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PubMed2002

The effect on treatment outcomes of assigning patients to ethnically focused inpatient psychiatric units.

OBJECTIVE: The authors examined whether assigning patients from three ethnic groups-blacks, Latinos, and Asians-to three ethnically focused psychiatric inpatient units would affect treatment outcome. METHODS: Retrospective administrative data for 5,983 inpatients at a large urban community hospital with several ethnically focused units were examined. The data represented 10,645 admissions between 1989 and 1996. Cox proportional-hazards models, logistic and multinomial regressions, and chi square analyses were used to assess the relationship between matching patients to ethnically focused units and time to rehospitalization, referral destination on discharge, and length of stay for Asian, black, and Latino patients. RESULTS: Ethnic matching status was strongly associated with referral destination for Asian and Latino patients but not for black patients. Asian and Latino patients who had been treated on the appropriate ethnically focused units were more frequently sent to outpatient or residential treatment (71 to 73 percent of discharges) than unmatched patients, black patients, and white patients (44 to 49 percent of discharges), who more frequently refused follow-up or were sent to locked facilities. No association was found between matching status and time to rehospitalization or length of stay for any ethnic group. CONCLUSIONS: Matching inpatients to ethnically focused psychiatric units was related to referral destination at discharge. Matched patients were more likely than unmatched patients to accept referral to postdischarge treatment, which has been shown previously to reduce readmission rates. Among persons with serious mental illness, matching patients to ethnically focused units may be important for enhancing communication and trust as a means of improving participation in ongoing treatment programs.

Adult↗
PubMed2003

Construct validity of the 15-item geriatric depression scale in older medical inpatients.

The construct validity of the 15-item Geriatric Depression Scale (sfGDS) has been assessed in selected populations. The aim of this study was to assess the appropriateness of applying the sfGDS to unselected older inpatients. The main component analysis of sfGDS was performed in 2032 medical inpatients (mean age = 76.3 +/- 8.4). sfGDS did not qualify as a unidimensional test. Three factors explained 47.7% of variance and explored the following dimensions: positive attitude toward life, distressing thoughts/negative judgment about the own condition, and inactivity/reduced self-esteem. The internal homogeneity was poor (Cronbach's alpha = .46). A higher fraction of variance was explained in patients independent in all or dependent in > or = 1 activity of daily living (ADL). In older medical inpatients, sfGDS is not a single construct, which prevents the univocal interpretation of the final score. The higher fraction of explained variance in patients with comparable ADL performance probably reflects the dependency of affective from physical status.

Activities of Daily Living↗
PubMed2004

An evaluation of the incremental validity of the MMPI-2 Superlative (S) scale in an inpatient psychiatric sample.

The MMPI-2 Superlative (S) scale was developed by Butcher and Han (1995) to assess individuals' tendencies to present themselves in an unrealistically positive light. The current study examined the performance of the L, K, and S scales in accurately distinguishing the MMPI-2 profiles of 379 psychiatric inpatients who produced one or more elevations on the basic scale profiles, from 82 psychiatric inpatients who produced no clinical range elevation on any of the eight basic clinical scales (excluding scales 5 and 0). The findings from the present study indicate that the S scale appears to be effective in the identification of defensiveness among psychiatric inpatients, with mean effect sizes in the moderate to large range. The optimal T-score cutoff for identifying defensive responders was 70 for both men and women. Further, results of hierarchical regression analyses showed that the S scale added incrementally to the prediction levels achieved by the optimal combination of the L and K scales.

Adult↗
PubMed2025

Patient Ethnicity and Staff Use of Restraints and Restrictive Practice in Inpatient Psychiatric Services: A Systematic Review.

Restrictive practices such as restraints, seclusion, and forced medication are only intended to be used when the threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated with the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient's ethnic identity was associated with staff use of restrictive practices in inpatient psychiatric services. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Four databases were searched (PsycINFO, Medline, Embase, and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Program Checklists. Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4), and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in studies having larger participant numbers, longer follow-up periods and less methodological bias. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity. Future research should explore beyond patient-level factors.

Humans↗
PubMed2006

Use of the Barthel Index and the Functional Independence Measure during early inpatient rehabilitation after single incident brain injury.

OBJECTIVE: To compare the appropriateness and responsiveness of the Barthel Index and the Functional Independence Measure (FIM) during early inpatient rehabilitation after single incident brain injury. DESIGN: Cohort study. SETTING: A regional neurological rehabilitation unit. PATIENTS: Two hundred and fifty-nine consecutive patients undergoing inpatient comprehensive neurological rehabilitation following a vascular brain injury due to single cerebral infarction (n = 75), spontaneous intracerebral haemorrhage (n = 34) and subarachnoid haemorrhage (n = 43), and 107 patients who had sustained traumatic brain injury. MEASUREMENTS: Admission and discharge FIM total, physical and cognitive scores and the Barthel Index were recorded. Appropriateness and responsiveness in the study samples were determined by examining score distributions and floor and ceiling effects, and by an effect size calculation respectively. Non-parametric statistical analysis was used to calculate the significance of the change in scores. RESULTS: In all patient groups there was a significant improvement (Wilcoxon's rank sum, P<0.0001) in the Barthel Index (mean change score: vascular 3.9, traumatic 3.95) and FIM (mean change score: vascular 17.3, traumatic 17.4) scores during rehabilitation, and similar effect sizes were found for the Barthel Index (effect size: vascular 0.65, traumatic 0.55) and FIM total (effect size: vascular 0.59, traumatic 0.48) and physical scores in all patient groups. In each patient group the cognitive component of the FIM had the smallest effect size (0.35-0.43). CONCLUSIONS: All measures were appropriate for younger (less than 65 years of age) patients undergoing early inpatient rehabilitation after single incident vascular or traumatic brain injury. The Barthel Index and the total and physical FIM scores showed similar responsiveness, whilst the cognitive FIM score was least responsive. These findings suggest that none of the FIM scores have any advantage over the Barthel Index in evaluating change in these circumstances.

Activities of Daily Living↗
PubMed2005

Inpatient pulmonary rehabilitation: does it make sense?

Among the nonpharmacological therapies, pulmonary rehabilitation (PR) is particularly appropriate for patients with chronic respiratory impairment who, despite any optimal drug management, are still symptomatic and experience restriction in every day activities. Pulmonary rehabilitation performed in inpatient, outpatient, or home settings demonstrates short- and long-term clinical efficacy. Although disease severity does not inherently dictate candidacy for exercise training, the degree of physiological and functional impairment may influence setting in which the training should occur. Therefore, inpatient rehabilitation is generally best-suited for the most sick and most disabled patients. The overall results from the literature confirm that the inpatient setting for a PR program is a feasible option and does not necessarily result in higher direct costs when balanced against duration and effectiveness in terms of improved outcomes.

Hospitalization↗
PubMed1983

The Sustaining Fantasy Questionnaire: measurement of sustaining functions of fantasies in psychiatric inpatients.

The concept of the sustaining fantasy and the Sustaining Fantasy Questionnaire (SFQ), an instrument for its measurement, is introduced. Sustaining fantasies represent characteristic ways to ameliorate intense negative affect or to restore self-esteem. The responses of 134 psychiatric inpatients were used to construct ten scales. The SFQ and MMPI were then administered to 125 nonpatients. Psychiatric inpatients had higher scores than normals on fantasies of death, withdrawal, restitution, suffering, God, and closeness. Fantasies of power and revenge, admiration of self, competition and aesthetics did not differentiate between groups. SFQ scales correlated significantly with MMPI scales and demographic characteristics as well with staff ratings of the inpatients.

Adult↗
PubMed2005

Clerkship sharing on inpatient internal medicine rotations: an emerging clerkship model.

BACKGROUND: "Clerkship sharing" is the coexistence of students from 2 or more medical schools rotating on the same specialty at a single clerkship site. PURPOSE: Clerkship sharing was characterized by answering three related questions regarding the prevalence of clerkship sharing on internal medicine inpatient rotations, stakeholders views of the advantages and disadvantages of clerkship sharing, and the ways that clerkship sharing affects medical student outcomes at an institution. METHODS: In 2001, the Clerkship Directors in Internal Medicine (CDIM) surveyed its members; 1 section addressed clerkship sharing on inpatient rotations. In addition, the authors surveyed a convenience sample of teachers and learners at 41% of schools with clerkship sharing. Finally, using a 10-year database from one institution, we searched for differences in clerkship outcomes among students who rotated at clerkship sites with or without clerkship sharing. RESULTS: The overall clerkship director (CD) survey response rate was 78% (96/123); 22 of 96 (23%) of CDs reported having clerkship sharing on inpatient rotations. Advantages reported included a greater diversity of clinical exposure for students (77%) and a fostering of collegial relationships (73%). We also collected 79 teacher and 77 medical student surveys from 9 (41%) medical schools identified as having clerkship sharing. The majority of these teachers and learners believed that sharing improves teaching and the overall rotation quality. All surveyed groups were concerned that clerkship sharing affected the clarity of clerkship goals, objectives, and grading. However, clerkship outcomes from 1 institution demonstrated no effect of clerkship sharing on faculty ratings of students or student examination performance. CONCLUSIONS: Clerkship sharing appears to be an emerging clerkship model, and, although it may have inherent advantages that benefit student education, CDs should address challenges such as common goals and expectations for students and teachers.

Clinical Clerkship↗
PubMed2002

Sleep deprivation does not affect seizure frequency during inpatient video-EEG monitoring.

OBJECTIVE: To determine whether acute sleep deprivation facilitates seizures during inpatient monitoring in a controlled protocol. METHODS: Eighty-four patients with medically refractory partial epilepsy undergoing inpatient monitoring were assigned in consecutive blocks to either sleep deprivation every other night or to normal sleep. In both groups, subjects were requested to stay awake during the day, from 6 AM to 10 PM. In the sleep deprivation group, patients also stayed awake between 10 PM and 6 AM every other night beginning with Day 2. Patients were removed from sleep deprivation if they had two or more secondarily generalized seizures within 24 hours. Patients were removed from the normal sleep group and were sleep deprived if they did not have a complex partial or secondarily generalized seizure by Day 6 of monitoring. In these patients removed from sleep deprivation or from normal sleep, data were analyzed up to and including the day of removal from the protocol. RESULTS: The sleep deprivation and normal sleep subjects did not differ in age, sex, seizure localization, or percent dosage reduction in antiepileptic drugs from baseline at days 1 to 3 of monitoring. Protocol duration was 6.5 +/- 2.4 days (mean +/- SD) for the sleep deprivation group and 5.8 +/- 2.0 days for the normal sleep group. Seizures per day for complex partial, secondarily generalized, and combined complex partial and secondarily generalized, calculated from admission until end of protocol, did not differ significantly between the two groups. CONCLUSION: Acute sleep deprivation did not affect seizure frequency during inpatient monitoring in our patients with intractable complex partial seizures with secondary generalization.

Adult↗
PubMed2006

A statistical survey of Canadian forensic mental health inpatient programs.

Secure hospital beds are vitally important for the assessment and treatment of mentally disordered accused persons. A forensic mental health system with an adequate level of hospital beds is essential for the courts and review boards to carry out of the mental disorder provisions of the Criminal Code. This article describes the results of a study that examined interprovincial differences in the structure of Canadian forensic mental health FMH inpatient programs. In total, 1523 hospital beds are designated for FMH programs in Canada. Across Canada, less than one (0.61) FMH hospital bed is available for every 10,000 adults in the general population, ranging from 0.37 in Manitoba to 1.08 in Nova Scotia. Interprovincial differences in the staffing and bed occupancy of Canadian FMH inpatient programs are also uncovered. The results of the present study confirm that interprovincial differences in the structure and organization of FMH inpatient programs exist in Canada.

Canada↗
PubMed2005

Evidence for inpatient rehabilitation as an effective intervention.

Rehabilitation in inpatient settings is expensive and staff-intensive. It is necessary for such services to demonstrate effectiveness to justify this. In contrast to popular notions, evidence for the effectiveness of inpatient rehabilitation does exist and is reviewed in this article. In particular, there is very good evidence for specialized inpatient stroke care and rehabilitation.

Aged↗
PubMed2004

Inappropriate medication use among frail elderly inpatients.

BACKGROUND: Inappropriate prescribing in frail elderly inpatients has not received as much investigation as in frail elderly nursing home patients. OBJECTIVE: To determine the prevalence and predictors of inappropriate prescribing for hospitalized frail elderly patients. METHODS: The study was conducted at 11 Veterans Affairs Medical Centers and involved a sample of 397 frail elderly inpatients. Inappropriate prescribing was measured by physician-pharmacist pair's consensus ratings for 10 criteria on the Medication Appropriateness Index (MAI). The MAI ratings generated a weighted score of 0-18 per medication (higher score = more inappropriate) and were summed across medications to achieve a patient score. RESULTS: Overall, 365 (91.9%) patients had > or =1 medications with > or =1 MAI criteria rated as inappropriate. The most common problems involved expensive drugs (70.0%), impractical directions (55.2%), and incorrect dosages (50.9%). The most common drug classes with appropriateness problems were gastric (50.6%), cardiovascular (47.6%), and central nervous system (23.9%). The mean +/- SD MAI score per person was 8.9 +/- 7.6. Stepwise ordinal logistic regression analyses revealed that both the number of prescription (adjusted OR 1.28; 95% CI 1.21 to 1.36) and nonprescription drugs (adjusted OR 1.17; 95% CI 1.06 to 1.29) were related to higher MAI scores. Analyses excluding the number of drugs revealed that the Charlson index (adjusted OR 1.62; 95% CI 1.12 to 2.35) and fair/poor self-rated health (adjusted OR 1.15; 95% CI 1.05 to 1.26) were related to higher MAI scores. CONCLUSIONS: Inappropriate drug prescribing is common for frail elderly veteran inpatients and is related to polypharmacy and specific health status characteristics.

Aged↗
PubMed2006

Acid suppressive therapy use on an inpatient internal medicine service.

BACKGROUND: Use of acid suppressant medications has increased in both frequency and breadth in recent years. Data have indicated that questionable use of acid suppressants for non-accepted indications is common. OBJECTIVE: To assess the indications and prevalence of acid suppressants used by inpatients on admission and at discharge. METHODS: A retrospective chart review of 213 patients admitted to the University of Michigan Hospital non-critical care general medical service was conducted. Relevant medical history, acid suppressant drug used, and indications were collected from both inpatient medical records and discharge medication lists. RESULTS: Of the 213 patients reviewed, 29% were taking acid suppressants prior to admission, with 33% being proton pump inhibitors (PPIs). Once patients were admitted, acid suppressant use increased to 71% (152 of 213), with 84% PPIs, 11% histamine(2)-receptor antagonists, and 5% combination therapy. Based upon our criteria, only 10% (15 of 152) of those on acid suppressants were found to have an acceptable indication. In patients where any history of gastroesophageal reflux disorder (GERD) was deemed as an acceptable indication (32 other patients), 31% (47 of 152) had an acceptable indication. For the 137 patients with non-accepted indications, 29% had no discernable indication and 38% were prescribed acid suppressants for corticosteroid-associated or stress ulcer prophylaxis. A history of gastrointestinal bleeds or peptic ulcer disease of more than 3 months since initial diagnosis or documented exacerbation of symptoms comprised 8% of the population. The aforementioned group of GERD patients made up 23% of this group. Compared to the 29% of patients taking acid suppressants prior to admission, 54% (115 of 213) of patients were prescribed acid suppressants at discharge. If only recent exacerbations of GERD were deemed as long-term indications, 10% (12 of 115) of these patients were found to have accepted indications. If all GERDs were acceptable long-term indications, 27% (31 of 115) would have met criteria for acceptable outpatient use. CONCLUSIONS: There is considerable excess usage of acid suppressants in both the inpatient and outpatient settings.

Adult↗
PubMed1999

Historical overview of inpatient care of mental patients who are deaf.

A review of published studies of deaf mentally ill inpatients is reported. While there are conflicts in the findings of some of the studies, several generalizations seem fairly universal across countries and time periods. For example, the data indicate a greater overall prevalence of mental illness in the deaf population than in the general population as a whole, based on the relative number of each group who are patients in psychiatric hospitals. In general, deaf patients have longer hospital stays. Characteristics symptoms leading to hospitalization of deaf people tend to be different from those of hearing patients. It was thought by most investigators that restriction of sign language use in schools was one reason for these differences. For both hearing and deaf inpatients, dual diagnosis (mental illness and substance abuse) is far more common today than in years past. All investigators found frequent misdiagnoses among deaf patients. The paucity of research on deaf inpatients over the last 2 decades is noted.

Deafness↗
PubMed1999

Psychopathy and antisocial personality disorder among alcoholic inpatients.

OBJECTIVE: The purpose of this study was to compare the adequacy of two measurement systems--the Revised Psychopathy Checklist (PCL-R) and DSM-III diagnosed antisocial personality disorder (APD)--to distinguish alcoholic inpatients with regard to alcoholism characteristics, criminal activities and psychiatric disorders. METHOD: The 740 patients, who included 440 men, 387 blacks and 199 Hispanics, were admitted to one of five New York State alcohol treatment inpatient centers. Each patient was interviewed, and DSM-III diagnoses and other characteristics were recorded, and trained interviewers completed the PCL-R. RESULTS: There was a statistically nonsignificant association between DSM-III-based APD diagnosis and PCL-based psychopathy diagnosis. APD (relative to non-APD) alcoholics had an earlier onset of problem drinking, higher levels of pathological drinking and social impairment, and a higher prevalence of familial alcoholism; a similar pattern was not indicated for PCL-R diagnosed psychopaths relative to nonpsychopaths. APD alcoholics also engaged in higher levels of criminal activities and violent acts. APD alcoholics had a higher prevalence of substance abuse disorders, and psychopaths had a higher prevalence of generalized anxiety disorder, panic disorder and schizophrenia. CONCLUSIONS: Distinct subpopulations of alcoholic inpatients are identified via the APD criteria of DSM-III and the psychopathy criterion of the PCL-R. The majority of the identified psychopathic alcoholics in this sample were likely to be secondary psychopaths, characterized by features of psychopathy (e.g., callousness, manipulativeness) and emotional dysregulation and/or thought disturbance.

Adult↗
PubMed1989

Changes in alcohol-related inpatient care in Stockholm County in relation to socioeconomic status during a period of decline in alcohol consumption.

Alcohol sales in Stockholm County decreased by 18 per cent from 1976 to 1981. The socioeconomic status of inpatients treated for alcohol psychosis, alcoholism, alcohol intoxication, liver cirrhosis, and pancreatitis was studied by linking data from the National Housing and Population Censuses in 1975 and 1980 with the inpatient care registers for 1976 and 1981. In both years, all rates were highest for people outside the labor market and lowest among white collar employees. The employment rate for those aged 25-44 years and treated in 1981 for alcohol psychosis, alcoholism, and alcohol intoxication--already low in 1975--had drifted further downward by 1980. Total rates of inpatient treatment for alcohol-related diagnoses generally declined but the gap between blue collar workers and white collar workers widened. We conclude that the goal for national alcohol policy, suggested by the WHO--a reduction of per capita consumption--should be combined with additional measures that will reach all social groups.

Adolescent↗
PubMed1996

Very low incidence rates of community-acquired hepatitis C virus infection in company employees, long-term inpatients, and blood donors in Japan.

To assess the contemporary rate of hepatitis C virus (HCV) propagation in Japanese community, we conducted a sentinel study on three groups of people: company employees, long-term inpatients, and blood donors. A total of 3079 company employees negative for anti-HCV were followed thereafter, and seroconversion to anti-HCV was found in 5 per 5786 person-years. None of them was positive for HCV RNA. In the group of 703 long-term inpatients (25 of whom were initially positive for anti-HCV) none showed seroconversion to anti-HCV per 2712 person-years. As for 114,266 repeated blood donors who were initially antibody-negative, 227 became anti-HCV positive later. Of these seroconverted donors, 83 were found to have anti-HCV with titers of 2(6) or greater. HCV RNA was positive in only 3 of them. Thus, the incidence rates of acquired HCV viremia in these three groups were 0 for both company employees and long-term inpatients, and 1.78 (95% C.I.: 0.37-5.19) per 100,000 person-years in blood donors. These results suggest that community-acquired HCV infection is now rare in Japan, and that even if it occurred it hardly leads to persistent viremia.

Adolescent↗
PubMed1996

The attitudes of medical inpatients toward psychiatric consultation: a re-examination.

OBJECTIVE: Several surveys from twenty to thirty years ago demonstrated that approximately 80 percent of patients were readily accepting of psychiatric consultation. The aim of this study was to re-examine whether medical inpatient attitudes toward psychiatric consultation have changed in the past twenty-five years and whether the type of psychiatric disorder affects the attitude toward consultation. METHOD: Forty-eight medical inpatients seen in psychiatric consultation consented to answering a questionnaire pre- and post-consultation to assess their attitudes to this intervention. Chi-square and t-tests were used to determine statistically significant differences between the "before" and "after" consultation groups. RESULTS: Eight-one percent stated they would be moderately, to very, agreeable to psychiatric consultation if their primary care doctor felt it was indicted. Sixty-seven percent claimed not to have been informed beforehand that a psychiatric consultation was requested. Only 8 percent of patients were disinterested in having the consultation. Psychiatric diagnosis (primary vs. organic) and the attitude toward psychiatric consultation were not significantly related. CONCLUSIONS: Our results show little change in attitude over the past twenty-five years and support earlier studies that show medical inpatients are generally accepting of psychiatric consultation, that consultation does not pose a threat to the doctor-patient relationship, and that careful preparation of the patient by the primary care provider can improve patients' attitudes toward the consultation.

Adult↗