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PubMed1989

Inpatient-outpatient randomized comparison of Cambridge diet versus milk diet in 17 obese women over 24 weeks.

Twenty-two obese women were recruited for a prospective cross-over trial of the effects of either the Cambridge Diet (CD) or 1200 ml milk with iron and vitamin supplements (milk) during a three-week inpatient study, then 20 weeks as outpatients, then a final week as inpatients. Five dropped out, leaving eight who took initially milk and then CD and nine who took CD and then milk. Within each diet group five women had their jaws wired together during the outpatient phase. The four groups (CD/milk, with/without jaw wiring) were initially well matched for age, height, weight and resting metabolic rate (RMR). There was no significant difference (by unpaired t test) between the groups during the initial inpatient phase in rate of weight loss, or N loss/kg weight loss, but patients on CD during days 13-22 had a greater daily N loss than those on milk (2.08 vs 0.28 g N/day, P = 0.02). When the change in weight loss, N loss and N/kg weight loss on changing diet within a patient group was compared by paired t test the patients changing from milk to CD showed no significant change, but patients changing from CD to milk showed a reduced rate of weight loss (0.36-0.23 kg/day; P = 0.012), a reduced N loss (2.02-0.28 g N/day; P = 0.0013) and reduced loss of N/kg (6.26 to 1.02 g N/kg; P = 0.025). During the outpatient phase weight loss was not significantly related to the diet, but patients with jaws wired lost more weight than those without jaw wiring (0.151 vs 0.077 kg/day; P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

[Clinical statistics on inpatients and operations in the Department of Urology, Toyooka Public Hospital (from January 1982 to December 1985)].

Statistical observations on inpatients and operations in our department from 1982 to 1985 were reviewed in comparison with the statistics for the preceeding three years. More elderly persons comprised the inpatients at our hospital than at other facilities. Urogenital tumors and urolithiasis were the predominant disease of the inpatients, as they were in the preceeding three years. Number of prostatic cancer has remarkably increased. Transurethral operations, TUR-P and TUR-Bt, were the most representative. Operations for the malignant disease, especially for prostatic cancer, were more frequent in this period than in the preceeding three years. As to urinary diversion, ileal conduit was the main procedure used during this four years. Kock continent ileal reservoir was adopted in 1985. In July 1985, open operations for urolithiasis were dramatically replaced by percutaneous and transurethral procedures.

Female↗
PubMed1983

[Clinical statistics on outpatients, inpatients and operations at the Department of Urology, Hyogo College of Medicine, in 1982].

Statistical studies on 2,040 new outpatients, 575 inpatients and 570 operative procedures at our department in 1982 revealed the following. The most frequent diseases among the outpatients were urogenital infections followed by anomalies and tumors. Over half of the inpatients were pediatric patients and the major diseases among inpatients were hypospadias, vesicoureteral reflux, urolithiasis, congenital urethral stenosis and undescended testis. A total of 570 operations were performed on 531 patients, and the major five operations were hypospadias repair (79), optic internal urethrotomy (71), TUR-P (49), ureterocystoneostomy (33) and orchidopexy (32).

Adolescent↗
PubMed1995

Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada.

OBJECTIVE: This study attempted to estimate the prevalence of dissociative symptoms and disorders in a Canadian adult psychiatric inpatient population and also attempted to determine the extent to which dissociative disorders were recognized by the attending clinical staff. METHOD: All appropriate and consenting adult psychiatric inpatients at the Kingston Psychiatric Hospital in Kingston, Ontario, were given the Dissociative Experiences Scale. Patients scoring 25 or greater were interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. Admission or discharge diagnoses data were used to determine whether or not dissociative disorders were being recognized. RESULTS: A total of 48 patients completed the Dissociative Experiences Scale and 14 (29%) scored 25 or greater. The prevalence of dissociative disorders in this hospital population was estimated to be 17%. Dissociative identity disorder was found in six percent, dissociative amnesia in eight percent and dissociative disorder not otherwise specified in two percent of the population. These disorders tended to be under-recognized. CONCLUSION: Research on more extensive populations is required to establish the true prevalence of dissociative symptoms and disorders in psychiatric inpatients.

Adult↗
PubMed1995

Inpatient care for the aircraft carrier battle group.

A case series of 417 consecutive ward admissions onboard the USS Forrestal (CV59) is presented. During the 1-year study period, the inpatient ward was open for 260 days while the ship was underway, including workups and extended Mediterranean deployment. The case series displays the variety of clinical inpatient care provided in the shipboard environment. The 10 most clinically challenging patients demonstrate the complexity of care provided. Implication for inpatient care capability afloat are discussed.

Adult↗
PubMed1994

Cost allocation patterns between hospital inpatient and outpatient departments.

OBJECTIVE: This study examines changes in hospitals' cost allocation patterns between inpatient and outpatient departments in response to the implementation of the prospective payment system. DATA SOURCES AND STUDY SETTINGS: The analysis was carried out using data for 3,961 hospitals obtained from the Medicare Cost Reports and from the American Hospital Association for the years 1984 through 1988. STUDY DESIGN: A total operating cost function was estimated on the two outputs of discharges and outpatient visits. The estimation results were instrumental in disaggregating costs into inpatient and outpatient components. This was done cross-sectionally for each of the five years. PRINCIPAL FINDINGS: Comparison of this cost breakdown with that of hospital revenue provides evidence of distinct patterns in which nonteaching, rural, and small hospitals increasingly allocated greater costs to outpatient departments than did large, urban, and teaching hospitals. CONCLUSIONS: The results suggest that small rural hospitals turned to the outpatient side in the face of tough economic challenges over the period of study. Because differences in cost allocation patterns occur by particular hospital category, analyses that rely on accounting cost or revenue data in order to identify cost differences among those same categories may come to erroneous conclusions. In particular, because teaching hospitals apportion costs more heavily on the inpatient side, cost allocation differences cause upward bias in the PPS medical education adjustment.

Cost Allocation↗
PubMed1993

[Intestinal flora of inpatients and isolation frequency of methicillin-resistant Staphylococcus aureus].

The authors compared intestinal flora from 30 healthy volunteers and 128 inpatients. E. coli, B. fragilis, and Bifidobacterium were each detected in the stools of healthy subjects at a frequency of more than 90%, while the incidences of such flora were low in the stools of inpatients: A significant difference was observed between the two groups. E. faecium, P. aeruginosa, Methicillin-resistant Staphylococcus aureus (MRSA), C. difficile, and Candida were detected at high frequencies in the stools of inpatients, as compared with healthy subjects. This finding is attributed to the administration of antimicrobial agents. It is also considered that microbial interaction in maintaining the balance among normal intestinal flora had been lost in patients from whom MRSA and/or C. difficile was isolated. The decrease or elimination of bacterial species antagonistic to such resistant strains must be guarded against, because this can lead to weakening of the defence mechanism against intestinal infection.

Enterococcus faecium↗
PubMed1993

Hospital response to psychosocial needs of AIDS inpatients.

Compassionate care for HIV-infected persons requires response to psychosocial needs. With no new external funding, Women's College Hospital, a 270-bed urban teaching hospital, provided effective psychosocial services for HIV-infected inpatients by developing a comprehensive policy, educating staff, organizing existing services into a psychosocial support team to provide crisis intervention, and developing liaisons with community AIDS organizations. A retrospective chart review of epidemiologic and psychosocial patient data was carried out for 59 HIV inpatients (58 men, 1 woman) admitted 1987-89. Of the cohort, 91% indicated homosexual contact as the only risk factor. A psychosocial support team contacted 90% of these inpatients. One third (36%) of the patients designated as next of kin individuals who were not legally or biologically related. Approximately 25%-30% made active arrangements for impending death, e.g. wills and funeral plans. Thirteen patients, 22%, died in hospital, and three, 5%, on first admission. Experience showed that psychosocial interventions that focus on human dignity and quality of life, normally seen as elements of palliative care, are critically important from the earliest stages of HIV disease and should not be reserved only for those who are terminally ill.

Acquired Immunodeficiency Syndrome↗
PubMed1996

RANZCP guidelines for psychotropic drugs: application to hospital inpatients. Royal Australian and New Zealand College of Psychiatrists.

The objective of this study was to monitor compliance with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) guidelines for psychiatric drug use, in the forensic section of a psychiatric institution in Queensland. The author performed an audit of the charts and medical records of 65 patients in three forensic hospital wards at the John Oxley Memorial Hospital, a 73-bed forensic/secure section of the Wolston Park Hospital Complex. It was found that many patient records were lacking some relevant documentation. There was a higher rate of prescription for multiple psychotropic drugs than is recommended for patients at discharge from inpatient units. This quality assurance exercise has provided a basis for discussion to find ways to more closely comply with the RANZCP Guidelines for Psychotropic Drugs in Psychiatric Practice. No benchmarks are available for equivalent continuing inpatients in a similar setting. It has been shown that, for continuing inpatients in a forensic hospital, there is poor compliance with Draft Clinical Indicator No. 2.1 for Pilot Test (developed jointly by the RANZCP and the ACHS). Perhaps the threshold for this indicator needs to be raised in this clinical setting. The situation may be clarified when the proposed follow-up audit has taken place. There were no patients receiving doses in excess of currently-accepted limits, that is, Clinical Indicator (CI) No. 2.2 was 0, and there were 31 patients (47.7%) concurrently receiving two or more antipsychotic drugs and CI no.2.3 had a value of 31.

Adolescent↗
PubMed1997

Inpatient group psychotherapy in Chinese patients.

OBJECTIVE: Inpatient group psychotherapy in acute psychiatric units has been a much maligned treatment modality with doubts cast upon its therapeutic value. However, local Chinese patients value and benefit from its inclusion in the therapeutic package after some adjustments to its structure and content. DESIGN: Groups of 8 inpatients met weekly with a regular therapist and co-therapist. Feedback forms were filled by consenting patients at the end of each session to rate the value of each treatment modality in the ward package and to ascertain if therapeutic factors had been achieved. SETTING AND PATIENTS: All were voluntary patients on an acute psychiatric ward based in a general hospital, who had consented to attend group therapy and were able to sit through a 45-minute session. Excluded were those with dementia, organic brain syndrome or those who were too disturbed. Thirty-nine patients completed the questionnaire legibly. RESULTS: In order of preference, patients rated individual attention from doctors first, followed by medication, relaxation therapy, then group therapy. Among the therapeutic factors, the ones achieved most were acceptance, altruism and self-awareness. Patients wanted instruction and advice on mental health. Twenty-eight of thirty-nine patients wanted to continue attending group therapy. CONCLUSION: In this study, group therapy ranked 4th in the therapy package on an inpatient unit. Patients were able to experience some therapeutic factors but they valued factors which were different from those described in Western literature. Increased educational input from therapists was the preferred agenda.

Adult↗
PubMed1997

Depression in elderly medical inpatients: a meta-analysis of outcomes.

OBJECTIVE: To determine the prognosis of elderly medical inpatients with depression. DATA SOURCES: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Eight reports (involving 265 patients with depression) met the following 5 inclusion criteria: original research, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affective state reported as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. DATA EXTRACTION: Information about the patient population, the proportion of cases detected and treated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. DATA SYNTHESIS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 3 months or less indicated that 18% of patients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors associated with worse outcomes included more severe depression, more serious physical illness and symptoms of depression before admission. CONCLUSIONS: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low and the mortality rate high.

Aged↗
PubMedDate not supplied

[Understanding of environmental impact with inpatients based on structural modeling].

This study examined how inpatients perceive environmental impacts using the ISM(Interpretive Structural Modeling)method. 18 new items among inpatients perceiving the environmental impacts were selected through a discussion with three researchers, two nurses, and six patients. This was applied to two inpatients who were not in the same ambulatory state in order to establish the validity of the structural models. As a result, the structuring models showed the difference depending on each patient. Therefore the structuring model is effective to assess the environmental impacts on individuals.

Humans↗
PubMed1998

Pulmonary rehabilitation in the acute inpatient rehabilitation hospital.

In closing, pulmonary rehabilitation in an inpatient rehabilitation hospital is not a new idea, but is now becoming more popular as the burden of care shifts away from the acute care hospital. Pulmonary rehabilitation has been demonstrated to be cost-effective, improve quality of life, and decrease the number of future hospital days for the patient. A few surveys have shown, however, that only 5% of pulmonary rehabilitation programs serviced inpatients in a rehabilitation hospital, and only 1% of 283 programs had a physiatrist as the medical director of the pulmonary rehabilitation program. Nine percent of programs surveyed serviced inpatients in rehabilitation units within the acute care hospital. Clearly, the majority of pulmonary rehabilitation programs are on an outpatient basis, and many of these are located within the walls of a rehabilitation hospital. Effective pulmonary rehabilitation can be done in the home setting when combined with outpatient therapy visits over a 12-week duration. The spectrum of pulmonary rehabilitation will continue to evolve into the twenty-first century, and clearly the rehabilitation hospital will be part of that change. Whether caring for very elderly COPD patients who are too debilitated to return home from the acute care hospital or managing ventilator-dependent patients with COPD, spinal cord injury, or neuromuscular disease, the IPR team and the rehabilitation hospital will have to demonstrate cost-effective outcomes. Physiatrists should play a major role in this evolution, on both a patient-benefit level and legislative level, to increase awareness of pulmonary rehabilitation.

Health Care Reform↗
PubMed1998

[Child and adolescent psychiatric services in the canton of Zurich: a comparison of outpatients, day clinic, and inpatient referral populations].

Findings in intervention research are an important basis for the discussion of issues pertaining to quality control. In Switzerland such findings have been rare. The present study of the entire 1988-1995 referred child and adolescent population of the Child and Adolescent Psychiatric Service of the Canton of Zurich (N = 7538 treated patients) concentrated on the demographic, diagnostic, and therapeutic attributes of the outpatient, day clinic, and inpatient populations that comprised the referred population. Marked differences are found in comparable studies from Germany with regard to patients treated in an inpatient setting. For example, the mean age of the patients in the Zurich sample is lower and patients with conduct disorders are more frequently represented. On the other hand, patients with psychotic illness are missing and, on the average, the duration of treatment is considerably longer. The reasons for these differences are to be found in the various structural attributes of the cantonal services that are provided in Zurich. In the area of inpatient care, where in comparison to outpatient settings and also day care settings patients with severe disorders are treated, there is a lack of places for the short-term care of acutely ill patients--for example, psychotic patients. This is especially true for adolescent patients. The limitations of traditional outpatient settings are frequently marked by unsatisfactory treatment results in outpatients with conduct disorders, developmental disorders, and a high impact of abnormal psychosocial circumstances.

Adolescent↗
PubMed1998

Do our patients understand? A comparison of understanding in adult inpatients and schoolchildren.

AIM: To test the assumption that if an explanation about a resuscitation policy is understood by a 12-year-old then it will be understood by an adult patient. METHOD: The comprehension of a paragraph about resuscitation by inpatients was compared to the comprehension of the same paragraph by 12-year-old schoolchildren. RESULTS: The schoolchildren demonstrated better comprehension of a paragraph about resuscitation than the inpatients (p = 0.02). CONCLUSIONS: Schoolchildren, aged 12, in a classroom setting show better comprehension than adult medical and surgical inpatients. This has implications about giving information to patients and seeking consent from them. Persons giving information to patients need to ensure the patients have understood it.

Adult↗
PubMed2005

[Utility of stool culture in inpatient].

Several studies have concluded that it is inappropriate to perform stool cultures (SC) to inpatients that have stayed hospitalized three days or more because nosocomial diarrhea is not due to enteric pathogenic bacteria that are searched through this exam. The aim of this paper was to analyze the SC yield performed to patients hospitalized in the UC Health Net since January to December 2002 and the rate of positive results obtained depending on the length of hospitalization in order to define if international guidelines are useful to the national reality. During twelve months 3474 SC were evaluated, 458 (13.2%) belonged to inpatients. Of them 16 (3.5%) were positive, 13 were obtained on the first day, 2 at the second day and 1 at the fifth day of hospitalization. Only 1/190 (0.5) SC obtained after two days of hospitalization yielded a positive result. These results reinforce the international recommendation of not performing SC to inpatients that have stayed more than three days at the hospital; besides, considering previous figures, we suggest to make a cutoff at day two of hospitalization, after two days there is no a significant clinical impact. This strategy means to reduce 41% of these analyses and to save the corresponding money.

Adolescent↗
PubMed2005

The role of rapid vs conventional human immunodeficiency virus testing for inpatients: effects on quality of care.

BACKGROUND: Rapid testing for human immunodeficiency virus (HIV) has improved HIV screening in the outpatient and perinatal settings, but few data report how it may be used to improve the quality of inpatient care. We compared quality of care for inpatients diagnosed in the emergency department via rapid testing vs patients whose conditions were diagnosed via conventional testing during their hospital admission. METHODS: We reviewed medical records to identify patients with first-time positive HIV tests and concurrent hospital admission who were tested via either rapid testing in the emergency department or conventional testing during their hospital admission. We compared quality-of-care end points for these patients. RESULTS: We identified 103 HIV-infected inpatients with no previous HIV diagnosis; the conditions of 48 patients (47%) were diagnosed by rapid testing and 55 (53%) by conventional testing. Mean length of stay was 6 days for the rapid test group vs 13 days for the conventional test group (P<.001); multivariate regression analysis showed that testing modality had an independent, statistically significant effect on length of stay. Nine (16%) of the patients in the conventional test group vs none in the rapid test group were discharged without receiving their HIV test results (P = .002). Patients in the rapid test group attended the outpatient HIV clinic in a mean of 22 days vs 50 days for the conventional test group patients (P = .05). CONCLUSIONS: Rapid HIV testing in the emergency department preceding admission may shorten hospital stay, increase the number of newly diagnosed patients with HIV who are discharged from the hospital aware of their HIV status, and improve entry into outpatient care for patients admitted at the time of their initial HIV diagnosis.

Adult↗
PubMed2005

Guided prescription of psychotropic medications for geriatric inpatients.

BACKGROUND: Inappropriate use or excessive dosing of psychotropic medications in the elderly is common and can lead to a variety of adverse drug events including falls, oversedation, and cognitive impairment. METHODS: We developed a database of psychotropic medication dosing and selection guidelines for elderly inpatients. We displayed these recommendations to physicians through a computerized order entry system at a tertiary care academic hospital. The system was activated for 2 of 4 six-week study periods in an off-on-off-on pattern. Main outcome measures were agreement with the recommended daily dose for the initial drug order, incidence of dosing at least 10-fold greater than the recommended daily dose, prescription of nonrecommended drugs, inpatient falls, altered mental status as measured by a brief nursing assessment, and hospital length of stay. RESULTS: A total of 7456 initial orders for psychotropic medications were prescribed for 3718 hospitalized elderly patients with a mean +/- SD age of 74.7 +/- 6.7 years. The intervention increased the prescription of the recommended daily dose (29% vs 19%; P<.001), reduced the incidence of 10-fold dosing (2.8% vs 5.0%; P<.001), and reduced the prescription of nonrecommended drugs (10.8% vs 7.6% of total orders; P<.001). Patients in the intervention cohort had a lower in-hospital fall rate (0.28 vs 0.64 falls per 100 patient-days; P = .001). No effect on hospital length of stay or days of altered mental status was found. CONCLUSION: A geriatric decision support system for psychotropic medications increased the prescription of recommended doses, reduced the prescription of nonrecommended drugs, and was associated with fewer inpatient falls.

Accidental Falls↗