevent influenza outbreaks, making it important to raise vaccination rates among both inpatients and hospital personnel if influenza outbreaks are to be controlled and prevented.
Cuttler, Sasha J; Barr-Walker, Jill; Cuttler, Lauren
Inpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods. To evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates. Performance improvement study with historic control. Four medical-surgical units in one US public acute care hospital. Adult medical-surgical inpatients units. A 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients' bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling. The main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009-September 2010 (baseline) with the follow-up period of January 2015-December 2015 (intervention). Falls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented. The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.
Ly, Neang S.; Bulitta, Jürgen B.; Rao, Gauri G.; Landersdorfer, Cornelia B.; Holden, Patricia N.; Forrest, Alan; Bergen, Phillip J.; Nation, Roger L.; Li, Jian; Tsuji, Brian T.
Objectives Colistin is an ‘old’ drug, which is being increasingly utilized due to limited therapeutic options. However, resistance emergence during monotherapy is concerning. Here, our objective was to optimize colistin combinations against Pseudomonas aeruginosa by profiling the time course of synergistic killing and prevention of resistance. Methods Hollow-fibre infection models over 10 days simulated clinically relevant dosage regimens of colistin and doripenem against two heteroresistant P. aeruginosa strains (MIC 1 mg/L) and one resistant (MIC 128 mg/L) strain (inoculum 109.3 cfu/mL). New mathematical mechanism-based models (MBMs) were developed using S-ADAPT. Results Against heteroresistant P. aeruginosa strains, colistin monotherapy resulted in initial killing (up to 2.64 log10 cfu/mL) within 24 h followed by regrowth. High-intensity combinations involving free steady-state colistin concentrations of 5 mg/L achieved complete eradication (>9.3 log10 killing) within 48 h. These combinations achieved synergy with up to 9.38 log10 greater killing compared with the most active monotherapy. Against the colistin-resistant strain, the combination yielded marked initial synergy with up to 6.11 log10 cfu/mL bacterial reductions within 72 h followed by regrowth. The MBMs quantified total and resistant subpopulations and the proposed synergy between colistin and doripenem. Conclusions Our findings provide insight into optimal antibiotic treatment and may serve as a framework for new drug combinations and combination modelling. PMID:25712313
Fond, Guillaume; Gaman, Alexandru; Brunel, Lore; Haffen, Emmanuel; Llorca, Pierre-Michel
Two studies have shown that increasing the consultation of the word "suicide" in the Google search engine was associated with a subsequent increase in the prevalence of suicide attempts. The main goal of this article was to explore the trends generated by a key-word search associated with suicide, depression and bipolarity in an attempt to identify general trends (disorders epidemics in the population/"real events" vs newsworthy advertisement/"media event"). Based on previous studies, the frequency of the search words "how to suicide" and "commit suicide" were analyzed for suicide, as well as "depression" (for depressive disorders) and "bipolar disorder". Together, these analyses suggest that the search for the words "how to suicide" or "commit suicide" on the Google search engine may be a good indicator for suicide prevention policies. However, the tool is not developed enough to date to be used as a real time dynamic indicator of suicide epidemics. The frequency of the search for the word "suicide" was associated with those for "depression" but not for "bipolar disorder", but searches for psychiatric conditions seem to be influenced by media events more than by real events in the general population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Brewer, Wayne; Ogbazi, Raluchukwu; Ohl, Devan; Daniels, Jeffry; Ortiz, Alexis
Physical therapists (PTs) work in a variety of healthcare settings with varied levels of physical activity demands placed on them. The purpose of this study is to compare the physical activity (PA) levels between PTs in inpatient versus outpatient environments for one work week using a cross-sectional design. Sixty-one PTs (30 inpatient, 31 outpatient) wore a tri-axial accelerometer and inclinometer for one work-week. The number steps-per-day, PA intensities, energy expenditures and postural positions adopted during the work day were recorded. Significantly longer amounts of time spent sitting was found for inpatient PTs regardless of the significantly higher number of steps-per-day. Outpatient PTs had a higher number of breaks from sedentary activity with those breaks being longer than the inpatient PTs. The percentage of time spent performing moderate-vigorous PA approached significance implying more time was spent performing these types of activities for outpatient PTs. The energy expenditures between the two groups of PTs were not different. This study compared the differences in physical activity levels between physical therapists who worked at inpatient versus outpatient environment as little is known about their activity levels. Inpatient physical therapists took more steps per day than outpatient physical therapists but the outpatient physical therapists were less sedentary and took more frequent and longer breaks from sedentary activities. The energy expenditures were similar between both types of therapists and this may be reflective of the gender and bodyweight differences between the groups that equalizes the energy expenditures. The findings of this study suggests that there are differences in the physical activity demands between inpatient and outpatient physical therapists. The results of this study may serve dual purposes: (1) employers may be able to more accurately describe the expected physical activity demands to future employees; (2
Full Text Available Abstract Background Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden. Methods The study population consisted of 9,973 (2006 and 10,927 (2010 children between 3 to 6years of age (~77% of the eligible population from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region. Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI ArcGIS system. Parish-level socioeconomic data were available. Results The overall proportion of caries-free (dmfs=0 children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level smoothed relative risks (SmRRs increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period. Conclusion Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive
Strömberg, Ulf; Holmn, Anders; Magnusson, Kerstin; Twetman, Svante
Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden. The study population consisted of 9,973 (2006) and 10,927 (2010) children between 3 to 6 years of age (~77% of the eligible population) from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region). Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI® ArcGIS system. Parish-level socioeconomic data were available. The overall proportion of caries-free (dmfs=0) children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level) smoothed relative risks (SmRRs) increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period. Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive care in child populations.
Kim, Yeon Soo; Song, Bong Kil; Oh, Ji Sun; Woo, Seung Seok
To evaluate the benefit of aerobic exercise on colonic transit time (CTT) for psychiatric inpatients in a closed ward. Sixty consecutive adult inpatients of the Somang Hospital Psychiatry Unit (Eumsung-gun, South Korea), without CTT-related diseases or drug therapies, were recruited for study from March to June of 2012. Upon enrollment, the patients were randomly assigned to partake in a 12-wk instructor-led group aerobic exercise program (exercise group; n = 30) or to maintain their ordinary daily activities (control group; n = 30). The exercise program was structured as 10 min warm-up (stretching), 40 min exercise, and 10 min cool-down (stretching) for three days each week. The exercise sessions consisted of walking only in week one and aerobics from weeks two to 12, with increasing intensity (50% heart rate reserve (HRR) for weeks one to four, 60% HRR for weeks five to eight, and 70% HRR for weeks nine to 12). CTT was measured before (baseline) and after (week 12) the exercise program, in duplicate (on days four and seven), using abdominal radiography and the multiple radio-opaque marker technique. Changes in the exercising patients' CTT and weight-, cardiovascular- and fitness-related parameters were statistically assessed. The study dropout rate was 30.0%, with 23 patients in the exercise group and 19 patients in the control group completing the study. At week 12, the exercise group showed decreases in body weight (mean ± SE) baseline: 69.4 ± 2.8 vs study-end: 67.6 ± 2.7; P exercise group showed significant improvements in leg muscle strength (baseline: 41.7 ± 4.3 vs study-end: 64.1 ± 5.0; P exercise group showed an exercise-induced reduction in total CTT (baseline: 54.2 ± 8.0 vs 30.3 ± 6.1), which was significantly different from that experienced by the control group over the 12-wk period (48.6 ± 9.3 vs 48.3 ± 12.3; P = 0.027); however, the exercise-induced decreases in CTT involving the three colonic segments examined (right, left and recto
Berends, Tamara; van Meijel, Berno; Nugteren, Willem; Deen, Mathijs; Danner, Unna N.; Hoek, Hans W.; van Elburg, Annemarie A.
Background: Relapse is common among recovered anorexia nervosa (AN) patients. Studies on relapse prevention with an average follow-up period of 18 months found relapse rates between 35 and 41 %. In leading guidelines there is general consensus that relapse prevention in patients treated for AN is a
Shen, Nicole T; Maw, Anna; Tmanova, Lyubov L; Pino, Alejandro; Ancy, Kayley; Crawford, Carl V; Simon, Matthew S; Evans, Arthur T
Systematic reviews have provided evidence for the efficacy of probiotics in preventing Clostridium difficile infection (CDI), but guidelines do not recommend probiotic use for prevention of CDI. We performed an updated systematic review to help guide clinical practice. We searched MEDLINE, EMBASE, International Journal of Probiotics and Prebiotics, and The Cochrane Library databases for randomized controlled trials evaluating use of probiotics and CDI in hospitalized adults taking antibiotics. Two reviewers independently extracted data and assessed risk of bias and overall quality of the evidence. Primary and secondary outcomes were incidence of CDI and adverse events, respectively. Secondary analyses examined the effects of probiotic species, dose, timing, formulation, duration, and study quality. We analyzed data from 19 published studies, comprising 6261 subjects. The incidence of CDI in the probiotic cohort, 1.6% (54 of 3277), was lower than of controls, 3.9% (115 of 2984) (P probiotic users was 0.42 (95% confidence interval, 0.30-0.57; I 2 = 0.0%). Meta-regression analysis demonstrated that probiotics were significantly more effective if given closer to the first antibiotic dose, with a decrement in efficacy for every day of delay in starting probiotics (P = .04); probiotics given within 2 days of antibiotic initiation produced a greater reduction of risk for CDI (relative risk, 0.32; 95% confidence interval, 0.22-0.48; I 2 = 0%) than later administration (relative risk, 0.70; 95% confidence interval, 0.40-1.23; I 2 = 0%) (P = .02). There was no increased risk for adverse events among patients given probiotics. The overall quality of the evidence was high. In a systematic review with meta-regression analysis, we found evidence that administration of probiotics closer to the first dose of antibiotic reduces the risk of CDI by >50% in hospitalized adults. Future research should focus on optimal probiotic dose, species, and formulation. Systematic
Birkenhäger, T.K.; Broek, W.W. van den; Moleman, P.; Bruijn, J.A.
Objective: The aim of this study was to examine the efficacy and the feasibility of a 4-step treatment algorithm for inpatients with major depressive disorder. Method: Depressed inpatients, meeting DSM-IV criteria for major depressive disorder, were enrolled in the algorithm that consisted of
Kalamaras, Jr, Peter
.... Based on size, structure, logistic complexity, and environmental uncertainty, the study concludes that inpatient expansion is not an effective component of the overall sourcing strategy. The study provides AMEDD executives with an evidenced-based assessment to consider revising the graduated response to provide inpatient care for the Nation's returning wounded.
Doctors and nurses taking care of diabetic inpatients were surveyed to assess their knowledge of diabetes inpatient management and their attitudes towards diabetic patients. The survey made use of the diabetes knowledge questionnaire (O'Brien) and the DAS3 scale. Results. The survey group comprised 115 health care ...
Viccellio, Peter; Zito, Joseph A; Sayage, Valerie; Chohan, Jasmine; Garra, Gregory; Santora, Carolyn; Singer, Adam J
Boarding of admitted patients in the emergency department (ED) is a major cause of crowding. One alternative to boarding in the ED, a full-capacity protocol where boarded patients are redeployed to inpatient units, can reduce crowding and improve overall flow. Our aim was to compare patient satisfaction with boarding in the ED vs. inpatient hallways. We performed a structured telephone survey regarding patient experiences and preferences for boarding among admitted ED patients who experienced boarding in the ED hallway and then were subsequently transferred to inpatient hallways. Demographic and clinical characteristics, as well as patient preferences, including items related to patient comfort and safety using a 5-point scale, were recorded and descriptive statistics were used to summarize the data. Of 110 patients contacted, 105 consented to participate. Mean age was 57 ± 16 years and 52% were female. All patients were initially boarded in the ED in a hallway before their transfer to an inpatient hallway bed. The overall preferred location after admission was the inpatient hallway in 85% (95% confidence interval 75-90) of respondents. In comparing ED vs. inpatient hallway boarding, the following percentages of respondents preferred inpatient boarding with regard to the following 8 items: rest, 85%; safety, 83%; confidentiality, 82%; treatment, 78%; comfort, 79%; quiet, 84%; staff availability, 84%; and privacy, 84%. For no item was there a preference for boarding in the ED. Patients overwhelmingly preferred the inpatient hallway rather than the ED hallway when admitted to the hospital. Copyright © 2013 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.
Stanwick, R S; Horne, J M; Peabody, D M; Postuma, R
The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hou...
Full Text Available Jessica Fields,1 Tahani Alturkistani,2 Neal Kumar,3 Arjun Kanuri,3 Deeb N Salem,1 Samson Munn,2 Deborah Blazey-Martin1 1Department of Medicine, Tufts Medical Center, Boston, MA, USA; 2Department of Radiology, Tufts Medical Center, Boston, MA, USA; 3Tufts University School of Medicine, Boston, MA, USA Objective: To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging. Design: Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital's adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study. Setting: Four hundred and fifteen bed urban academic hospital over 3 years (2008–2010. Patients: All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded. Measurements and main results: Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20–98. More than half of falls were men (55% and patients considered at risk of falls (56%. Falls were evenly distributed across morning (33%, evening (34%, and night (33% shifts. Of 530 falls, 178 (34% patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700 from head computed tomography (CT. Conclusion: Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward
Ringen, Petter Andreas; Faerden, Ann; Antonsen, Bjørnar; Falk, Ragnhild S; Mamen, Asgeir; Rognli, Eline B; Solberg, Dag K; Andreassen, Ole A; Martinsen, Egil W
Cardiovascular diseases are a major cause for the markedly reduced life expectancy in people with severe mental illness (SMI). Hospital departments should provide adequate prevention of cardiometabolic risk by optimizing prevention and treatment. Characteristics of cardiometabolic risk factors in inpatients are still not well known. We aimed to describe the status of cardiometabolic risk factors in inpatients with SMI and identify associations with psychiatric status and treatment. A cross sectional descriptive study of inpatients with SMI from long term psychosis treatment wards in South Eastern Norway was performed. Comprehensive assessments of cardiometabolic risk factors, physical activity, lifestyle habits, symptoms, life satisfaction and treatment were made. Associations and potential prognostic factors were analyzed using linear and logistic regressions. A total of 83 patients were included in the study, but many individual datasets were incomplete. Over half of the subjects had unhealthy eating habits. Obesity (class 1-3) was found in 44%, 23% had elevated fasting triglycerides, 26% had elevated blood pressure and 78% smoked daily. Low levels of physical activity were significantly associated with higher levels of depression (p = .007). A nominal increase in cardiometabolic risk factors was found for olanzapine and clozapine users. Inpatients in long term psychosis treatment wards have alarmingly high cardiometabolic risk. Level of physical activity was associated with both psychiatric and somatic health. Focus on lifestyle and somatic health should be an integral part of the treatment for hospitalized SMI patients.
Full Text Available Liliane J Dableh, James L HenryDepartment of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, CanadaBackground: Progesterone is emerging as an important protective agent against various injuries to the nervous system. Neuroprotective and remyelinating effects have been documented for this neurosteroid, which is synthesized by, and acts on, the central and peripheral nervous systems. Neuropathic pain is a severe, persistent condition that is generally resistant to treatment, and poses major personal, social, and economic burdens. The purpose of this study was to determine if single-dose or repeated progesterone administration would alleviate tactile hypersensitivity in a rat model of neuropathic pain, and to determine if early versus late initiation of treatment has an effect on the outcome.Methods: Rats were unilaterally implanted with a polyethylene cuff around the sciatic nerve, and sensitivity to von Frey filament stimulation was measured over approximately 12 weeks.Results: Rats given progesterone starting one hour after cuff implantation, and daily until day 4, exhibited tactile hypersensitivity similar to that of vehicle-treated rats for the duration of the study. When progesterone was started one hour after cuff implantation and given daily until day 10, rats exhibited no tactile hypersensitivity in the later part of the study, after treatment had stopped. When progesterone treatment was initiated at 20 days, once the model had been fully established, and given daily for 4 or even 11 days, no differences in withdrawal thresholds were observed compared with controls. Progesterone did not have any effect on withdrawal thresholds when given as a single dose, as measured at 30, 60 and 90 minutes after administration.Conclusion: These results indicate that progesterone, when administered immediately after nerve injury, and for a sufficient period of time, can prevent the development of neuropathic pain, and may
Chen, Qiongni; Zhou, Jiansong
To systematically review and analyze literature on episodes of aggression in psychiatric wards and to determine the coping and preventive strategies employed to deal with aggression of patients with schizophrenia. We used the key words such as "schizophrenia" and "aggression" to collect literature citations, which were published between July 1997 and November 2011, by searching databases such as the Chinese Journal Full-text Database (CJFD). The literature reports of aggression by patients with schizophrenia were surveyed by computer-assisted searches, scanning of reference lists, and manual search of relevant journals. We analyzed the reports of episodes of aggression in psychiatric wards. Prevalence of aggression in psychiatric wards was reported to range from 9.1% (95% CI: 6.3 to 11.9) to 49.6% (95% CI: 41.1 to 58.1), with most reports in the range of 20% to 40% (mean 28.0%). The aggressive behavior often occurred in special groups and typically bore a close relationship with the patient's personal qualities, social environment, or psychiatric symptoms. The aggressive behaviors can be attributed to a lack of standardized assessments and intervention instruments. There is a high risk of aggression in Chinese inpatients with schizophrenia, and it is urgent to establish the scientific, standardized, operational systems for assessing and treating the aggression of these patients.
Elovikova, T M; Belokonova, N A; Shurygina, E A; Eshchenko, Ia A; Raspopova, N N
Inflammatory periodontal disease in patients with type II diabetes mellitus are characterized by a more severe course. Properly organized oral hygiene can effectively prevent and treat inflammation of periodontal tissues. The choice of therapeutic-prophylactic toothpaste, as one of the main means of personal hygiene, is especially important in patients with diabetes in surgical in-patient department. The study revealed high need in dental care (90%) in 20 patients with diabetes mellitus type II admitted to purulent surgery unit. After a week of using toothpaste Parоdontax Extra Fresh oral hygiene index improved 1.8 times and BOP index reduced twice-folds. Decrease of tissue swelling and tartar formation was also seen.
Parikh, Pratik J; Ballester, Nicholas; Ramsey, Kylie; Kong, Nan; Pook, Nancy
Ineffective inpatient discharge planning often causes discharge delays and upstream boarding. While an optimal discharge strategy that works across all units at a hospital is likely difficult to identify and implement, a strategy that provides a reasonable target to the discharge team appears feasible. We used observational and retrospective data from an inpatient trauma unit at a Level 2 trauma center in the Midwest US. Our proposed novel n-by-T strategy-discharge n patients by the Tth hour-was evaluated using a validated simulation model. Outcome measures included 2 measures: time-based (mean discharge completion and upstream boarding times) and capacity-based (increase in annual inpatient and upstream bed hours). Data from the pilot implementation of a 2-by-12 strategy at the unit was obtained and analyzed. The model suggested that the 1-by-T and 2-by-T strategies could advance the mean completion times by over 1.38 and 2.72 h, respectively (for 10 AM ≤ T ≤ noon, occupancy rate = 85%); the corresponding mean boarding time reductions were nearly 11% and 15%. These strategies could increase the availability of annual inpatient and upstream bed hours by at least 2,469 and 500, respectively. At 100% occupancy rate, the hospital-favored 2-by-12 strategy reduced the mean boarding time by 26.1%. A pilot implementation of the 2-by-12 strategy at the unit corroborated with the model findings: a 1.98-h advancement in completion times (Pstrategies, such as the n-by-T, can help substantially reduce discharge lateness and upstream boarding, especially during high unit occupancy. To sustain implementation, necessary commitment from the unit staff and physicians is vital, and may require some training.
Tan, Lester Teong Jin; Wong, Seng Joung; Kwek, Ernest Beng Kee
The estimated incidence of hip fractures worldwide was 1.26 million in 1990 and is expected to double to 2.6 million by 2025. The cost of care for hip fracture patients is a significant economic burden. This study aimed to look at the inpatient cost of hip fractures among elderly patients placed under a mature orthogeriatric co-managed system. This study was a retrospective analysis of 244 patients who were admitted to the Department of Orthopaedics of Tan Tock Seng Hospital, Singapore, in 2011 for hip fractures under a mature orthogeriatric hip fracture care path. Information regarding costs, surgical procedures performed and patient demographics was collected. The mean cost of hospitalisation was SGD 13,313.81. The mean cost was significantly higher for the patients who were managed surgically than for the patients who were managed non-surgically (SGD 14,815.70 vs. SGD 9,011.38; p average cost (SGD 2,689.99 more than if there were no complications; p = 0.011). Every additional day from admission to time of surgery resulted in an increased cost of SGD 575.89, and the difference between the average cost of surgery within 48 hours and that of surgery > 48 hours was SGD 2,716.63. Reducing the time to surgery and preventing pre- and postoperative complications can help reduce overall costs. A standardised care path that empowers allied health professionals can help to reduce perioperative complications, and a combined orthogeriatric care service can facilitate prompt surgical treatment. Copyright: © Singapore Medical Association
Adil, Eelam; Xiao, Roy; McGill, Trevor; Rahbar, Reza; Cunningham, Michael
Maintaining an outpatient practice and providing high-quality inpatient care pose significant challenges to the traditional call team approach. To introduce a unique rotating hospitalist inpatient program and assess its clinical, educational, and financial impact. The chief of service (COS) program requires 1 attending physician to rotate weekly as chief of the inpatient service with no conflicting elective duties. This was a retrospective internal billing data review performed at a tertiary pediatric hospital. A total of 1241 patients were evaluated by the COS from October 2012 through October 2013. All patients were treated by the inpatient service under the supervision of the COS. A retrospective analysis of patient encounters and procedures, including International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes, locations of service, clinicians, service dates, and average weekly relative value units (RVUs). Over the study period, the COS was involved in the care of 1241 patients, generating 2786 billable patient encounters. The COS averaged 11.2 patient encounters per day. The most common reasons for consultation were respiratory distress, dysphagia, and stridor. Of patient encounters, 63.0% resulted in a procedure; 82.8% of those procedures were performed in the operating room with the most common being lower airway endoscopy (340 [19.4%]). The average weekly RVUs for the COS (232) were comparable with those of the average weekly outpatient clinic and procedural RVUs of the other otolaryngology faculty in the group (240). The COS program was created to meet the clinical, educational, and organizational demands of a high-volume and high-acuity inpatient service. It is a financially sustainable model with unique advantages, particularly for the staff who maintain their outpatient practices without disruption and for the trainees who have the opportunity to work closely with the entire faculty. Patients are
Full Text Available Objective. Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD. Design. A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented. Setting. Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town. Subjects. Children and adolescents (2 to 18 years presenting to an inpatient unit (n=737. Results. 10.3% (n=76 met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male; girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated demonstrated significant improvement. Delays in seeking treatment and problems with the primary support group were highly prevalent. Conclusion. PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.
The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292\\/16079 (14%) of in-patient cases and 242\\/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.
Nguyen, Phuong T; Lamkin, Joanna; Coverdale, John H; Scott, Samuel; Li, Karen; Gordon, Mollie R
Human trafficking is a serious and prevalent human rights violation that closely intersects with mental health. Limited empirical attention has been paid to the presentations and identification of trafficking victims in psychiatric settings. The primary goal of this paper is to describe the varied presentations of trafficking victims on an urban inpatient psychiatric unit. A literature review was conducted to identify relevant empirical articles to inform our examination of cases. Adult inpatient cases meeting criteria for known or possible human trafficking were systematically identified and illustrative cases were described. Six cases were identified including one male and five females. Two had been labor trafficked and four were suspected or confirmed to have been sex trafficked. The cases demonstrated a tremendous diversity of demographic and psychiatric identifying factors. These cases indicate the importance of routinely screening for trafficking victims in inpatient psychiatry settings. Identification of cases is a requisite step in providing informed and evidence-based treatments and enabling the secondary prevention of re-exploitation. Additional research is warranted given the limited current empirical research on this topic area.
Paul, Jomon A; Ni, Huan; Bagchi, Aniruddha
This article investigates the impact of Certificate of Need (CON) laws on competition in the inpatient care market. One of the major criticisms of these laws is that it may hinder competition in the health care market, which can lead to higher prices. However, from a theoretical standpoint, CON laws could also promote competition by limiting excessive expansion from incumbents. Our main conclusion is that CON laws by and large enhanced competition in the inpatient market during the period of our study. This indicates that the effects of CON laws to hinder predatory behavior could dominate its effects of preventing new entrants into the inpatient care market. We do not find statistically significant evidence to reject the exogeneity assumption of either CON laws or their stringency in our study. We also find factors such as proportion of population aged 18-44, proportion of Asian American population, obesity rate, political environment, etc., in a state significantly impact competition. Our findings could shed some light to public policy makers when deciding the appropriate health programs or legislative framework to promote health care market competition and thereby facilitate quality health care.
Meng, Karin; Musekamp, Gunda; Seekatz, Bettina; Glatz, Johannes; Karger, Gabriele; Kiwus, Ulrich; Knoglinger, Ernst; Schubmann, Rainer; Westphal, Ronja; Faller, Hermann
Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n = 540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients' self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. This study evaluates the effectiveness of a
Blumenthal, Kimberly G; Shenoy, Erica S; Hurwitz, Shelley; Varughese, Christy A; Hooper, David C; Banerji, Aleena
Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P allergy over time (54% vs 80%; P allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Thomas, J B; Haslam, C O
WHAT IS KNOWN ABOUT THE SUBJECT?: Self-harm plays a function, commonly in the form of distress management. There has been little focussed exploration of how individuals who use self-harm to manage distress cope when prevented from self-harm in an inpatient environment and how staff respond to this issue. This paper uses the experiences of mental health staff to add to the existing knowledge that self-harm has a functional role and supports the notion that interventions for self-harm should focus on the origins of distress. It describes the potential consequences that focussing on prevention of self-harm as opposed to actually managing distress may have on service-users, how staff attempt to manage these consequences and factors that may impact on staff interventions to prevent further distress/harm. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that mental healthcare staff should aim to understand the function of self-harm, use this understanding to develop an individualized care plan with the aim of managing distress and identify barriers to the effectiveness of the interventions so they can be worked around. Introduction Literature describes self-harm as functional and meaningful. This creates difficulties for service-users detained in an inpatient environment where self-harm is prevented. Aim Mental healthcare staff were interviewed to build on existing evidence of issues with the prevention approach and explore, from a staff perspective, how self-harm prevention impacts on service-users, how they manage distress and how this impacts on staff and their approach to care. Methods Qualitative methods were used to allow unexpected themes to arise. Ten semi-structured interviews were carried out with mental healthcare staff and thematically analysed. Findings and discussion The findings provide new evidence on the benefits and limitations of the inpatient environment for individuals who self-harm. Findings indicate that being unable to self-harm can
Otto, Hans F; England, Ronald W; Quinn, James M
Few studies have examined inpatient referral patterns for fellowship training programs and none for allergy/immunology (AI) since 2003. The primary end point was the reason for consultation, and secondary end points included the AI diagnosis made and outcomes. We retrospectively reviewed all inpatient AI consultations from July 1, 2001 through June 30, 2007. These 6 years of data were combined with 14 years of data examining the reason for consult from a previous study. The data were analyzed for trends and changes over the entire 20-year period. A total of 254 AI inpatient consults were reviewed over the 6 years studied. Thirty-six percent (92/254) of inpatient consults were for evaluation of adverse drug reactions (ADRs), 22% (55/254) miscellaneous reasons, 17% (43/254) urticaria/angioedema, 13% (32/254) for possible immunodeficiency, 9% (23/254) for anaphylaxis, and 3% (8/254) for asthma. AI inpatient consults show a significant decline over the recent 6-year period (p = 0.0023) despite stable total hospital admissions since 1998. Over the last 20 years, an 85% decrease (p < 0.00001) in inpatient asthma consults and increases (p < 0.05) in immunodeficiency, rash, and urticaria/angioedema evaluations have been observed. Not following AI recommendations resulted in a 16.6 odds ratio (95% CI, 5.55-49.93) that a patient's clinical status would be worse or unchanged. Inpatient AI consults have declined with associated reduction in asthma inpatient consults. Although ADRs and anaphylaxis consults have been stable, evaluations for immunodeficiency, rash, and urticaria/angioedema have increased. Following inpatient AI recommendations is associated with improved patient outcomes.
da Cunha, Silvia Mendes; Araujo, Renata Brasil; Bizarro, Lisiane
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. 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. 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. 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. 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.
Hunderfund, Andrea N. Leep; Sweeney, Cynthia M.; Mandrekar, Jayawant N.; Johnson, LeAnn M.; Britton, Jeffrey W.
OBJECTIVE: To evaluate whether the addition of a physician assessment of patient fall risk at admission would reduce inpatient falls on a tertiary hospital neurology inpatient unit. PATIENTS AND METHODS: A physician fall risk assessment was added to the existing risk assessment process (clinical nurse evaluation and Hendrich II Fall Risk Model score with specific fall prevention measures for patients at risk). An order to select either “Patient is” or “Patient is not at high risk of falls by physician assessment” was added to the physician electronic admission order set. Nurses and physicians were instructed to reach consensus when assessments differed. Full implementation occurred in second-quarter 2008. Preimplementation (January 1, 2006, to March 31, 2008) and postimplementation (April 1, 2008, to December 31, 2009) rates of falls were compared on the neurology inpatient unit and on 6 other medical units that did not receive intervention. RESULTS: The rate of falls during the 7 quarters after full implementation was significantly lower than that during the 9 preceding quarters (4.12 vs 5.69 falls per 1000 patient-days; P=.04), whereas the rate of falls on other medical units did not significantly change (2.99 vs 3.33 falls per 1000 patient-days; P=.24, Poisson test). The consensus risk assessment at admission correctly identified patients at risk for falls (14/325 at-risk patients fell vs 0/147 low-risk patients; P=.01, χ2 test), but the Hendrich II Fall Risk Model score, nurse, and physician assessments individually did not. CONCLUSION: A multidisciplinary approach to fall risk assessment is feasible, correctly identifies patients at risk, and was associated with a reduction in inpatient falls. PMID:21193651
Fennig, Silvana; Brunstein Klomek, Anat; Shahar, Ben; Sarel-Michnik, Zohar; Hadas, Arie
Examine changes in core perceptions and thoughts during the weight restoration phase of inpatient treatment for adolescents with anorexia nervosa. Forty-four adolescents with anorexia nervosa consecutively admitted (2009-2012) to an inpatient paediatric-psychiatric unit specializing in eating disorders. The programme consisted of a complete inpatient intervention combining weight restoration by structured supervised meals with individual and group cognitive-behavioural therapy, parental training/family intervention and educational activities, followed by a half-way day-treatment weight-stabilizing phase and progressive reintroduction to the community. The study focused on changes from hospital admission to discharge in patients' responses to self-report questionnaires on eating disorder symptoms, depression, anxiety and suicidal ideation. No significant changes in core anorexic thoughts and perceptions as Body dissatisfaction, Drive for thinness, Weight concern and Shape concern were noted. However, a reduction in the general severity of eating disorder symptoms (including Restraint and Eating concern) was observed, mainly related to the treatment structure. Levels of depression significantly decreased but remained within pathological range. We also found a concerning increase in suicidal ideation not correlated with a concomitant increase in depressive symptomatology. Inpatient treatment of anorexia nervosa in adolescents does not significantly modify core anorexic thoughts and perceptions. This may explain the high relapse rates. Changes in core beliefs may be crucial for recovery and prevention of relapse in anorexia nervosa at this critical age. This study may have clinical implications for the development of better treatment strategies to target the gap between disturbed thoughts and distorted perceptions - the core aspects of anorexia nervosa and physical recovery during and after the weight restoration phase. © 2015 Wiley Publishing Asia Pty Ltd.
Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P
Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all...... hospitalizations in the United States. Hospitalization rates for AD or eczema were highest in the northeast during the winter and south during the summer. Geometric mean cost of care (95% confidence interval) was lower for a primary diagnosis of AD or eczema versus no AD or eczema in adults ($3,502 [$3......, there is a substantial inpatient financial burden of AD in the United States....
Berentzen, Nina E.; Smit, Henriette A.; Bekkers, Marga B. M.; Brunekreef, Bert; Koppelman, Gerard H.; De Jongste, Johan C.; Kerkhof, Marjan; Van Rossem, Lenie; Wijga, Alet H.
We investigated associations of time in bed and multiple sleep quality characteristics with cardiometabolic markers in children. Data from the prevention and incidence of asthma and mite allergy study, a population-based prospective birth-cohort study started in 1996-1997 in the Netherlands, were
Full Text Available ... Lumbar Zygapophysical (Facet) Joint Injections PREVENTION Lifestyle Choices 10 Tips for a Healthy Back Smoking Weight Patient ... the floor; rotate from side to side. Repeat 10 times. Check with your physician; if you are ...
Zumsteg, Jennifer M; Ennis, Stephanie K; Jaffe, Kenneth M; Mangione-Smith, Rita; MacKenzie, Ellen J; Rivara, Frederick P
To develop evidence-based and expert-driven quality indicators for measuring variations in the structure and organization of acute inpatient rehabilitation for children after traumatic brain injury (TBI) and to survey centers across the United States to determine the degree of variation in care. Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence to these indicators was determined from a survey of rehabilitation facilities. Inpatient rehabilitation units in the United States. A sample of rehabilitation programs identified using data from the National Association of Children's Hospitals and Related Institutions, Uniform Data System for Medical Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded 74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric and 28 all age units. Not applicable. Variations in structure and organization of care among institutions providing acute inpatient rehabilitation for children with TBI. Twelve indicators were developed. Pediatric inpatient rehabilitation units and units with higher volumes of children with TBI were more likely to have: a census of at least 1 child admitted with a TBI for at least 90% of the time; adequate specialized equipment; a classroom; a pediatric subspecialty trained medical director; and more than 75% of therapists with pediatric training. There were clinically and statistically significant variations in the structure and organization of acute pediatric rehabilitation based on the pediatric focus of the unit and volume of children with TBI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Chiodo, Anthony; Wilke, Ruste; Bakshi, Rishi; Craig, Anita; Duwe, Doug; Hurvitz, Edward
Performance improvement is a mainstay of operations management and maintenance of certification. In this study at a University Hospital inpatient rehabilitation unit, Lean management techniques were used to manage throughput of patients into and out of the inpatient rehabilitation unit. At the start of this process, the average admission time to the rehabilitation unit was 5:00 p.m., with a median time of 3:30 p.m., and no patients received therapy on the day of admission. Within 8 mos, the mean admission time was 1:22 p.m., 50% of the patients were on the rehabilitation unit by 1:00 p.m., and more than 70% of all patients received therapy on the day of admission. Negative variance from this performance was evaluated, the identification of inefficient discharges holding up admissions as a problem was identified, and a Lean workshop was initiated. Once this problem was tackled, the prime objective of 70% of patients receiving therapy on the date of admission was consistently met. Lean management tools are effective in improving throughput on an inpatient rehabilitation unit.
Full Text Available Abstract Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1 the fall risk assessment tool, 2 an intervention protocol to prevent in-patient falls, 3 specific environmental safety interventions, 4 staff education, and 5 multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331 in 2004 versus 1.53 falls per 1000 patient days (263/172325 in 2010, representing a significant decrease (p = 0.039. In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368, increasing to 97.6% in 2010 (10564/10828. The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.
Molin, Jenny; Graneheim, Ulla Hällgren; Ringnér, Anders; Lindgren, Britt-Marie
WHAT IS KNOWN ON THE SUBJECT?: Psychiatric inpatient care has been described by both ward staff and patients as being demanding and disorganized, lacking opportunities for quality interactions in everyday life through joint activities. Qualitative research on interprofessional teams' perspectives on everyday life processes in psychiatric inpatient care is lacking. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Staff have ideals about care and collaboration, but the obstacles they face in everyday life, such as a poor environment, power asymmetry, lacking structure and the demands of managing chaos, mean that they appear to resign and shift focus from the patients' best interests to self-survival. Different professions in general describe the same obstacles in everyday life on the wards but there are also profession-specific perspectives on distancing and feelings of abandonment. To our knowledge, these findings have not been reported in the international evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given these findings we suggest interventions such as Protected Engagement Time as well as reflective dialogues within interprofessional teams. This would help staff to resume their caring role in everyday life in psychiatric inpatient care and put their ideals into practice. Introduction Patients and ward staff describe psychiatric inpatient care as demanding, characterized by unpredictable events, yet research on interprofessional teams perspectives of everyday life processes in psychiatric inpatient care lacks. Aim This study aims to explore everyday life processes in psychiatric inpatient care, as reported by staff in interprofessional teams. Method A grounded theory design was used and 36 participants were interviewed. Results The analysis resulted in a process-oriented core category From ideals to resignation. Related to this core category were three further categories: Knowing where to go, Walking a path of obstacles and Shifting focus from the patient's best
Doerfler, Martin E; D'Angelo, John; Jacobsen, Diane; Jarrett, Mark P; Kabcenell, Andrea I; Masick, Kevin D; Parmentier, Darlene; Nelson, Karen L; Stier, Lori
As part of a zero-tolerance approach to preventable deaths, North Shore-LIJ Health System (North Shore-LIJ) leadership prioritized a major patient safety initiative to reduce sepsis mortality in 2009 across 10 acute care hospitals (an 11th joined later). At baseline (2008), approximately 3,500 patients were discharged with a diagnosis of sepsis, which ranked as the top All Patient Refined Diagnosis-Related Group by number of deaths (N = 883). Initially, the focus was sepsis recognition and treatment in the emergency departments (EDs). North Shore-LIJ, the 14th largest health care system in the United States, cares for individuals at every stage of life at 19 acute care and specialty hospitals and more than 400 outpatient physician practice sites throughout New York City and the greater New York metropolitan area. The health system launched a strategic partnership with the Institute for Healthcare Improvement (IHI) in August 2011 to accelerate the pace of sepsis improvement. Throughout the course of the initiative, North Shore-LIJ collaborated with many local, state, national, and international organizations to test innovative ideas, share evidence-based best practices, and, more recently, to raise public awareness. North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008-2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals. Improvements were achieved by engaging leadership; fostering interprofessional collaboration, collaborating with other leading health care organizations; and developing meaningful, real-time metrics for all levels of staff.
Falen, Thomas; Noblin, Alice M; Russell, O Lucia; Santiago, Nonica
Of critical concern to hospitals today is the prevention of postoperative (surgical site) infections that often result in increased lengths of stays for patients, increased resource demands and costs, loss of public trust and lawsuits, and needless pain and suffering for patients and their families. While all surgical patients have the potential to develop a postoperative infection, the main challenge is to identify key risk factors (both patient centered and operational) through an electronic early-warning system to reduce the likelihood of a postoperative infection from occurring. Currently, most postoperative infection risk prevention practices encompass limited use of informatics technologies or do not maximize the potential benefits. In addition, from a research perspective, there has been more focus on extrapolating electronically housed data (eg, from progress notes, operative notes, laboratory, pharmacy, radiology) retrospectively to describe poor patient outcomes for benchmarking purposes (revealing poor results and opportunities for improvement) rather than using similar sources of real-time data to prevent poor patient outcomes from occurring. This article proposes that standardized indicators, both patient centered and operational, linked to the patient's electronic health record could allow for implementation of 24/7, "real-time" monitoring/surveillance to implement well-timed preventive interventions scaled to each patient and facility to assist caregivers in reducing the numbers of postoperative infections and improve the overall quality and costs of patient care.
U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...
U.S. Department of Health & Human Services — 2001 forward. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...
Conclusions: The characteristics of inpatients with severe asthma vary depending on age. We need to establish countermeasures for asthma exacerbation according to the characteristics of patients depending on age.
O'Malley, N T
While the quality and efficiency of out-patient orthopaedic referrals are well documented in the literature, there is little on the standard and appropriateness of inpatient orthopaedic consultations.
U.S. Department of Health & Human Services — The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each...
Alyssa Todaro Brooks
Full Text Available This prospective, repeated measures study utilized a convergent parallel mixed methods approach to assess sleep experiences among individuals who were alcohol-dependent undergoing inpatient detoxification and treatment at a clinical research facility across the transition periods associated with the rehabilitation process: the initial adjustment to becoming an inpatient and the transition from inpatient to outpatient status.This study included individual semi-structured interviews and quantitative measures relating to psychological distress, sleep quality, daytime sleepiness, and sleep-related beliefs and behavior (n = 33; 66.7% male. Interviews were conducted and questionnaires were administered within one week of participants' scheduled discharge date and again four to six weeks post-discharge when they returned for a follow-up visit (or via phone.Participants self-reported significant sleep disturbances at both study time points. Of those participants with valid data at both time points (n = 28, there were no significant changes in mean scores from pre- to post-discharge with the exception of self-efficacy for sleep (SE-S being significantly higher post-discharge. Preliminary qualitative findings suggested differences between those with ongoing sleep disturbances, those whose sleep disturbances had resolved, and those with no sleep disturbances at either time point.This analysis highlights individual variation in sleep throughout the process of inpatient treatment and transition to outpatient aftercare in individuals with alcohol dependence. Collecting quantitative and qualitative data concurrently and combining emerging themes from qualitative data with quantitative analyses allowed for a more thorough examination of this relatively novel area of research and provided information that can be utilized to inform future behavioral sleep interventions.
Abela-Dimech, Frances; Johnston, Kim; Strudwick, Gillian
A mental health organization in Ontario, Canada, noted an increase in unsafe items entering locked inpatient units. The purpose of this project was to develop and implement a search protocol to improve patient, staff, and visitor safety by preventing unsafe items from entering a locked inpatient unit. Under the guidance of a clinical nurse specialist, an interprofessional team used the Failure Mode and Effects Analysis framework to identify what items were considered unsafe, how these unsafe items were entering the unit, and what strategies could be used to prevent these items from entering the unit. A standardized search protocol was identified as a strategy to prevent items from entering the unit. The standardized search protocol was developed and piloted on 1 unit. To support the search protocol, an interprofessional team created a poster using a mnemonic aid to educate patients, staff, and visitors about which items could not be brought onto the unit. Educational sessions on the search protocol were provided for staff. The difference between the number of incidents before and after the implementation of the search protocol was statistically significant. Safety on an inpatient unit was increased as incidents of unsafe items entering the unit decreased.
Dunne, Eileen M.; Mantanitobua, Silivia; Singh, Shalini P.; Reyburn, Rita; Tuivaga, Evelyn; Rafai, Eric; Tikoduadua, Lisi; Porter, Barbara; Satzke, Catherine; Strachan, Janet E.; Fox, Kimberly K.; Jenkins, Kylie M.; Jenney, Adam; Baro, Silo; Mulholland, E. Kim
As part of the World Health Organization Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD) surveillance in Suva, Fiji, cerebrospinal fluid (CSF) samples from suspected meningitis patients of all ages were examined by traditional methods (culture, Gram stain, and latex agglutination for bacterial antigen) and qPCR for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Of 266 samples tested, pathogens were identified in 47 (17.7%). S. pneumoniae was the most co...
Bair, Aaron E; Song, Wheyming T; Chen, Yi-Chun; Morris, Beth A
In this study, a discrete-event simulation approach was used to model Emergency Department's (ED) patient flow to investigate the effect of inpatient boarding on the ED efficiency in terms of the National Emergency Department Crowding Scale (NEDOCS) score and the rate of patients who leave without being seen (LWBS). The decision variable in this model was the boarder-released-ratio defined as the ratio of admitted patients whose boarding time is zero to all admitted patients. Our analysis shows that the Overcrowded(+) (a NEDOCS score over 100) ratio decreased from 88.4% to 50.4%, and the rate of LWBS patients decreased from 10.8% to 8.4% when the boarder-released-ratio changed from 0% to 100%. These results show that inpatient boarding significantly impacts both the NEDOCS score and the rate of LWBS patient and this analysis provides a quantification of the impact of boarding on emergency department patient crowding.
Wartberg, Lutz; Moll, Bettina; Baldus, Christiane; Thomsen, Monika; Thomasius, Rainer
In epidemiological studies high prevalence estimates for pathological Internet use in adolescence were reported. There are only few studies published, reporting data of adolescents seeking treatment concerning their pathological Internet use. Currently, a comparison of patients in inpatient versus outpatient treatment is not available. We investigated 74 adolescents reporting pathological Internet use with standardized questionnaires concerning problematic Internet use, psychopathological symptoms and life satisfaction. Overall, 35 adolescents were treated in an outpatient and another 39 adolescents in an inpatient setting. A substantial portion in both groups showed comorbid mental health problems. There were no differences in the degree of problematic Internet use between the two groups. However, compared to adolescents in an outpatient setting, adolescents in inpatient treatment reported longer average Internet usage times, a lower life satisfaction as well as more anxiety/depressiveness and self-esteem problems. In a multivariate logistic regression analysis Internet usage time and life satisfaction were identified as statistically significant factors for the affiliation to one of the two treatment groups. The results of the present study could be useful as a further description of this group of patients and more general to develop interventions for adolescents reporting pathological Internet use.
Clairton Marcos Citolino Filho
Full Text Available Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%, the lack of harmony (77.6% or stress of any member of staff (67.3%, lack of material and/or equipment failure (57.1%, lack of familiarity with the emergency trolleys (98.0% and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1% are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.
Beaty, Rachel S; Bernhardt, M Brooke; Berger, Amanda H; Hesselgrave, Joy E; Russell, Heidi V; Okcu, M Fatih
Approximately 18% of the United States' gross domestic product is attributed to healthcare expenditures. Several studies have illustrated that shifting healthcare from the inpatient to the outpatient setting is more cost effective, in addition to improving patient satisfaction. Vincristine, dactinomycin, and cyclophosphamide (VAC) are used together to treat children with solid tumors. Our traditional treatment approach included a two day inpatient admission. The purpose of this project was to establish a process for the administration of VAC in the outpatient setting to improve satisfaction, and reduce costs. We aimed to benchmark practice standards with other institutions, revised our treatment approach to permit outpatient administration, and implemented the new protocol in a stepwise manner. We collected caregiver satisfaction metrics through the use of surveys. Costs of encounters were obtained from administrative data. Total costs and costs by service type were compared using descriptive and mean comparisons. Seven patients received a total of 31 cycles of VAC in the outpatient setting. The time to achieve an appropriate pre-chemotherapy specific gravity was reduced by a median of 120 min. In addition, time spent in the hospital setting was reduced by a mean of 27.2 hr. Adverse effects were minimal and all caregivers reported greater satisfaction with the outpatient regimen. Outpatient administration of VAC was $3,300 less on average compared to the inpatient administration. Outpatient VAC provides a safe alternative for administration that reduces healthcare costs, reduces healthcare utilization, and improves patient satisfaction. © 2015 Wiley Periodicals, Inc.
Block, Lauren; Hutzler, Lindsey; Habicht, Robert; Wu, Albert W; Desai, Sanjay V; Novello Silva, Kathryn; Niessen, Timothy; Oliver, Nora; Feldman, Leonard
Etiquette-based communication may improve the inpatient experience but is not universally practiced. We sought to determine the extent to which internal medicine interns practice behaviors that characterize etiquette-based medicine. Trained observers evaluated the use of 5 key communication strategies by internal medicine interns during inpatient clinical encounters: introducing one's self, explaining one's role in the patient's care, touching the patient, asking open-ended questions, and sitting down with the patient. Participants at 1 site then completed a survey estimating how frequently they performed each of the observed behaviors. A convenience sample of 29 interns was observed on a total of 732 patient encounters. Overall, interns introduced themselves 40% of the time and explained their role 37% of the time. Interns touched patients on 65% of visits, asked open-ended questions on 75% of visits, and sat down with patients during 9% of visits. Interns at 1 site estimated introducing themselves and their role and sitting with patients significantly more frequently than was observed (80% vs 40%, P < 0.01; 80% vs 37%, P < 0.01; and 58% vs 9%, P < 0.01, respectively). Resident physicians introduced themselves to patients, explained their role, and sat down with patients infrequently during observed inpatient encounters. Residents surveyed tended to overestimate their own practice of etiquette-based medicine. © 2013 Society of Hospital Medicine.
Newman, Julie; Paun, Olimpia; Fogg, Louis
The current article presents the effects of a 90-minute staff training intervention aimed at reducing inpatient psychiatric seclusion rates through strengthened staff commitment to seclusion alternatives and improved de-escalation skills. The intervention occurred at an 18-bed adult inpatient psychiatric unit whose seclusion rates in 2015 were seven times the national average. Although the project's primary outcome compared patient seclusion rates before and after the intervention, anonymous staff surveys measured several secondary outcomes. Seclusion rates were reduced from a 6-month pre-intervention average of 2.95 seclusion hours per 1,000 patient hours to a 6-month post-intervention average of 0.29 seclusion hours per 1,000 patient hours, a 90.2% reduction. Completed staff surveys showed significant staff knowledge gains, non-significant changes in staff attitudes about seclusion, non-significant changes in staff de-escalation skill confidence, and use of the new resource sheet by only 17% of staff. The key study implication is that time-limited, focused staff training interventions can have a measurable impact on reducing inpatient seclusion rates. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.
Cho, Un Jung; Lee, JooYoung; Kim, Hyo-Won; Lee, Jung Sun; Joo, Yeon-Ho; Kim, Seong-Yoon; Kim, Chang Yoon; Shin, Yong-Wook
Study of inpatient aggression in psychiatric inpatient units (PIUs), where vulnerable patients interact intensely in small groups, is hampered by a lack of systematic monitoring of aggressive events in the context of group dynamics. Our current study examines the relationship between aggression and group structure in the PIU of a general tertiary-care hospital over a 9-month period. The severity of aggression was monitored daily using the Overt Aggression Scale (OAS). Clinical data including the daily number and mean age of subpopulations with different diagnoses were acquired. Cross-correlation function and autoregressive integrated moving average modeling were used to assess the effects of various group structure parameters on the incidence of aggressive events in the PIU. The daily total OAS score correlated positively with the daily mean age of patients with schizophrenia and bipolar disorder. By contrast, the OAS total score demonstrated a negative correlation with the daily mean age of patients with major depression. The age of the patients at diagnosis is an important group structure that affects the incidence of aggression in a PIU.
Hefner, Jennifer L; Sieck, Cynthia J; Walker, Daniel M; Huerta, Timothy R; McAlearney, Ann Scheck
Inpatient portals, a new type of patient portal tailored specifically to the hospital setting, can allow patients to access up-to-date health information and exchange secure communications with their care team. As such, inpatient portals present an opportunity for patients to increase engagement in their care during a time of acute crisis that emphasizes focus on a patient's health. While there is a large body of research on patient portals in the outpatient setting, questions are being raised specifically about inpatient portals, such as how they will be incorporated into the flow of patient care in hectic, stressed, team-based hospital settings. Our aim is to improve understanding about hospital care team members' perceptions of the value of an interactive patient portal for admitted patients, as well as to ascertain staff orientation toward this new technology. Throughout the course of 2016, an inpatient portal, MyChart Bedside (MCB) was implemented across a five-hospital health system. The portal is a tablet-based app that includes a daily schedule, lab/test results, secure messaging with the care team, a place to take notes, and access to educational materials. Within a month of initial rollout, hospital care team members completed a 5-minute, anonymous online survey to assess attitudes and perceptions about MCB use and staff training for the new technology. Throughout the health system, 686 staff members completed the survey: 193 physicians (23.6%), 439 nurses (53.7%), and 186 support staff (22.7%). Questions about the importance of MCB, self-efficacy in using MCB with patients, and feelings about sufficient training and resources showed that an average of 40-60% of respondents in each group reported a positive orientation toward the MCB technology and training received. This positive orientation was highest among support staff, lower among nurses, and lowest for physicians (all differences by staff role were statistically significant at Pteam members
Morgan, Peter T; Angarita, Gustavo A; Canavan, Sofija; Pittman, Brian; Oberleitner, Lindsay; Malison, Robert T; Mohsenin, Vahid; Hodges, Sarah; Easton, Caroline; McKee, Sherry; Bessette, Andrew; Forselius, Erica
To determine whether the increase in slow-wave sleep associated with modafinil treatment in chronic cocaine users mediates improved clinical outcomes. 57 cocaine dependent participants were randomized to receive modafinil 400mg or placebo daily during a period of inpatient treatment followed by six weeks of outpatient treatment. Participants underwent polysomnographic sleep recording during inpatient treatment prior to and after starting modafinil. Outpatient treatment consisted of weekly cognitive behavioral therapy. Contingency management was used to promote participation in treatment and research demands, including thrice weekly visits during the outpatient phase for urine toxicology screens and other assessments. The primary clinical outcome was the percent of urine toxicology screens that were negative for cocaine. Modafinil treatment was associated with a higher mean percentage (52% vs. 26%) of cocaine-free urine screens (p=0.02) and an increase in N3 sleep time (p=0.002). The change in N3 sleep time mediated the higher rate of cocaine-free urine screens. Modafinil treatment was also associated with more consecutive days abstinent during outpatient treatment, greater survival of abstinence, higher daily rates of abstinence, and less sleep degradation typically associated with abstinence from chronic cocaine use. Morning-dosed modafinil improves slow-wave sleep in abstinent cocaine users in the inpatient setting, and this effect is a statistical mediator of improved clinical outcomes associated with continued modafinil treatment. The high rates of abstinence achieved in this trial suggest that promoting healthy sleep physiology in an inpatient setting may be important in the effective treatment of cocaine dependence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Wang, N J; Petersen, P E; Sveinsdóttir, E G
consistent in all countries, but considerable differences in routines between the countries persisted during the period. The most used and maximum planned recall intervals were on average 14.8 (sd 4.8) and 18.5 (sd 4.6) months in 2014, respectively 3.1 and 3.5 months longer than in 1996 (p⟨0.05). In 2014...... with children were included, while in Iceland all dentists were mailed questionnaires. Complete information was provided by 1082 of 1834 dentists (64%) in 1996 and 1366 of 2334 dentists (59%) in 2014. Results were assessed using chi-square and analysis of variance with post-hoc tests. RESULTS: Some trends were...... dentists used ample time delivering preventive care to children. Dentists reported spending significantly more time providing preventive care for caries risk children than for other children both in 1996 and 2014. Concurrent with extended intervals, dentists reported spending longer performing routine...
O'Brien, Shannon P; Billmire, David A
Burns are common injuries in the pediatric population, with an estimated 250,000 pediatric burn patients seeking medical care annually. A relative few require inpatient management. This article discusses suggestions for burn prevention, as well as acute burn care and long-term management of small burns.
Kandler, Rosalind; Ponnusamy, Athi; Wragg, Claire
Video ambulatory EEG (V-AEEG) is a new technique which could add increased capacity for long term EEG monitoring to overstretched inpatient video telemetry (IPVT) services. We compare V-AEEG and IPVT for diagnostic efficacy, recording quality, patient acceptability and technologist time required. Forty-one V-AEEG and 64 IPVT adult patients were included. Patients were investigated to diagnose attacks or to obtain polysomnography (PSG) prior to multiple sleep latency test (MSLT). Number of attacks recorded, whether the diagnostic question was answered, quality of video and EEG recording and patients' preference for investigation at home or in hospital were noted. For V-AEEG patients, ease of procedure and extra technologist time required were recorded. Of patients investigated for diagnosis of attacks, 74% V-AEEG patients and 62% IPVT had typical attacks during the investigation. All PSGs were useful in interpreting the MSLTs. Diagnostic questions were answered by 73% V-AEEGs and 73% IPVTs. Quality of EEG and video recording was similar using V-AEEG and IPVT. Four patients had difficulty using V-AEEG equipment but diagnostic information was lost in only one. 5% of V-AEEG patients would have preferred hospital investigation but 45% of IPVT patients would have preferred home investigation. Extra technologist time for home visits (mean 2h) was required only for the first 7 patients. Video EEG recording quality and diagnostic efficacy from V-AEEG are similar to IPVT. V-AEEG is acceptable to most patients and does not require additional technical time. Hence, V-AEEG offers a convenient, economical alternative to IPVT. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Nanji, Karen C; Seger, Diane L; Slight, Sarah P; Amato, Mary G; Beeler, Patrick E; Her, Qoua L; Dalleur, Olivia; Eguale, Tewodros; Wong, Adrian; Silvers, Elizabeth R; Swerdloff, Michael; Hussain, Salman T; Maniam, Nivethietha; Fiskio, Julie M; Dykes, Patricia C; Bates, David W
To define the types and numbers of inpatient clinical decision support alerts, measure the frequency with which they are overridden, and describe providers' reasons for overriding them and the appropriateness of those reasons. We conducted a cross-sectional study of medication-related clinical decision support alerts over a 3-year period at a 793-bed tertiary-care teaching institution. We measured the rate of alert overrides, the rate of overrides by alert type, the reasons cited for overrides, and the appropriateness of those reasons. Overall, 73.3% of patient allergy, drug-drug interaction, and duplicate drug alerts were overridden, though the rate of overrides varied by alert type (P 75% of the time. The vast majority of duplicate drug, patient allergy, and formulary substitution alerts were appropriate, suggesting that these categories of alerts might be good targets for refinement to reduce alert fatigue. Almost three-quarters of alerts were overridden, and 40% of the overrides were not appropriate. Future research should optimize alert types and frequencies to increase their clinical relevance, reducing alert fatigue so that important alerts are not inappropriately overridden.
McGill, Rita L; Tsukahara, Tomoki; Bhardwaj, Rahul; Kapetanos, Anastasios T; Marcus, Richard J
Depleted venous access is frequently cited as a reason for low fistula achievement. These quality assurance studies were designed to clarify the interactions between kidney disease, acuity of care and vascular access practices, and define the impact of nephrology intervention. The inpatient population at an urban teaching hospital was surveyed three times between May 2010 and May 2012. Data were collected on limb protection and vascular access practices, as well as level of kidney function and level of care. Peripherally inserted central catheter (PICC) insertion consistently exceeded 30% in patients with chronic kidney disease; reasons for insertion were often poorly defined. More than 50% of patients had devices in the nondominant arm; use of limb protection bracelets was rare. An educational intervention designed to increase nephrologist awareness increased limb protection slightly, but did not affect the distribution of vascular access devices. PICC placement and invasion of the nondominant arm are both frequent in patients with abnormal kidney function, in spite of guidelines discouraging their use. The rate of PICC is higher than that of patients with normal kidney function. Current vascular access practices have substantial potential to affect future fistula rates. Effective vein protection may require participation of the entire medical community.
Nuckols, Teryl K; Needleman, Jack; Grogan, Tristan R; Liang, Li-Jung; Worobel-Luk, Pamela; Anderson, Laura; Czypinski, Linda; Coles, Courtney; Walsh, Catherine M
The aim of this study is to evaluate the clinical effectiveness and incremental net cost of a fall prevention intervention that involved hourly rounding by RNs at 2 hospitals. Minimizing in-hospital falls is a priority, but little is known about the value of fall prevention interventions. We used an uncontrolled before-after design to evaluate changes in fall rates and time use by RNs. Using decision-analytical models, we estimated incremental net costs per hospital per year. Falls declined at 1 hospital (incidence rate ratio [IRR], 0.47; 95% confidence interval [CI], 0.26-0.87; P = .016), but not the other (IRR, 0.83; 95% CI, 0.59-1.17; P = .28). Cost analyses projected a 67.9% to 72.2% probability of net savings at both hospitals due to unexpected declines in the time that RNs spent in fall-related activities. Incorporating fall prevention into hourly rounds might improve value. Time that RNs invest in implementing quality improvement interventions can equate to sizable opportunity costs or savings.
Dua, Anahita; Wei, Shuyan; Safarik, Justin; Furlough, Courtney; Desai, Sapan S
While statistics exist regarding the overall rate of fatalities in motorcyclists with and without helmets, a combined inpatient and value of statistical life (VSL) analysis has not previously been reported. Statistical data of motorcycle collisions were obtained from the Centers for Disease Control, National Highway Transportation Safety Board, and Governors Highway Safety Association. The VSL estimate was obtained from the 2002 Department of Transportation calculation. Statistics on helmeted versus nonhelmeted motorcyclists, death at the scene, and inpatient death were obtained using the 2010 National Trauma Data Bank. Inpatient costs were obtained from the 2010 National Inpatient Sample. Population estimates were generated using weighted samples, and all costs are reported using 2010 US dollars using the Consumer Price Index. A total of 3,951 fatal motorcycle collisions were reported in 2010, of which 77% of patients died at the scene, 10% in the emergency department, and 13% as inpatients. Thirty-seven percent of all riders did not wear a helmet but accounted for 69% of all deaths. Of those motorcyclists who survived to the hospital, the odds ratio of surviving with a helmet was 1.51 compared with those without a helmet (p helmeted motorcyclists (p helmeted riders ($203,248 vs. $175,006) but led to more than 50% greater VSL generated (absolute benefit, $602,519 per helmeted survivor). A cost analysis of inpatient care and indirect costs of motorcycle riders who do not wear helmets leads to nearly $2.2 billion in losses per year, with almost 1.9 times as many deaths compared with helmeted motorcyclists. The per capita cost per fatality is more than $800,000. Institution of a mandatory helmet law could lead to an annual cost savings of almost $2.2 billion. Economic analysis, level III.
Kolstad, Jonathan T.; Kowalski, Amanda E.
In April 2006, Massachusetts passed legislation aimed at achieving near-universal health insurance coverage. The key features of this legislation were a model for national health reform, passed in March 2010. The reform gives us a novel opportunity to examine the impact of expansion to near-universal coverage state-wide. Among hospital discharges in Massachusetts, we find that the reform decreased uninsurance by 36% relative to its initial level and to other states. Reform affected utilization by decreasing length of stay, the number of inpatient admissions originating from the emergency room, and preventable admissions. At the same time, hospital cost growth did not increase. PMID:23180894
Le Pogam, Marie-Annick; Quantin, Catherine; Reich, Oliver; Tuppin, Philippe; Fagot-Campagna, Anne; Paccaud, Fred; Peytremann-Bridevaux, Isabelle; Burnand, Bernard
Frail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide. Anticoagulant-related adverse events and the quality of anticoagulation management should thus be routinely assessed to improve patient safety in vulnerable older inpatients. This project aims to develop and validate a set of outcome and process indicators based on linked administrative health data (ie, insurance claims data linked to hospital discharge data) assessing older inpatient safety related to anticoagulation in both Switzerland and France, and enabling comparisons across time and among hospitals, health territories, and countries. Geriatric patient safety indicators (GPSIs) will assess anticoagulant-related adverse events. Geriatric quality indicators (GQIs) will evaluate the management of anticoagulants for the prevention and treatment of arterial or venous thromboembolism in older inpatients. GPSIs will measure cumulative incidences of thromboembolic and bleeding adverse events based on hospital discharge data linked to insurance claims data. Using linked administrative health data will improve GPSI risk adjustment on patients' conditions that are present at admission and will capture in-hospital and postdischarge adverse events. GQIs will estimate the proportion of index hospital stays resulting in recommended anticoagulation at discharge and up to various time frames based on the same electronic health data. The GPSI and GQI development and validation process will comprise 6 stages: (1) selection and specification of candidate indicators, (2) definition of administrative data
Full Text Available People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment tools.
Singh, Salil; Lipscomb, George; Padmakumar, Kadukkavil; Ramamoorthy, Radha; Ryan, Shirley; Bates, Vivien; Crompton, Sandra; Dermody, Emma; Moriarty, Kieran
For gastroenterology, The Royal College of Physicians reiterates the common practice of two to three consultant ward rounds per week. The Royal Bolton Hospital NHS Foundation Trust operated a 26-bed gastroenterology ward, covered by two consultants at any one time. A traditional system of two ward rounds per consultant per week operated, but as is commonplace, discharges peaked on ward round days. To determine whether daily consultant ward rounds would improve patient care, shorten length of stay and reduce inpatient mortality. A new way of working was implemented in December 2009 with a single consultant taking responsibility for all ward inpatients. Freed from all other direct clinical care commitments for their 2 weeks of ward cover, they conducted ward rounds each morning. A multidisciplinary team (MDT) meeting followed immediately. The afternoon was allocated to gastroenterology referrals and reviewing patients on the medical admissions unit. The changes had an immediate and dramatic effect on average length of stay, which was reduced from 11.5 to 8.9 days. The number of patients treated over 12 months increased by 37% from 739 to 1010. Moreover, the number of deaths decreased from 88 to 62, a reduction in percentage mortality from 11.2% to 6%. However, these major quality outcomes involved a reduction in consultant-delivered outpatient and endoscopy activity. This new method of working has both advantages and disadvantages. However, it has had a major impact on inpatient care and provides a compelling case for consultant gastroenterology expansion in the UK.
Greysen, S Ryan; Khanna, Raman R; Jacolbia, Ronald; Lee, Herman M; Auerbach, Andrew D
Inadequate patient engagement in hospital care inhibits high-quality care and successful transitions to home. Tablet computers may provide opportunities to engage patients, particularly during inactive times between provider visits, tests, and treatments, by providing interactive health education modules as well as access to their personal health record (PHR). We conducted a pilot project to explore inpatient satisfaction with bedside tablets and barriers to usability. Additionally, we evaluated use of these devices to deliver 2 specific Web-based programs: (1) an interactive video to improve inpatient education about hospital safety, and (2) PHR access to promote inpatient engagement in discharge planning. We enrolled 30 patients; 17 (60%) were aged 40 years or older, 17 (60%) were women, 17 (60%) owned smartphones, and 6 (22%) owned tablet computers. Twenty-seven (90%) reported high overall satisfaction with the device, and 26 (87%) required ≤ 30 minutes for basic orientation (70% required ≤ 15 minutes). Twenty-five (83%) independently completed an interactive educational module on hospital patient safety. Twenty-one (70%) accessed their personal health record (PHR) to view their medication list, verify scheduled appointments, or send a message to their primary care physician. Next steps include education on high-risk medications, assessment of discharge barriers, and training clinical staff (such as respiratory therapists, registered nurses, or nurse practitioners) to deliver tablet interventions. © 2014 Society of Hospital Medicine.
Altenburg, T.M.; Lakerveld, J.; Bot, S.D.M.; Nijpels, G.; Chin A Paw, M.J.M.
Background: Sedentary time has been identified as an important and independent risk factor for the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) in adults. However, to date most studies have focused on TV time, few also included other sedentary behaviours such as
Channon, Andrew Amos; Andrade, Monica Viegas; Noronha, Kenya; Leone, Tiziana; Dilip, T.R.
The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country. PMID:23041128
Capodaglio, P; Cimolin, V; Tacchini, E; Precilios, H; Brunani, A
The aim of the present paper is to provide initial evidence that in-patient multidisciplinary rehabilitation is effective in minimizing the obesity-related disability and enhancing functional capacities in obese patients with motor disability. Four hundred and sixty-four obese patients with orthopedic conditions admitted to our Rehabilitation Unit for multidisciplinary rehabilitation were enrolled in this study. At admission and discharge (after 4 weeks), the following outcome measures were computed: body weight (BW) (kg), body mass index (BMI) (kg/m2), Functional Independence Measure (FIM) motor and cognitive, Obesity-related disability test (TSD-OC), Visual Analogue Score (VAS) for functioning, Timed-Up-Go (TUG). Intensive rehabilitation addressed to obese patients with orthopedic conditions and motor difficulties consisted of a 4-week and 3-h daily multidisciplinary program covering nutritional, motor and psychological aspects. All of the outcomes measured, except the FIM cognitive score, improved significantly after in-patient rehabilitation. The obesity-specific disability scale appears sensitive to changes among groups with different grades of disability and the percentage of change does not differ among groups. Younger obese individuals generally showed to benefit more from rehabilitation interventions than the older ones. In-patient rehabilitation interventions appear effective in reducing both mild and severe disabilities related to obesity with orthopedic co-morbidities. This paper provides initial evidence that in-patient multidisciplinary intensive rehabilitation is effective in minimizing the obesity-related disability and initial support to the indications of the Italian Ministry of Health for such rehabilitation pathway. The disability grading could help the decision making of allocating patients to appropriate rehabilitation settings.
Full Text Available Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing.We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically.Paper or electronic medication records were shown to patients in only 4 (2% of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture.Patients appear to have more access to paper-based records than
Full Text Available Abstract Background This study investigated the incidence of potentially preventable hospitalisations in the first two years of life among children in the National Health Insurance (NHI system of Taiwan. It also examined income disparities in potentially preventable hospitalisations across four economic categories: below a government-established poverty line and low-, middle-, and upper-income. Five major diseases causing potentially preventable hospitalisations were investigated: gastroenteritis and dehydration, asthma and chronic bronchitis, acute upper respiratory infections, lower respiratory infections, and acute injuries and poisonings. Methods NHI data on enrolee registrations and use of ambulatory and hospital care by all children born between July 1, 2003 and June 30, 2004 (n = 218,158 was used for the study. The negative binomial regression method was used to identify factors associated with total inpatient care and the severity level for various types of potentially preventable hospitalisations during the first two years of life. Results This study found high inpatient expenses for lower respiratory infections for children in all income categories. Furthermore, results from the multivariate analysis indicate that children in the lowest economic category used inpatient care to a much greater extent than better-off children for problems considered potentially avoidable through primary prevention or through timely outpatient care. This was especially true for acute injuries and poisonings and for lower respiratory infections. On average, and controlling for other variables, a child in poverty spent 6.1 times more days in inpatient care for acute injuries and poisonings (p Conclusions There were high hospital admission rates and lengths of stays for lower respiratory infections among young children in all income categories. Hospital care use of young children in the poorest category was significantly higher for acute injuries and
Zarrabian, Sina; Belkacemi, Rabie; Babalola, Adeniyi A.
In this paper, a novel intelligent control is proposed based on Artificial Neural Networks (ANN) to mitigate cascading failure (CF) and prevent blackout in smart grid systems after N-1-1 contingency condition in real-time. The fundamental contribution of this research is to deploy the machine learning concept for preventing blackout at early stages of its occurrence and to make smart grids more resilient, reliable, and robust. The proposed method provides the best action selection strategy for adaptive adjustment of generators' output power through frequency control. This method is able to relieve congestion of transmission lines and prevent consecutive transmission line outage after N-1-1 contingency condition. The proposed ANN-based control approach is tested on an experimental 100 kW test system developed by the authors to test intelligent systems. Additionally, the proposed approach is validated on the large-scale IEEE 118-bus power system by simulation studies. Experimental results show that the ANN approach is very promising and provides accurate and robust control by preventing blackout. The technique is compared to a heuristic multi-agent system (MAS) approach based on communication interchanges. The ANN approach showed more accurate and robust response than the MAS algorithm.
Fichter, Manfred M; Quadflieg, Norbert; Nisslmüller, Kerstin; Lindner, Susanne; Osen, Bernhard; Huber, Thomas; Wünsch-Leiteritz, Wally
Technological advancements allow new approaches to psychotherapy via electronic media. The eating disorder literature currently contains no studies on internet intervention in anorexia nervosa (AN). This study presents a RCT on an internet-based relapse prevention program (RP) over nine months after inpatient treatment for AN. The sample comprised 258 women, randomized to the RP or treatment as usual (TAU). Expert- and self-ratings were evaluated by intent-to-treat analyses. Concerning age, age at onset and comorbidity, both groups were comparable at randomization. During the RP, the intervention group gained weight while the TAU group had minimal weight loss. RP completers gained significantly more body weight than patients in the TAU condition. Group-by-time comparisons for eating-related cognitions and behaviors and general psychopathology showed a significantly more favorable course in the RP program for "sexual anxieties" and "bulimic symptoms" (interview), and "maturity fears" and "social insecurity" (EDI-2). General psychopathology showed no significant group-by-time interaction. Important factors for successful relapse prevention were adherence to the intervention protocol and increased spontaneity. Considering the unfavorable course and chronicity of anorexia nervosa (AN), internet-based relapse prevention in AN following inpatient treatment appears a promising approach. Future internet-based programs may be further improved and enhanced. Copyright Â© 2012 Elsevier Ltd. All rights reserved.
Riccardo Dalle Grave
Full Text Available Enhanced cognitive behaviour therapy (CBT-E for eating disorders has been developed and evaluated only in outpatient setting. Aim of the paper is to describe a novel model of inpatient treatment, termed inpatient CBT-E, indicated for patients with an eating disorder of clinical severity not manageable in an outpatient setting or that failed outpatient treatment. Inpatient CBT-E is derived by the outpatients CBT-E with some adaptations to rend the treatments suitable for an inpatient setting. The principal adaptations include: 1 multidisciplinary and non-eclectic team composed of physicians, psychologists, dieticians and nurses all trained in CBT; 2 assisted eating; 3 group sessions; and a CBT family module for patients younger than 18 years. The treatment lasts 20 weeks (13 for inpatients followed by seven weeks of residential day treatment and, as CBT-E, is divided in four stages and can be administered in a focused form (CBT-F or in a broad form (CBT-B. A randomized control trial is evaluating the effectiveness of the treatment.
Noblin, J Leigh; Venta, Amanda; Sharp, Carla
Although the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) has shown validity in adult samples, only one study has explored its validity in adolescents and, to our knowledge, the measure has not been validated with inpatient adolescents. The aim of the current study was to evaluate the reliability, and convergent and criterion validity, of the MSI-BPD in an effort to establish the clinical utility of the MSI-PBD as a screening measure for BPD in inpatient adolescents. A total of 121 adolescents from an acute care inpatient unit were recruited for the study. Convergent validity was examined with established measures of BPD in adolescents, including the use of receiver operating characteristics analyses to establish a clinical cutoff score for the MSI-BPD in predicting a diagnosis of BPD. Criterion validity was examined by using this clinical cutoff to investigate group differences in suicidal ideation and Axis I symptoms, known correlates of BPD. Findings demonstrated support for validity of the MSI-BPD when used among inpatient adolescents, and established a clinical cutoff of 5.5. Taken together, this study demonstrates adequate validity for the MSI-BPD, and suggests it is a valuable screening measure for BPD in adolescent inpatients. © The Author(s) 2013.
Fernández-Plata, Rosario; Olmedo-Torres, Daniel; Martínez-Briseño, David; González-Cruz, Herminia; Casa-Medina, Guillermo; García-Sancho, Cecilia
Periodontal disease is a chronic inflammatory gingival process that has been associated with the severity of respiratory diseases. In Mexico a prevalence of 78% was found in population with social security and > 60 years old. The aim of this study is to establish the association between periodontal disease and respiratory diseases according to the inpatient days. A cross-sectional study was conducted from January to December 2011. We included hospitalized patients, ≥ 18 years of age, without sedation or intubated. A dentist classified patients into two groups according to the severity of the periodontal disease: mild-to-moderate and severe. We estimated medians of inpatient days by disease and severity. Negative binomial models were adjusted to estimate incidence rate ratios and predicted inpatient days. 3,059 patients were enrolled. The median of observed and predicted inpatient days was higher in the group of severe periodontal disease (p disease, tuberculosis, and influenza had the highest incidence rates ratios of periodontal disease (p periodontal disease is positively -associated with inpatient days of patients with respiratory diseases.
Altenburg, Teatske M; Lakerveld, Jeroen; Bot, Sandra D; Nijpels, Giel; Chinapaw, Mai J M
Sedentary time has been identified as an important and independent risk factor for the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) in adults. However, to date most studies have focused on TV time, few also included other sedentary behaviours such as computer use and reading, and most studies had a cross-sectional design. We aimed to examine the prospective relationship between time spent on sedentary behaviours in different domains with individual and clustered cardiometabolic risk in adults. Longitudinal data of 622 adults aged 30-50 years (42% males) at increased cardiometabolic risk were used. Leisure time TV viewing, computer use, reading and other sedentary activities (e.g. passive transport) were assessed using a subscale of the Activity Questionnaire for Adolescents and Adults (AQuAA), and summed into overall sedentary behaviour (min/day). Weight and blood pressure were measured, waist-to-hip ratio and BMI calculated, and fasting plasma levels of glucose, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides determined. T2DM risk score was estimated according to the ARIC formula and CVD mortality risk according to the SCORE formula. Generalized Estimating Equation analysis demonstrated that over a two-year period higher levels of overall sedentary time and TV time were weakly but negatively associated with one out of 13 studied cardiometabolic risk factors (i.e. HDL cholesterol). Overall sedentary time, as well as sedentary time in different domains, was virtually not related with cardiometabolic risk factors.
Background Sedentary time has been identified as an important and independent risk factor for the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) in adults. However, to date most studies have focused on TV time, few also included other sedentary behaviours such as computer use and reading, and most studies had a cross-sectional design. We aimed to examine the prospective relationship between time spent on sedentary behaviours in different domains with individual and clustered cardiometabolic risk in adults. Methods Longitudinal data of 622 adults aged 30-50 years (42% males) at increased cardiometabolic risk were used. Leisure time TV viewing, computer use, reading and other sedentary activities (e.g. passive transport) were assessed using a subscale of the Activity Questionnaire for Adolescents and Adults (AQuAA), and summed into overall sedentary behaviour (min/day). Weight and blood pressure were measured, waist-to-hip ratio and BMI calculated, and fasting plasma levels of glucose, HbA1c, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides determined. T2DM risk score was estimated according to the ARIC formula and CVD mortality risk according to the SCORE formula. Results Generalized Estimating Equation analysis demonstrated that over a two-year period higher levels of overall sedentary time and TV time were weakly but negatively associated with one out of 13 studied cardiometabolic risk factors (i.e. HDL cholesterol). Conclusion Overall sedentary time, as well as sedentary time in different domains, was virtually not related with cardiometabolic risk factors. PMID:25027974
Mountain Debbie A
Full Text Available Abstract Background At any time, about 1% of people with severe and enduring mental illness such as schizophrenia require in-patient psychiatric rehabilitation. In-patient rehabilitation enables individuals with the most challenging difficulties to be discharged to successful and stable community living. However, the length of rehabilitation admission that is required is highly variable and the reasons for this are poorly understood. There are very few case-control studies of predictors of outcome following hospitalisation. None have been carried out for in-patient rehabilitation. We aimed to identify the factors that are associated with achieving discharge from in-patient rehabilitation by carrying out a case-control study. Methods We compared two groups: 34 people who were admitted to the Rehabilitation Service at the Royal Edinburgh Hospital and discharged within a six year study period, and 31 people who were admitted in the same period, but not discharged. We compared the groups on demographic, illness, treatment and risk variables that were present at the point of their admission to rehabilitation. We used independent t tests and Pearson Chi-Square tests to compare the two groups. Results We found that serious self harm and suicide attempts, treatment with high dose antipsychotics, antipsychotic polypharmacy and previous care in forensic psychiatric services were all significantly associated with non-discharge. The non-discharged group were admitted significantly later in the six year study period and had already spent significantly longer in hospital. People who were admitted to rehabilitation within the first ten years of developing psychosis were more likely to have achieved discharge. Conclusions People admitted later in the study period required longer rehabilitation admissions and had higher rates of serious self harm and treatment resistant illness. They were also more likely to have had previous contact with forensic services. This
Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies on treatment of depression
Full Text Available Abstract Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions. Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies
Zanca, Jeanne M; Natale, Audrey; Labarbera, Jacqueline; Schroeder, Sally Taylor; Gassaway, Julie; Backus, Deborah
Inpatient rehabilitation for spinal cord injury (SCI) includes the use of both individual and group physical therapy sessions. A greater understanding of group physical therapy use will help in the evaluation of the appropriateness of its use and contribute to the development of standards of practice. This report describes the extent to which group physical therapy is being used in inpatient rehabilitation for SCI, identifies group physical therapy interventions being delivered, and examines patterns in the types of activities being used for people with different levels and completeness of injury (ie, injury groups). The SCIRehab Study is a 5-year, multicenter investigation that uses practice-based evidence research methodology. Data on characteristics of participants and treatments provided were collected through detailed chart review and customized research documentation completed by clinicians at the point of care. The analyses described here included data from 600 participants enrolled during the first year of the project. Most of the participants (549/600) spent time in group physical therapy, and 23% of all documented physical therapy time was spent in group sessions. The most common group physical therapy activities were strengthening, manual wheelchair mobility, gait training, endurance activities, and range of motion/stretching. Time spent in group physical therapy and the nature of activities performed varied among the injury groups. Physical therapy use patterns observed in the 6 participating centers may not represent all facilities providing inpatient rehabilitation for SCI. Research documentation did not include all factors that may affect group physical therapy use, and some sessions were not documented. The majority of physical therapy was provided in individual sessions, but group physical therapy contributed significantly to total physical therapy time. Group physical therapy time and activities differed among the injury groups in patterns
Adam W. Kiefer
Full Text Available Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance.
Pachana, Nancy A; McWha, J Lindsay; Arathoon, Maureen
A brief history of the link between horticultural activities and care of patients, particularly psychiatric patients, is reviewed in this article. Past research on both passive and active garden activities is examined in terms of physical and psychological benefits to patients. A passive garden intervention on an inpatient geriatric ward is described. Participants in this study were patients on a geriatric inpatient ward in a mid-sized regional hospital in New Zealand. Behavioral observations of patient movement on the ward were used to demonstrate the effects on patient behavior in response to the presence of the conservatory garden. Results showed a positive reaction to the conservatory, which was maintained 6 months after the initial plants were installed. The benefits of such garden installations are discussed, and areas for further research are outlined. Procedures, ethical concerns, and practical considerations of setting up such a conservatory on an inpatient ward are discussed.
Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit. Copyright© by the American Nephrology Nurses Association.
Strömberg, Ulf; Holmn, Anders; Magnusson, Kerstin
Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time...
Georgakopoulos, C.G.; Vonaparti, A.; Stamou, M.; Kiousi, P.; Lyris, E.; Angelis, Y.S.; Tsoupras, G.; Wuest, B.; Nielen, M.W.F.; Panderi, I.; Koupparis, M.
A new combined doping control screening method for the analysis of anabolic steroids in human urine using liquid chromatography/electrospray ionization orthogonal acceleration time-of-flight mass spectrometry (LCoaTOFMS) and gas chromatography/electron ionization orthogonal acceleration
Full Text Available Canine and feline preventative healthcare consultations can be more complex than other consultation types, but they are typically not allocated additional time in the United Kingdom (UK. Impacts of the perceived length of UK preventative healthcare consultations have not previously been described. The aim of this novel study was to provide the first qualitative description of owner and veterinary surgeon reflections on time during preventative healthcare consultations. Semi-structured telephone interviews were conducted with 14 veterinary surgeons and 15 owners about all aspects of canine and feline preventative healthcare consultations. These qualitative data were thematically analysed, and four key themes identified. This paper describes the theme relating to time and consultation length. Patient, owner, veterinary surgeon and practice variables were recalled to impact the actual, versus allocated, length of a preventative healthcare consultation. Preventative healthcare consultations involving young, old and multi-morbid animals and new veterinary surgeon-owner partnerships appear particularly susceptible to time pressures. Owners and veterinary surgeons recalled rushing and minimizing discussions to keep consultations within their allocated time. The impact of the pace, content and duration of a preventative healthcare consultation may be influential factors in consultation satisfaction. These interviews provide an important insight into the complex nature of preventative healthcare consultations and the behaviour of participants under different perceived time pressures. These data may be of interest and relevance to all stakeholders in dog and cat preventative healthcare.
Archer, R P; Ball, J D; Hunter, J A
This study investigated MMPI characteristics of male and female adolescent inpatients with diagnoses of borderline personality disorder (n = 28) in contrast to adolescent inpatients receiving principal diagnoses of conduct disorder (n = 21), dysthymic disorder (n = 50), other personality disorders (n = 17), and other diagnoses (n = 30). The borderline group has significantly higher elevations than comparison groups on MMPI scales F, Hs, D, Pd, Pa, Pt, Sc, and Ma. A stepwise discriminant analysis resulted in 82.1% accuracy in correctly classifying borderline patients and 78.0% accuracy in identifying nonborderline patients. Findings are discussed in terms of potential uses and limitations in identifying borderline personality disorder with the MMPI.
Ho, Allen L; Li, Alexander Y; Sussman, Eric S; Pendharkar, Arjun V; Iyer, Aditya; Thompson, Patricia A; Tayag, Armine T; Chang, Steven D
This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 - 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are increasingly being referred to outpatient centers.
St-Onge, Marie-Pierre; Ard, Jamy; Baskin, Monica L; Chiuve, Stephanie E; Johnson, Heather M; Kris-Etherton, Penny; Varady, Krista
Eating patterns are increasingly varied. Typical breakfast, lunch, and dinner meals are difficult to distinguish because skipping meals and snacking have become more prevalent. Such eating styles can have various effects on cardiometabolic health markers, namely obesity, lipid profile, insulin resistance, and blood pressure. In this statement, we review the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency (number of daily eating occasions), and timing of eating occasions. Furthermore, we propose definitions for meals, snacks, and eating occasions for use in research. Finally, data suggest that irregular eating patterns appear less favorable for achieving a healthy cardiometabolic profile. Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management. © 2017 American Heart Association, Inc.
Full Text Available Tiffany Lee, Erin Davis, Jason Kielly School of Pharmacy, Memorial University, St John's, NL, Canada Background: Anticoagulant therapies provide management options for potentially life-threatening thromboembolic conditions. They also carry significant safety risks, requiring careful consideration of medication dose, close monitoring, and follow-up. Inpatients are particularly at risk, considering the widespread use of anticoagulants in hospitals. This has prompted the introduction of safety goals for anticoagulants in Canada and the USA, which recommend increased pharmacist involvement to reduce patient harm. The goal of this review is to evaluate the efficacy and safety of pharmacist-led inpatient anticoagulation services compared to usual or physician-managed care. Methods: This narrative review includes articles identified through a literature search of PubMed, Embase, and International Pharmaceutical Abstracts databases, as well as hand searches of the references of relevant articles. Full publications of pharmacist-managed inpatient anticoagulation services were eligible if they were published in English and assessed clinical outcomes. Results: Twenty-six studies were included and further divided into two categories: 1 autonomous pharmacist-managed anticoagulation programs (PMAPs and 2 pharmacist recommendation. Pharmacist management of heparin and warfarin appears to result in improvements in some surrogate outcomes (international normalized ratio [INR] stability and time in INR goal range, while results for others are mixed (time to therapeutic INR, length of stay, and activated partial thromboplastin time [aPTT] measures. There is also some indication that PMAPs may be associated with reduced patient mortality. When direct thrombin inhibitors are managed by pharmacists, there seems to be a shorter time to therapeutic aPTT and a greater percentage of time in the therapeutic range, as well as a decrease in the frequency of medication
Procedures that may be used for the life time assessments and growth laws for failure mechanisms with respect to cyclic operation has been compiled. Experience and analyzes of the effects of cyclical operation of steam drums, steam boxes, steam accumulators and valves has been compiled. For the strain-induced corrosion cracking in steam drums a correlation between the voltage level and the crack growth rate has been developed.
Sugai, Takuro; Suzuki, Yutaro; Yamazaki, Manabu; Shimoda, Kazutaka; Mori, Takao; Ozeki, Yuji; Matsuda, Hiroshi; Sugawara, Norio; Yasui-Furukori, Norio; Minami, Yoshitake; Okamoto, Kurefu; Sagae, Toyoaki; Someya, Toshiyuki
Objectives To clarify the prevalence of underweight and overweight/obesity, and laboratory data for nutritional status in Japanese outpatients and inpatients with schizophrenia. Design Cross-sectional study. Setting A questionnaire conducted in inpatient and outpatient facilities in Japan. Participants The population of adult patients with schizophrenia in Japan (N=23 116). Main outcome measures The prevalence of underweight and undernutrition in Japanese inpatients and outpatients with schizophrenia. Results We conducted a large-scale investigation of the prevalence of underweight and undernutrition in 520 outpatient facilities and 247 inpatient facilities belonging to the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7655 outpatients and 15 461 inpatients with schizophrenia. There was a significant difference in the distribution of three body mass index levels between outpatients and inpatients (punderweight inpatients with schizophrenia was significantly higher than that among outpatients (punderweight individuals aged ≥40 years was higher in inpatients than in outpatients and in the general Japanese population. The proportion of individuals with hypocholesterolaemia was significantly higher in inpatients with schizophrenia than in outpatients (punderweight between outpatients and inpatients with schizophrenia; the proportion of severe underweight in inpatients was twofold higher than in outpatients. Conclusions The prevalence of underweight and undernutrition in Japanese inpatients with schizophrenia was higher than in outpatients and the general population. Therefore, the physical risk of inpatients should be carefully considered in clinical practice. PMID:26656016
Hodis, Howard N; Mack, Wendy J
A major misperception concerning postmenopausal hormone replacement therapy (HRT) is that the associated risks are large in magnitude and unique to HRT, but over the past 10 years, sufficient data have accumulated so that the magnitude and perspective of risks associated with the primary coronary heart disease prevention therapies of statins, aspirin, and postmenopausal HRT have become more fully defined. Review of randomized controlled trials indicates that the risks of primary prevention therapies and other medications commonly used in women's health are of similar type and magnitude, with the majority of these risks categorized as rare to infrequent (risks of postmenopausal HRT are predominantly rare (risks, including breast cancer, stroke, and venous thromboembolism are common across medications and are rare, and even rarer when HRT is initiated in women younger than 60 or who are less than 10 years since menopause. In Part 1 of this series, the sex-specificity of statins and aspirin and timing of initiation of HRT as modifiers of efficacy in women were reviewed. Herein, the comparative risks of primary prevention therapies in women are discussed. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Full Text Available Abstract Background Intermittent preventive treatment (IPT has recently been accepted as an important component of the malaria control strategy. Intermittent preventive treatment for children (IPTc combined with timely treatment of malaria related febrile illness at home to reduce parasite prevalence and malaria morbidity in children aged between six and 60 months in a coastal community in Ghana. This paper reports persistence of reduced parasitaemia two years into the intervention. The baseline and year-one-evaluation findings were published earlier. Objective The main objective in the second year was to demonstrate whether the two interventions would further reduce parasite prevalence and malaria-related febrile illness in the study population. Methods This was an intervention study designed to compare baseline and evaluation findings without a control group. The study combined home-based delivery of intermittent preventive treatment for children (IPTc aged 6 - 60 months and home treatment of suspected febrile malaria-related illness within 24 hours. All children aged 6 - 60 months received home-based delivery of intermittent preventive treatment using amodiaquine + artesunate, delivered at home by community assistants every four months (6 times in 24 months. Malaria parasite prevalence surveys were conducted before the first and after the third and sixth IPTc to the children. The evaluation surveys were done four months after the third and sixth IPTc was given. Results Parasite prevalence which reduced from 25% to 3.0% at year-one evaluation had reduced further from 3% to 1% at year-two-evaluation. At baseline, 13.8% of the children were febrile (axilary temperature of ≥37.5°C compared to 2.2% at year-one-evaluation while 2.1% were febrile at year-two-evaluation. Conclusion The year-two-evaluation result indicates that IPTc given three times in a year (every four months combined with timely treatment of febrile malaria illness, is
Bauman William A
Full Text Available Abstract Background Anabolic steroids, such as nandrolone, slow muscle atrophy, but the mechanisms responsible for this effect are largely unknown. Their effects on muscle size and gene expression depend upon time, and the cause of muscle atrophy. Administration of nandrolone for 7 days beginning either concomitantly with sciatic nerve transection (7 days or 29 days later (35 days attenuated denervation atrophy at 35 but not 7 days. We reasoned that this model could be used to identify genes that are regulated by nandrolone and slow denervation atrophy, as well as genes that might explain the time-dependence of nandrolone effects on such atrophy. Affymetrix microarrays were used to profile gene expression changes due to nandrolone at 7 and 35 days and to identify major gene expression changes in denervated muscle between 7 and 35 days. Results Nandrolone selectively altered expression of 124 genes at 7 days and 122 genes at 35 days, with only 20 genes being regulated at both time points. Marked differences in biological function of genes regulated by nandrolone at 7 and 35 days were observed. At 35, but not 7 days, nandrolone reduced mRNA and protein levels for FOXO1, the mTOR inhibitor REDD2, and the calcineurin inhibitor RCAN2 and increased those for ApoD. At 35 days, correlations between mRNA levels and the size of denervated muscle were negative for RCAN2, and positive for ApoD. Nandrolone also regulated genes for Wnt signaling molecules. Comparison of gene expression at 7 and 35 days after denervation revealed marked alterations in the expression of 9 transcriptional coregulators, including Ankrd1 and 2, and many transcription factors and kinases. Conclusions Genes regulated in denervated muscle after 7 days administration of nandrolone are almost entirely different at 7 versus 35 days. Alterations in levels of FOXO1, and of genes involved in signaling through calcineurin, mTOR and Wnt may be linked to the favorable action of nandrolone on
Dhand, Amar; Bucelli, Robert; Varadhachary, Arun; Tsiaklides, Michael; de Bruin, Gabriela; Dhaliwal, Gurpreet
The Institute of Medicine report Improving Diagnosis in Health Care called for tools to monitor physicians' diagnostic process. We addressed this need by developing a tool for clinicians to record and analyze their diagnostic process. The tool was a secure web application in which clinicians used a structured grading system to assess the relative impact of clinical, laboratory, and neuroimaging data for every new diagnosis. Four neurohospitalists used the tool for 6.5 months on a general neurology ward service at a single tertiary-level teaching hospital. Process measures of tool use included number of diagnoses entered, time spent on each data entry, and concordance of diagnoses compared to the medical record. We also aggregated the data across clinicians to examine the average process scores across common inpatient disorders. The 4 clinicians entered 254 new diagnoses that took approximately 3 minutes per patient. In 50 randomly chosen cases, the neurohospitalists' diagnoses entered into the tool agreed with 92% of diagnoses in the medical record, which was better than the agreement between billing code and medical record diagnoses (74%). The diagnostic process varied across disease categories, showing a spectrum of clinical-dominant (eg, headache), laboratory-dominant (eg, encephalitis), and neuroimaging-dominant (eg, stroke) disorders. This study demonstrated the feasibility of a clinician-driven diagnostic process monitoring system, along with preliminary characterization of the process for common disorders. The tracking of diagnostic process has the potential to promote reflection on clinical practice, deconstruct neurologists' clinical decision-making, and improve health-care safety.
Muula, Adamson S; Misiri, Humphreys E
Background Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. Methods A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. Results A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2%) of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%), alleviating factors 5 (5.5%), pain radiation 7 (7.7%), exacerbating factors in 9 (9.9%) and periodicity in 43 (47.3%) of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p < 0.01. Paracetamol was the commonest analgesic prescribed. Conclusion Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value. PMID
Muula Adamson S
Full Text Available Abstract Background Pain is a leading symptom which influences patients to seek medical attention. The management of pain among patients attending in-patient care in southern African countries has been little described. Information regarding the prevalence of pain and the quality of its management may be useful in guiding clinical decisions, training of health workers and health care quality improvements. Methods A hospital-based audit was conducted to estimate the prevalence of pain and examine the quality of its management among patients admitted to adult medical wards at Queen Elizabeth Central Hospital (QECH, Blantyre, Malawi in 2004. Data were abstracted from ward charts of consecutive patients' who had been either been discharged or had died within a specified period. Characteristics of interest included; socio-demographic data, presence or absence of pain at admission, characterization or description of pain when present, and drug treatment given. Data were analyzed to obtain frequencies and proportions of the characteristics and assess the prevalence of pain and quality of care. Results A total of 121 patients' case notes were reviewed and the prevalence of pain was recorded for 91 (75.2% of the patients. Clinicians had recorded pertinent information regarding pain management with the following frequency: pain severity or intensity 5/91 (5.5%, alleviating factors 5 (5.5%, pain radiation 7 (7.7%, exacerbating factors in 9 (9.9% and periodicity in 43 (47.3% of the cases. Males with pain were more than 3 times more likely to receive analgesic as compared to females, p Conclusion Inadequate management of pain among patients attending medical wards at QECH was found. There is need for prospective studies to further characterize pain management and identify pain management gaps in Malawi. Interviews of clinicians and documentation of observations within clinical practice are likely to be of value.
Font Noguera, I; Fernández Megía, M J; Ferrer Riquelme, A J; Balasch I Parisi, S; Edo Solsona, M D; Poveda Andres, J L
Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. 1.000 beds tertiary hospital. prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. 131 patients with treatments prescribed within 24h after admission and with 4 drugs. safety indicators (medication errors), and efficiency indicators (complaints and time delays). Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.
Kent, B D
BACKGROUND: Venous thromboembolic disease (VTED) prophylaxis is a key strategy in reducing preventable deaths in medical inpatients. We assessed compliance with internationally published guidelines for VTED prophylaxis in at-risk medical patients before and 1 month after an educational intervention to enhance compliance with such guidelines. RESULTS: One hundred and fifty patients were assessed on each occasion. Pre-intervention, VTED prophylaxis was prescribed in only 48% of at-risk cases. Compliance was best among patients under stroke services and worst for those under acute medical teams. Patients within specialist units were more likely to be prescribed prophylaxis than those in general wards (75 vs. 53%; p = 0.0019). Post-intervention, overall compliance improved to 63% (p = 0.041 for comparison). There was a significant improvement among general medical teams (48 vs. 75%; p = 0.001), and in general wards (52 vs. 74%; p = 0.003). CONCLUSIONS: Thromboprophylaxis is under-prescribed in medical inpatients, but compliance with international guidelines can be significantly enhanced with targeted educational intervention.
O'Shea, Laura E; Picchioni, Marco M; Mason, Fiona L; Sugarman, Philip A; Dickens, Geoffrey L
The Historical, Clinical and Risk Management Scales (HCR-20) may be a better predictor of inpatient aggression for selected demographic and clinical groups but homogeneity of study samples has prevented definitive conclusions. The aim of this study, therefore, was to test the predictive validity of the HCR-20 as a function of gender, diagnosis, age, and ethnicity while controlling for potential covariates. A pseudo-prospective cohort study (n=505) was conducted in a UK secure/forensic mental health setting using routinely collected data. The HCR-20 predicted aggression better for women than men, and for people with schizophrenia and/or personality disorder than for other diagnostic groups. In women, the presence of the risk management items (R5) was important while men׳s aggression was best predicted solely by current clinical features from the C5 scale. R5 items were better than C5 items for predicting aggression in people with organic and developmental diagnoses. Our data provide additional information on which HCR-20 raters can formulate overall summary judgements about risk for inpatient aggression based on important demographic and clinical characteristics. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Ford, Kevin R; DiCesare, Christopher A; Myer, Gregory D; Hewett, Timothy E
Biofeedback training enables an athlete to alter biomechanical and physiological function by receiving biomechanical and physiological data concurrent with or immediately after a task. To compare the effects of 2 different modes of real-time biofeedback focused on reducing risk factors related to anterior cruciate ligament injury. Randomized crossover study design. Biomechanics laboratory and sports medicine center. Female high school soccer players (age 14.8 ± 1.0 y, height 162.6 ± 6.8 cm, mass 55.9 ± 7.0 kg; n = 4). A battery of kinetic- or kinematic-based real-time biofeedback during repetitive double-leg squats. Baseline and posttraining drop vertical jumps were collected to determine if either feedback method improved high injury risk landing mechanics. Maximum knee abduction moment and angle during the landing was significantly decreased after kinetic-focused biofeedback (P = .04). The reduced knee abduction moment during the drop vertical jumps after kinematic-focused biofeedback was not different (P = .2). Maximum knee abduction angle was significantly decreased after kinetic biofeedback (P knee abduction load and posture from baseline to posttraining during a drop vertical jump.
Marimuthu, Kalisvar; Venkatachalam, Indumathi; Khong, Wei Xin; Koh, Tse Hsien; Cherng, Benjamin Pei Zhi; Van La, My; De, Partha Pratim; Krishnan, Prabha Unny; Tan, Thean Yen; Choon, Raymond Fong Kok; Pada, Surinder Kaur; Lam, Choong Weng; Ooi, Say Tat; Deepak, Rama Narayana; Smitasin, Nares; Tan, Eng Lee; Lee, Jia Jun; Kurup, Asok; Young, Barnaby; Sim, Nancy Tee Wen; Thoon, Koh Cheng; Fisher, Dale; Ling, Moi Lin; Peng, Brenda Ang Sze; Teo, Yik-Ying; Hsu, Li Yang; Lin, Raymond Tzer Pin; Ong, Rick Twee-Hee; Teo, Jeanette; Ng, Oon Tek
transmission clusters involving 13 subjects were detected. Clinical CRE trend among adult inpatients showed stabilization following a rapid rise since introduction in 2010 potentially due to infection prevention measures and antimicrobial stewardship. More work is needed on understanding CPE transmission dynamics. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: firstname.lastname@example.org.
Full Text Available Atypical environmental conditions with drought followed by heavy rainfall and flooding in arid areas in sub-Saharan Africa can lead to explosive epidemics of malaria, which might be prevented through timely vector-control interventions.Wajir County in Northeast Kenya is classified as having seasonal malaria transmission. The aim of this study was to describe in Wajir town the environmental conditions, the scope and timing of vector-control interventions and the associated resulting burden of malaria at two time periods (1996-1998 and 2005-2007.This is a cross-sectional descriptive and ecological study using data collected for routine program monitoring and evaluation.In both time periods, there were atypical environmental conditions with drought and malnutrition followed by massive monthly rainfall resulting in flooding and animal/human Rift Valley Fever. In 1998, this was associated with a large and explosive malaria epidemic (weekly incidence rates peaking at 54/1,000 population/week with vector-control interventions starting over six months after the massive rainfall and when the malaria epidemic was abating. In 2007, vector-control interventions started sooner within about three months after the massive rainfall and no malaria epidemic was recorded with weekly malaria incidence rates never exceeding 0.5 per 1,000 population per week.Did timely vector-control interventions in Wajir town prevent a malaria epidemic? In 2007, the neighboring county of Garissa experienced similar climatic events as Wajir, but vector-control interventions started six months after the heavy un-seasonal rainfall and large scale flooding resulted in a malaria epidemic with monthly incidence rates peaking at 40/1,000 population. In conclusion, this study suggests that atypical environmental conditions can herald a malaria outbreak in certain settings. In turn, this should alert responsible stakeholders about the need to act rapidly and preemptively with appropriate
van der Baan-Slootweg, Olga; Benninga, Marc A.; Beelen, Anita; van der Palen, Jacobus Adrianus Maria; Tamminga-Smeulders, Christine; Tijssen, Jan G.P.; van Aalderen, Wim M.C.
Importance Severe childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown. Objective To determine whether an inpatient treatment program is more effective
Pettit, Jeremy W.; Green, Kelly L.; Grover, Kelly E.; Schatte, Dawnelle J.; Morgan, Sharon T.
Little is known about the role of chronic stress in youth suicidal behaviors. This study examined the relations between specific domains of chronic stress and suicidal behaviors among 131 inpatient youth (M age = 15.02 years) who completed measures of stress, suicidal ideation, suicide attempt, and suicide intent. After controlling for…
Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, W.A.M.; van Harten, Willem H.; van Harten, Wim H.
BACKGROUND: As the demand for health care services increases, the need to improve patient flow between departments has likewise increased. Understanding how the master surgical schedule (MSS) affects the inpatient wards and exploiting this relationship can lead to a decrease in surgery
Niet, G.J. De; Tiemens, B.G.; Hutschemaekers, G.J.M.
This article describes a pilot study that was carried out to in order to gain an indication as to whether mental healthcare nurses can apply evidence-based interventions for sleep problems effectively in inpatient mental health care. The study had a pre-test/post-test design and a comparison group
Mitmansgruber, Horst; Beck, Thomas; Mulser, Hubert; Dahlbender, Reiner W; Schüssler, Gerhard
How clearcut is the clinical significance of mature and immature defense mechanisms in psychological symptoms? Defense mechanisms, symptoms and well-being were assessed in 293 inpatients, 316 outpatients and 157 students. The factors "mature defense" and "immature defense" predict well-being/symptoms to a substantial degree. The assessment of defense mechanism via self-report is clinically useful.
Objective: The aim of this report was to establish a profile of patients with borderline personality disorder (BPD) admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year. Methods: A retrospective record review was conducted to investigate the ...
Lawrence, Ryan E; Perez-Coste, Maria M; Arkow, Stan D; Appelbaum, Paul S; Dixon, Lisa B
Violent and aggressive behaviors are common among psychiatric inpatients. Hospital security officers are sometimes used to address such behaviors. Research on the role of security in inpatient units is scant. This study examined when security is utilized and what happens when officers arrive. The authors reviewed the security logbook and the medical records for all patients discharged from an inpatient psychiatry unit over a six-month period. Authors recorded when security calls happened, what behaviors triggered security calls, what outcomes occurred, and whether any patient characteristics were associated with security calls. A total of 272 unique patients were included. A total of 49 patients (18%) generated security calls (N=157 calls). Security calls were most common in the first week of hospitalization (N=45 calls), and roughly half of the patients (N=25 patients) had only one call. The most common inciting behavior was "threats to persons" (N=34 calls), and the most common intervention was intramuscular antipsychotic injection (N=49 calls). The patient variables associated with security calls were having more than one prior hospitalization (odds ratio [OR]=4.56, p=.001, 95% confidence interval [CI]=1.80-11.57), involuntary hospitalization (OR=5.09, pSecurity officers were often called for threats of violence and occasionally called for actual violence. Patient variables associated with security calls are common among inpatients, and thus clinicians should stay attuned to patients' moment-to-moment care needs.
The research study aimed to identify the factors contributing to premature termination of treatment for substance addiction. The investigation took the form of a differential research design based on archival data obtained from patient files at an inpatient drug rehabilitation centre in Gauteng. One independent variable ...
Objective: To review in-patient management of leg ulcers and to compare our experiences with those from other similar centres. Design: A retrospective study. Setting: University of Benin Teaching Hospital, Nigeria. Patients: Forty five patients hospitalisad with leg ulcers. Results: There were 27 male and 18 females (MF 3:2) ...
Bowers, L.; Nijman, H.L.I.; Banda, T.
The literature on inpatient suicides was systematically reviewed. English, German, and Dutch articles were identified by means of the electronic databases PsycInfo, Cochrane, Medline, EMBASE psychiatry, CINAHL, and British Nursing Index. In total, 98 articles covering almost 15,000 suicides were
Background Approximately 75% of medical inpatients at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi are HIV seropositive, and a third of these patients are on antiretroviral therapy (ART). Malawi guidelines recommend targeted viral load (VL) testing for patients on ART for at least one year who report ...
Admissions are mostly related to diabetes itself, but the frequency of admissions for problems not related to diabetes is increasing as the prevalence of diabetes increases in the population. Proper inpatient .... femur fracture and one patient had a diabetic foot with sepsis. The mean age of patients who died was higher, ...
CLARKIN, JOHN F.; HULL, JAMES; YEOMANS, FRANK; KAKUMA, TATSUYUKI; CANTOR, JENNIFER
The relationship of antisocial traits to treatment response in 35 female inpatients with borderline personality disorder was studied. Antisocial traits were measured with the Personality Assessment Inventory. Treatment response was measured by weekly ratings on the Symptom Checklist-90—Revised over 25 weeks of hospitalization. Treatment course was found to be significantly associated with the level of antisocial behavior reported at admission.
Nurses' experiences of inpatients suicide in a general hospital. *. Mirriam Matandela, Mokgadi C. Matlakala. *. Department of Health Studies, University of South Africa, PO BOX 392, UNISA, 0003, South Africa article info. Article history: Received 9 February 2015. Accepted 5 October 2015. Available online xxx. Keywords:.
Pattern of psychiatric inpatient admission in Ibadan: implications for service organisation and planning. ... Introduction: Reports from different parts of the world has shown a seasonal pattern in psychiatric admission. Seasonal changes in climatic and social situations have been attributed. Such audit of psychiatric services is ...
Peris-Lopez, Pedro; Orfila, Agustin; Mitrokotsa, Aikaterini; van der Lubbe, Jan C A
Errors involving medication administration can be costly, both in financial and in human terms. Indeed, there is much potential for errors due to the complexity of the medication administration process. Nurses are often singled out as the only responsible of these errors because they are in charge of drug administration. Nevertheless, the interventions of every actor involved in the process and the system design itself contribute to errors (Wakefield et al. (1998). Proper inpatient medication safety systems can help to reduce such errors in hospitals. In this paper, we review in depth two recent proposals (Chien et al. (2010); Huang and Ku (2009)) that pursue the aforementioned objective. Unfortunately, they fail in their attempt mainly due to their security faults but interesting ideas can be drawn from both. These security faults refer to impersonation and replay attacks that could produce the generation of a forged proof stating that certain medication was administered to an inpatient when it was not. We propose a leading-edge solution to enhance inpatient medication safety based on RFID technology that overcomes these weaknesses. Our solution, named Inpatient Safety RFID system (IS-RFID), takes into account the Information Technology (IT) infrastructure of a hospital and covers every phase of the drug administration process. From a practical perspective, our system can be easily integrated within hospital IT infrastructures, has a moderate cost, is very ease to use and deals with security aspects as a key point. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Lehmann, Christoph U
In the past 3 years, the Health Information Technology for Economic and Clinical Health Act accelerated the adoption of electronic health records (EHRs) with providers and hospitals, who can claim incentive monies related to meaningful use. Despite the increase in adoption of commercial EHRs in pediatric settings, there has been little support for EHR tools and functionalities that promote pediatric quality improvement and patient safety, and children remain at higher risk than adults for medical errors in inpatient environments. Health information technology (HIT) tailored to the needs of pediatric health care providers can improve care by reducing the likelihood of errors through information assurance and minimizing the harm that results from errors. This technical report outlines pediatric-specific concepts, child health needs and their data elements, and required functionalities in inpatient clinical information systems that may be missing in adult-oriented HIT systems with negative consequences for pediatric inpatient care. It is imperative that inpatient (and outpatient) HIT systems be adapted to improve their ability to properly support safe health care delivery for children. Copyright © 2015 by the American Academy of Pediatrics.
Peter A. Lazzarini
Full Text Available We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes. We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD, peripheral neuropathy (PN, and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p<0.01. Previous amputation (4.1% was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p<0.01. Previous foot ulceration (9.8% was associated with PN, PAD, past podiatry, and past nurse treatment (p<0.02. PAD (21.0% was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p<0.02. PN (22.0% was associated with older age, diabetes, mobility impairment, and PAD (p<0.05. Foot deformity (22.4% was associated with older age, mobility impairment, past podiatry treatment, and PN (p<0.01. Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
The aim of this retrospective study was to examine the trend and pattern of utilization of in-patient physiotherapy services in the management and care of patients by various medical specialties at the University of Benin Teaching Hospital, Benin City, Nigeria within a period of 4 years. Medical records of all patients admitted ...
Background. Information on adverse events (AEs) in hospitalised patients in developing countries is scanty. Objective. To compare the magnitude and characteristics of inpatient AEs in a tertiary, not-for-profit healthcare facility in Kenya, using medical records review and incident reporting. Methods. Estimation of prevalence ...
current admission.It was confirmed that, there are potentially avoidable nights in patients receiving OAT. The majority of this group were those being commenced on OAT for the first time (p = 0.00002), in the specialities of Cardiology, Cardiothoracic surgery and Care of the Elderly. The potential number of bed nights to be saved is 13 per week for the hospital or 1.1 bed nights per 10,000 general hospital admissions. These were predominantly weekday nights. The estimated cost of avoidable inpatient OAT dose optimization was approximately euro8300 per week. CONCLUSION: With rising costs and the increasing demands for acute hospital beds, alterations to inpatient management for this group of patients should be considered. Alternatives include increasing the size of current anticoagulation clinics, introduction of POCT (point of care testing) devices and increased GP management. POCT can be justified based upon the publication by Gardiner et al, who showed that 87% of patients find self testing straightforward, 87% were confident in the result they obtained using the devices and 77% preferred self testing.
Bair, Aaron E.; Song, Wheyming T.; Chen, Yi-Chun; Morris, Beth A.
In this study, a discrete-event simulation approach was used to model Emergency Department’s (ED) patient flow to investigate the effect of inpatient boarding on the ED efficiency in terms of the National Emergency Department Crowding Scale (NEDOCS) score and the rate of patients who leave without being seen (LWBS). The decision variable in this model was the boarder-released-ratio defined as the ratio of admitted patients whose boarding time is zero to all admitted patients. Our analysis sho...
Passarge, Michelle; Fix, Michael K; Manser, Peter; Stampanoni, Marco F M; Siebers, Jeffrey V
To develop a robust and efficient process that detects relevant dose errors (dose errors of ≥5%) in external beam radiation therapy and directly indicates the origin of the error. The process is illustrated in the context of electronic portal imaging device (EPID)-based angle-resolved volumetric-modulated arc therapy (VMAT) quality assurance (QA), particularly as would be implemented in a real-time monitoring program. A Swiss cheese error detection (SCED) method was created as a paradigm for a cine EPID-based during-treatment QA. For VMAT, the method compares a treatment plan-based reference set of EPID images with images acquired over each 2° gantry angle interval. The process utilizes a sequence of independent consecutively executed error detection tests: an aperture check that verifies in-field radiation delivery and ensures no out-of-field radiation; output normalization checks at two different stages; global image alignment check to examine if rotation, scaling, and translation are within tolerances; pixel intensity check containing the standard gamma evaluation (3%, 3 mm) and pixel intensity deviation checks including and excluding high dose gradient regions. Tolerances for each check were determined. To test the SCED method, 12 different types of errors were selected to modify the original plan. A series of angle-resolved predicted EPID images were artificially generated for each test case, resulting in a sequence of precalculated frames for each modified treatment plan. The SCED method was applied multiple times for each test case to assess the ability to detect introduced plan variations. To compare the performance of the SCED process with that of a standard gamma analysis, both error detection methods were applied to the generated test cases with realistic noise variations. Averaged over ten test runs, 95.1% of all plan variations that resulted in relevant patient dose errors were detected within 2° and 100% within 14° (error, determination of error
H Irene Hall
Full Text Available OBJECTIVE: Early and regular care and treatment for human immunodeficiency virus (HIV infection are associated with viral suppression, reductions in transmission risk and improved health outcomes for persons with HIV. We determined, on a population level, the association of care visits with time from HIV diagnosis to viral suppression. METHODS: Using data from 19 areas reporting HIV-related tests to national HIV surveillance, we determined time from diagnosis to viral suppression among 17,028 persons diagnosed with HIV during 2009, followed through December 2011, using data reported through December 2012. Using Cox proportional hazards models, we assessed factors associated with viral suppression, including linkage to care within 3 months of diagnosis, a goal set forth by the National HIV/AIDS Strategy, and number of HIV care visits as determined by CD4 and viral load test results, while controlling for demographic, clinical, and risk characteristics. RESULTS: Of 17,028 persons diagnosed with HIV during 2009 in the 19 areas, 76.6% were linked to care within 3 months of diagnosis and 57.0% had a suppressed viral load during the observation period. Median time from diagnosis to viral suppression was 19 months overall, and 8 months among persons with an initial CD4 count ≤ 350 cells/µL. During the first 12 months after diagnosis, persons linked to care within 3 months experienced shorter times to viral suppression (higher rate of viral suppression per unit time, hazard ratio [HR] = 4.84 versus not linked within 3 months; 95% confidence interval [CI] 4.27, 5.48. Persons with a higher number of time-updated care visits also experienced a shorter time to viral suppression (HR = 1.51 per additional visit, 95% CI 1.49, 1.52. CONCLUSIONS: Timely linkage to care and greater frequency of care visits were associated with faster time to viral suppression with implications for individual health outcomes and for secondary prevention.
Crofts, J F; Lenguerrand, E; Bentham, G L; Tawfik, S; Claireaux, H A; Odd, D; Fox, R; Draycott, T J
To investigate management and outcomes of incidences of shoulder dystocia in the 12 years following the introduction of an obstetric emergencies training programme. Interrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99), (ii) Early training (2001-04), and (iii) Late training (2009-12). Southmead Hospital, Bristol, UK, with approximately 6000 births per annum. Infants and their mothers who experienced shoulder dystocia. A bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000. Neonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval). Compliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P shoulder dystocia. © 2015 Royal College of Obstetricians and Gynaecologists.
Andersen, Charlotte; Kolmos, Anne; Andersen, Kjeld
BACKGROUND: Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach that i...... a SM approach in mental healthcare facilities has a significant effect on the reduction of restraint and seclusion. As a part of the implementation, staff training and education in SM are crucial.......BACKGROUND: Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach...... that is associated with reduced rates of seclusion and restraint in mental healthcare, but there is need for more research in this area. AIMS: Using SM to reduce restraint and seclusion in inpatient mental health care. METHODS: The study included two similar psychiatric units where one unit implemented SM and one...
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905 Limits on inpatient...
Mikhail, Emad; Salemi, Jason L; Schickler, Robyn; Salihu, Hamisu M; Plosker, Shayne; Imudia, Anthony N
To describe the frequency and temporal trends of inpatient hospitalization for tubal ectopic pregnancy as well as patients' characteristics, determinants and the current national trends in surgical management of ectopic pregnancy. We conducted a retrospective, cross-sectional analysis of patients who were treated for tubal ectopic pregnancy in an inpatient hospital setting in the United States from 1998 to 2011 using data from the Nationwide Inpatient Sample databases. National frequency and significant changes in the rate of surgical management of tubal ectopic pregnancy in the inpatient setting are described. The study included 334 639 tubal ectopic pregnancies for women aged 18-50 in the United States from 1998 to 2011. The rate of tubal ectopic pregnancy (per 10 000 maternal admissions) decreased from 77.2 in 1998 to 40.5 in 2011. The proportion of tubal ectopic pregnancies for which salpingostomy was performed decreased from 17.0% in 1998 to 7.0% in 2011, while the rate of salpingectomy increased from 69.3% in 1998 to 80.9% in 2011. The temporal change in surgical choice was not different in states with comprehensive in vitro fertilization insurance mandates. The rate of tubal ectopic pregnancy managed in the inpatient setting in the United States decreased 5% annually between 1998 and 2011. The rate of salpingectomies performed annually increased whereas that of salpingostomy decreased over time. The surgical approach selected for the management of tubal ectopic pregnancies was not influenced by a state's in vitro fertilization mandate status. © 2018 Japan Society of Obstetrics and Gynecology.
Modestin, J; Stephan, P L; Erni, T; Umari, T
In 200 inpatients on regular neuroleptics, point prevalence of extrapyramidal syndromes, including Parkinson syndrome, akathisia and tardive dyskinesia (TD), was studied and found to be 20, 11 and 22%, respectively. A total of 46 patients have currently, and for a longer time, (average about 3years, median over 1year) been treated with clozapine, and 127 with typical neuroleptics (NLs). Comparing both groups, higher TD scores were found in the clozapine sample. Investigating the influence of a set of seven clinical variables on the TD score with the help of multiple regression analysis, the influence of the treatment modality disappeared, whereas the age proved to be the only significant variable. Studying the role of past clozapine therapy in patients currently on typical NLs and comparing 10 matched pairs of chronic patients with and without TD in whom a complete life-time cumulative dose of NLs was identified, a relationship between TD and length of current typical NL therapy and life-time typical NL dosage could be demonstrated. On the whole, long-term relatively extensive use of clozapine has not markedly reduced the prevalence of extrapyramidal syndromes in our psychiatric inpatient population. In particular, we failed to demonstrate a beneficial effect of clozapine on prevalence of TD. There are certainly patients who suffer from TD in spite of a long-term intensive clozapine treatment.
Petzold, Max; Hägg, Staffan
Background Numerous observational studies suggest that preventable adverse drug reactions are a significant burden in healthcare, but no meta-analysis using a standardised definition for adverse drug reactions exists. The aim of the study was to estimate the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions in adult outpatients and inpatients. Methods Studies were identified through searching Cochrane, CINAHL, EMBASE, IPA, Medline, PsycINFO and Web of Science in September 2010, and by hand searching the reference lists of identified papers. Original peer-reviewed research articles in English that defined adverse drug reactions according to WHO’s or similar definition and assessed preventability were included. Disease or treatment specific studies were excluded. Meta-analysis on the percentage of patients with preventable adverse drug reactions and the preventability of adverse drug reactions was conducted. Results Data were analysed from 16 original studies on outpatients with 48797 emergency visits or hospital admissions and from 8 studies involving 24128 inpatients. No studies in primary care were identified. Among adult outpatients, 2.0% (95% confidence interval (CI): 1.2–3.2%) had preventable adverse drug reactions and 52% (95% CI: 42–62%) of adverse drug reactions were preventable. Among inpatients, 1.6% (95% CI: 0.1–51%) had preventable adverse drug reactions and 45% (95% CI: 33–58%) of adverse drug reactions were preventable. Conclusions This meta-analysis corroborates that preventable adverse drug reactions are a significant burden to healthcare among adult outpatients. Among both outpatients and inpatients, approximately half of adverse drug reactions are preventable, demonstrating that further evidence on prevention strategies is required. The percentage of patients with preventable adverse drug reactions among inpatients and in primary care is largely unknown and should be
Latha, S; Choon, S E
Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia. To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients. A prospective study was conducted among medical inpatients from July to December 2014. A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had "probable" causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction. The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.
Full Text Available In 1988, a cardiovascular prevention program which combined an individual and a population-based strategy was launched within primary health-care in Sollentuna, a municipality in Stockholm County. The aim of this study was to investigate time trends in the incidence of and mortality from acute myocardial infarction and all-cause mortality in Sollentuna compared with the rest of Stockholm County during a period of two decades following the implementation of a cardiovascular prevention program.The average population in Sollentuna was 56,589 (49% men and in Stockholm County (Sollentuna included 1,795,504 (49% men during the study period of 1987-2010. Cases of hospitalized acute myocardial infarction and death were obtained for the population of Sollentuna and the rest of Stockholm County using national registries of hospital discharges and deaths. Acute myocardial infarction incidence and mortality were estimated using the average population of Sollentuna and Stockholm in 1987-2010.During the observation period, the incidence of acute myocardial infarction decreased more in Sollentuna compared with the rest of Stockholm County in women (-22% vs. -7%; for difference in slope <0.05. There was a trend towards a greater decline in Sollentuna compared to the rest of Stockholm County in the incidence of acute myocardial infarction (in men, acute myocardial mortality, and all-cause mortality but the differences were not significant.During a period of steep decline in acute myocardial infarction incidence and mortality in Stockholm County the municipality of Sollentuna showed a stronger trend in women possibly compatible with favorable influence of a cardiovascular prevention program.ClinicalTrials.gov NCT02212145.
Katz, Gregory; Kunyvsky, Yehuda; Hornik-Lurie, Tzipi; Raskin, Sergey; Abramowitz, Moshe Z
Psychoactive substance abuse, which includes abuse of alcohol and street drugs, is common among first-episode psychosis patients, but the prevalence of cannabis abuse is particularly high. However, there have been very few reported studies concerning the occurrence of psychoactive substance abuse among first-episode psychotic individuals using standard toxicological testing. We study the prevalence of cannabis and alcohol abuse among first-psychoticepisode inpatients as well as compare the demographic, diagnostic, and psychopathological profiles of substance abusers versus nonusers. Subjects were recruited from the Jerusalem Mental Health Center between 2012 and 2014. Ninety-one consecutively admitted psychiatric patients diagnosed using the DSM-IV criteria with a first psychotic episode due to schizophrenia, schizophreniform disorder, bipolar disorder, brief psychotic episode, and psychosis NOS disorder entered the study. The diagnoses of schizophrenia (all types), psychosis NOS disorder, brief psychotic episode, and schizophreniform disorder were categorized as "only psychosis" and those of bipolar disorder manic episode with psychotic features (congruent and incongruent) and severe depression with psychotic features were categorized as "predominantly affective symptoms." Urine tests for tetrahydrocannabinol (THC) were performed during the first 48 hours of admission, and likewise self-report questionnaires were administered. Alcohol abuse and dependence were diagnosed by self-report. Of the 91 subjects in the study, 49 (53.8%) did not abuse any illegal psychoactive substance. Twenty patients (22%) abused only cannabis; 14 (15.4%) abused cannabis and another psychoactive substance; 54 (59.3%) of the subjects reported no alcohol abuse; 33 (36.3%) reported occasional drinking (between two and ten times a month); and 4 (4.4%) reported continuous repeated drinking (more than ten times a month). There was no correlation between the demographic characteristics and the
Full Text Available This article aims to describe and analyze the situations of epidemiological prevalence, prevention, care and treatment of HIV in indigenous populations of Latin America. In order to do so, 304 published materials – including declarations, public policy and health program protocols, case studies and literature reviews with local, national and regional scopes – were identified, classified and analyzed. The differential social vulnerability to HIV infection and the inequity in health care access among indigenous populations can be attributed to the juxtaposition of factors such as structural violence, gender, racism, and discrimination due health condition (living with HIV as well as the subordinated position of indigenous peoples in societies stratified not only socially and economically but also ethnically and culturally. The few studies done in the region on epidemiological prevalence, morbidity and mortality that are disaggregated by ethnicity reveal alarming data highlighting the need for further information on the epidemic in this population so as to address its repercussions in terms of prevention, care and timely follow-up.
Torkelson, Diane J; Seed, Mary S
This study explored the difference between male and female psychiatric nurses' job performance and job satisfaction levels on an acute care inpatient unit. The amount of time male (n = 28) and female (n = 45) nurses spent on 10 specific functions and roles during a shift were observed and recorded. The nurses also self-rated the amount of time they spent on these specific functions and roles. The observed and self-rated functions were then correlated with job satisfaction. Female nurses were observed and self-rated as spending significantly more time on patient care activities, and these activities were significantly correlated with higher job satisfaction levels. Male nurses who self-rated spending more time on patient care activities had significantly lower job satisfaction scores. Findings confirm the concepts from social role theory that gender identity and expectations influence job performance in psychiatric nursing. The results offer insight for increasing job satisfaction and recruitment/retention efforts. Copyright 2011, SLACK Incorporated.
Seffner, Fernando; Garcia, Jonathan; Muñoz-Laboy, Miguel; Parker, Richard
The Casa Fonte Colombo (CFC) is a religious organisation that assists people living with HIV/AIDS (PLWHA). The funding for its activities comes from public sources such as the Brazilian National STD/AIDS Program as well as the Catholic Church. Capuchin (Franciscan) priests run the CFC and it has an extensive group of volunteers made up mostly of women. Between 2006 and 2009, we observed daily life at the CFC and interviewed priests, volunteers, employees, service providers, and clients. We also attended meetings, group sessions, and celebrations. Everyday actions carried out by the CFC reveal the efforts to resolve the tension between the position of the Catholic Church and the Brazilian state in the politics of AIDS. These efforts affirm that the CFC presents itself as a space where the position of the Catholic Church, as much as the politics of public health, are re-worked, giving way to a progressive act of Catholic prevention and assistance for AIDS that we call 'theology of prevention'.
McEwen, Daniel; Taillon-Hobson, Anne; Bilodeau, Martin; Sveistrup, Heidi; Finestone, Hillel
Exercise using virtual reality (VR) has improved balance in adults with traumatic brain injury and community-dwelling older adults. Rigorous randomized studies regarding its efficacy, safety, and applicability with individuals after stroke are lacking. The purpose of this study was to determine whether an adjunct VR therapy improves balance, mobility, and gait in stroke rehabilitation inpatients. A blinded randomized controlled trial studying 59 stroke survivors on an inpatient stroke rehabilitation unit was performed. The treatment group (n=30) received standard stroke rehabilitation therapy plus a program of VR exercises that challenged balance (eg, soccer goaltending, snowboarding) performed while standing. The control group (n=29) received standard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance (performed in sitting). VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period. Objective outcome measures of balance and mobility were assessed before, immediately after, and 1 month after training. Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test, with both groups meeting minimal clinical important differences after training. More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain (P=0.04) immediately after training. This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes. Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR. http://www.ANZCTR.org.au/. Unique identifier: ACTRN12613000710729. © 2014 American Heart Association, Inc.
Timko, Christine; Ilgen, Mark; Haverfield, Marie; Shelley, Alexandra; Breland, Jessica Y
Polysubstance use, the consumption of more than one substance over a defined period, is common and associated with psychiatric problems and poor treatment adherence and outcomes. This study examined past-month polysubstance use at intake among psychiatry inpatients with co-occurring mental health and substance use disorders, and outcomes 3 months later. Participants (n=406 psychiatry inpatients with documented mental health and substance use disorders) completed a baseline and a 3-month follow-up (84%) interview. With baseline data, a latent class analysis was conducted on substances used in the past 30days. Analyses of covariance tested for differences among classes on outcomes at 3-month follow-up. At baseline, three classes were estimated: Cannabis+Alcohol (35.1%), Alcohol (49.3%), and Polysubstance, notably, cocaine plus alcohol and marijuana (15.7%). At follow-up, the Polysubstance class had more severe alcohol and drug use, support for abstinence, and motivation for help-seeking, but less abstinence self-efficacy; it was most likely to attend 12-step groups. The Cannabis+Alcohol class was least likely to obtain outpatient substance use treatment, and had the lowest percent days abstinent. Psychiatry inpatients with co-occurring substance use and mental health disorders have varying substance use patterns that correspond to substance-related outcomes concurrently and over time. Many patients achieved abstinence for most days of the 3-month post-hospitalization period. To further increase abstinence, providers could build on polysubstance-using patients' high motivation to increase self-efficacy. In addition, because patients using mainly cannabis plus alcohol may perceive little harm from cannabis use, providers may consider modifying risk perceptions through effective education. Published by Elsevier B.V.
Hintzen, Barbara L; Knoer, Scott J; Van Dyke, Christie J; Milavitz, Brian S
The effect of lean process improvement on an inpatient university hospital pharmacy was evaluated. The University of Minnesota Medical Center (UMMC), Fairview, implemented lean techniques in its inpatient pharmacy to improve workflow, reduce waste, and achieve substantial cost savings. The sterile products area (SPA) and the inventory area were prospectively identified as locations for improvement due to their potential to realize cost savings. Process-improvement goals for the SPA included the reduction of missing doses, errors, and patient-specific waste by 30%, 50%, and 30%, respectively, and the reallocation of two technician full-time equivalents (FTEs). Reductions in pharmaceutical inventory and returns due to outdating were also anticipated. Work-flow in the SPA was improved through the creation of accountability, standard work, and movement toward one-piece flow. Increasing the number of i.v. batches decreased pharmaceutical waste by 40%. Through SPA environment improvements and enhanced workload sharing, two FTE technicians from the SPA were redistributed within the department. SPA waste reduction yielded an annual saving of $275,500. Quality and safety were also improved, as measured by reductions in missing doses, expired products, and production errors. In the inventory area, visual control was improved through the use of a double-bin system, the number of outdated drugs decreased by 20%, and medication inventory was reduced by $50,000. Lean methodology was successfully implemented in the SPA and inventory area at the UMMC, Fairview, inpatient pharmacy. Benefits of this process included an estimated annual cost saving of $289,256 due to waste reduction, improvements in workflow, and decreased staffing requirements.
Johnson, Joseph M; Wu, Chris Y; Winder, Gerald Scott; Casher, Michael I; Marshall, Vincent D; Bostwick, Jolene R
This study examines the association between cannabis use and the hospital course of patients admitted to the psychiatric inpatient unit with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder. Many confounding variables potentially contribute to the clinical presentation of hospitalized patients in the psychiatric unit. Illicit drug use, in particular, has been associated with acute agitation, and questions can be raised as to what lasting effects drug use prior to admission may have throughout a patient's hospital stay. Subjects with a discharge diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, or psychosis not otherwise specified (N = 201) were retrospectively identified, and those with positive results of urine drug screen for cannabis on admission were compared to negative counterparts. Agitation and aggression were measured using an adaptation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC). These markers were also quantified by comparing charted episodes of restraint and seclusion and administration of as needed medications, such as benzodiazepines and antipsychotics. Positive urine drug screen results for cannabis was correlated with young (p = .001) males (p = .003) with bipolar disorder (p = .009) exhibiting active manic symptoms (p = .003) at the time of admission. Cannabis use was further associated with a shorter length of stay (p = .008), agitation triggering adapted PANSS-EC nursing assessments (p = .029), and oral medications as needed (p = .002) for agitation. Cannabis use, as defined by positive urine drug screen results, was more common in patients with bipolar disorder and was accompanied by a higher incidence of inpatient agitation. Although these patients also had short hospital lengths of stay, there was no clear relationship between level of agitation and length of stay across all patient groups. One possible explanation for patients with bipolar disorder
Bernhofer, Esther I; Higgins, Patricia A; Daly, Barbara J; Burant, Christopher J; Hornick, Thomas R
To describe light exposure, sleep-wake patterns, mood, pain and their relationships in adult medical inpatients. The hospital environment may contribute to patient discomfort by providing a lighting structure that interferes with circadian rhythmicity, sleep, mood and pain. A descriptive correlational design was used in this preliminary study. Between May 2011-April 2012, data were collected from a convenience sample of 23 women and 17 men admitted to a large academically affiliated hospital in the United States. Over 72 hours, light exposure and sleep-wake patterns were continuously measured with wrist actigraph/light meters for each participant. Mood was measured daily using the Profile Of Mood States Brief™ Form. Subjective pain scores were abstracted from medical records. Light exposure levels were low: mean daytime light intensity was 104·80 lux. Sleep time was fragmented and low: mean 236·35 minutes of sleep/night. Intra-daily stability scores indicated little sleep-wake synchronization with light. Fatigue and total mood disturbance scores were high and inversely associated with light. Pain levels were also high and positively associated with fatigue, but not directly with light exposure. Low light exposure significantly predicted fatigue and total mood disturbance. Medical inpatients were exposed to light levels insufficient for circadian entrainment. Nevertheless, higher light exposure was associated with less fatigue and lower total mood disturbance in participants with pain, suggesting the need for further investigation to determine if manipulating light exposure for medical inpatients would be beneficial in affecting sleep-wake disturbances, mood and pain. © 2013 John Wiley & Sons Ltd.
Massimo, Luisa; Rossoni, Nicoletta; Mattei, Francesca; Bonassi, Stefano; Caprino, Daniela
Adolescents affected by a severe disease who undergo high-risk treatment may experience stress, pain, extreme frustration, depression, and anger. In this large spectrum of emotions, several situations must be considered carefully. To improve coping and quality of services offered to adolescents in paediatric hospitals, we elaborated a semi-structured interview and a short questionnaire (Quality of life-adolescent-Istituto Giannina Gaslini, QoL-adol-IGG scale) to investigate the quality of life, the needs and expectations of adolescent in-patients. The study sample includes 117 in-patients aged between 10 and 20 years coming from several Italian regions who were admitted to the G. Gaslini Research Children's Hospital for a period of 10 days or more, regardless of the disease. The QoL-adol-IGG scale was administered - after obtaining informed consent from the children and their parents - in one single encounter by trained psychologist. The distribution of the answers was evaluated after stratification by patient's age, gender, area of residence, and clinical diagnosis. Continuous data were compared using the Kruskal-Wallis, while the χ2-test was used for categorical data. Seventy-two percent had difficulty practicing normal daily activities during their stay in the hospital, not only because of the disease (40%), but also because of the poor organization within the hospital, the lack of proposals/activities and space for spare time, and the limited access to technologies. Adolescents ≥15 years were more frequently dissatisfied than youngsters concerning the access to Internet and other technologies, the possibility to make new friends and to take part in social activities. The results of this study, which evaluated the hospital's organization, but also psychological functioning in a representative sample of patients, may contribute to optimize internal procedures of clinical departments where adolescent in-patients are present, on the basis of their requests and
She, Pan; Zeng, Hongling; Yang, Bingxiang
The aim of the study was to explore the efficacy of structural group therapy on the self-consistency and congruence of inpatient adolescents with a diagnosis of schizophrenia. Sixty inpatient adolescents with schizophrenia were randomly assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group was provided with a 12-session structural group therapy program for six weeks (1 h, two times per week), while the control group participated in a handicraft group. All patients were assessed with the Self-Consistency and Congruence Scale (SCCS) and the Positive and Negative Syndrome Scale (PANSS) at pretest, posttest, three-month and one-year follow-up. The results were analyzed using t-test and repeated measures ANOVA. The two groups had no significant difference at the pre-test of outcome measures (p > 0.05). Significant differences existed between the two groups in ego-dystonic, self-flexibility, SCCS scores, positive syndrome, general psychopathology and PANSS scores after the intervention (p < 0.05). At the three-month follow-up, ego-dystonic, self-flexibility and PANSS scores were also found to be significantly different between the two groups (p < 0.05). But the outcome measures were not significantly different between the two groups at the one-year follow-up. Structural group therapy in a mental health setting had a positive effect on improving self-consistency and congruence, positive symptoms and general psychopathology of inpatient adolescents with a diagnosis of schizophrenia. Copyright © 2015 Elsevier Ltd. All rights reserved.
Huang, Zhengxing; Dong, Wei; Wang, Fei; Duan, Huilong
Modeling and clustering medical inpatient journeys is useful to healthcare organizations for a number of reasons including inpatient journey reorganization in a more convenient way for understanding and browsing, etc. In this study, we present a probabilistic model-based approach to model and cluster medical inpatient journeys. Specifically, we exploit a Bayesian Hidden Markov Model based approach to transform medical inpatient journeys into a probabilistic space, which can be seen as a richer representation of inpatient journeys to be clustered. Then, using hierarchical clustering on the matrix of similarities, inpatient journeys can be clustered into different categories w.r.t their clinical and temporal characteristics. We evaluated the proposed approach on a real clinical data set pertaining to the unstable angina treatment process. The experimental results reveal that our method can identify and model latent treatment topics underlying in personalized inpatient journeys, and yield impressive clustering quality.
Gluyas, Cathy; Lum, Carmel; Chong, Sinn Yuin; Borg, Cynthia; Haines, Terry P
The objectives of this study were to characterize the psychiatric comorbidity of a group of older subacute inpatients and then determine whether their psychiatric comorbidity affected measures of rehabilitation outcomes. Eighty-eight older subacute inpatients were recruited for this prospective study. Psychiatric comorbidity was defined according to a participants' performance on four inventory scales: the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Brief Psychiatric Rating Scale and Health of the Nation Outcome Scale 65+. Rehabilitation outcome referred to the participants' length of stay and their performance at discharge on the EuroQol-5D health-related quality of life questionnaire and Barthel index. 68% of the participants scored in the clinical range on at least one of the four scales assessing psychiatric comorbidity at admission, with 51% in the clinical range for GDS and 32% for the GAI. The decrease in scores by the time of discharge was significant for all four scales. Linear regression analyses pointed to a trend for depressive symptoms at admission to be an influential but nonsignificant predictor of rehabilitation outcome. An interesting association was found between the length of the previous acute admission and the GDS score on admission to the subacute unit. A high prevalence of psychological symptoms was identified upon admission, with a significant decrease by the time of discharge. These factors did not significantly predict the selected measures of rehabilitation outcome. Opportunities for future longitudinal research on the prevalence and impact of psychiatric comorbidities on patient outcomes are considered.
McCue, Michael J; Nayar, Preethy
Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services.
Saulnier, George E; Castro, Janna C; Cook, Curtiss B; Thompson, Bithika M
Apply methods of damped trend analysis to forecast inpatient glycemic control. Observed and calculated point-of-care blood glucose data trends were determined over 62 weeks. Mean absolute percent error was used to calculate differences between observed and forecasted values. Comparisons were drawn between model results and linear regression forecasting. The forecasted mean glucose trends observed during the first 24 and 48 weeks of projections compared favorably to the results provided by linear regression forecasting. However, in some scenarios, the damped trend method changed inferences compared with linear regression. In all scenarios, mean absolute percent error values remained below the 10% accepted by demand industries. Results indicate that forecasting methods historically applied within demand industries can project future inpatient glycemic control. Additional study is needed to determine if forecasting is useful in the analyses of other glucometric parameters and, if so, how to apply the techniques to quality improvement.
Huang, Hsieh-Hong; Ku, Cheng-Yuan
In order to provide enhanced medication safety for inpatients, the medical mechanism which adopts the modified grouping proof protocol is proposed in this paper. By using the grouping proof protocol, the medical staffs could confirm the authentication and integrity of a group of Radio-Frequency Identification (RFID) tags which are embedded on inpatient bracelets and the containers of drugs. This mechanism is designed to be compatible with EPCglobal Class-1 Generation-2 standard which is the most popular specification of RFID tags. Due to the light-weight computational capacity of passive tags, only the pseudo-random number generator (PRNG) and cyclic redundancy code (CRC) are allowed to be used in the communication protocol. Furthermore, a practical scenario of using this proposed mechanism in hospital to examine the medication safety is also presented.
Chien, Hung-Yu; Yang, Chia-Chuan; Wu, Tzong-Chen; Lee, Chin-Feng
Owing to the low cost and convenience of identifying an object without physical contact, Radio Frequency Identification (RFID) systems provide innovative, promising and efficient applications in many domains. An RFID grouping protocol is a protocol that allows an off-line verifier to collect and verify the evidence of two or more tags simultaneously present. Recently, Huang and Ku (J. Med. Syst, 2009) proposed an efficient grouping protocol to enhance medication safety for inpatients based on low-cost tags. However, the Huang-Ku scheme is not secure; an attacker can easily make up fake grouping records to cheat the verifier. This weakness would seriously endanger the safety of inpatient medication safety. This paper will show the weaknesses, and then propose two RFID-based solutions to enhance medication safety for two different scenarios. The proposed schemes are practical, secure and efficient for medication applications.
Teh, Ruth C-A; Visvanathan, Renuka; Ranasinghe, Damith; Wilson, Anne
To evaluate clinicians' perspectives, before and after clinical implementation (i.e. trial) of a handheld health information technology (HIT) tool, incorporating an iPad device and automatically generated visual cues for bedside display, for falls risk assessment and prevention in hospital. This pilot study utilized mixed-methods research with focus group discussions and Likert-scale surveys to elicit clinicians' attitudes. The study was conducted across three phases within two medical wards of the Queen Elizabeth Hospital. Phase 1 (pretrial) involved focus group discussion (five staff) and surveys (48 staff) to elicit preliminary perspectives on tool use, benefits and barriers to use and recommendations for improvement. Phase 2 (tool trial) involved HIT tool implementation on two hospital wards over consecutive 12-week periods. Phase 3 (post-trial) involved focus group discussion (five staff) and surveys (29 staff) following tool implementation, with similar themes as in Phase 1. Qualitative data were evaluated using content analysis, and quantitative data using descriptive statistics and logistic regression analysis, with subgroup analyses on user status (P ≤ 0.05). Four findings emerged on clinicians' experience, positive perceptions, negative perceptions and recommendations for improvement of the tool. Pretrial, clinicians were familiar with using visual cues in hospital falls prevention. They identified potential benefits of the HIT tool in obtaining timely, useful falls risk assessment to improve patient care. During the trial, the wards differed in methods of tool implementation, resulting in lower uptake by clinicians on the subacute ward. Post-trial, clinicians remained supportive for incorporating the tool into clinical practice; however, there were issues with usability and lack of time for tool use. Staff who had not used the tool had less appreciation for it improving their understanding of patients' falls risk factors (odds ratio 0.12), or
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Nogario,Aline Carniato Dalle; Barlem,Edison Luiz Devos; Tomaschewski-Barlem,Jamila Geri; Lunardi,Valéria Lerch; Ramos,Aline Marcelino; Oliveira,Aline Cristina Calçada de
OBJECTIVEUnderstanding nursing actions in the practice of inpatient advocacy in a burn unit.METHODA single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis.RESULTSThree emerging categories were identified, namely: (1) instructing the patient; (2) protecting the patient; and (3) ensu...
The thesis with the name "Unsaturated fatty acids in the diet of inpatients" is divided into a theoretical and a research parts. The theoretical part is focused on sorting out lipids and the recommended daily dosing. Next there are described the chemical structure of fatty acids and basic differences between saturated (SFA) and unsaturated (trans and cis) fatty acids. The biggest part of the theory is formed by the unsaturated fatty acids, their characteristics, food source and their effect o...
Brandes, I; Wunderlich, B; Niehues, C
The aim of the EVA study was to develop an outpatient education programme for women with endometriosis with a view to permanent transfer into routine care. Implementation of the programme generated several problems and obstacles that are not, or not to this extent, present in the inpatient setting of a rehabilitation clinic. The patient education programme was developed in line with an existing inpatient programme, taking into account the criteria for evaluating such training programmes. Several adjustments to process, structure and content level had to be made to achieve the conditions of the outpatient setting. Since May 2008, 17 training courses took place in various outpatient and acute inpatient settings, and a total of 156 women with diagnosed endometriosis participated. The problems and obstacles that emerged affected similarly the process, structure and content of the training programme. On the structural level, especially problems with availability of rooms, technical equipment and trainers occurred, leading to significant time pressures. The main problem on the procedural level was the recruitment of participants, since--in contrast to the inpatient setting and to disease management programmes--no assignment by physicians or insurers takes place. Furthermore, gainful activity of the participants and the resulting shift of the training beyond the usual working and opening hours are important barriers for implementation. The unavailability of trainers in these settings requires creative solutions. Regarding the contents of the training it has to be taken into consideration that--unlike the inpatient setting--no aftercare intervention and no individual psychological consultation are possible. The training programme has to be designed in such a way that all problems that have occurred could be dealt with appropriately. In summary, the permanent implementation of an outpatient training programme is possible but is more time-consuming than inpatient trainings
Nwosu, B O; Eke, N O; Obi-Nwosu, A; Osakwe, O J; Eke, C O; Obi, N P
This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.
Porto, Alessandra N; Borges, Alvaro H; Rocatto, Grace; Matos, Fernanda Z; Borba, Alexandre M; Pedro, F L Miranda; Lima, Suellen L; Tonetto, Mateus R; Bandéca, Matheus C; Aranha, A M Fabio
The bidirectional relationship between the periodontal diseases and systemic diseases was attributed to the focal infection concept. The aims of this study were to assess the periodontal and microbiological profile of intensive care unit (ICU) inpatients submitted to orotracheal intubation, and classify them regarding gender, age group, ethnic, hospitalization reason and period, nosocomial infection occurrence, and death. Inpatients were assessed, distributed into toothed and toothless groups. The periodontal clinical condition was assessed 24 hours after the ICU admission through plaque index, gum index, probing depth, and clinical level of insertion. All microbiological samples were collected on the 6th day of admission. These samples were collected from different intraoral sites, depending on the group: In the toothed group, samples were collected from gingival sulcus and in the toothless group, from buccal mucosa and tongue. Identification for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was accomplished and analyzed, using absolute quantification and specific primer pairs through an amplification system with probes. Forty subjects composed the sample: Gender characterized by 60% of male, 27.5% of all patients were older than 60, and 22.5% were hospitalized due to cerebrovascular accident. Regarding hospitalization period, 55% of patients were hospitalized for 6 days and 70% of them died during the period of hospitalization. Of inpatients, 40% presented periodontal disease and 100% presented dental biofilm on assessed sites. When assessing the microbiota, statistical significance was observed between Aa, Pg, and Tf, for both toothed and toothless group (p bacteria originally from the oral cavity.
Ranga, Vikram; Panda, Pradeep
Access to health care in rural areas is a major concern for local populations as well as for policy makers in developing countries. This paper examines spatial access to in-patient health care in northern rural India. In order to measure spatial access, impedance-based competition using the Three-Step floating Catchment Area (3SFCA) method, a modification of the simple gravity model, was used. 3SFCA was chosen for the study of the districts of Pratapgarh and Kanpur Dehat in the Uttar Pradesh state and Vaishali in the Bihar state, two of India's poorest states. This approach is based on discrete distance decay and also considers more parameters than other available methods, hence is believed to be a robust methodology. It was found that Vaishali district has the highest spatial access to in-patient health care followed by Pratapgarh and Kanpur Dehat. There is serious lack of health care, in Pratapgarh and Kanpur Dehat with 40% and 90% of the villages having shortage of in-patient care facilities in these respective districts. The most important factor affecting spatial access was found to be the distance to the nearest major urban agglomeration.
Chiu, Chui-De; Meg Tseng, Mei-Chih; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo; Ross, Colin A
Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Vico-Romero, Judit; Cabré-Roure, Mateu; Monteis-Cahis, Rosa; Palomera-Faneges, Elisabet; Serra-Prat, Mateu
To determine the prevalence of insomnia in inpatient in an Internal Medicine Department and to identify risk factors of sleep disorders. A cross-sectional observational study was designed. Inpatients over eighteen years old hospitalized for acute medical conditions were recruited. Insomnia was assessed by the Athens insomnia scale. A nurse administered a questionnaire on risk factors including socio-demographic factors, reason for admission, comorbidities, current medications, functional status, nocturnal symptoms, and environmental factors. A total of 299 patients were recruited with a mean age of 73.7 years (SD 14.2). Overall prevalence of insomnia was 42.1%, slightly higher in women (48.2%) than in men (37.0%) (P=.052). In those less than 65 years the prevalence was 33.8%, and in patients aged 65 or over it was 44.9% (P=.093). The main factors associated with insomnia were a history of anxiety, depression and stroke, heartburn, pain, fear, and poor functional capacity at admission. Environmental factors such as noise, the sensation of cold or heat, and changing habits involved in hospitalization did not reach statistical significance. In patients 65 years or older, the use of beta-blockers was associated with insomnia. The multivariate analysis showed stroke, heartburn, and pain as independent risk factors for insomnia. Insomnia is highly prevalent among inpatient, and is associated with some treatable or modifiable factors. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Misono, Alexander S; Mueller, Peter R; Hirsch, Joshua A; Sheridan, Robert M; Siddiqi, Assad U; Liu, Raymond W
Interventional radiology (IR) has historically failed to fully capture the value of evaluation and management services in the inpatient setting. Understanding financial benefits of a formally incorporated billing discipline may yield meaningful insights for interventional practices. A revenue modeling tool was created deploying standard financial modeling techniques, including sensitivity and scenario analyses. Sensitivity analysis calculates revenue fluctuation related to dynamic adjustment of discrete variables. In scenario analysis, possible future scenarios as well as revenue potential of different-size clinical practices are modeled. Assuming a hypothetical inpatient IR consultation service with a daily patient census of 35 patients and two new consults per day, the model estimates annual charges of $2.3 million and collected revenue of $390,000. Revenues are most sensitive to provider billing documentation rates and patient volume. A range of realistic scenarios-from cautious to optimistic-results in a range of annual charges of $1.8 million to $2.7 million and a collected revenue range of $241,000 to $601,000. Even a small practice with a daily patient census of 5 and 0.20 new consults per day may expect annual charges of $320,000 and collected revenue of $55,000. A financial revenue modeling tool is a powerful adjunct in understanding economics of an inpatient IR consultation service. Sensitivity and scenario analyses demonstrate a wide range of revenue potential and uncover levers for financial optimization. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.
Park, Min Jae; Kim, Jung Hyun; Jeong, Jae Min; Lee, Dong Soo; Jang, Jung Chan; Kim, Chang Ho
We established a model to calculate radioactive waste from sewage disposal tank of hospitals to optimize the number of patients receiving inpatient radioiodine therapy within the safety guideline in our country. According to this model and calculation of radioactivity concentration using the number of patients per week, the treatment dose of radioiodine, the capacity and the number of sewage tanks and the daily amount of water waste per patient, estimated concentration of radioactivity in sewage waste upon disposal from disposal tanks after long term retention were within the safety guideline (30 Bq/L) in all the hospitals examined. In addition to the fact that we could increase the number of patients in two thirds of hospitals, we found that the daily amount of waste water was the most important variable to allow the increase of the number of patients within the safety margin of disposed radioactivity. We propose that saving the water amount be led to increase the number of patients and they allow two patients in an already furnished hospital inpatient room to meet the increasing need of inpatient radioiodine treatment for thyroid cancer
Rylander, Melanie; Colon-Sanchez, Dayan; Keniston, Angela; Hamalian, Gareen; Lozano, Abby; Nussbaum, Abraham M
Readmission rates have been proposed as a possible quality metric for inpatient psychiatry. Little is known about predicting readmissions and identifying modifiable factors that may reduce early readmissions in these settings. We reviewed 693 medical records from our adult inpatient psychiatric unit to identify factors associated with patients' readmission within 90 days of discharge. After adjusting for all variables, and including interactions between identified factors, we found several demographic features predicting readmission, including male gender with suicidal ideation on admission (odds ratio [OR] = 13.2; 95% confidence interval [CI], 3.4-51.9), a diagnosis of a psychotic disorder with a prior medical admission (OR = 5.7; 95% CI, 1.7-20.6), and suicidal ideation with comorbid personality disorder (OR = 5.3; 95% CI, 1.4-20.6). Demographic features decreasing the odds of readmission included being non-white with homeless living situation (OR = 0.18; 95% CI, 0.04-0.82), medication changes made within 48 hours of discharge (OR = 0.44; 95% CI, 0.23-0.84), and the number of medications dispensed without documented follow-up plan or appointment (OR = 0.88; 95% CI, 0.81-0.96). Future prospective studies utilizing qualitative and quantitative methods are required to more precisely define a wider array of metrics. Improved identification of demographic features associated with early readmissions may suggest areas to target as we seek to the quality of inpatient psychiatric care.
Lemieux, Jeff; Mulligan, Teresa
Our goal was to present detailed descriptive data on transaction prices paid by commercial insurers and their enrollees for inpatient hospital care. To estimate transaction prices for inpatient hospital stays (hospital cost only), we used the MarketScan data set of commercial claims and administrative records for 45 to 50 million covered enrollees under age 65 years with commercial group health insurance. Prices are defined as average allowed charges, including insurer-paid reimbursements plus patient costsharing obligations, and are shown for 350 specific admission categories and for many states and localities. Intensity adjustments to account for increased complexity or resource use in hospital stays were estimated from changes in the numbers of procedures per admission, the complexity of admission codes, and patients' risk scores. Unadjusted inpatient hospital prices per admission grew by 8.2% per year from 2008 to 2010 for the commercially insured population (under age 65 years) in the MarketScan data set. We estimate that approximately 1.3 to 1.9 percentage points of the growth in prices can be attributed to increased intensity per admission. Thus, we estimate that intensity-adjusted price increases ranged from 6.2% to 6.8% annually in the 2008-2010 period. Price levels and trends varied considerably across admission types, states, and localities.
Yu, Junhan; Ross, Colin A.; Keyes, Benjamin B.; Li, Ying; Dai, Yunfei; Zhang, Tianhong; Wang, Lanlan; Fan, Qing; Xiao, Zeping
The purpose of the study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study consisted of 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria for Mental Disorders, Version 3 (CCMD-3). All participants completed a self-report measure of dissociation, the Dissociative Experiences Scale (DES) and none had a prior diagnosis of a dissociative disorder. Ninety-six randomly selected participants were interviewed with a structured interview, the Dissociative Disorders Interview Schedule (DDIS) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or on the self-report measure dissociation. A total of 28 (15.3%, after weighting of the data) patients received a clinical diagnosis of a dissociative disorder based on DSM-IV-TR criteria. Dissociative identity disorder was diagnosed in 2 (0.53%, after weighting) patients. Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% versus 22.1%), but the two groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China. PMID:20603768
Ji, Wu; Ding, Kai; Li, Ling-Tang; Wang, Dan; Li, Ning; Li, Jie-Shou
Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, benefits, and safety of OPLC. Two hundred patients who had received laparoscopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classified into two groups: OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparoscopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented. One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Follow-up showed that 90% of the patients were satisfied with the procedure
Rodgers, Helen; Price, Chris
Stroke units reduce death and disability through the provision of specialist multidisciplinary care for diagnosis, emergency treatments, normalisation of homeostasis, prevention of complications, rehabilitation and secondary prevention. All stroke patients can benefit from provision of high-quality basic medical care and some need high impact specific treatments, such as thrombolysis, that are often time dependent. A standard patient pathway should include assessment of neurological impairment, vascular risk factors, swallowing, fluid balance and nutrition, cognitive function, communication, mood disorders, continence, activities of daily living and rehabilitation goals. Good communication and shared decision making with patients and their families are key to high-quality stroke care. Patients with mild or moderate disability, who are medically stable, can continue rehabilitation at home with early supported discharge teams rather than needing a prolonged stay in hospital. National clinical guidelines and prospective audits are integral to monitoring and developing stroke services in the UK. © Royal College of Physicians 2017. All rights reserved.
Bushe, Chris J
BACKGROUND: Weight gain is commonly observed during psychotropic treatments for chronic forms of severe mental illness and is most rapid during the early treatment phases. All formats of behavioural weight intervention programmes have suggested that weight gain can be prevented or reversed in some patients. There is no data on these programmes in acutely unwell inpatients whom may be the major beneficiaries. METHODS: A modular behavioural intervention programme (Solutions for Wellness) used in SMI outpatients since 2002 in Ireland has been adapted for inpatient use. Preliminary data is reported from 5 centres in Ireland. RESULTS: In 47 inpatients the mean weight change was +0.26 kg (SD 2.02) with a median change of 0 kg. Mean follow-up was 23.7 (SD 21.6) days, and median 14 days (range 6-98 days). There was no difference in mean weight change in those patients involved for > 35 days compared with < 35 days (+0.26 kg; 0.25 kg; p = 0.5). Weight loss or maintenance was seen in 70% of patients. CONCLUSION: These preliminary data are supportive of the concept that acutely unwell inpatients with SMI may engage with a behavioural weight programme. Weight change observed contrasts with the significant weight gain often seen in most subjects. Further clinical trials are warranted.
Rudnicka, Alicja R; Kapetanakis, Venediktos V; Wathern, Andrea K; Logan, Nicola S; Gilmartin, Bernard; Whincup, Peter H; Cook, Derek G; Owen, Christopher G
The aim of this review was to quantify the global variation in childhood myopia prevalence over time taking account of demographic and study design factors. A systematic review identified population-based surveys with estimates of childhood myopia prevalence published by February 2015. Multilevel binomial logistic regression of log odds of myopia was used to examine the association with age, gender, urban versus rural setting and survey year, among populations of different ethnic origins, adjusting for study design factors. 143 published articles (42 countries, 374 349 subjects aged 1-18 years, 74 847 myopia cases) were included. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence, reaching 69% (95% credible intervals (CrI) 61% to 77%) at 15 years of age (86% among Singaporean-Chinese). Blacks in Africa had the lowest prevalence; 5.5% at 15 years (95% CrI 3% to 9%). Time trends in myopia prevalence over the last decade were small in whites, increased by 23% in East Asians, with a weaker increase among South Asians. Children from urban environments have 2.6 times the odds of myopia compared with those from rural environments. In whites and East Asians sex differences emerge at about 9 years of age; by late adolescence girls are twice as likely as boys to be myopic. Marked ethnic differences in age-specific prevalence of myopia exist. Rapid increases in myopia prevalence over time, particularly in East Asians, combined with a universally higher risk of myopia in urban settings, suggest that environmental factors play an important role in myopia development, which may offer scope for prevention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Bischoff, Kara; O'Riordan, David L; Marks, Angela K; Sudore, Rebecca; Pantilat, Steven Z
Care planning is a critical function of palliative care teams, but the impact of advance care planning and goals of care discussions by palliative care teams has not been well characterized. To describe the population of patients referred to inpatient palliative care consultation teams for care planning, the needs identified by palliative care clinicians, the care planning activities that occur, and the results of these activities. This was a prospective cohort study conducted between January 1, 2013, and December 31, 2016. Seventy-eight inpatient palliative care teams from diverse US hospitals in the Palliative Care Quality Network, a national quality improvement collaborative. Standardized data were submitted for 73 145 patients. Inpatient palliative care consultation. Overall, 52 571 of 73 145 patients (71.9%) referred to inpatient palliative care were referred for care planning (range among teams, 27.5%-99.4% of patients). Patients referred for care planning were older (73.3 vs 67.9 years; F statistic, 1546.0; P planning needs in 52 825 of 73 145 patients (72.2%) overall, including 42 467 of 49 713 patients (85.4%) referred for care planning and in 10 054 of 17 475 patients (57.5%) referred for other reasons. Through care planning conversations, surrogates were identified for 10 571 of 11 149 patients (94.8%) and 9026 patients (37.4%) elected to change their code status. Substantially more patients indicated that a status of do not resuscitate/do not intubate was consistent with their goals (7006 [32.1%] preconsultation to 13 773 [63.1%] postconsultation). However, an advance directive was completed for just 2160 of 67 955 patients (3.2%) and a Physicians Orders for Life-Sustaining Treatment form was completed for 8359 of 67 955 patients (12.3%) seen by palliative care teams. Care planning was the most common reason for inpatient palliative care consultation, and care planning needs were often found even when the consultation was
von Auer, Anne Kristin; Kleindienst, Nikolaus; Ludewig, Sonia; Soyka, Oliver; Bohus, Martin; Ludäscher, Petra
In April 2004 the inpatient unit "Wellenreiter" at the Vorwerker Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Lubeck (Germany) opened its doors. Despite reservations by the therapeutic community, we implemented a specialized treatment for female adolescents with symptoms of borderline personality disorder - the I;>ialectical Behavior Therapy for Adolescents (DBT-A). In this article we present the concept, our experiences, and data from the past 10 years of clinical work in this specialized unit.
Full Text Available To investigate the effect of a simplified prevention bundle with alcohol-based, dual hand hygiene (HH audit on the incidence of early-onset ventilation-associated pneumonia (VAP.This 3-year, quasi-experimental study with interrupted time-series analysis was conducted in two cardiovascular surgery intensive care units in a medical center. Unaware external HH audit (eHH performed by non-unit-based observers was a routine task before and after bundle implementation. Based on the realistic ICU settings, we implemented a 3-component bundle, which included: a compulsory education program, a knowing internal HH audit (iHH performed by unit-based observers, and a standardized oral care (OC protocol with 0.1% chlorhexidine gluconate. The study periods comprised 4 phases: 12-month pre-implementation phase 1 (eHH+/education-/iHH-/OC-, 3-month run-in phase 2 (eHH+/education+/iHH+/OC+, 15-month implementation phase 3 (eHH+/education+/iHH+/OC+, and 6-month post-implementation phase 4 (eHH+/education-/iHH+/OC-.A total of 2553 ventilator-days were observed. VAP incidences (events/1000 ventilator days in phase 1-4 were 39.1, 40.5, 15.9, and 20.4, respectively. VAP was significantly reduced by 59% in phase 3 (vs. phase 1, incidence rate ratio [IRR] 0.41, P = 0.002, but rebounded in phase 4. Moreover, VAP incidence was inversely correlated to compliance of OC (r2 = 0.531, P = 0.001 and eHH (r2 = 0.878, P < 0.001, but not applied for iHH, despite iHH compliance was higher than eHH compliance during phase 2 to 4. Compared to eHH, iHH provided more efficient and faster improvements for standard HH practice. The minimal compliances required for significant VAP reduction were 85% and 75% for OC and eHH (both P < 0.05, IRR 0.28 and 0.42, respectively.This simplified prevention bundle effectively reduces early-onset VAP incidence. An unaware HH compliance correlates with VAP incidence. A knowing HH audit provides better improvement in HH practice. Accordingly, we suggest
Hammond, Flora M; Gassaway, Julie; Abeyta, Nichola; Freeman, Erma S; Primack, Donna; Kreider, Scott E D; Whiteneck, Gale
To investigate associations of social work/case management (SW/CM) services during inpatient rehabilitation following spinal cord injury (SCI) and patient characteristics with outcomes. Prospective observational cohort of individuals with SCI receiving inpatient rehabilitation. Six inpatient rehabilitation centers. 1032 individuals with traumatic SCI. Not applicable. Type of residence at the time of rehabilitation discharge. Employment/school status, presence of a pressure ulcer, Patient History Questionnaire, Satisfaction with Life Scale, Craig Handicap Assessment and Reporting Technique (CHART) subscales, and rehospitalization at 1-year post-injury. The intensity of specific SW/CM services is associated with multiple outcomes examined. More sessions dedicated to discharge planning for a home discharge and financial planning were associated positively with more discharge to home, while more sessions focused on planning for discharge to a location other than home, e.g. nursing home or long-term acute care facilities, have negative associations with societal participation outcomes (CHART Social Integration, Occupation, and Mobility scores) as well as with residing at home at the time of the 1-year injury anniversary. The intensity and type of SW/CM services are associated with outcomes at rehabilitation discharge and at 1-year post-injury. Discharge to home may require assistance from SW/CM in the area of discharge planning and financial planning, while discharge to non-home residence demands directed SW/CM services for such placement. Note: This is the eighth of nine articles of this SCIRehab series.
Bloomfield, Sally F; Rook, Graham Aw; Scott, Elizabeth A; Shanahan, Fergus; Stanwell-Smith, Rosalind; Turner, Paul
To review the burden of allergic and infectious diseases and the evidence for a link to microbial exposure, the human microbiome and immune system, and to assess whether we could develop lifestyles which reconnect us with exposures which could reduce the risk of allergic disease while also protecting against infectious disease. Using methodology based on the Delphi technique, six experts in infectious and allergic disease were surveyed to allow for elicitation of group judgement and consensus view on issues pertinent to the aim. Key themes emerged where evidence shows that interaction with microbes that inhabit the natural environment and human microbiome plays an essential role in immune regulation. Changes in lifestyle and environmental exposure, rapid urbanisation, altered diet and antibiotic use have had profound effects on the human microbiome, leading to failure of immunotolerance and increased risk of allergic disease. Although evidence supports the concept of immune regulation driven by microbe-host interactions, the term 'hygiene hypothesis' is a misleading misnomer. There is no good evidence that hygiene, as the public understands, is responsible for the clinically relevant changes to microbial exposures. Evidence suggests a combination of strategies, including natural childbirth, breast feeding, increased social exposure through sport, other outdoor activities, less time spent indoors, diet and appropriate antibiotic use, may help restore the microbiome and perhaps reduce risks of allergic disease. Preventive efforts must focus on early life. The term 'hygiene hypothesis' must be abandoned. Promotion of a risk assessment approach (targeted hygiene) provides a framework for maximising protection against pathogen exposure while allowing spread of essential microbes between family members. To build on these findings, we must change public, public health and professional perceptions about the microbiome and about hygiene. We need to restore public
Tchanturia, Kate; Adamson, James; Leppanen, Jenni; Westwood, Heather
Previous research has demonstrated links between anorexia nervosa and autism spectrum disorder however, few studies have examined the possible impact of symptoms of autism spectrum disorder on clinical outcomes in anorexia nervosa. The aim of this study was to examine the association between symptoms of autism spectrum disorder and eating disorders, and other psychopathology during the course of inpatient treatment in individuals with anorexia nervosa. Participants with anorexia nervosa (n = 171) completed questionnaires exploring eating disorder psychopathology, symptoms of depression and anxiety, and everyday functioning at both admission and discharge. Characteristics associated with autism spectrum disorder were assessed using the Autism Spectrum Quotient, short version. Autism spectrum disorder symptoms were significantly positively correlated with eating disorder psychopathology, work and social functioning, and symptoms of depression and anxiety, but not with body mass index. Autism Spectrum Quotient, short version scores remained relatively stable from admission to discharge but there was a small, significant reduction in scores. There was no interaction between time and Autism Spectrum Quotient, short version scores on clinical symptom change. In anorexia nervosa, autism spectrum disorder symptoms appear to be associated with a more severe clinical presentation on admission to inpatient care. Autism spectrum disorder symptoms as assessed by self-report measures may be exacerbated by other mental health psychopathology, which warrants further investigation.
Figueroa, Rosa L; Vallejos, Guido E
This work presents a study of medical equipment availability in the short and long term. The work is divided in two parts. The first part is an analysis of the medical equipment inventory for the institution of study. We consider the replacement, maintenance, and reinforcement of the available medical equipment by considering local guidelines and surveying clinical personnel appreciation. The resulting recommendation is to upgrade the current equipment inventory if necessary. The second part considered a demand analysis in the short and medium term. We predicted the future demand with a 5-year horizon using Holt-Winters models. Inventory analysis showed that 27% of the medical equipment in stock was not functional. Due to this poor performance result we suggested that the hospital gradually addresses this situation by replacing 29 non-functional equipment items, reinforcing stock with 40 new items, and adding 11 items not available in the inventory but suggested by the national guidelines. The results suggest that general medicine inpatient demand has a tendency to increase within the time e.g. for general medicine inpatient service the highest increment is obtained by respiratory (12%, RMSE=8%) and genitourinary diseases (20%, RMSE=9%). This increment did not involve any further upgrading of the proposed inventory.
Kröger, Christoph; Harbeck, Susanne; Armbrust, Michael; Kliem, Sören
To examine the effectiveness of dialectical behavior therapy for inpatients with borderline personality disorder (BPD), small sample sizes and, predominantly, tests of statistical significance have been used so far. We studied 1423 consecutively admitted individuals with BPD, who were seeking a 3-month inpatient treatment. They completed the Borderline Symptom List (BSL) as the main outcome measure, and other self-rating measures at pre- and post-treatment. Therapy outcome was defined in three ways: effect size (ES), response based on the reliable change index, and remission compared to the general population symptom level. Non-parametric conditional inference trees were used to predict dropouts. In the pre-post comparison of the BSL, the ES was 0.54 (95% CI: 0.49-0.59). The response rate was 45%; 31% remained unchanged, and 11% deteriorated. Approximately 15% showed a symptom level equivalent to that of the general population. A further 10% of participants dropped out. A predictive impact on dropout was demonstrated by substance use disorders and a younger age at pre-treatment. In future research, follow-up assessments should be conducted to investigate the extent to which response and remission rates at post-treatment remain stable over time. A consistent definition of response appears to be essential for cross-study and cross-methodological comparisons. Copyright © 2013 Elsevier Ltd. All rights reserved.
Stockdale, Susan E; Sherin, Jonathan E; Chan, Jeffrey A; Hermann, Richard C
To explore hospital leaders' perceptions of organisational factors as barriers and/or facilitators in improving inpatient-outpatient (IP-OP) communication. Semistructured in-person interviews. Constant comparative method of qualitative data. Inpatient psychiatry units in 33 general medical/surgical and specialty psychiatric hospitals in California and Massachusetts (USA). Psychiatry chair/chief, service director or medical director. Importance to leadership, resources, organisational structure and culture. A majority of hospital leaders rated the IP-OP communication objective as highly or moderately important. Hospitals with good IP-OP communication had structures in place to support communication or had changed/implemented new procedures to enhance communication, and anticipated clinicians would 'buy in' to the goal of improved communication. Hospitals reporting no improvement efforts were less likely to have structures supporting IP-OP communication, anticipated resistance among clinicians and reported a need for technological resources such as electronic health records, integrated IT and secure online communication. Most leaders reported a need for additional staff time and information, knowledge or data. For many hospitals, successfully improving communication will require overcoming organisational barriers such as cultures not conducive to change and lack of resources and infrastructure. Creating a culture that values communication at discharge may help improve outcomes following hospitalisation, but changes in healthcare delivery in the past few decades may necessitate new strategies or changes at the systems level to address barriers to effective communication.
Kortüm, K U; Müller, M; Babenko, A; Kampik, A; Kreutzer, T C
In times of increased digitalization in healthcare, departments of ophthalmology are faced with the challenge of introducing electronic clinical health records (EHR); however, specialized software for ophthalmology is not available with most major EHR sytems. The aim of this project was to create specific ophthalmological user interfaces for large inpatient eye care providers within a hospitalwide EHR. Additionally the integration of ophthalmic imaging systems, scheduling and surgical documentation should be achieved. The existing EHR i.s.h.med (Siemens, Germany) was modified using advanced business application programming (ABAP) language to create specific ophthalmological user interfaces for reproduction and moreover optimization of the clinical workflow. A user interface for documentation of ambulatory patients with eight tabs was designed. From June 2013 to October 2014 a total of 61,551 patient contact details were documented. For surgical documentation a separate user interface was set up. Digital clinical orders for documentation of registration and scheduling of operations user interfaces were also set up. A direct integration of ophthalmic imaging modalities could be established. An ophthalmologist-orientated EHR for outpatient and surgical documentation for inpatient clinics was created and successfully implemented. By incorporation of imaging procedures the foundation of future smart/big data analyses was created.
Full Text Available AIM: This descriptive survey purposed to evaluate inpatients' attitudes towards the rationale use of drugs at a cardiology ward in GATA. METHODS: Rational Drug Use Questionnaire designed by T.C. Health Ministry was performed. The patients hospitalized during the research period were tried to be reached and 121 inpatients completed the questionnaire. SPSS 15.0 program was used for data evaluation. Descriptive statistics were indicated with mean, standard deviation, frequency. Pearsons Chi-Square Test was used for comparison of groups. Statistical significance at p<0.05 was adopted. RESULTS: Mean age of patient surveyed was 29.3+/-16.4 year and 68.6% of the patients were male. It was seen that 49.6% of the patients reserved residual drugs of a treatment at home to reuse, 87.6% of the patients applied to a physician when drug side effect was seen. 42.1% of female and 36.2% of married participants were seen to use painkiller without prescription. Additionally, significant relationship was observed between attitude of using painkiller without prescription and gender, marital status. CONCLUSION: Our research participants' attitudes towards rational drug use found more positive than previous researches performed in Turkey. It is assessed this difference resulted from participant's high education level and participants' obligation to use drugs for long time because most of them had chronic or congenital heart disease. [TAF Prev Med Bull 2015; 14(2.000: 137-144
Atashi, Alireza; Khajouei, Reza; Azizi, Amirabbas; Dadashi, Ali
While studies have shown that usability evaluation could uncover many design problems of health information systems, the usability of health information systems in developing countries using their native language is poorly studied. The objective of this study was to evaluate the usability of a nationwide inpatient information system used in many academic hospitals in Iran. Three trained usability evaluators independently evaluated the system using Nielsen's 10 usability heuristics. The evaluators combined identified problems in a single list and independently rated the severity of the problems. We statistically compared the number and severity of problems identified by HIS experienced and non-experienced evaluators. A total of 158 usability problems were identified. After removing duplications 99 unique problems were left. The highest mismatch with usability principles was related to "Consistency and standards" heuristic (25%) and the lowest related to "Flexibility and efficiency of use" (4%). The average severity of problems ranged from 2.4 (Major problem) to 3.3 (Catastrophe problem). The experienced evaluator with HIS identified significantly more problems and gave higher severities to problems (pHeuristic Evaluation identified a high number of usability problems in a widely used inpatient information system in many academic hospitals. These problems, if remain unsolved, may waste users' and patients' time, increase errors and finally threaten patient's safety. Many of them can be fixed with simple redesign solutions such as using clear labels and better layouts. This study suggests conducting further studies to confirm the findings concerning effect of evaluator experience on the results of Heuristic Evaluation.
Bokshan, Steven L; Han, Alex; DePasse, J Mason; Marcaccio, Stephen E; Eltorai, Adam E M; Daniels, Alan H
OBJECTIVE Sarcopenia, the muscle atrophy associated with aging and disease progression, accounts for nearly $18.5 billion in health care expenditures annually. Given the high prevalence of sarcopenia in patients undergoing orthopedic surgery, the goal of this study was to assess the impact of sarcopenia on inpatient costs following thoracolumbar spine surgery. METHODS Patients older than 55 years undergoing thoracolumbar spine surgery from 2003 to 2015 were retrospectively analyzed. Sarcopenia was measured using total psoas area at the L-4 vertebra on perioperative CT scans. Hospital billing data were used to compare inpatient costs, transfusion rate, and rate of advanced imaging utilization. RESULTS Of the 50 patients assessed, 16 were sarcopenic. Mean total hospital costs were 1.75-fold greater for sarcopenic patients compared with nonsarcopenic patients ($53,128 vs $30,292, p = 0.04). Sarcopenic patients were 2.1 times as likely to require a blood transfusion (43.8% vs 20.6%, p = 0.04). Sarcopenic patients had a 2.6-fold greater usage of advanced imaging (68.8% vs 26.5%, p = 0.002) with associated higher diagnostic imaging costs ($2452 vs $801, p = 0.01). Sarcopenic patients also had greater pharmacy, laboratory, respiratory care, and emergency department costs. CONCLUSIONS This study is the first to show that sarcopenia is associated with higher postoperative costs and rates of blood transfusion following thoracolumbar spine surgery. Measuring the psoas area may represent a strategy for predicting perioperative costs in spine surgery patients.
Kruisdijk, Frank; Deenik, Jeroen; Tenback, Diederik; Tak, Erwin; Beekman, Aart-Jan; van Harten, Peter; Hopman-Rock, Marijke; Hendriksen, Ingrid
Sedentary behaviour and lack of physical activity threatens health. Research concerning these behaviours of inpatients with severe mental illness is limited but urgently needed to reveal prevalence and magnitude. In total, 184 inpatients (men n =108, women n =76, mean age 57,4, 20% first generation antipsychotics, 40% second generation antipsychotics, 43% antidepressants, mean years hospitalisation 13 years), with severe mental illness of a Dutch psychiatric hospital wore an accelerometer for five days to objectively measure total activity counts per hour and percentages in sedentary behaviour, light intensity physical activity and moderate to vigorous physical activity. Accelerometer data were compared with data of 54 healthy ward employees. Patients showed significantly less activity counts per hour compared to employees (p=0.02), although the differences were small (d=0.32). Patients were sedentary during 84% of the wear time (50min/h), spend 10% in light intensity physical activity and 6% in moderate to vigorous physical activity. Age was the only significant predictor, predicting less total activity counts/h in higher ages. Decreasing sedentary behaviour and improving physical activity in this population should be a high priority in clinical practice. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Medina-Mirapeix, Francesc; Oliveira-Sousa, Silvana L; Escolar-Reina, Pilar; Sobral-Ferreira, Marta; Lillo-Navarro, M Carmen; Collins, Sean M
Few empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety. The aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care. Using qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes. Patients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient-therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care. The participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.
Kaur, Manvir; Himadi, Elaine; Chi, Donald L
Adolescents with psychiatric conditions may be at risk for xerostomia. In this preliminary study, we estimated xerostomia prevalence in adolescents ages 9 to 17 years from an inpatient psychiatric clinic (N = 25) and examined whether: (1) gender and age were associated with xerostomia and (2) xerostomia was associated with self-reported cavities. We used a modified 11-item Xerostomia Index to identify xerostomia (no/yes) and asked if adolescents ever had or currently have cavities (no/yes). The mean age was 14 years (SD = 2.3) and 72% were male. Sixty percent reported xerostomia (SD = 50). There were no significant associations between xerostomia and gender (p = 0.99) or age (p = 0.66), or between xerostomia and past (p = 0.26) or current cavities (p = 0.11). Larger proportions of adolescents with xerostomia reported previous and current cavities. Sixty percent of adolescents from an inpatient psychiatric clinic reported having xerostomia, which may lead to increased caries risk over time. Additional research should examine the prevalence and consequences of xerostomia in high-risk adolescents. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.
Stone, Lindsey B; Liu, Richard T; Yen, Shirley
Adolescents with a history of suicidal behavior are especially vulnerable for future suicide attempts, particularly following discharge from an inpatient psychiatric admission. This study is the first to test whether adolescents׳ tendency to generate stress, or report more dependent events to which they contributed, was predictive of prospective suicide events. Ninety adolescent psychiatric inpatients who were admitted for recent suicide risk, completed diagnostic interviews, assessments of history of suicidal behavior, and a self-report questionnaire of major life events at baseline. Participants were followed over the subsequent 6 months after discharge to assess stability vs. onset of suicide events. Cox proportional hazard regressions were used to predict adolescents׳ time to suicide events. Results supported hypothesis, such that only recent greater dependent events, not independent or overall events, predicted risk for prospective suicide events. This effect was specific to adolescent girls. Importantly, dependent events maintained statistical significance as a predictor of future suicide events after co-varying for the effects of several established risk factors and psychopathology. Results suggest that the tendency to generate dependent events may contribute unique additional prediction for adolescent girls׳ prospective suicide risk, and highlight the need for future work in this area. Published by Elsevier Ireland Ltd.
The aim of this paper is to explore important considerations when planning an acute mental health inpatient unit. Planning a mental health acute inpatient facility should be about more than just building a beautiful, fabulous facility. A novel architectural design, fancy gadgets, safe tapware, new lounge suites, good light and air circulation are all incredibly important and good architects and designers can inform us about new developments in architecture and design that we must incorporate in our design plans. However, to design a facility that is right for tomorrow, it is also important to spend time trying to understand what happens in the facility and how the new facility is going to make things different and better. Planning of a health facility should be about creating an environment that is not only pleasant, comfortable and safe but also one that would enable and facilitate better care. It is important to map processes before rather than after building a facility, so that this process mapping can inform design and we do not keep falling into the trap of building a beautiful new facility but losing the opportunity to make care better.
Grundmann, Johanna; Lincoln, Tania M; Lüdecke, Daniel; Bong, Sönke; Schulte, Bernd; Verthein, Uwe; Schäfer, Ingo
Traumatic experiences and posttraumatic stress disorder (PTSD) are prevalent in patients with alcohol use disorders (AUDs) and affect its course and outcome. Prior prevalence reports are limited by the inclusion of individuals with additional substance use disorders (SUDs), a focus on childhood events only and the use of self-ratings only. To examine the prevalence of traumatic experiences, revictimization and PTSD in inpatients treated for alcohol dependence without other SUD, emphasizing interpersonal violence across the whole lifespan. For this cross-sectional study alcohol-dependent patients without additional SUD (N = 230, 73% male, mean age 43 years) were recruited in an inpatient detoxification unit and were administered the Structured Trauma Interview, the Posttraumatic Diagnostic Scale, and the Structured Clinical Interview for DSM-IV. Data analysis comprised descriptive statistics and appropriate significance tests. 36.2% reported severe childhood physical or sexual abuse and 45.6% reported at least one of these types of abuse in adulthood. The lifetime rate of interpersonal violence was 61.1%. The prevalence of current PTSD was 13.2%. Women with a history of childhood abuse were about seven times as likely to be victimized in adulthood as women without these experiences, while in men revictimization was not significant. Even in patients with alcohol dependence without additional SUD experiences of interpersonal violence and PTSD are frequent. In order to adequately respond to the needs of this population, trauma and PTSD should routinely be assessed in alcohol-dependence treatment and considered in treatment planning if necessary.
Hart, Jessica R; Venta, Amanda; Sharp, Carla
Previous research has documented increased incidence of insecure attachment and theory of mind (ToM) deficits in individuals experiencing psychotic disorders. ToM has been theorized as a possible mediator of the relation between attachment and psychosis (Korver-Nieberg et al., 2014). The current study sought to extend this area of research to adolescents for the first time by examining adolescent-parent attachment and ToM in inpatient adolescents. Participants were 362 inpatient adolescents and their parents; participants completed the Child Attachment Interview, Movie for the Assessment of Social Cognition, Youth Self Report, and Child Behavior Checklist. Bivariate correlations indicated that attachment coherence (a marker of security) was significantly and positively correlated with ToM abilities, and that low attachment coherence and poor ToM performance were each associated with increased youth- and parent-reported thought problems. Mediational models indicated that ToM mediated the relation between insecure attachment and thought problems according to both parent- and self-report. The results of the current study provide support for a model in which impairments in ToM contribute to the frequently documented association between insecure attachment and emerging psychotic symptoms. Theoretical and clinical implications of these results are discussed, including the potential support for ToM-based interventions for early psychotic symptoms. Copyright © 2017 Elsevier Inc. All rights reserved.
Full Text Available There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN. Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11-19 years (14.3±1.8 years, with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall and 1 week prior (24 hour food recall, modifiable activity questionnaire. Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.
Crowson, Matthew G; Kahmke, Russel; Ryan, Marisa; Scher, Richard
The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets (p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use.
Robinson, Thomas N.; Matheson, Donna M.; Kraemer, Helena C.; Wilson, Darrell M.; Obarzanek, Eva; Thompson, Nikko S.; Alhassan, Sofiya; Spencer, Tirzah R.; Haydel, K. Farish; Fujimoto, Michelle; Varady, Ann; Killen, Joel D.
Objective To test a 2-year community- and family-based obesity prevention intervention for low-income African-American girls. Design Randomized controlled trial with follow-up measures scheduled at 6, 12, 18 and 24 months. Setting Low-income areas of Oakland, CA. Participants 261 8–10 year old African-American girls and their parents/caregivers. Interventions Families were randomized to two-year, culturally-tailored interventions: (1) after school Hip-Hop, African and Step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education. Main Outcome Measure Body mass index (BMI) change. Results Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [−.18, .27] kg/m2 per year). Among secondary outcomes, fasting total cholesterol (−3.49 [−5.28, −1.70] mg/dL per year), LDL-cholesterol (−3.02 [−4.74, −1.31] mg/dL per year), incidence of hyperinsulinemia (Relative Risk 0.35 [0.13, 0.93]), and depressive symptoms (−0.21 [−0.42, −0.001] per year) fell more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P=.02) and/or those whose parents/guardians were unmarried (Pdance and screen time reduction intervention for low-income, preadolescent African-American girls did not significantly reduce BMI gain compared to health education, but produced potentially clinically important reductions in lipids, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls. PMID:21041592
Robinson, Thomas N; Matheson, Donna M; Kraemer, Helena C; Wilson, Darrell M; Obarzanek, Eva; Thompson, Nikko S; Alhassan, Sofiya; Spencer, Tirzah R; Haydel, K Farish; Fujimoto, Michelle; Varady, Ann; Killen, Joel D
To test a 2-year community- and family-based obesity prevention program for low-income African American girls: Stanford GEMS (Girls' health Enrichment Multi-site Studies). Randomized controlled trial with follow-up measures scheduled at 6, 12, 18, and 24 months. Low-income areas of Oakland, California. African American girls aged 8 to 10 years (N=261) and their parents or guardians. Families were randomized to one of two 2-year, culturally tailored interventions: (1) after-school hip-hop, African, and step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education. Changes in body mass index (BMI). Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [-0.18 to 0.27] per year). Among secondary outcomes, fasting total cholesterol level (adjusted mean difference, -3.49 [95% confidence interval, -5.28 to -1.70] mg/dL per year), low-density lipoprotein cholesterol level (-3.02 [-4.74 to -1.31] mg/dL per year), incidence of hyperinsulinemia (relative risk, 0.35 [0.13 to 0.93]), and depressive symptoms (-0.21 [-0.42 to -0.001] per year) decreased more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P = .02) and/or those whose parents or guardians were unmarried (P = .01). A culturally tailored after-school dance and screen time reduction intervention for low-income, preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinically important reductions in lipid levels, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls.
Han, Der-Yan; Lin, Yi-Yin; Liao, Shih-Cheng; Lee, Ming-Been; Thornicroft, Graham; Wu, Chia-Yi
Disclosure of mental distress to physicians is important for mental illness identification, early referrals and proper treatment to prevent suicide. Little is known about what affects mental health communication in the clinical settings in the Chinese societies. The study aimed to identify the demographic, psychosocial and medical factors related to people with non-disclosure of their mental distress. We interviewed a series of consecutive inpatients from two medical wards of a general hospital in northern Taiwan. We collected depressive symptoms (the Patient Health Questionnaire, PHQ-9), living arrangement, threatening life events, suicide risks (i.e. past self-harm history, lifetime suicide ideas and hopelessness) and recent experience of mental distress disclosure. Furthermore, we explored the reasons of non-disclosure. A total of 230 medical inpatients agreed to participate (53.5% males). The results indicated that only 5.7% actually communicated their mental health concerns, and that 12.3% were willing to talk about their mental health problems. Among the 69 (30%) depressed participants (PHQ-9 score ≥ 10 points), the disclosure rate was low (8.7%) and the wish to talk about mental distress was also low (10.3%). After adjustment, living alone (OR = 7.58, 95% CI = 1.56-36.91) and having stressful life events (OR = 3.68, 95% CI = 1.09-12.46) remained significant in predicting disclosure of mental distress. The 109 participants attributed their refusal of communicating mental distress as medical-related attributes, subjective perceptions or sociocultural factors. Communication of mental distress in medical settings was uncommon due to medical or psychosocial barriers in Taiwan. Skill training to facilitate disclosure in medical education and public campaigns to improve knowledge of depression and enhance help-seeking deserve more attention, particularly under the influence of stigma in the Chinese societies. © The Author(s) 2014.
Full Text Available Tella Lantta,1 Raija Kontio,1–3 Michael Daffern,4 Clive E Adams,5 Maritta Välimäki1,6,7 1Department of Nursing Science, University of Turku, Turku, Finland; 2Helsinki University, Helsinki, Finland; 3Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland; 4Centre for Forensic Behavioural Science (CFBS, Swinburne University of Technology, Melbourne, VIC, Australia; 5Institute of Mental Health, University of Nottingham, Nottingham, UK; 6Turku University Hospital, Turku, Finland; 7School of Nursing, The Hong Kong Polytechnic University, Hong Kong Purpose: This paper aims to explore the acceptability of Dynamic Appraisal of Situational Aggression (DASA from the perspective of patients, its actual use by mental health nurses, and the predictive validity of the DASA instrument. Methods: A feasibility study design incorporating quantitative and qualitative components was used. The study was conducted in three mental health inpatient units at three hospitals in southern Finland. Quantitative data were used to explore demand (nurses’ actual use of the DASA, limited efficacy (predictive validity, and acceptability (measured through patients’ participation in the project. Qualitative data were collected to enhance the understanding of acceptability by describing patients’ perceptions of the strengths and weaknesses of the DASA. Results: Nurses used the DASA for most patient assessments. The predictive validity of the DASA was outstanding or excellent, depending on the type of aggression predicted, although the patient recruitment ratio was low. Patients reported both strengths and weaknesses of the DASA, providing complementary information regarding the instrument’s acceptability and clinical application. Conclusion: The DASA accurately predicts inpatient aggression. The patients’ preferences and concerns regarding risk assessment have been noted. More patient involvement in risk assessment research and
Bergquist-Beringer, Sandra; Daley, Christine Makosky
Clinical practice guidelines on pressure ulcer (PU)prevention have been written primarily for inpatient settings,but we currently lack data as to how these guidelines have been adapted for use in home health care. The purpose of this study was to delineate interventions and activities used to prevent PU in home health care. Focus group study using text analysis. A focus group was conducted with 9 certified wound care nurses who practiced in home health care at least 50% of the time. Most of the participants had 10 or more years of home health experience and 5 or more years of wound care experience. The single 75-minute focus group was convened by teleconference and audiotaped. A semistructured moderator's guide was used to lead the discussion. Transcribed data were analyzed using standard text analysis. Preliminary results were distributed to focus group participants for review, comment, or clarification, and refined as needed. Certified wound care nurse participants used an array of interventions, including those recommended by clinical practice guidelines, to prevent PU in home health patients.However, specific activities differed from those performed in hospitals and nursing homes. Interventions unique to homehealth care included (1) assessment of patients' economic and insured status to determine implementation options, (2) assessment of caregiving resources and caregivers' ability to manage PU prevention, and (3) collaboration with community resources and health care vendors to obtain needed prevention materials and supplies. Findings provide insight into guideline adaptation in home health care and suggest that PU prevention in the homehealth care setting is more complex than that in hospitals and nursing homes and requires significant skills in communication and collaboration.
Serrano, Daniel; Manack, Aubrey N; Reed, Michael L; Buse, Dawn C; Varon, Sepideh F; Lipton, Richard B
To quantify the cost differences and predictors of lost productive time (LPT) in persons with chronic migraine (CM) and episodic migraine (EM). The American Migraine Prevalence and Prevention (AMPP) study is a US national longitudinal survey of severe headache. Cost estimates were obtained via U.S. Census income data. To elucidate the unique predictors of LPT, the optimal distribution for modeling was determined. Zero inflation models for LPT were predicted from sociodemographics, headache features, characteristics and disability, medication use, and depression. The interaction between headache status and age was the primary effect of interest. The eligible sample included 6329 persons with EM and 374 persons with CM. Men with CM aged 45 to 54 years cost employers nearly $200 per week more than do their EM counterparts. Likewise, for women, costs were higher for CM, with the cost differential between EM and CM being $90 per week. After comprehensive adjustment, increases in LPT with age were significantly higher in CM than in EM (rate ratio 1.03; 95% confidence interval 1.01-1.05). When age was recoded to a decade, metric rates of LPT increased 25% more per decade for CM than for EM (rate ratio 1.25; 95% confidence interval 1.004-1.5). LPT is more costly and increases more rapidly for those with CM than for those with EM as age increases. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Kennedy, Carol A; Amick, Benjamin C; Dennerlein, Jack T; Brewer, Shelley; Catli, Starly; Williams, Renee; Serra, Consol; Gerr, Fred; Irvin, Emma; Mahood, Quenby; Franzblau, Al; Van Eerd, Dwayne; Evanoff, Bradley; Rempel, David
Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries. A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?" The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects". It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.
Bolger, Ashlee; Collins, Andrew; Michels, Michelle; Pruitt, David
Conversion disorder (CD) can lead to impaired functioning. Few studies present demographic and outcome data for pediatric patients. Many have had success with rehabilitation; however, further details are not known. To identify characteristics and outcomes of children admitted to a pediatric inpatient rehabilitation program with CD symptoms. Retrospective study. Inpatient rehabilitation unit within a large children's hospital. All patients with diagnosis of CD or functional gait disorder (FGD) during designated time period. Data were obtained from chart review and United Data Systems for Medical Rehabilitation. Descriptive statistics and Wilcoxon signed rank tests were used to analyze data. A P value of conversion disorder symptoms in the 12 months following discharge, and school reentry characteristics. 30 admissions were identified that met criteria. Before diagnosis, duration of symptoms was 58 ± 145 days, physician visits averaged 1.9 ± 2.1, hospital admissions to the same hospital averaged 0.7 ± 0.9, and absence from school was 6 ± 12 weeks. Overall, 83% exhibited mixed symptoms. Length of inpatient rehabilitation stay was 8.4 ± 4.2 days with WeeFIM score change of 30 ± 11.9 (P conversion disorder and leads to sustained functional improvement and return to school after discharge. ?? Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Slade, Eric P; Wissow, Lawrence S; Davis, Maryann; Abrams, Michael T; Dixon, Lisa B
This study examined low-income young adults' use of outpatient mental health services after an inpatient mental health stay, with a focus on Medicaid enrollment lapses and public mental health safety-net coverage. The sample included 1,174 young adults ages 18 to 26 who had been discharged from inpatient psychiatric care in a mid-Atlantic state. All were enrolled in Medicaid at the time of discharge, and all were eligible for continued outpatient public mental health services regardless of Medicaid enrollment. Administrative claims data were used to examine outpatient mental health clinic use, psychotropic medication possession, inpatient readmission, and emergency department admission during the 365-day period after the index discharge. The main independent variable was a lapse in Medicaid enrollment. An instrumental-variables regression model was used to minimize estimation bias resulting from unmeasured confounding between lapses and service use. Nearly a third (30%) of the young adults had an enrollment lapse. In instrumental-variables analysis, those whose coverage lapsed were less likely than those who had continuous Medicaid coverage to have at least two clinic visits (38% versus 80%); they also had a lower average psychotropic medication possession ratio (25% versus 55%). Age-related Medicaid enrollment lapses were common in this sample of young adults and were associated with receipt of less clinical care postdischarge despite continued eligibility for public services. States should examine opportunities to assist young adults with serious mental health problems who are aging out of Medicaid enrollment categories for children.
Megan M. Bowen
Full Text Available Only one randomized clinical trial (RCT has examined feedback-assisted (Fb treatment in an inpatient eating-disordered population. Results from this study suggested that those who received Fb treatment were more likely to recover than participants in the treatment-as-usual condition; however, long-term effects of this treatment have not been investigated. This is especially pertinent in eating-disordered populations, where outcomes tend to be poor and course of illness chronic. In the current study, fifty-three women from the aforementioned RCT were contacted three to four years after leaving inpatient care to assess their current distress level and psychological functioning. Results suggested no significant difference between treatment conditions. The vast majority of women sought out multiple forms of treatment over the follow-up period, regardless of treatment condition. This is consistent with past research suggesting that women with more severe pathology (i.e. those requiring inpatient treatment tend to experience a more chronic pattern of symptoms even after intensive treatment. Overall, the superiority of feedback-assisted treatment found at discharge diminished over time and could not be detected at follow-up. Suggestions for further research are delineated.
Wahlberg, Lara; Nirenberg, Anita; Capezuti, Elizabeth
To examine distress and coping self-efficacy in inpatient oncology nurses. . Cross-sectional survey design. . Oncology Nursing Society (ONS) chapter meetings and Hunter-Bellevue School of Nursing, both in New York, New York, as well as social media. . 163 oncology nurses who work with an inpatient adult population. . Participants were recruited through the ONS New York, New York, area chapter meetings, Hunter College, and ONS Facebook pages. An adapted Nurse Distress Thermometer (NDT) measured distress levels. The Occupational Coping Self-Efficacy Questionnaire for Nurses (OCSE-N) used a Likert-type scale to measure coping self-efficacy. Open-ended questions elicited additional perceptions of nurse respondents. . Descriptive statistics summarized sample demographics. A Pearson correlation between distress levels and coping self-efficacy scores was calculated. Low, normal, and high coping scores were compared to mean distress levels. . Survey participants showed high levels of distress, with a mean NDT score of 8.06. Those with higher coping self-efficacy scores reported less distress. A moderate, negative correlation was shown, with a statistically significant Pearson coefficient of -0.371. Responses to the open-ended questions revealed common stressors and pointed to solutions that institutions might implement to support nurses. . Because coping self-efficacy related to lower distress levels in inpatient oncology nurses, institutional-level support for oncology nurses should be provided. . Interventions aimed at coping self-efficacy may prepare oncology nurses to cope better with their professional demands. Future research should explore how nurse distress affects patients.
Molfenter, Todd; Connor, Tim; Ford, James H; Hyatt, John; Zimmerman, Dan
Thirty-day hospital readmission rates have become a quality indicator for many regulators and payers, but published accounts of reducing these rates across a patient population are lacking. This article describes and evaluates the Wisconsin Mental Health Readmissions Project, which aimed to reduce psychiatric inpatient 30-day readmission rates in Wisconsin. Nineteen county human services boards representing 23 of Wisconsin's 72 counties and 61% of the state's residential admissions participated in a statewide quality improvement collaborative from January 1, 2010 to December 31, 2013. Participants applied a standardized organizational change model, called NIATx, in the context of a multicounty quality improvement collaborative to reduce 30-day readmission rates. Readmission rates were tracked through national and state databases, using 2009 as a baseline, and analyzed using a chi-square analysis to test the proportion of means. The study team compared readmission rates of Wisconsin counties that participated in the statewide collaborative with those that did not. Between 2009 and 2013, the 30-day readmission rates in Wisconsin declined significantly for counties that participated in the project when compared to those that did not (2009-2013) [Χ2(4) = 54.503, P < .001], based on a 2.5% decline for participants vs a 0.7% decline for nonparticipants. Reductions to behavioral health inpatient readmission rates beyond individual case examples have been difficult to document. This analysis evaluates a method that Wisconsin behavioral health providers applied as part of a multicounty program addressing readmission rates. The findings highlight quality improvement program design elements and interventions to consider in reducing inpatient behavioral health readmissions, as well as the need for further research on this complex systems issue.
Alan, Janine; Burmas, Melinda; Preen, David; Pfaff, Jon
To describe three aspects of inpatient use for ex-prisoners within the first 12 months of release from prison: the proportion of released prisoners who were hospitalised; the amount of resources used (bed days, separations and cost); and the most common reasons for hospitalisation. Secondary analysis of whole-population linked prison and inpatient data from the Western Australian Data Linkage System. The main outcome measure was first inpatient admission within 12 months of release from prison between 2000 and 2002 and related resource use. One in five adults released from Western Australian prisons between 2000 and 2002 were hospitalised in the 12 months that followed, which translated into 12,074 inpatient bed days, 3,426 separations and costs of $10.4 million. Aboriginals, females and those released to freedom were most at risk of hospitalisation. Mental health disorders such as schizophrenia and depression, and injuries involving the head or face and/or fractures, accounted for 58.9% of all bed days. Ex-prisoners were 1.7 times more likely to be hospitalised during a year than Western Australia's general adult population of roughly the same age. Using whole-population administrative linked health and justice data, our findings show that prisoners are vulnerable to hospitalisation in the 12-month period following their release from prison, particularly Aboriginals, females and those with known mental health problems. Further research is needed to assess whether contemporary services to support community re-entry following incarceration have led to a measurable reduction in hospital contacts, especially for the subgroups identified in this study. © 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.
Zeh, R; Baumann, U
Cochlear implants (CI) have proven to be a highly effective treatment for severe hearing loss or deafness. Inpatient rehabilitation therapy is frequently discussed as a means to increase the speech perception abilities achieved by CI. However, thus far there exists no quantitative evaluation of the effect of these therapies. A retrospective analysis of audiometric data obtained from 1355 CI users compared standardized and qualitative speech intelligibility tests conducted at two time points (admission to and discharge from inpatient hearing therapy, duration 3-5 weeks). The test battery comprised examination of vowel/consonant identification, the Freiburg numbers and monosyllabic test (65 and 80 dB sound pressure level, SPL, free-field sound level), the Hochmair-Schulz-Moser (HSM) sentence test in quiet and in noise (65 dB SPL speech level; 15 dB signal-to-noise ratio, SNR), and a speech tracking test with and without lip-reading. An average increase of 20 percentage points was scored at discharge compared to the admission tests. Patients of all ages and duration of deafness demonstrated the same amount of benefit from the rehabilitation treatment. After completion of inpatient rehabilitation treatment, patients with short duration of CI experience (below 4 months) achieved test scores comparable to experienced long-term users. The demonstrated benefit of the treatment was independent of age and duration of deafness or CI experience. The rehabilitative training program significantly improved hearing abilities and speech perception in CI users, thus promoting their professional and social inclusion. The present results support the efficacy of inpatient rehabilitation for CI recipients. Integration of this or similar therapeutic concepts in the German catalog of follow-up treatment measures appears justified.