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PubMed1994

[Evaluation of inpatient long term group psychotherapy--a contribution to differential psychotherapy research on inpatient settings].

The paper describes an attempt to evaluate a highly specialized inpatient treatment setting differentially. In addition, it was investigated if patients differing with respect to their outcome, can be discriminated on the basis of their assessments of the basic component of the treatment program, i.e, the psychoanalytically oriented group psychotherapy. 31 patients (treated for approximately 6 months) formed the sample of the study showing that a differential assessment of treatment outcome could clarify questions related to specificities of inpatient settings. It is proposed to develop a basic inventory as well as a basic strategy to intensify differential process and outcome research within the field of inpatient psychotherapy.

Adult↗
PubMed2000

[Inpatient rehabilitation in inpatients with chronic obstructive lung diseases (COPD): effect on physical capacity for work, psychological wellbeing and quality of life].

Success of inpatient rehabilitation for patients with chronic obstructive pulmonary disease (COPD) was assessed in a prospective study of 39 patients (mean age = 71 years). Six months after hospital stay (mean duration 22.4 days), physical endurance as assessed by the 6-minute walk distance remained unchanged. Subjective health measures improved (SF36 21 vs 29%; p < 0.05), MRC-dyspnoea was reduced (2.61 vs 2.19; p < 0.05) and measures of global quality of life also improved (56.1 vs 67.5; p < 0.05). Meanwhile, anxiety symptoms were reduced (7.7 vs 6.0; p < 0.05); no changes in depression scores were observed (6.8 vs 6.2; p = 0.271). A novel visual method to assess the burden of suffering, PRISM (Pictorial Representation of Illness and Self Measure), was applied for the first time in COPD patients. PRISM scores improved significantly (6.3 vs 12.2; p < 0.001). In conclusion, inpatient pulmonary rehabilitation improved subjective physical health measures and reduced anxiety levels.

Aged↗
PubMed1996

Hospice inpatient care: an overview of NHO's 1995 inpatient survey results.

Hospice inpatient care is currently provided through a variety of arrangements, including freestanding facilities, dedicated units, and contracted beds, but lack of standard definitions of the various types of arrangements has led to confusion about the number and type of facilities actually in operation. This study identified a total of 97 freestanding facilities and dedicated hospice units with a total of 1,165 beds. Fifty-six percent were freestanding facilities; the balance were units located within other facilities, primarily hospitals. Forty-six percent of the units provided mainly acute hospice care, 17% provided mainly residential care, and the balance mixed acute and residential care. Seventy-seven of these facilities were operational in 1994, and these were classified into five facility types. Length of stay for the acute level of care averaged 9.7 days with a median of 6.8 days for the 36 reporting facilities. Length of stay for residential care averaged 33.2 days with a median of 30 days for the 22 reporting facilities. Bed size, total inpatient days of care, average daily census, occupancy rate, and charges are also reported by facility type.

Bed Occupancy↗
PubMed1997

Casemix for inpatient care of elderly people: rehabilitation and post-acute care. Casemix for the Elderly Inpatient Working Group.

BACKGROUND: defining contracts for the care of elderly people on the basis of the number of episodes is inappropriate as it fails to take account of the wide variation in their physical disability and rehabilitation needs. Resource use on a day-to-day basis can be estimated for patients using the Resource Utilization Groups version III (RUG-III) casemix system. For practical use, RUG-III assessments cannot be made daily and so assessments at different time intervals were evaluated in order to give an indication of resource use for an inpatient stay. This study describes how RUG-III assessments can be used to give an indication of resource use for an inpatient episode. METHOD AND RESULTS: RUG-III assessments were completed for all admissions to elderly care rehabilitation wards in two Health Districts over a 10 week period. There were 336 patients and 965 RUG-III assessments. The average time required to make RUG-III assessments fell from 10 to 4 min by the end of the study period. Fortnightly assessment intervals including a discharge assessment correlated well with the average of weekly assessments (R2 = 0.88-0.91, P < 0.0001). CONCLUSION: using the results from these assessments we propose a model for use of the RUG-III system in contracts for rehabilitation and post-acute care of elderly people which addresses the difficulty of combining clinical characteristics, rehabilitation, resource use and length of stay into a single useful meaningful casemix system.

Aftercare↗
PubMed1991

Six- and twelve-month abstinence rates in inpatient alcoholics treated with aversion therapy compared with matched inpatients from a treatment registry.

Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p less than 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p less than 0.05) but not at 12 months. The largest differences between treatment groups in 6-month alcohol abstinence rates were noted for males (p less than 0.001), those over 35 (p less than 0.001), daily drinkers (p less than 0.001), and those with alcohol-related work performance problems (p less than 0.05).

Adult↗
PubMed2006

Possible criteria for inpatient psychiatric admissions: which patients are transferred from emergency services to inpatient psychiatric treatment?

BACKGROUND: Patients with psychiatric problems often seek help and assistance in hospital emergency departments. An important task of emergency room staff is to decide whether such patients need to be admitted or whether they can be treated on an outpatient basis. METHODS: Psychiatric treatments given in the Central Interdisciplinary Emergency Department (CED) at the Medical University of Hannover (MHH) in 2002 were analysed. RESULTS: Of a total of 2632 patients seeking psychiatric help, 51.4% were admitted for inpatient treatment. Patients with dementia syndromes were admitted more frequently than patients with other psychiatric diseases. Suicidality was often the reason for admission. Accompanied patients were less likely to be hospitalised, unless a care-order was in force. Restraining measures and acute medication also had an impact on the rate of admissions. CONCLUSION: The results may help psychiatrists in the emergency department to make a more effective decision regarding inpatient admission in the interest of the individual patient.

Adolescent↗
PubMed1997

Six- and twelve-month abstinence rates in inpatient alcoholics treated with either faradic aversion or chemical aversion compared with matched inpatients from a treatment registry.

Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p < 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p < 0.05) but not at 12 months. These comparisons pooled faradic aversion and chemical aversion results. In order to determine whether or not the faradic aversion gave comparable results to the chemical aversion, the two groups were separately analyzed. No significant differences in outcome were found. In fact, the faradic aversion group showed a slight (nonsignificant) increase in abstinence rate.

Adult↗
PubMed2002

The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay.

OBJECTIVES: To investigate the relationship between access block in the emergency department (ED) (defined as total time from arrival to transfer from the ED over eight hours) and inpatient length of stay (LOS). DESIGN AND SETTING: Retrospective cohort study of all admissions through the ED to a tertiary hospital in Canberra, Australian Capital Territory, during 1999. MAIN OUTCOME MEASURES: Total time in the ED and LOS, calculated in days from ED departure to hospital discharge (non-overnight admissions were assigned LOS of one day, and all LOS were truncated at 10 days). RESULTS: 11 906 admissions were included, and 919 experienced access block (7.7%). Mean LOS was 4.9 days in those who experienced access block (95% CI, 4.7-5.1), compared with 4.1 days in the no-block group (95% CI, 4.0-4.2; P < 0.0001). Subgroup analysis showed that this "access block effect" occurred across different severities of illness and diagnoses. A strong relationship was found between longer LOS and arrival of access-block patients on the inpatient ward outside office hours (0800-1600 weekdays). CONCLUSIONS: This is the first study to show an association between access block and a measure of outcome outside the ED. If the effect of access block on LOS is reproduced in other settings, there are major implications for hospital management.

Adolescent↗
PubMedDate not supplied

[Prognostic predictors in medium-term inpatient treatment in longitudinal assessment--is there a lower limit for inpatient length of stay?].

A predictor for the individual length of stay (ILOS) was stable for 3 consecutive cohorts of annual inpatient admissions (n = 1.230, excluding drop-outs, crisis interventions for 14 days and less, longterm treatment for 250 days and more), in spite of decreasing average length of stay (ALOS). The predictor consists of CASCAP psychopathology variables, motivational and social functioning variables assessed by the therapist. ICD-10-diagnoses had no influence on ILOS. Improvement on MAS axis VI needed longer average LOS than improvement in symptoms. Unchanged patients had shorter LOS than improved ones, the lower limit of effective LOS being more than about 55 days for improvement of symptoms. Due to our findings, DRGs are not an adequate instrument to determine reimbursement of inpatient treatment in child and adolescent psychiatry.

Adolescent↗
PubMed1989

[Full inpatient versus partial inpatient psychiatric after-care--a comparative retrospective study].

In a retrospective study 80 inpatients (Sociotherapy, Therapeutic Community) were compared to 160 outpatients (80 patient Day Clinic, 80 patients Night Clinic). With a mean treatment duration of 4-5 1/2 month a significant decrease was found for each group in the frequency and duration of further hospital admissions after end of therapy. Day and Night Clinic patients tending to a better outcome than the inpatients. Advantages of the Day and Night Clinic are seen e.g. in a higher degree of acceptance by patients and family doctors, disadvantages in the increased rate of suicide found in our sample.

Adult↗
PubMed1989

[2 to 3 years following inpatient crisis intervention: further inpatient treatment, present adjustment and subjective assessment of the index treatment in retrospect].

2-3 years after having been treated in a special crisis intervention inpatient department, 404 patients were asked to write down in an anonymous letter what kind of therapy they had since undergone, how they feel at present, and how they rate the treatment in retrospect. The main reasons for the crisis had been conflicts in partnership relations such as separation or divorce. The patients covered by the inquiry--about 40% of them had been treated directly after attempted suicide--had again consulted their family doctor (almost 80%) or a psychiatrist (slightly more than 40%). 50% of the patients who could be contacted, had since participated in individual or group therapy. 23% had to return to inpatient treatment. Feeling tone (according to a standard rating scale) was depressive in only 40% of the patients and normal in far more than one-half. Index treatment was considered as "unhelpful" by only 3.4% of the patients. More than 95% of the patients would recommend the crisis intervention ward to other patients, too.

Adult↗
PubMed1997

[Quality assurance in inpatient treatment of depression. Aspects of quality monitoring and external quality assurance exemplified by a pilot project of inpatient treatment of depression].

Aspects of a Pilot Study on Depression Treatment According to Quality Monitoring and External Quality Assurance: Experiences and results of a pilot study on quality of the treatment of depressed inpatients in 4 different psychiatric hospitals (2 state mental hospitals, 1 university clinic, 1 psychiatric clinic at a city general hospital) according to so-called process and outcome quality, are reported. Outcome data (self-ratings, observer rating, clinical global impression admission versus discharge, patient satisfaction with treatment, duration of inpatient stay/and patient data are reported while comparing the 4 hospitals. Difficulties and problems of data collection, assessments and comparison of 4 different hospitals are discussed.

Adult↗
PubMed2000

Autopsy in elderly psychiatric inpatients: a retrospective review of autopsy findings of deceased elderly psychiatric inpatients in north Cheshire 1980-1996.

In this 17-year review of death certificates of elderly inpatients of a large psychiatric hospital in North Cheshire, the frequency, trend and value of performing autopsies were examined. Details of death certificates were compared with certificates issued after post-mortem examination to see whether an autopsy yielded any additional or relevant information about conditions that are not directly related to death but might well be of importance to public health. The rate of post-mortem examination, at 9.5% of total hospital deaths, did not show any significant trend over most of the review period. The vast majority of autopsies examined had been requested by the coroner and not by the clinicians. The review showed that an autopsy may be of some value in providing more information regarding any underlying causes of death in elderly psychiatric patients, but has no value in ensuring higher rate of the recording of conditions such as dementia, in particular Alzheimer's disease. Selective hospital autopsy in elderly psychiatric patients to verify, neuropathologically, the clinical diagnosis of Alzheimer's disease, will improve our diagnostic accuracy and provide valid statistics to be used in estimating prevalence, trends, risk factors and for use in all aspects of future research into Alzheimer's disease.

Aged↗
PubMed1995

[Annual number of Pseudomonas aeruginosa isolated inpatients, and antibacterial activity of various antibiotics against P. aeruginosa isolated from clinical specimens of inpatients].

In recent years, isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) has decreased, while the rate of Pseudomonas aeruginosa has increased. This phenomenon may be a result of regulation of use of antibiotics which belongs to the third cephems and extensive preventive measures against hospital acquired infections due to MRSA. Based on our investigation in which we determined MICs of various antibiotics against P. aeruginosa strains isolated from inpatients, the antibacterial activities of cefclidin (CFCL) was superior to those of other antibiotics. The antibacterial activity of CFCL against P. aeruginosa tested was similar to or stronger than that of tobramycin.

Anti-Bacterial Agents↗
PubMed1994

Can we talk? Inpatient discussions about advance directives in a community hospital. Attending physicians' attitudes, their inpatients' wishes, and reported experience.

BACKGROUND: The attitudes of hospitalized patients and their attending physicians about advance directives have not been well studied. We compared these attitudes and explored relationships between them and the frequency of actual directives and directive discussions during hospitalization. METHODS: We conducted scripted interviews with 258 (94.5%) of 273 patients admitted consecutively to the acute medical service of a community teaching hospital in Rochester, NY, and contemporaneously surveyed their attending physicians (n = 68) regarding attitudes about advance directives. Primary outcome measures were patients' willingness to discuss directives, actual physician-patient directive discussions, and patients' preferences for life-sustaining treatments. Also measured were physicians' indications for directive discussions, their reasons not to discuss directives, and their knowledge and attitudes about life-sustaining treatments. RESULTS: Eighty-one percent (172/212) of competent interviewed patients either did (100) or wanted to (72) discuss advance directives in hospital. Forty-one percent of patients chose to forgo cardiopulmonary resuscitation; 24% to 41% refused other life-sustaining interventions (intensive care unit admission, mechanical ventilation, cardioversion, vasopressors). Overall, 90% (246/273) of all patients met at least one of three criteria reported by their physicians as indications for advance directive discussions: age at least 75 years, critical or potentially fatal illness, and patients' desire to discuss directives. Multiple logistic regression revealed that these same variables predicted patients' willingness to discuss cardiopulmonary resuscitation, their preferences to receive or forgo cardiopulmonary resuscitation, and the frequency of physician-patient discussions about these issues. CONCLUSIONS: Most medical inpatients in a community hospital want to, are able to, and meet their own physicians' indications to discuss advance directives. Hospitalization presents an unrealized opportunity for physicians and patients to initiate these discussions.

Adolescent↗
PubMed1993

Prediction of short-term outcome of neurotic-depressive inpatients. Results of an empirical study of 134 inpatients.

A study was carried out involving 134 neurotic-depressive inpatients (according to ICD-9) treated with cognitive behaviour therapy and in a subgroup additionally with antidepressants. Using standardized rating instruments, a large set of potential predictor variables was tested. After cross-validation according to the split-half technique, only very few of these proved to be suitable as predictors for the main outcome criteria. These predictors included certain aspects of social functioning before index admission, intensity of depressive symptoms at admission and the degree of self-evaluated mood disturbances three weeks after admission. Several predictors known from the literature could not be reproduced in this study, demonstrating the well-known instability of most predictor findings. On the other side, the predictor profile of the neurotic-depressive patients was quite similar to that found in endogenous depressives, a result which might--together with other findings, such as the response of neurotic depressives to antidepressants--question the traditional subclassification of functional depressive states into these subgroups.

Adolescent↗
PubMed1998

The cost of inpatient endometriosis treatment: an analysis based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample.

OBJECTIVE: To determine the prevalence and cost of endometriosis-related hospitalizations based on the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP-3). STUDY DESIGN: Retrospective analysis based on nationwide clinical practice data. PATIENTS AND METHODS: Data were obtained for 1991 and 1992 from the HCUP-NIS database, which was a 20% sample of all US hospital discharges. ICD-9 codes (236.0, 617.0 to 617.9) were used to identify females, aged 15 to 54, with endometriosis as a diagnosis. The distribution of endometriosis admissions by admission type, length of stay (LOS), mean total charge, specific types of endometriosis, principal procedures, and other diagnosed diseases was described. RESULTS: In 1991 and 1992, 37,273 (22.6/1000) and 38,834 (23.7/1000) hospital admissions, respectively, were for endometriosis (as any diagnosis). The average LOS and total hospital charges for endometriosis as the primary diagnosis were 3.8 days and $6,597 for 1991, and 3.5 days and $7,450 for 1992. Most endometriosis admissions occurred in females aged 35 to 49. About 87% of the endometriosis hospitalizations were routine admissions. The most common diagnosis was endometriosis of the uterus (51%); the most common procedure was a total abdominal hysterectomy (55%-60%). Older and African-American patients had the longest LOS and the highest total charges. The estimated total hospitalization costs, as represented by hospital charges, for women with endometriosis as the primary diagnosis in the United States were $504 million for 1991 and $579 million for 1992. CONCLUSION: Endometriosis-related hospitalization is a major burden on healthcare systems.

Adolescent↗