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PubMed2000

Medical leave granted to psychiatric inpatients--a one-year retrospective review.

INTRODUCTION: Of the 676 patients warded in 1998 at the National University Hospital (NUH) Department of Psychological Medicine, over a third (n = 268) required certification of absence from work. Duration of inpatient stay and immediate post-discharge medical leave were examined for this group. These durations were correlated against the patients' diagnoses and their demographic variables. The mental health morbidity of teachers was specifically studied. MATERIALS AND METHODS: In this retrospective study, we used medical certificate counterfoils to determine the lengths of admission and post-discharge medical leave duration. ANOVA and Kruskal-Wallis tests of the SPSS computer package were used for statistical analysis. RESULTS: The sex and marital status of these patients did not affect either duration significantly. However, those 45 years and older were granted longer outpatient medical leave. Patients diagnosed with mood and psychotic disorders required longer inpatient stay and were granted longer outpatient medical leave, as compared with other diagnostic groups. It was found that the teachers admitted were largely 45 years and older, had a diagnosis of depression and required extended periods of outpatient medical leave compared to other occupational groups. CONCLUSIONS: The mean number of days of inpatient stay and outpatient medical leave may serve as a helpful guideline of current practice. As introduced in this paper, the use of medical certificate counterfoils is a simple yet effective way of measuring days off-work. With the inclusion of those psychiatric patients not working and the medical leave granted long after discharge, calculations of the economic costs of specific mental disorders to Singapore can then be attempted.

Adolescent↗
PubMed2002

Association between reported education and intellectual functioning in an ethnically diverse adult psychiatric inpatient sample.

Patients' pre-existing survival skills, educational attainment, and intellectual functioning should be included in the development and implementation of treatment planning for adult psychiatric inpatients. When considering culturally diverse inpatient populations with possible cultural and language barriers, these variables may attain additional importance. Utilizing a sample (N = 60) primarily consisting of Asian/Pacific Islander inpatients, the present study investigated: (a) the rate at which professionals from different disciplines inquired about educational attainment; (b) the association between self-reported education and standardized measures of intelligence; and (c) the correspondence between different IQ scores. Axis 1 diagnoses included schizophrenia (N = 19; 32%), schizoaffective disorder or bipolar disorder (N = 23; 38%), and organic or substance-related disorders (N = 18; 30%). Thirty-five percent of the sample (N = 21) had dual diagnoses. The results indicated that only psychologists who administered IQ tests consistently inquired about educational attainment. An expected overall positive association between self-reported education and standardized intelligence measures was found. High correlations between the Test of Nonverbal Intelligence, 2nd edition (TONI-2) and Wechsler Adult Intelligence Test-Revised (WAISQ-R) IQs suggested that both tests were valid in the assessment of intellectual functioning. Implications included the need for more systematic assessment and incorporation of pre-existing skill-based information and the utility of self-reported education and different measures of intellectual functioning (including TONI-2).

Adult↗
PubMed2002

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2003 rates. Final rule.

We are revising the Medicare acute care hospital inpatient prospective payment systems for operating and capital costs to implement changes arising from our continuing experience with these systems. In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 2002. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the acute care hospital inpatient prospective payment systems. In addition, we are setting forth changes to other hospital payment policies, which include policies governing: Payments to hospitals for the direct and indirect costs of graduate medical education; pass-through payments for the services of nonphysician anesthetists in some rural hospitals; clinical requirements for swing-bed services in critical access hospitals (CAHs); and requirements and responsibilities related to provider-based entities.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

[Treatment in psychiatric day hospital in comparison with inpatient wards in different European health care systems--objectives of EDEN project].

The paper presents the objectives and design of an ongoing multicenter randomized, controlled trial EDEN (European Day Hospital EvaluatioN). The EDEN-study aims to evaluate the efficacy of acute psychiatric treatment in a day hospital setting in five European centres: Dresden, London, Michalovce, Prague and Wroclaw. The main hypothesis is that day hospital treatment for acute psychiatric patients is as effective as conventional inpatient hospital care. The objectives of the study are to evaluate the viability and effectiveness of day hospitals for acute psychiatric treatment, to identify subgroups of patients with a more or less favourable outcome so that the treatment setting might be specifically applied and to ascertain the cost-effectiveness of day hospital treatment compared to conventional inpatient treatment. The study utilises a Randomised Controlled Trial (RCT) design with repeated measures at a maximum of six time points: at admission (t1), one week after admission (t2), four weeks after admission (t3), discharge (t4), three months after discharge (t5), and 12 months after discharge (t6). A combination of well-established standardised assessment instruments and open questions is used in 6 time periods. If the findings accept the main hypothesis of the study, some practical consequences could be inevitable: at a mental health policy level, these results could lead to an increase in the capacity of day hospitals; at the clinical level clinicians could redefine their concepts of care to consider the day hospital as an alternative to conventional inpatient treatment; from economic point of view could lead to reduction of treatment costs.

Czech Republic↗
PubMedDate not supplied

Satisfaction with health care among dermatological inpatients.

Measuring patient satisfaction is regarded as one of the principal methods for obtaining patients' evaluation of services they receive. During the last decades more interest has been devoted to inpatients' preferences and needs. Surveys on patient satisfaction may provide information to hospitals about areas where improvement is needed. In this survey, 648 questionnaires were completed by dermatological inpatients and were analyzed for overall satisfaction and seven satisfaction determinants. Background factors and clinical parameters were considered. Emotional support was recognized as a critical area. "Coordination of care" and "information and education" were identified as the most relevant determinants for overall patient satisfaction. The Hospital Management, taking into account the results, planned training in order to improve personnel's communication skills. This study confirms that patient satisfaction analysis is a useful instrument also among dermatological inpatients, and satisfaction is a valid measure of quality of health care.

Adolescent↗
PubMed2004

Recovery of ambulation during inpatient rehabilitation: physical therapist prognosis for children and adolescents with traumatic brain injury.

BACKGROUND AND PURPOSE: Evidence to guide physical therapist prognosis for recovery of the ability to ambulate in children and adolescents with traumatic brain injury (TBI) is limited. The aim of this study was to delineate a predictive model and determine the value of key demographic and clinical variables in establishing a prognosis for ambulation without the assistance of a device or person over 15.24 m on a flat, level surface following inpatient rehabilitation. SUBJECTS AND METHODS: For this retrospective study, a consecutive series of 95 children and adolescents with TBI (aged 2-18 years) admitted to an inpatient rehabilitation program was assessed using information from medical records. A multiple logistic regression analysis was conducted to identify predictors for ambulation at the time of discharge from the rehabilitation setting. RESULTS: Fifty-six percent of the children achieved ambulation at discharge. Lower-extremity hypertonicity (measured on physical therapist examination as resistance to passive stretch), brain injury severity, and lower-extremity injury together were predictors of the ability to ambulate. DISCUSSION AND CONCLUSION: Impairment and injury-related variables were important in predicting a minimal level of unassisted ambulation after discharge from inpatient rehabilitation. Awareness of predictors of recovery of the ability to ambulate that are gathered as part of a physical therapist's examination may assist in developing a prognosis for ambulation and in establishment of an appropriate plan of care.

Adolescent↗
PubMed1992

Factors affecting interstate use of inpatient care by Medicare beneficiaries.

This article examines the extent to which interstate inflow and outflow of patients affects their observed use of Medicare Part A inpatient care. Interstate patient flow can bias utilization rates and may be due to seasonal migration, interstate inpatient care market areas, or purposive seeking of specialized/high-quality care. Examination of state level patient flow data drawn from 1987 Medicare discharge indicate that most interstate patient flow occurs between adjacent states probably as an outgrowth of interstate markets. Regression analyses of patient flow data suggest that while seasonal migration is an important determinant of patient flow, its importance is secondary to that of indicators of the availability of specialized services. These findings suggest research questions that may be best answered in detailed analyses of inpatient utilization in interstate market areas and seasonal migration.

Aged↗
PubMed2003

[Randomized controlled trial on effectiveness of the community re-entry program to inpatients with schizophrenia spectrum disorder, centering around acquisition of illness self-management knowledge].

OBJECTIVE: The objective of this study was to examine by randomized controlled trial the effectiveness and safety of the Japanese version of the Community Re-Entry Program, a manualized psycho-educational program with cognitive-behavioral therapy techniques, in discharge preparation for inpatients with schizophrenia. Our hypotheses are that firstly the program is effective for patients in acquiring illness self-management knowledge, that secondly the program shows positive effects on objective behavior and symptoms, and that thirdly the program has no adverse effects on subjective quality of life (QOL). METHOD: The subjects were 32 psychiatric inpatients, 24 male and 8 female, hospitalized in psychiatric rehabilitation wards, who gave written informed consent to participate in this study. The Community Re-Entry Program consists of 16 small-group sessions of one hour each that teach illness self-management knowledge and related skills to prepare patients for discharge from hospital and re-entry to the community with cognitive-behavioral techniques such as demonstration, roleplay, feedback, behavioral modeling and homework assignments. A specialized trainer's manual, demonstration videotape and patient workbook are utilized in the program. The program content includes defining discharge readiness, identifying symptoms and medication effects, assisting with discharge planning, connecting with community care, medication self-management, monitoring relapse warning signs, and preparing for emergencies. Except for considerations of the sex ratio in both groups, subjects were randomly allocated to the program (the program group) or ordinary occupational therapy (the control group). Of 32 patients, 31 were diagnosed with schizophrenia and 1 with schizotypal disorder. For the patients in the program group, we administered the program of 16 sessions as well as introductory and closing sessions, twice a week for 9 successive weeks. Nursing staffs in the wards took the roles of trainers with careful fidelity to the manual and supervision by psychiatrists with extensive experience in cognitive-behavioral therapy. The subjects were assessed concerning psychopathology with PANSS by psychiatrists, objective behavior with REHAB by nurses, subjective QOL with subjects' self-reports on WHO/QOL-26 and illness self-management knowledge also by self-report questionnaire attached to the trainers' manual of the program, before and after the whole program. RESULTS: Before the program, no significant differences were observed between groups concerning age, illness duration, education, length of current hospitalization, amount of antipsychotic medication, psychopathology, objective behavior, subjective QOL and illness self-management knowledge. One patient dropped out of the program because of transient ischemic attack. After the program, the patients in the program group significantly improved in illness self-management knowledge, as well as in speech skills and social activity score, factors of REHAB concerned with objective behavior evaluation, compared with those in the control group. Positive symptoms thus seemed to improve in the patients in the program group compared with those in the control group. No significant changes were observed in other items, including subjective QOL, in the patients of both groups. No patients experienced psychotic relapse in the observation term. DISCUSSION: We consider that the results supported most of our hypotheses, as they showed positive effects of the program in learning illness self-management knowledge, objective behavior and possible positive effect on positive symptoms, and no adverse effects were observed in psychopathology, behavior or subjective QOL. Further study is necessary on illness self-management behavior acquisition and the effects on long-term clinical outcomes. Study on whether the program is effective for younger patients with shorter hospitalization are expected, because the subjects in this study were rather older (45.9 +/- 11.5 years in the program group) and hospitalized longer (37.8 +/- 36.7 months in the program group). CONCLUSION: The Japanese version of the program was effective and relatively safe for schizophrenia spectrum disorder inpatients for learning illness self-management knowledge in preparation for discharge and planning community re-entry.

Adult↗
PubMed2004

[Introduction of cognitive-behavioral therapy for alcoholic inpatients at Kurihama National Hospital].

A new inpatient treatment program for alcoholism based on cognitive-behavioral therapy was introduced at Kurihama National Hospital in March 2000. We have classified the dysfunctional cognitions frequently exhibited by alcoholics into eight categories. The therapy is premised on the notion that the presence of one or more of the dysfunctional cognitions can trigger worsening of an alcoholic's drinking problem. We have devised a cognitive model in which the patients themselves examine their dysfunctional cognitions and recover from the vicious cycle of alcoholism. Cognitive-behavioral therapy is conducted at Kurihama National Hospital based on these hypotheses. The cognitive-behavioral therapy employed at Kurihama National Hospital is administered in group therapy in an inpatient treatment setting. Since the treatment is provided on an inpatient basis, dropouts from the program as a result of the patient starting to drink again can be prevented. Furthermore, since group therapy are used, cognitions of alcohol are examined not just in the context of the relationship between patient and therapist, but also in the context of the relationships among patients. It thus becomes easier to examine dysfunctional cognitions from a multifaceted perspective. It will be easier for patients to examine their future drinking behavior concretely through the introduction of cognitive-behavioral therapy, and improvements in outcome should be achieved. However, the relationship between change in cognitions and prognosis needs to be studied in the future.

Alcohol Drinking↗
PubMed2004

The use of restraint and seclusion in different racial groups in an inpatient forensic setting.

The purpose of this study was to determine if physical restraint and/or seclusion had been used with different frequencies in patients of different racial groups in an inpatient forensic psychiatry facility. The method used was a retrospective correlational study of all inpatients (n = 806) treated from January 1993 through August 2000 at Kirby Forensic Psychiatric Center, a maximum-security inpatient forensic facility in Ward's Island, NY, near New York City. Episodes of restraint and/or seclusion were measured in each racial group. The number of violent incidents involving patients of each racial group was also measured. Racial groups at Kirby did not differ significantly from each other in number of violent incidents nor in the number of episodes of restraints. However, Asians and blacks as racial groups were more likely to have been secluded than were other racial groups. This difference did not persist when the number of incidents of seclusion was considered individually rather than for entire racial groups.

Forensic Psychiatry↗
PubMed2004

Suicidal behaviour and aggression in psychiatric inpatients.

OBJECTIVE: Theoretically, suicidal behaviour and aggression are usually said to be correlated. Such relationship is, however, not reliably supported by clinical and experimental evidence. It has been more frequently found when suicidal psychiatric patients are compared with healthy non-suicidal controls rather than when the comparison is done within the group of the psychiatric patients. Therefore we decided to investigate whether such relationship exists in a group with a high risk of suicidal behaviour--psychiatric male inpatients. MATERIAL AND METHODS: 113 male inpatients, mostly with schizophrenia and other psychotic disorders and mood disorders were studied in the first five days after their admission. Using a structured clinical interview and formal rating scales data were collected about the number of suicide attempts and aggressive acts committed throughout their lives, current suicide ideation and suicide planning behaviour, alcohol use, depression and outwardly directed aggression. Correlation analysis and chi-square test were used to analyze the data. RESULTS: There is no significant relation between current aggressivity and current suicide risk, as well as between the lifetime aggression and the lifetime suicide behaviour. The current suicide ideation and suicide planning behaviour are related to previous suicidal behaviour and to the current depression level. The lifetime aggression is related to the alcohol use. CONCLUSIONS: The results of our study do not define aggression as a suicide risk factor within the group of psychiatric inpatients. This findings could benefit the evaluation of the suicidal risk in psychiatric clinic.

Adolescent↗
PubMed2005

Vaginal misoprostol for cervical ripening at term: comparison of outpatient vs. inpatient administration.

OBJECTIVE: To compare outpatient with inpatient misoprostol for preinduction cervical ripening at term. STUDY DESIGN: This concurrent cohort study was conducted between August 1999 and July 2002 at a rural community hospital. Pregnancies > or =38 weeks with an unfavorable cervix were eligible if there was a reactive nonstress test with no regular contractions or active medical/obstetric complications. Outpatients were given a single dose of misoprostol (50 microg intravaginally). A cohort group consisted of similar patients undergoing misoprostol therapy in the hospital. RESULTS: No differences were found between the outpatient (n=177) and inpatient (n=96) misoprostol groups for maternal age, parity, gestational age, and initial cervical dilation and station. No home deliveries occurred with outpatient therapy. Advanced cervical dilation at hospital admission the next morning was more common with outpatient misoprostol (10.2% vs. 2.1%; RR 5.0, 95% CI 1.2, 21.5). Differences in mean times from admission to vaginal delivery were significantly shorter with outpatient than inpatient misoprostol (nulliparas, 3.1 hours, 95% CI 1.5, 4.7; multiparas, 5.3 hours; 95% CI 3.8, 6.8). The very low proportions of fetal intolerance to labor, low Apgar scores and newborn complications were not different between the 2 groups. CONCLUSION: Outpatient vaginal misoprostol in a selected population led to more advanced cervical dilation at hospital admission the next morning and explained the shorter time until vaginal delivery.

Administration, Intravaginal↗
PubMed2006

[Homology analysis of the epidemiological strains of meticillin-resistant Staphylococcus aureus and the strains isolated from the nasal fossa of the medical staff and inpatients].

OBJECTIVE: To investigate the relation between the epidemiological strains of meticillin-resistant Staphylococcus aureus (MRSA) and the strains isolated from the nasal fossa of the medical staff and inpatients. METHODS: The MRSA strains were isolated from the nasal fossa of the medical staff and inpatients in the Department of Neurosurgery. The genes of the isolated strains were amplified by randomly amplified polymorphic DNA (RAPD) assay. RESULTS: Three and 12 MRSA strains were isolated from the nasal fossa of the medical staff and patients who were hospitalized for more than 1 week, respectively, and RAPD assay revealed high homology between the isolated strains. CONCLUSION: Cross infection can be present between the medical staff, inpatients, and the infected patients.

China↗
PubMed2006

[Effect of hospice care on the quality of life and psychological state of aged mortal inpatients].

OBJECTIVE: To investigate the influence of hospice care on the life quality and psychological state of aged mortal inpatients. METHODS: Seventy-six aged patients were randomly divided into 2 groups (n=38). The research group was treated with hospice care, while the control group was treated with conventional nursing. Before and after more than one month of the interference, the quality of life, social support, satisfied degree, anxiety, and depression mood were investigated. RESULTS: All the indexes, such as total scale of life quality, appetite, spirit, sleep, family comprehension and coordination, recognition of cancer, attitude to therapy, and facial expression of the mortal inpatients after the interference, were raised and higher than those of the controls (P<0.05 or P<0.01). Life satisfaction index and the total scale of social support and subjective support, utilization ratio of support were raised and higher than those of the controls (P<0.05 or P<0.01). The level of anxiety and depression was decreased and lower than the control (P<0.05 or P<0.01). CONCLUSION: Hospice care can raise the life quality, subjective support, utilization ratio of support and life satisfaction of aged mortal inpatients. It could decrease the negative mood, such as anxiety and depression and improve the psychological state.

Aged↗
PubMed2006

Cost-benefit analysis of an intensive adverse product reactions monitoring program of inpatients in Thailand.

The objective of this study was to analyze the costs and benefits of the intensive adverse products reactions (APRs) monitoring program of inpatients in medical wards at Nakhon Ping Hospital, Chiang Mai, Thailand. The data were retrospectively collected from inpatients who had APRs during admission period from November 16, 2004 to March 31, 2005. Products included were drugs, electrolyte solutions, bloods and blood derivatives. Only direct medical costs were considered using provider's perspective. The results showed that there were 1,407 admitted patients during the study period. Adverse products reactions were found in 31 patients. Of those, three patients had two APRs. Therefore, a total of 34 APRs were found yielding the APRs incidence rate of 24 per 1,000 inpatients. Of the APRs found, 20 were reported after the symptoms had begun, but the remaining APRs were preventable. Drugs were the main causes for APRs (94.12%). Cost of intensive APRs monitoring was 1,426.37 US dollars and included 939.44 US dollars for labor costs, 12.5 US dollars for material costs, 29.07 US dollars for capital cost and 445.36 US dollars for APRs treatment and investigation. The program cost saving excluding the cost of hemodialysis was 3,090.85 US dollars. Net benefit was 1,664.48 US dollars and benefit to cost (B/ C) ratio was 2.17. When one time hemodialysis cost was included, cost saving increased to 4,040.85 US dollars. Net benefit and B/C ratio were 2,614.48 US dollars and 2.84 respectively. The results of sensitivity analysis represented that net benefit and B/C ratio were increased when duration of digoxin intoxication was prolonged. However, net benefit and B/C ratio were decreased when pharmacist labor cost was increased. Results indicate that intensive APR monitoring is a cost beneficial program and should be continuously implemented.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

[Orthostatic hypotension in elderly inpatients].

PURPOSE: To determine the prevalence of orthostatic hypotension (OH) in elderly inpatients, to identify known risk factors as well as to investigate quality of care given to these patients. PATIENTS AND METHODS: One hundred elderly inpatients aged 60 and over (mean age: 69.2 years), 66 women and 34 men were investigated. We measured supine (after resting for 30 minutes) and one, two, three, four and five minutes standing blood pressures. Orthostatic hypotension was defined as a decrease in systolic pressure of 20 mmHg or more with or without symptoms. The case notes of these subjects were reviewed and the presence of risk factors (diseases and medications associated with OH) was recorded as well as the short of treatment given to these patients. RESULTS: The prevalence of OH was 30% (30 patients); 1/3 had symptoms, one or more known risk factors were found in every patient. Neurogenic orthostatic hypotension was found in 5 patients (5 out of 30 patients). Only one patient with OH was diagnosed (1-30 patients). CONCLUSION: There is a high prevalence of OH in elderly inpatients and its association with various known risk factors. Most patients are not diagnosed and therefore not managed properly.

Aged↗
PubMed1991

[Empirical study of inpatients viewed from the individual psychotherapy].

There are very few empirical studies which address the effect of psychotherapy in inpatient settings. The author extracted 45 inpatient cases which could withstand detailed statistical analysis among patients who had been admitted to the psychiatric ward of the Tokai University Hospital between 1975 and 1981. Therapists of the cases were interviewed individually and the cases were evaluated retrospectively based on the criteria proposed by the study of Menninger Foundation. Significant statistical improvements were found on every items of evaluation. Furthermore, patients who had shown good interpersonal relationships and motivation at the time of admission showed positive conditions at the time of discharge. Factor analysis of therapeutic variables yielded five factors which delineated the following characteristics of the therapists: 1) having a psychoanalytic orientation, 2) viewing the improvement of symptoms as the goal of therapy, 3) utilizing one's experiences and skills, 4) utilizing a supportive approach, and 5) giving careful attention to the structuring of the psychotherapy sessions. As for the situational variables of the patients, factor analysis yielded only one factor, and multiple regression analysis revealed no significant therapeutic effects. Two types of multiple regression analysis were conducted to determine therapeutic effects and therapeutic variables, but no significant factors were found. Thus, the cases were classified into five groups according to interpersonal relationships factors and were analyzed according to "quantification method II" (Hayashi, C.). The following results were obtained: 1) the structuring of inpatient therapy should correspond with the patient's level of responsibility, 2) as for the structure of psychotherapy, the quality of improvement depended on the closeness to the psychoanalytic structure, i.e., the closer to the psychoanalytic structure, the higher the improvement, 3) the quality of improvement was poor when transference issues (in the sessions) were not brought up during the psychotherapy sessions, 4) the quality of improvement rose according to the degree that dreams and fantasies were dealt with, 5) hospital admission periods of 101 to 120 days showed the highest of improvement, 6) the frequency of sessions did not determine the quality of improvement, 7) the personality of therapist had strong effects when it worked in a negative way, and 8) the quality of improvement corresponded to the degree of the permissive atmosphere in the therapeutic relationship.

Adolescent↗