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PubMed1978

Breast biopsy. A comparison of outpatient and inpatient experience.

Nine hundred ninety-seven breast biopsies that were performed at one hospital over the five-year period from 1971 through 1975 were reviewed because of a changing pattern in the use of breast biopsies on outpatients who were under local anesthesia. In 1971, 17% of all breast biopsies were performed as outpatient procedures; by 1975, the figure was 60%. In 1971, 5% of all malignant neoplasms were diagnosed by the use of biopsies as outpatient procedures and 30% in 1975. Hospital charges for biopsy on an inpatient basis of benign breast disease were 7.2 times higher than for biopsy on an outpatient basis. Interviews of 102 patients clearly suggested that most patients were satisfied with the outpatient breast biopsy experience. Outpatient breast biopsy under local anesthesia is a safe procedure that is more economical in terms of medical cost, surgeons' time, and patients' time away from home and/or job. Preliminary biopsy of malignant lesions using local anesthesia permits more efficient use of diagnostic procedures to stage the extent of disease prior to treatment. Patient acceptance of breast biopsy as an outpatient procedure under local anesthesia was similar to their acceptance of biopsy on an inpatient basis under general anesthesia.

Ambulatory Care↗
PubMed1978

The relation between trait anxiety and the Harris MMPI PD subscales among psychiatric inpatients.

Investigated the relationship between trait anxiety and MMPI PD scores among psychiatric inpatients from a multidimensional standpoint by means of the Harris PD subscales. The trait anxiety scale of the State-Trait Anxiety Inventory and the Harris PD subscales were administered to 24 female and 21 male psychiatric inpatients. Trait anxiety was correlated positively with the basic PD scale in accord with previous findings. However, the Self-Alienation and Social Alienation PD subscales were the only Harris subscales that were correlated significantly with anxiety in the positive direction. The Social Imperturbability PD subscale was related inversely to trait anxiety. The findings were discussed primarily in terms of the potential benefit of employing the Harris subscales in studies of psychopathy and in clinical settings.

Adolescent↗
PubMed1979

A study of mental status and anamnestic factors related to the decision for inpatient or outpatient treatment.

Reviewed previous studies of the determinants of disposition decision-making. Experimental flaws in these studies are indicated. A study of the intake decision process and its relationship to mental status and anamnestic variables obtained during the intake examination is presented (N = 523). Results suggest that diagnoses of psychosis and personality disorder are rleated to inpatient care, while the diagnosis of neurosis is related to outpatient care. In addition, depressed/suicidal symptomatology is found to be related to inpatient treatment, while a previous history of either sexual maladjustment or stubbornness/retardation is found to be related to outpatient care. Results are discussed in terms of universal and local criteria that are involved in intake decision-making.

Adult↗
PubMed1978

The effectiveness of planning for community mental health center inpatient units.

The number of beds identified among 308 community mental health centers in operation in 1972 bore little relation to inpatient case load or to the proportion of center patients likely to require hospitalization. Analysis of occupancy data indicated that there was a surplus of beds in many centers. These findings suggest a lack of effective planning for community mental health center impact on the nature of psychiatric treatment provided. This is suggested by the close relationship between inpatient capacity and average duration of stay.

Adolescent↗
PubMedDate not supplied

Inpatient bed needs for psychiatric care.

Along with other types of hospital inpatient care, acute psychiatric units are subject to state certificate-of-need review under Public Law 93-641. A study of 15 hospitals in Virginia suggests that prevailing techniques for determining inpatient bed needs are not appropriate for psychiatric beds, if indeed they are for other types of care. An alternative technique is offered, not as a substitute for judgment in such matters, but as assistance to it.

Beds↗
PubMed1979

The interaction of family therapy and psychodynamic individual therapy in an inpatient setting.

Although individual psychotherapy is an established treatment modality in psychoanalytically oriented hospitals, family therapy is a relative newcomer. When family therapy is introduced into such an inpatient setting, it raises issues which have not yet been widely discussed. On the one hand there is the question of how inpatient family therapy differs from outpatient family therapy, and what its special characteristics are. This question has only begun to be discussed. On the other hand there is the question of how family therapy relates to individual therapy that is being conducted simultaneously with a member of the same family. In general the individual psychotherapy literature tends to speak as if family therapy did not exist, and the family therapy literature speaks as if individual therapy should be abolished and supplanted by family therapy. Some authors have begun to try to build bridges between the two fields on the level of theory, but almost none have reported on the interaction between the two treatment modalities on a pragmatic level when they are conducted simultaneously (Kugel, 1974).

Adult↗
PubMed1977

Learning child psychiatry skills on the adult inpatient service.

Integration of child psychiatry training into general psychiatric residency programs is often unsuccessful. The authors describe an innovative model of training in child psychiatry that involves the children of adult inpatients. This model offers several advantages: splitting of child-adult psychiatric training is avoided, child diagnostic and evaluative skills tend to be learned rapidly, preventive orientations develop, and family process is both learned and used. Preliminary experience with this model on two inpatient services suggests that it is both didactically effective and economical in child psychiatry staff hours.

Adolescent↗
PubMed1975

Short-term follow-up after brief inpatient treatment.

A total of 110 patients admitted to the inpatient unit of a community mental health center in Philadelphia were followed up between 90 and 120 days after discharge to determine their level of functioning after an average hospital stay of 21 days. All but five of the patients were referred for aftercare, and 80 received outpatient or day hospital care after their release. Sixteen patients were readmitted to inpatient care within 90 days after discharge. The author describes the patients' social and community adjustment at follow-up, based on information obtained from aftercare therapists.

Adolescent↗
PubMed1978

Developing a psychiatric inpatient service in a rural area.

An inpatient psychiatric service was developed in a community hospital in Appalachia by building on the hospital's existing mental health components, a comprehensive alcoholism program and an inservice training program for general-duty nurses. In its first phase, the program offered a consultation service to help physicians deal with emotional problems of medical-surgical patients and a daytime therapy program for selected patients referred by the consultation service. In the second phase, psychiatric patients were admitted directly from the community and placed in wards throughout the hospital. Eventually a separate 23-bed psychiatric unit was opened. Between 1973 and 1976 more than 2200 patients were treated by the therapy service or as psychiatric inpatients. The author discusses problems that occurred during each phase of development, including a continuing shortage of nursing staff.

Hospital Bed Capacity, 300 to 499↗
PubMed1979

A validity scale sign calling for caution in the interpretation of MMPIs among psychiatric inpatients.

Three expert MMPI judges classified 100 psychiatric inpatients as psychotic or non-psychotic on the basis of their MMPIs. Validity scale data, as well as clinical scale scores, were included for 50 of the profiles, while the validity scale scores were withheld from the judges for the remaining 50 profiles. Within each of the above two groups, half had a "positive" validity scale sign (a defensive validity scale configuration defined as L or K greater than or equal to 70, or both greater than or equal to 60) and half had a negative validity scale sign, indicating a lack of defensiveness. Using actual diagnosis as the external criterion, results indicated that the majority of defensive psychotic patients produced clinical scale configurations which appeared nonpsychotic to the judges. Conversely, the majority of nondefensive nonpsychotics produced psychotic-appearing clinical scale configurations. These two types of test misses suggest that K corrections on MMPI scales relating to psychosis are not optimal for psychiatric inpatients. Guidelines were developed for interpreting defensive profiles.

Defense Mechanisms↗
PubMed1979

Substitution of outpatient care for inpatient care:problems and experience.

This paper provides a logical framework for considering possible alternatives to inpatient care. First it presents the concept of a substitute-complement relationship among factors of production (or goods and services in consumption) and examines several problems often encountered when applying this concept. Second, it presents four general sources of substitution: (1) technological innovation; (2) changes in organization; (3) capital accumulation; and (4) the dissemination of knowledge. Third, it examines nine activities which are frequently mentioned as providing alternatives to inpatient care. Fourth, it examines some problems and consequences of governmental efforts to plan substitution. The general thrust of the paper is that the substitution process is complex and often depends upon amorphous variables whose influences are subtle, generally nonquantifiable, and often of overriding importance. These variables introduce a downward bias in estimates of program costs and an upward bias in the estimates of program accomplishments. The result is that government attempts to plan substitution are not well conceived and will generally fall short of announced goals and/or cost significantly more than original estimates.

Ambulatory Care↗
PubMed2026

Genomic Characterization of Antimicrobial Resistance and Virulence in ST11 Carbapenem-Resistant Klebsiella Pneumoniae Colonizing the Intestinal Tract of Elderly Inpatients.

BACKGROUND: This study aimed to elucidate the molecular epidemiology and virulence characteristics of ST11 carbapenem-resistant Klebsiella pneumoniae (CRKP) colonizing the intestinal tract of elderly inpatients in the Chongzhou region, providing a basis for controlling the transmission of such resistant bacteria in high-risk populations. METHODS: CRKP strains isolated from the intestines of elderly inpatients in this region between January 2023 and June 2024 were collected. ST11 strains were identified via multilocus sequence typing (MLST). Whole-genome sequencing, antimicrobial susceptibility testing, and string test, serum killing, biofilm formation, capsular polysaccharide quantification were employed to characterize their resistance genes, virulence genes, and molecular typing profiles. RESULTS: Among 58 CRKP isolates, 17 (29.3%) were ST11. ST11-KL64 was the dominant clone (70.6%). All isolates carried the carbapenemase gene bla KPC-2 and exhibited extensive drug resistance, with tigecycline retaining the highest susceptibility (64.7%). The yersiniabactin system genes (ybtS, fyuA, entB) were universally present, whereas the aerobactin gene cluster (iucABCD-iutA) was detected in only 17.6% of isolates. The virulence regulator rmpA2 was incomplete in all carriers. The hypermucoviscosity phenotype was observed in 35.3% of isolates, which correlated with serum resistance in some strains. Biofilm formation was variable. The mortality rate among colonized patients was 35.3%. CONCLUSION: The ST11-KL64 clone is dominant among CRKP strains colonizing the intestinal tract of elderly patients in this region. This clone universally carries the bla KPC-2 gene conferring carbapenem resistance and exhibits a unique virulence gene profile characterized by a low carriage rate of classical hypervirulence markers and an incomplete rmpA2 regulator gene. This finding clarifies the local epidemic status of this clone and underscores the importance of implementing active surveillance and targeted prevention strategies for high-risk populations.

KL64 serotype↗
PubMed1977

A point prevalence study of outpatients and inpatients in the mental health services, general hospital psychiatric units, and under private psychiatrists in Perth, Western Australia.

A one day point prevalence study of all inpatients and a one week point prevalence study of all out-patients, seen by psychiatrists in Perth, Western Australia, was conducted. On the census day in July 1971, 61 per cent of all psychiatric inpatients in Perth were long-stay patients. Of the short-stay patients 75 per cent were in Mental Health Services hospitals, 17 per cent were in general hospital psychiatric units and 8 per cent were under private psychiatrists. The bed occupancy rate was 129.7 per 100,000 population for the whole State--83.2 long-stay and 46.5 short-stay. These rates were low compared with published figures in other countries. The proportions of total outpatients seen during the census week by the Mental Health Services, general hospital units and private psychiatrists were 53.5 per cent, 16.0 per cent and 30.5 per cent respectively. There was a differential use of psychiatric services between immigrants and Australian-born outpatients.

Adult↗
PubMed1978

Meniscectomy. A comparison of two series treated as outpatients and inpatients.

A total of 129 patients were operated on for meniscus lesion in the knee joint. Of these, 64 were operated as outpatients and 65 as inpatients. The outpatients reported to the operation department in the morning and left the hospital in the evening of the same day, after the operations. The inpatients were admitted to the hospital the day before the operation and were discharged 1--3 days after the operation. Objective postoperative findings, sick-leave periods and the number of visits to the outpatient clinic show no differences between the groups. The end result in the two groups is the same. This investigation also shows that it is possible to operate on patients with meniscus injury as outpatients without increased discomfort for the individual and without medical risks. Thus expensive nursing resources are released for other groups requiring more nursing care.

Adult↗
PubMed1978

Does adipose tissue cellularity or the age of onset of obesity influence the response to short-term inpatient treatment of obese women?

Thirty-three obese women were admitted as inpatients to a metabolic ward and had an average intake of 3.35 MJ (800 kcal) daily for three weeks. Fat biopsies were taken at three subcutaneous sites and average fat cell mass (CM) and apparent fat cell number (FCN) were calculated. There was no significant correlation between adipose tissue cellularity (CM or FCN) and total weight loss or resting metabolic rate, provided due allowances were made for the severity of obesity in each case. Neither was there any significant correlation between short-term weight loss and the age of onset of obesity. Resting metabolic rate, and not adipose tissue cellularity or age of onset of obesity, is a better indicator of short-term weight loss under controlled inpatient conditions.

Abdominal Muscles↗
PubMed1979

The development of an acute short-term inpatient child psychiatric setting: a pediatric-psychiatric model.

The authors describe the establishment of a unit for children that emphasizes the integration of the pediatric model of acute, short-term inpatient care with the psychological and developmental perspective of the psychiatric model. Of the 145 children admitted during the first year, more than 33% manifested aggressive or hyperactive behavior and 25%, depression or suicidal behavior. Eighty-five percent were discharged to their homes or previous residences after an average length of stay of 24 days. The authors suggest that similar units established in children's hospitals or general hospitals could help meet the urgent need for acute inpatient psychiatric care of children in this country.

Adolescent↗
PubMed1979

Inpatient performance of primary care residents: impact of reduction in time on the ward.

The inpatient (ward/intensive-care-unit) performance of primary care medical residents was compared with that of their peers in the standard internal medicine residency program. The primary care residents spent half as much time on inpatient rotations as did their peers in the first two years of training. History-taking, physical examination, case presentation, record-keeping, patient management, and overall performance were assessed and scored by the attending physicians using the American Board of Internal Medicine's Clinical Performance Evaluation Form. The performances of the two groups were nearly identical, suggesting that substantial time in the first two years of residency can be devoted to ambulatory training without markedly compromising development of acute care skills.

Clinical Competence↗
PubMed1979

Hypercalcaemia in adult hospital population: comparison of inpatients of 1966 with those of 1976.

During 1976, inpatients with hypercalcaemia at The Royal Melbourne Hospital were identified from the worksheets of the Department of Biochemistry and compared with those discovered in a similar study in 1966. In 1966, the estimation of plasma calcium level had to be ordered specifically, whereas in 1976, for technical reasons, the measurement of plasma calcium level was frequently performed when not requested. Despite a six-fold increase in plasma calcium in the rate of detection of hypercalcaemia. In both studies, malignant disease was the most common casue of hypercalcaemia, but primary common cause of hypercalcaemia, but primary hyperparathyroidism was found slightly more frequently in 1976. This study suggests that screening inpatients for hypercalcaemia is of little value.

Clinical Laboratory Techniques↗