SEARCH · Search PubMed

Results for “Inpatients”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 505 records · Page 28Linked to original sources

PubMed2006

The premature demise of public child and adolescent inpatient psychiatric beds : Part II: challenges and implications.

Psychiatric disorders are the leading reason for hospitalization among 5-19 year olds. Current data, however, suggest there are fewer than necessary available services for children and adolescents requiring intensive, inpatient psychiatric care. Children and adolescents with behavioral health problems, the majority of whom do not receive appropriate treatment, have increased risk of school failure, family disruption, out-of-home placements, poor employment opportunities, and poverty in adulthood. This paper will examine the challenges inherent in serving children and adolescents with serious emotional disturbances, avenues of financing for treatment and services, and various loci of intervention for high-risk children, including inpatient settings and systems of care. The goals of this paper are to illustrate the complexities of working with children and adolescents most in need of intensive psychiatric services, to explore how inpatient services "fit" into existing treatment approaches, and to discuss the efficacy of downsizing or closing inpatient psychiatric units for this population.

Adolescent↗

PubMed1987

Coping behaviors among depressed and nondepressed medical inpatients.

Sixty medical inpatients completed a variety of psychological measures related to factors associated with depression. An analysis of self-reported depression and coping response indices revealed significant differences in coping strategies between depressed and nondepressed medical inpatients. Depressed patients more often reported avoidance strategies to cope with the stressors associated with hospitalization, while nondepressed patients were more likely to utilize active coping techniques. Since the coping and depression measures were assessed concurrently, the direction of influence cannot be determined. Still, these findings are consistent with the learned helplessness model of depression for medical inpatients and suggest specific psychological interventions for treating this population. Such treatment would attenuate the adverse effects of inpatient medical depression and thereby enhance the desired benefits of medical hospitalization. It is suggested that future research examine the effectiveness of coping in a prospective design to clarify the direction of the coping and depression relationship.

Adaptation, Psychological↗

PubMed1984

Inpatient psychiatry: perspectives from the general, the private, and the state hospital.

Although it is widely recognized that inpatient psychiatry is different as it is practiced in the general, private, and state hospital, why and how it is different have not been clearly articulated. In this paper, the directors of inpatient units in a general hospital, a private hospital, and a state hospital first provide an analysis of how the history and the organizational structures of these units have shaped their identity. The authors then specifically detail the different patient populations, referral sources, financial bases, leadership arrangements, milieu philosophies, research and training activities, and lengths of stay on these units. Finally, on the basis of the reality and the value of different inpatient settings, a view toward the future of inpatient psychiatry is offered.

Community Mental Health Centers↗

PubMed1992

Dissociative experiences among psychiatric inpatients.

The Dissociative Experiences Scale was administered to 299 inpatients on an acute care general adult psychiatric ward over a 2-year period. The average score was 14.6, which is significantly higher than the mean for the general population. About one in six inpatients reported very high scores above 50 on the seven most common items in the scale, indicating a high level of dissociative psychopathology. Based on the responses to four items which form a scale factor called Activities of Dissociated States, an estimate is made that 6%-8% of general adult inpatients may have multiple personality disorder. Dissociative psychopathology is common on inpatient units.

Adult↗

PubMed1994

Costs and outcomes of inpatient versus outpatient hernia repair.

This study sought to compare treatment costs and outcomes for a large number of Medicare patients undergoing inpatient versus outpatient hernia repair around the country. Medicare physician and hospital claims were obtained for all Medicare enrollees residing in eleven states in 1987 and 1988, in order to take advantage of geographic variation in treatment location. All patients undergoing uncomplicated inguinal hernia repair were identified from the surgeon's bill; the location of surgery was then validated by the facility bill (n = 27,036). Over one-third of all hernia repairs in our sample were performed on an ambulatory basis, but with tremendous variation across states, ranging from 89.9% of cases in Washington in outpatient settings to almost none (6.3%) in Georgia. Treatment costs were 56% higher for hernias repaired on an inpatient basis, $2341 versus $1505 for those performed in outpatient settings. There were no detectable differences between inpatients and outpatients along such outcomes as complication rates, deaths and hernia recurrence, but readmission rates were higher for inpatients. The dramatic differences in costs, along with the apparent absence of adverse outcomes, suggests that Medicare should actively encourage surgeons to perform more hernia repairs on an outpatient basis.

Aged↗

PubMed1991

High prevalence of historical risk factors for blood-borne infections among inpatients at three community hospitals.

To determine the prevalence of risk factors for blood-borne infections in a city with a low prevalence of human immunodeficiency virus (HIV), we confidentially surveyed 397 adult inpatients in three community hospitals. Twenty-one percent of inpatients reported one or more risk factors, 56% denied risks, 15% were unable to respond, and 8% declined to respond. Inpatients reporting a blood-borne infection risk factor, those declining response, and those denying risk were of comparable age, sex, race, and marital status. On medical floors, 28% of patients reported risk; on surgical floors, 23%; in intensive care units, 11%; and on obstetric floors, 5%. A recent blood transfusion (59%) and history of hepatitis (40%) were reported most often. Only 2.4% of persons with risks reported being positive for HIV antibody; however, 24% of reported risks were those frequently associated with HIV infection. By using history alone to determine isolation categories and by classifying patients unable to respond and those declining response as potentially infectious, more than 40% of our community's inpatients would require blood and body fluid precautions. This high historical risk supports use of a type of body substance isolation for all patients.

Cross Infection↗

PubMed1994

The relevance of the in- versus outpatient status for studies on HPA-axis in depression: spontaneous hypercortisolism is a feature of major depressed inpatients and not of major depression per se.

Increased spontaneous activity of the hypothalamic-pituitary-adrenal (HPA)-axis is frequently reported in major depressed inpatients. The aim of the present study was to determine whether there are differences in spontaneous HPA-axis activity between major depressed inpatients and outpatients. Toward this end, the authors measured basal 9:00 a.m. plasma cortisol and the integrated assessment of plasma morning cortisol secretion over 2 (AUC 120) hours in 48 major depressed inpatients, 17 major depressed outpatients and 73 normal volunteers. Major depressed inpatients exhibit significantly higher plasma cortisol values than healthy controls and major depressed outpatients. The cortisol data from the latter are not significantly different from these of the healthy controls. The cortisol differences between in and outpatients were still present after considering the influences of age, sex, body mass index, severity or endogeneity of illness, unipolar/bipolar subclassification, or specific symptoms such as suicidal thoughts, insomnia, psychomotor disorders, psychoticism, weight loss or anxiety. The results indicate that hypercortisolism as measured by basal morning plasma levels is not a feature of major depression per se, but rather of an interaction between the illness and hospitalization.

Adolescent↗

PubMed1996

Inpatient vs. outpatient pain management: results of a randomised controlled trial.

Inpatient and outpatient cognitive behavioural pain management programmes for mixed chronic pain patients were compared. Patients were randomly allocated to the 4 week inpatient programme or to the 8 half day per week outpatient programme, or to a waiting list control group. Staff, teaching materials, and setting were the same for the two treatment groups. Patients were assessed pre-treatment, and at 1 month after discharge, and treated patients also at 6 months and 1 year after discharge, by assessors blind to treatment group; assessments included physical, functional and psychological measures, and medication use. In total, 121 mixed chronic pain patients (mean age 50 years; mean chronicity 8.1 years) were included in the study, following medical examination to ensure that no further medical treatment was appropriate. There was no change in the control group; inpatients and outpatients, comparable before treatment, both made significant improvements in physical performance and psychological function, and reduced medication use. Inpatients made greater gains, and maintained them better at 1 year; they also used less health care than outpatients. There were no outstanding predictors of improvement other than treatment group.

Ambulatory Care↗

PubMedDate not supplied

Outcome of domiciliary care after inpatient alcoholism treatment in male veterans.

Current literature is ambiguous as to the impact of extended treatment services following hospitalization on outcomes such as abstinence. This study compares the outcomes of care for 276 veterans who completed inpatient treatment for alcoholism, 77 of whom (28%) were transferred to a domiciliary and the remainder of whom were discharged directly into the community. The domiciliary group of alcoholics differed at baseline from alcoholics discharged to the community with significantly higher psychiatric comorbidity and lower social support, both negative predictors of treatment outcome. A multiple logistic regression model was used to assess the impact of domiciliary placement on: (a) 3-month abstinence comparing the time after discharge from either the domiciliary or the inpatient treatment unit and (b) 12-month abstinence after discharge from the inpatient treatment unit, including patients placed in the domiciliary. Controlling for baseline differences, domiciliary placement was found to be a significant predictor of abstinence (odds ratios of 2.3 for 3-month and 2.5 for 12-month abstinence, p < or = 0.01). In a survival analysis, domiciliary placement was also a significant predictor of time to readmission after treatment discharge with a risk ratio of 0.2 (p < 0.01). Our results demonstrate a protective effect of domiciliary after-care for high risk alcoholics after inpatient treatment.

Adult↗

PubMed2004

Inpatient smoking-cessation counseling and all-cause mortality among the elderly.

BACKGROUND: Although smoking cessation is essential to the management of acute myocardial infarction (AMI), prevalence and benefits of smoking-cessation counseling in the inpatient setting are not well described among older adults. The objective of this study was to evaluate associations between inpatient smoking-cessation counseling and 5-year all-cause mortality among older adults hospitalized with AMI. METHODS: The Cooperative Cardiovascular Project (January 1994-July 1995) included 788 Medicare beneficiaries aged >/=65 years who were current smokers, admitted to acute care facilities in North Carolina with confirmed AMI, and discharged alive. Information on smoking-cessation advice or counseling prior to discharge was abstracted from medical records. Associations of counseling with 5-year risk of death were assessed with multivariate Cox proportional hazards regression. RESULTS: Smoking-cessation counseling was provided to 40% of AMI patients before discharge. Women (p =0.06) and blacks (p =0.02) were less likely to receive counseling. Counseling was associated with a history of chronic obstructive pulmonary disease (p =0.01). Increasing age, discharge to a skilled nursing facility, and histories of hypertension, heart failure, or stroke were associated with no counseling (p <0.05, all cause). Age-adjusted mortality rates (per 1000 enrollees) at 5 years were 488.3 for patients who were given counseling compared to 579.3 for patients without counseling. After adjustment for age, race, gender, prior histories of hypertension, cardiovascular diseases, diabetes, and chronic obstructive pulmonary disease, Killip class III or IV, and discharge to a skilled nursing facility; inpatient counseling remained associated with improved survival (relative hazard, 0.78; 95% confidence interval, 0.63-0.97). CONCLUSIONS: Inpatient counseling on smoking cessation is suboptimal among older smokers hospitalized with AMI. Even without confirmation of actual cessation, these data suggest that provision of smoking-cessation advice or counseling has a major impact on survival of older adults.

Age Factors↗

PubMed2004

Relationship between suicidal behavior of psychotic inpatients and serotonin transporter gene in Han Chinese.

Strong evidence indicates that central serotoninergic system dysfunction is associated with suicidal behavior. The relationship between the serotonin transporter protein (5-HTT) gene of psychotic patients in Han Chinese with suicidal behavior was studied since the 5-HTT plays an important role in serotoninergic transmission. Two hundred and seventy-two psychotic inpatients with suicidal behavior (suicide group) and 275 psychotic inpatients without suicidal behavior (patient control group) were recruited from six mental health facilities in Shanghai, China. Another 628 healthy adults (healthy control group) without suicidal behavior and mental disorder history were enrolled from Shanghai, China. All subjects were Han Chinese. The genotypes and the alleles of 5-HTT genes of the three groups were examined by PCR amplification. Neither the intron 2 variable number tandem repeat (VNTR) polymorphism and 5-HTTLPR (5-HTT gene-linked polymorphic region), nor the haplotype frequencies of this gene have significant differences between the suicide group and the two control groups. However, there was a significant difference in 5-HTTLPR polymorphism between inpatients with a first episode of suicidal behavior and those with recurrent suicidal behavior. Except for the possible heterogeneity between inpatients with a first episode of suicidal behavior and those with more than one, the 5-HTT gene was unlikely to be associated with suicidal behavior of psychotic patient in Han Chinese.

Adult↗

PubMed2001

The observation unit: a new interface between inpatient and outpatient care.

PURPOSE: Observation units for patients who present to emergency departments with chest pain have become common. We describe our 3-year experience with a multipurpose observation unit in which chest pain accounts for only a minority of patients' presenting clinical syndromes. SUBJECTS AND METHODS: We analyzed the effects of a 12-bed observation unit on inpatient admissions for common clinical syndromes, as well as its overall effects on inpatient medical admissions during its first 3 years of operation (1996 to 1998) compared with the 3 years preceding its creation (1993 to 1995). RESULTS: Among 7,507 patients admitted to the observation unit in 1996 to 1998, 6,334 (85%) were discharged home within 23 hours. Total inpatient medical admissions fell by a similar number (n = 5,366) during the 3 years of operation of the observation unit when compared with the 3 preceding years (39,569 admissions in 1996 to1998 versus 44,935 in 1993 to 1995). Analysis of local area trends suggested that the use of the observation unit contributed to reduced hospital admissions, rather than vice versa. CONCLUSION: Observation units can serve patients with diverse clinical syndromes and may reduce inpatient admissions. This novel "point of care" deserves further evaluation.

Ambulatory Care↗

PubMed1996

Risk factors for death and emergency transfer in acute and subacute inpatient rehabilitation.

OBJECTIVES: To compare the risk of death or emergency transfer (ET) to an acute care hospital for acute and subacute rehabilitation inpatients, to identify risk factors, and to determine whether the risk factors vary by level of care. DESIGN: Proportional hazards regression analysis of retrospective cohort data. Explanatory variables included level of care, age, sex, medical stability at admission, and diagnosis. SETTING: An acute inpatient rehabilitation hospital and a skilled nursing facility-based subacute rehabilitation program. PATIENTS: Patients were selected from a database of all acute and subacute inpatients discharged between January 1992 and August 1994 (N = 4,755). Readmissions and pediatric patients were excluded (n = 896). Patients who had complete data (n = 3,185) were included in the survival analysis; a separate univariable analysis was performed for patients who lacked complete data (n = 674). OUTCOME MEASURE: Rate of death or emergency transfer during rehabilitation. RESULTS: The overall risk was greater for subacute patients than for acute inpatients, 20.6% vs 11.6%, odds ratio = 2.0, CI = 1.6 to 2.5. The survival analysis indicated that age, level of care, sex, and stability were associated with the risk of death or emergency transfer (2.1 < or = zeta < or = 4.7; p < .05 for each). However, the difference in risk between subacute and acute care was greatest among younger patients. CONCLUSIONS: Careful consideration of risk factors is critical for proper assignment of patients to rehabilitation levels of care. However, research is needed to test these findings in other settings and to improve identification of high-risk patients.

Aged↗

PubMed1999

Cognitive and affective improvement in brain dysfunctional patients who achieve inpatient rehabilitation goals.

OBJECTIVE: To evaluate whether improvements in specific cognitive and affective functions are associated with achieving inpatient rehabilitation goals after the acute onset of brain dysfunction. DESIGN: Retrospective analysis of data obtained in a prospective inception cohort study. STUDY SETTING: Medical center and neurological institute. SUBJECTS: Ninety-five heterogeneous brain dysfunctional patients who participated in an interdisciplinary inpatient neurorehabilitation program. Subjects were classified as having achieved their rehabilitation goals (Group 1) or not (Group 2) at time of discharge. MAIN OUTCOME MEASURE: Number of treatment goals attained. RESULTS: Although overall level of performance on the BNI Screen (BNIS) for Higher Cerebral Functions distinguished patients who later achieved their inpatient rehabilitation goals, on admission only performance on the visual spatial subtest was associated with later goal attainment. In contrast, at discharge, patients who showed greater improvement in awareness, affect, visual spatial skills, memory, and attention/concentration were likely to obtain their rehabilitation goals. This was true when the initial level of performance was taken into account. CONCLUSIONS: Measurement of overall neuropsychological status and specific visual spatial abilities at time of admission may help determine which brain dysfunctional patients will obtain inpatient rehabilitation goals. Improvement in a variety of cognitive and affective functions was associated with goal attainment. Early cognitive rehabilitation should focus on both cognitive and affective disturbances to facilitate recovery and rehabilitation outcome.

Analysis of Variance↗

PubMedDate not supplied

Dissociative experiences and dissociative disorders in acute psychiatric inpatients.

The study attempted to determine the extent of dissociative experiences and the prevalence of dissociative disorders (DDs) in a series of acute psychiatric inpatients and to correlate these experiences and disorders with some sociodemographic, clinical, and historical variables. A total of 207 consecutively admitted psychiatric inpatients qualified for the study. All were examined with the Dissociative Experiences Scale (DES), Structured Clinical Interview for DSM-III-R Personality Questionnaire (SCID-II PQ), Parental Bonding Instrument (PBI), and Frankfurter Self-Concept Scales (FS). Patients who scored greater than 20 on the DES were examined with the Dissociative Disorders interview Schedule (DDIS). Altogether, 20% of patients scored greater than 20 on the DES. In 5% of the patients, a DD was diagnosed. Significant positive correlations were found between DES scores and SCID-II PQ items' frequency with regard to all personality disorder types, especially borderline, antisocial, schizotypal, and dependent. Less pronounced correlations were found between DES and PBI scores, and between DES score and age. Clinical axis I diagnoses did not have any pronounced influence on the DES score. In contrast, patients with greater proneness to dissociation scored lower on most FS scales. There was a tendency for patients with DDs to report childhood abuse more frequently and they complained significantly more of somatic symptoms. Dissociative experiences seem to be as frequent in Swiss as in North American inpatients, whereas DDs (and childhood abuse) were encountered less frequently in Swiss inpatients. A correlation seems to exist between dissociation and somatization.

Acute Disease↗

PubMedDate not supplied

Psychiatric comorbidity differences in male and female adult psychiatric inpatients with substance use disorders.

To examine gender differences in the co-occurrence of DSM-III-R axis I disorders and axis II personality disorders in young adult psychiatric inpatients with substance use disorders (SUDs), a consecutive series of 70 inpatients (33 men and 37 women) with SUD were reliably assessed with structured diagnostic interviews. Higher rates of dysthymia and eating disorders were observed in SUD females and higher rates of cluster A personality disorders were observed in SUD males. No gender differences were found for depression or anxiety in our SUD inpatients; these findings contrast with gender ratios for these disorders in the general population. In conclusion, relatively few gender differences were found in young adult inpatients with SUD, even where they would be expected based on general population gender patterns.

Adolescent↗

PubMedDate not supplied

Longitudinal assessment of inpatient use and functioning of seriously mentally ill veterans with and without co-occurring substance use disorders.

The purpose of this study was to delineate differences in inpatient service utilization and functional and subjective outcomes between veterans with a serious mental illness (SMI) and those with co-occurring serious mental illnesses and substance abuse (SA) disorders. This study assessed 2-year inpatient utilization and outcomes for 682 SMI veterans enrolled in specialized psychosocial treatment programs which did not have a substance abuse focus. Outcomes included psychiatric symptomatology, impairment in activities of daily living, global life satisfaction, days of hospitalization per year, and number of hospital admissions per year. Of the 682 patients, 198 (29%) had secondary diagnoses of substance abuse/dependence. Patients with co-occurring serious mental illness and substance use disorders had significantly more inpatient admissions per year than other SMI patients but did not differ in cumulative inpatient stays. The SMI/SA patients improved more than the other patients in terms of clinician rating of Global Assessment of Functioning. Patients with SMI/SA had significantly fewer psychiatric symptoms on the Brief Psychiatric Rating Scale, and all patients showed improvement on the BPRS, instrumental activities of daily living, and general life satisfaction rating. Seriously mentally ill patients with co-occurring substance use disorders fared as well as other SMI patients when enrolled in intensive, specialized state-of-the-art treatment programs.

Adult↗

PubMedDate not supplied

Implementing a randomized clinical trial on a pediatric psychiatric inpatient unit at a children's hospital: the case of clonidine for post-traumatic stress.

Randomized clinical trials (RCTs) of psychotropic medications are uncommon among child and adolescent populations, and even rarer on pediatric, psychiatric inpatient units. We mention some of these studies, and then discuss the advantages and challenges of conducting a RCT among youngsters on an inpatient psychiatric unit in a pediatric hospital, using as an example our ongoing study of clonidine for intrusive symptoms of post-traumatic stress. Our purpose is to alert potential investigators to the obstacles they may encounter while implementing a RCT, while also pointing the way to potential resources. Advantages of inpatient units for RCTs include easy access to patients, with the potential for careful monitoring of both patients' clinical status and of medication administration. Challenges include the need for the psychiatric researcher to form liaison with other important areas within the hospital, such as the Institutional Review Board, the Pharmacy, and sometimes a General Clinical Research Center and a Clinical Research Program. The functions of these departments are discussed, and additional support for clinicians in hospital settings without these departments is described. Other issues include training clinical nurses to conduct research while making adequate provisions for their time to do so. Attitudes on a clinical psychiatric inpatient unit toward research also merit consideration. Furthermore, as with any study in a hospital setting, recruitment presents its own set of challenges. Finally, one must be cognizant of how clinical information flows between clinicians and researchers.

Child↗