Search PubMed⌕ Search

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.

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

At least 541 records · Page 30Linked to original sources
PubMed2002

Do abnormal liver function tests predict inpatient imaging yield? An evaluation of clinical decision making.

RATIONALE, AIMS AND OBJECTIVES: Diagnostic abdominal imaging is frequently performed in hospitalized patients to assess the cause of abnormal liver function tests (LFTs). We undertook this study to assess whether the extent and severity of LFTs abnormalities predicted the yield of inpatient imaging. METHODS: We retrospectively reviewed inpatients' abdominal imaging studies performed for abnormal LFTs during a 27 month period. Imaging results were matched to LFTs performed during a 5 day collection window surrounding the image request date. Five LFTs were categorized by severity of abnormality and were then collapsed into three classes based on pathophysiology. RESULTS: Among 759 imaging studies completed for the indication of abnormal LFTs, 196 (26%) were positive (abnormal and explained the abnormal LFTs). Among the LFT classes, severity of laboratory test abnormality correlated with positive imaging examinations yield only for the transaminases: 18% for the normal-mildly abnormal transaminases compared with 31% for moderately-severely abnormal transaminases. The number of abnormal LFT classes per study correlated only slightly better: 21% of patients with none or one abnormal LFT class had a positive imaging study compared with 35% of patients with all three abnormal LFT classes. CONCLUSIONS: The yield of inpatient abdominal imaging for abnormal LFTs correlates only weakly with both the severity and the extent of different abnormal LFTs. Further research is needed to define the optimal imaging strategies for evaluating inpatients with suspected hepatobiliary disease.

Biliary Tract Diseases↗
PubMed1998

Ambulatory versus inpatient rotations in teaching third-year students internal medicine.

We studied 63 randomly selected third-year students who split their 10-week medicine clerkship between ambulatory and inpatient components. Compared with their inpatient experience, during the ambulatory rotation, the 63 students felt more like doctors, more responsible for patients, and more able to know and help their patients. Students reported that ambulatory attending staff appeared happier and less stressed, and did not embarrass them as frequently. Compared with their 619 "inpatient" classmates, these 63 "ambulatory" students scored as well on the medicine examination, and were as likely to receive honors (44% vs 41%), and to choose internal medicine residencies (35% vs 34%). In conclusion, students experienced better relationships with their patients and teachers during the ambulatory rotation, which was academically comparable to the inpatient experience.

Adult↗
PubMed2003

What effect does increasing inpatient time have on outpatient-oriented internist satisfaction?

OBJECTIVE: Because career satisfaction among general internists is relatively low, we sought to understand the impact on satisfaction of general internists managing patients both in and outside of the hospital. Using data from a national survey, we asked, "Among outpatient-oriented general internists (i.e., internists who spend less than 50% of their clinical time caring for inpatients), what effect does time spent in the hospital have on physician satisfaction, stress, and burnout?" DESIGN/PARTICIPANTS: The Physician Worklife Study, in which 5,704 physicians in primary and specialty nonsurgical care selected from the American Medical Association's Masterfile were surveyed (adjusted response rate = 52%), was used. Our analyses focused on clinically active outpatient-oriented general internists (N = 339). MEASUREMENTS AND MAIN RESULTS: We constructed multivariate linear models to test for statistically significant associations between the amount of time spent seeing inpatients and physician satisfaction as measured by several satisfaction scales. Even after controlling for total hours worked and other possible confounding variables, we found that increased time working in the hospital was significantly associated with decreases in satisfaction with administration, specialty, autonomy, and personal time, and significantly associated with an increase in life stress. There was also a significant association between increased time spent in the hospital and burnout. CONCLUSIONS: Our findings imply that there may be a tension between the practice of inpatient and outpatient medicine by general internists, and suggest that fewer hospital duties may increase career satisfaction for outpatient-oriented internists. Although additional studies are warranted in order to better understand why these relationships exist, our data suggest that the hospitalist model of inpatient care might be one approach to alleviate stress and improve satisfaction for many general internists.

Adult↗
PubMed2003

Medical errors related to discontinuity of care from an inpatient to an outpatient setting.

OBJECTIVE: To determine the prevalence of medical errors related to the discontinuity of care from an inpatient to an outpatient setting, and to determine if there is an association between these medical errors and adverse outcomes. PATIENTS: Eighty-six patients who had been hospitalized on the medicine service at a large academic medical center and who were subsequently seen by their primary care physicians at the affiliated outpatient practice within 2 months after discharge. DESIGN: Each patient's inpatient and outpatient medical record was reviewed for the presence of 3 types of errors related to the discontinuity of care from the inpatient to the outpatient setting: medication continuity errors, test follow-up errors, and work-up errors. MEASUREMENTS: Rehospitalizations within 3 months after the initial postdischarge outpatient primary care visit. MAIN RESULTS: Forty-nine percent of patients experienced at least 1 medical error. Patients with a work-up error were 6.2 times (95%confidence interval [95% CI], 1.3 to 30.3) more likely to be rehospitalized within 3 months after the first outpatient visit. We did not find a statistically significant association between medication continuity errors (odds ratio [OR], 2.5; 95%CI, 0.7 to 8.8) and test follow-up errors (OR, 2.4; 95%CI, 0.3 to 17.1) with rehospitalizations. CONCLUSION: We conclude that the prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of rehospitalization.

Ambulatory Care↗
PubMed2002

Contribution of ED admissions to inpatient hospital revenue.

Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

Adult↗
PubMed2002

Mobility status during inpatient rehabilitation: a comparison of patients with stroke and traumatic brain injury.

OBJECTIVES: To compare the mobility status (admission and discharge status, change in status) between patients with stroke and traumatic brain injury (TBI) during inpatient rehabilitation and to determine the relationship between mobility status and outcome variables including length of stay (LOS). DESIGN: Prospective study. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: A total of 210 patients with stroke (n = 136) and TBI (n = 74) consecutively admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical Outcome Variable Scale (COVS), a 13-item scale of mobility status (measured on admission and discharge from inpatient rehabilitation), and rehabilitation LOS. RESULTS: With age and time since injury controlled in the model, the TBI group showed a significantly higher mobility status on admission and discharge over the stroke group, but the change (improvement) in mobility status did not differ. The admission mobility status accounted for 61% and 60% of variability of the discharge mobility status for the stroke and TBI groups, respectively. The admission mobility status accounted for 40% and 50% of the variability in rehabilitation LOS for the stroke and TBI groups, respectively. Either the admission mobility status or the physical therapist's prediction of the discharge status could be used to determine the actual discharge mobility status, although the physical therapist's predictions were more accurate than using a statistical model. CONCLUSIONS: The TBI group showed a higher mobility status at admission and discharge from inpatient rehabilitation than the stroke group; however, the rate of improvement (improvement in mobility status per day) did not differ between groups. Admission mobility status using the COVS was an excellent predictor of discharge mobility status and rehabilitation LOS in stroke and TBI patients.

Activities of Daily Living↗
PubMed2002

[Heavy users of inpatient psychiatric services].

OBJECTIVE: This paper describes the extent of heavy use of inpatient psychiatric services. It reveals predictors of heavy use. METHODS: 969 users of inpatient psychiatric services in the city of Leipzig were identified based on health insurance data. RESULTS: 16,7 % of the patients had at least 3 admissions and were classified as heavy users. They accounted for 36,4 % of the total inpatient cost. Patients suffering from schizophrenia or a comorbidity with personality disorders had a higher risk to be a heavy user. The kind of facility and the way of discharge were also predictors for heavy use. CONCLUSIONS: Further qualitative analyses should identify reasons for heavy users to utilize inpatient services and find out other opportunities of care for these patients.

Adolescent↗
PubMed2004

[Bodyweight in inpatients with schizophrenia].

OBJECTIVE: Epidemiological studies show overweight to be a major health problem in Germany. There is some evidence that psychiatric patients often are overweight. In view of the high frequency of weight gain during the treatment with neuroleptics, particularly atypicals, in this study the bodyweight of schizophrenics should be examined. METHODS: The body-mass-index (BMI) of two samples of schizophrenic inpatients was compared to BMI-data of the German general population. RESULTS: 90 inpatients with the first episode of schizophrenic psychoses showed an average BMI of 22.2 +/- 3.3. The BMI in all age groups were lower compared to the general population, but in a follow-up these patients showed a higher weight gain. 238 chronic schizophrenic inpatients with at least 5 years duration of illness (mean 15.3 +/- 8.3 years) showed BMI-values in the range of the general population. Only the age group 30 - 35 years showed a significantly higher BMI. However, in many age groups of schizophrenic inpatients the proportion of obesity (BMI > 30) was higher compared to the general population. CONCLUSIONS: The bodyweight of first episode schizophrenics is lower compared to the general population. In contrast, chronic schizophrenic patients frequently are overweight or show obesity. However, thus far the causes of pronounced weight gain in schizophrenic patients remain to be elucidated.

Adolescent↗
PubMed2005

[The burden on relatives of acute mentally ill within the first four weeks of day hospital and inpatient treatment. Results from a randomized controlled trial].

OBJECTIVE: To assess the burden on relatives as well as their mental well-being within the context of a randomized controlled trial on the effectiveness of acute psychiatric day hospital treatment as compared to inpatient treatment. METHOD: The study was conducted at the Department of Psychiatry and Psychotherapy, Dresden University of Technology. A sample of 95 relatives was assessed at admission and after four weeks of treatment using the Involvement Evaluation Questionnaire (IEQ) and the General Health Questionnaire (GHQ-28), the period to be rated being the last four weeks prior to assessment. RESULTS: Relatives reported a mean level of burden, which for both settings decreased during the first four weeks of treatment. With respect to this period, burden on relatives of day hospital patients did not differ from that on relatives of inpatients. The relatives' mental well-being was markedly impaired, and only that of the inpatients' relatives did slightly improve during treatment. CONCLUSIONS: Treating acute mentally ill as day hospital patients does not result in greater burden on relatives compared to treating them as inpatients. Independently from treatment setting, relatives of psychiatric patients should be actively approached and offered information, coping strategies, and help. Further research should include qualitative methods.

Acute Disease↗
PubMed2005

[Individual therapists in inpatient psychotherapy -- a pilot study on their importance for therapeutic outcome].

OBJECTIVE: How much does the individual psychotherapist influence therapy outcome in a multimodal inpatient setting with several therapeutic relationships and the additional influence of group processes. METHODS: We studied the outcome of n = 293 psychotherapy inpatients (mean treatment duration: 11 weeks) who were treated in an integrated inpatient concept by 9 mostly psychodynamically oriented psychotherapists (professional experience 0.5 to 7 yrs, 13 to 56 patients per therapist). Patients had an extensive evaluation of process and outcome variables (e. g. SCL 90R, IIP, Global outcome rating, Helping Alliance Questionnaire - HAQ). Differences in outcome between patients of different therapists were calculated. RESULTS: Patients assigned to the participating therapists did not differ in their basic clinical characteristics, except in the clinical severity rating carried out by therapists themselves. Outcome in the SCL90R - GSI residual score and global rating differed significantly between the therapists (d (SCL-pooled SD) = 0.43 to 1.10, explained variance: 10 %). The same holds true for the therapeutic alliance (HAQ, explained variance: 45 %). Assessment of therapeutic relationship shows good correlation between patients and therapists, outcome assessment does not. Therapists differed in the degree of matching between their own and their patients' evaluations. CONCLUSIONS: We found significant therapist differences in outcome and alliance. Despite the multifaceted inpatient setting the individual therapist is an important determinant of therapeutic success.

Adult↗
PubMed2006

[Pre- and post-treatment in inpatient psychosomatic rehabilitation].

Patients who are referred to psychosomatic inpatient rehabilitation are mostly suffering from long-term illnesses. Therefore, it is necessary to take pre- and post-treatment into account. Epidemiological questions are frequency and type of pre- and post-treatment and their relation to course and outcome of rehabilitation. Pre-treatment, recommendations for follow-up treatment, and course of treatment in 1284 patients of the department of behaviour therapy and psychosomatics of the rehabilitation centre Seehof were assessed. Before admission, 75.4 % of patients had been in psychiatric treatment, and 31.3 % had received psychotherapy. The inpatient stay was significantly longer in patients with psychiatric pre-treatment and those with a combination of psychiatric treatment and psychotherapy. These patients were more often unemployed and showing an insufficient social network. Pre-treatment was unrelated to changes in the SCL-90-R, to physician ratings of therapeutic outcome or the ability to work at the end of rehabilitation. Patients pre-treated by a general practitioner, psychiatrist or psychotherapist returned to that therapeutic setting after rehabilitation. Patients only treated by general practitioners were referred to specialist treatment. These data show the need to integrate inpatient rehabilitation in long-term pre- and post-treatment. One effect of inpatient rehabilitation is to optimize treatment. This requires good communication across different areas of health care.

Adult↗
PubMed1991

Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy.

In a double-blind trial 40 patients with bulimia nervosa according to DSM III-R criteria were randomly assigned either to a 60 mg fluoxetine group or to a placebo control group. Fluoxetine or placebo was given over a period of 35 days. Parallel to the drug trial, patients participated in an intensive inpatient behavioral psychotherapy program. There were no dropouts at all in the study. Fluoxetine was well tolerated and had only minor adverse effects. In self-ratings and expert ratings concerning attitudes towards eating, eating behavior, and general psychopathology, significant improvements over time were observed in both groups. Using analysis of variance (ANOVA), however, there were no statistically significant "group by time" differences. Results show that the intensive inpatient-care and psychotherapy program was highly effective in changing eating behavior and attitudes as well as general psychopathology. Fluoxetine showed a significant reduction in body weight, especially during the first three weeks of fluoxetine treatment. It was not possible to demonstrate a statistically significant improvement in eating attitudes, eating behavior, and general psychopathology beyond that elicited by intensive inpatient psychotherapy and general inpatient care. These results can possibly be explained by the existence of a "ceiling effect".

Adult↗
PubMed2003

Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a meta-analysis of randomized controlled trials.

BACKGROUND: Antibiotic prophylaxis has been reported to decrease bacterial infections and fatality rates in inpatients with cirrhosis. We performed a systematic review to evaluate the efficacy of antibiotic prophylaxis in inpatients with cirrhosis, regardless of the underlying risk factors that led to hospital admission. METHODS: A comprehensive literature search strategy was performed including the Cochrane Library, Embase, Medline, a manual search of bibliographic references, and contacting the authors of each included trial. We included any randomized clinical trial comparing different types of antibiotic prophylaxis with placebo or no intervention in inpatients with cirrhosis. Two reviewers independently applied the selection criteria to all identified references, appraised the methodological quality of each trial and extracted the relevant data. Relative risks and 95% confidence intervals were estimated using the fixed effect model. A test of heterogeneity and a funnel plot were performed and an intention-to-treat approach was used for the outcome measures. RESULTS: Nineteen randomized trials were identified, 13 of which were included in the review. A significant beneficial effect on mortality (RR: 0.70; 95% CI: 0.56, 0.89) and prevention of bacterial infections (RR: 0.39; 95% CI: 0.32, 0.48) was observed, regardless of the underlying risk factors. Few adverse events were reported and there was no heterogeneity between studies. We identified a funnel plot asymmetry for the included trials. CONCLUSIONS: Antibiotic prophylaxis for inpatients with cirrhosis is efficacious in reducing the number of deaths and bacterial infections regardless of the underlying risk factors.

Antibiotic Prophylaxis↗
PubMed2004

Deep venous thrombosis: a new task for primary health care. A randomised economic study of outpatient and inpatient treatment.

OBJECTIVE: A health economic evaluation of two alternative treatment settings, inpatient care and outpatient care, for acute deep venous thrombosis. DESIGN: A randomised multicentre trial in a defined population in regular clinical practice. SETTING: Hospitals and related health care centres in the Jönköping county council in Sweden. INTERVENTIONS: Patients were randomised to either an inpatient strategy (n = 66) or an outpatient strategy (n = 65) using low-molecular-weight heparin, dalteparin, administered subcutaneously once daily and adjusted for body weight. SUBJECTS: Of 224 eligible patients, 131 entered the trial and 124 completed the economic part of the study. MAIN OUTCOME MEASURES: Direct medical and direct non-medical costs during a 3-month period. RESULTS: Total direct costs were higher for those in the inpatient strategy group, i.e. Swedish Crowns (SEK) 16400 per patient (Euro 1899) compared to SEK 12100 per patient (Euro 1405) in the outpatient strategy group (p < 0.001). More patients in the outpatient group received assistance when they returned home. Few patients in either group reported sick leave. There was no difference in total number of days between the two groups. CONCLUSIONS: Total direct costs were significantly lower for the outpatient treatment strategy for deep venous thrombosis compared to the inpatient treatment strategy. No significant difference in health impact could be detected. Deep venous thrombosis can to a greater extent than previously be treated in primary care, safely, at a lower cost, and in accordance with patient preferences.

Administration, Cutaneous↗
PubMed2001

The Prevalence of Cigarette Smoking in an Acute Inpatient Physical Medicine and Rehabilitation Population.

The purpose of this study was to determine the prevalence of cigarette smoking among patients before and after discharge from an acute inpatient physical medicine and rehabilitation unit and to assess smokers' interest in and desire for smoking cessation. A consecutive sample of inpatients (n = 233) admitted over a 5-month period to a regional rehabilitation inpatient center for acute rehabilitation treatment was surveyed for their smoking patterns. Ten percent of patients admitted to rehabilitation were active smokers prior to their hospitalization. In spite of reporting high motivation to stop smoking, half were not interested in participating in a smoking cessation program if one were offered to them. Following discharge from inpatient rehabilitation, 54% of a small sample of patients who could be contacted had resumed smoking (all within 4 weeks of being home). Given the prevalence of smoking in this population and its adverse consequences on health and quality of life, we suggest that rehabilitation professionals actively address this health problem during the patient's hospitalization.

Journal Article↗
PubMed2004

Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation.

PURPOSE: (1). To examine the prevalence of depressive symptoms and operationally defined depressive disorder (major depression) in an Irish sample of subjects undergoing inpatient rehabilitation following their first stroke. (2). To investigate factors predictive of depression following stroke. (3). To examine the relationship between post-stroke depression and outcome following inpatient rehabilitation. METHODS: Fifty consecutive patients meeting inclusion criteria who were admitted for inpatient rehabilitation to a specialised unit following their first stroke were prospectively studied. INCLUSION CRITERIA: first stroke 3 - 12 months previously, lesion identified on CT or MRI, age 18 - 65 years, at least some sensory/motor impairment, no pre-existing disabling condition and Barthel Index score > 14 prior to stroke. Mood (Center for Epidemiologic Studies Depression scale, Hamilton Depression Rating Scale, DSM-IV diagnostic criteria for Major Depressive Disorder), Cognition (Mini-Mental State Examination) and Disability (Barthel Index, Rankin Disability Scale) were assessed one week after admission (baseline) and again after 2 months of rehabilitation. Outcome was measured as effectiveness of rehabilitation (Shah et al., 1990) and length of inpatient stay (LOS). RESULTS: 10/50 (20%) of the sample met criteria for major depressive disorder on admission. The best predictor of depression was gender, with females having a two-fold higher rate of both subjectively reported and objectively rated depressive symptoms. Depression was unrelated to baseline Barthel Disability, side of lesion or previous psychiatric history. The best predictor of effectiveness of rehabilitation was baseline Barthel Disability score. Depression did not predict either effectiveness or LOS. CONCLUSION: (1). Major depression is common in subjects undergoing rehabilitation following their first stroke. (2). Females appear to be especially at risk, possibly reflecting an increased general risk of depression. (3). Depression in our sample was not related to functional disability following stroke or early functional outcome following rehabilitation.

Adult↗
PubMed2000

Comparative efficiency ratings between public and private acute inpatient facilities.

OBJECTIVES: The aims of this study are to compare clinical outcomes and efficiency ratings in an acute psychiatric inpatient facility with findings from other studies, and to examine relationships between symptom severity, admission medico-legal status and length of stay. METHOD: The Health of the Nation Outcome Scales was administered at admission and discharge and analysed against admission medico-legal status and length of stay. Efficiency ratings were calculated and compared with those from other acute psychiatric inpatient settings. RESULTS: Clinical outcomes and efficiency ratings were similar to those from other public acute inpatient facilities, with greater admission severities and higher efficiency ratings than those found in private facilities. Involuntary hospitalisation was found to be associated with higher admission severities and longer lengths of stay. CONCLUSIONS: Outcome or effect size is enhanced by higher admission severities, however, mean outcome per 10 days of stay is decreased by involuntary admission legal status. Factors unrelated to admission legal status effect differences in efficiency ratings found between public and private acute psychiatric inpatient facilities.

Acute Disease↗
PubMed2003

A comparison between dually diagnosed inpatients with and without Axis II comorbidity and the relationship to treatment outcome.

UNLABELLED: The presence of a personality disorder (PD) has been associated with certain types of poor treatment outcomes in patients with substance use disorders (SUDs). The purpose of this study was to determine the prevalence of comorbid PDs in psychiatrically hospitalized adults with both non-SUD Axis I disorders and SUDs, and to assess the relationship between Axis II psychopathology and degree of pretreatment addiction severity and treatment outcome. METHOD: One hundred consecutive inpatients admitted to a mixed dual diagnosis inpatient unit were assessed using semistructured interviews for SUDs, non-SUD Axis I disorders, and PDs. Pretreatment severity was assessed using a modified version of the Addiction Severity Index (ASI). Outcome measures were assessed both during hospitalization and at an initial follow-up appointment after discharge. Statistical analyses were performed comparing dually diagnosed patients with and without Axis II psychopathology. RESULTS: A significant number (53%) of the patients met criteria for at least one personality disorder. Of the PDs, Cluster B PDs were the most prevalent, particularly borderline personality disorder (74%) and antisocial personality disorder (66%). Dually diagnosed patients without an Axis II diagnosis had less severe pretreatment severity measures. During hospitalization, patients with Axis II disorders had higher levels of psychopathology on the Brief Symptom Inventory (BSI) subscales of sensitivity and hostility. However, there was no difference in overall degree of global improvement during hospitalization. During follow-up, patients with Axis II disorders were significantly less likely to be compliant in attending their initial follow-up appointment. CONCLUSIONS: Dual diagnosis inpatients with PDs appear to improve as much as patients without PDs during their inpatient hospitalizations; however, they appear to be less likely to be compliant with attending their initial follow-up appointment.

Adult↗