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At least 865 records · Page 48Linked to original sources
PubMed2003

Complications and determinants of length of stay for inpatient pediatric otolaryngologic procedures.

OBJECTIVE: To identify clinical factors associated with morbidity, mortality, and length of stay (LOS) for inpatient pediatric otolaryngologic procedures. STUDY DESIGN: Retrospective cohort study. METHODS: Records of patients undergoing pediatric otolaryngologic procedures were extracted from the National Hospital Data Survey for the calendar years 1995 through 1999. These records were examined to determine demographics, morbidity, mortality, type of procedure (as defined by anatomic subsite), and LOS. The effects of morbidity and type of procedure on LOS were identified. RESULTS: A total of 4861 children underwent inpatient otolaryngologic procedures. The overall morbidity rate was 4.6%. The most common morbidity was pneumonia, occurring in 171 patients (3.5%). The presence of any morbidity was associated with a significantly increased LOS (18.4 days vs 4.6 days; P<.001). The occurrence of pneumonia was associated with an increase in LOS to 19.7 days vs 4.7 days in patients without pneumonia (P<.001). Procedures involving the larynx, trachea, or esophagus carried the longest LOS (12.3 days; P<.001) among all procedural categories. The overall mortality rate was distinctly low at 0.4%. However, the occurrence of morbidity was associated with an increased risk of death, with an odds ratio of 8.0 (P =.001). Mortality was highest (13 of 18 deaths) after procedures on the larynx, trachea, or esophagus. CONCLUSIONS: Medical complications in children undergoing inpatient otolaryngologic procedures are associated with significantly increased LOS. Despite procedural complexity, overall mortality is remarkably low. Efforts to decrease medical morbidity in this population may result in decreased LOS and improved clinical outcomes.

Adolescent↗
PubMed1997

Yield from stool testing of pediatric inpatients.

OBJECTIVES: To quantify the yield from stool testing in pediatric inpatients and to identify criteria to test stool more deliberately without sacrificing diagnostic sensitivity. DESIGN: A retrospective review was performed of all stool cultures, ova and parasite examinations, and Clostridium [correction of Clostridia] difficile toxin assays performed on pediatric inpatients, aged 3 days to 18 years, at Thomas Jefferson University Hospital, Philadelphia, Pa, for 1 year. Medical records were reviewed for positive cases, each with 2 controls matched for age and test type. For this study, the term admission refers to the interval between the times each patient was admitted to and discharged from the hospital. Some patients had multiple stool tests sent to the laboratory during a single admission; some patients had more than 1 admission during the study period. Statistical analysis was performed using X2 analysis and the Student 2-tailed t test with a commercially available statistical software package (Statworks, Cricket Software, Philadelphia). RESULTS: Of 250 patient admissions to the hospital for which stool was cultured, 7 cultures (2.8%) were positive. Of 63 patient admissions having ova and parasite testing, 1 (2%) had a positive result. Clostridium [correction of Clostridia] difficile toxin assays were performed on 40 patient admissions to the hospital, and 7 (18%) had a positive result. Only 18 (3.0%) of 598 of all test results reviewed were positive. Costs of negative test results totaled $26,084. More patients (71%) with positive stool cultures than control patients (21%) had a temperature higher than or equal to 38 degrees C (X2, P < .05); however, relying on this sign missed 29% of the children with bacterial infection. A white blood cell band count of at least 0.10 was 100% sensitive and 79% specific in identifying patients with positive stool culture. There was no statistically significant relationship between stool culture results and age, total white blood cell count or white blood cell segmented neutrophil count, and no relationship between C. difficile toxin assay results and any of the above characteristics. Clostridium [correction of Clostridia] difficile was the most common pathogen identified (6 of 9) in patients developing gastrointestinal symptoms after admission; however, Salmonella enteritidis and Shigella sonnei were also significant causes (3 of 9). CONCLUSIONS: There is low yield from stool testing of pediatric inpatients: C. difficile toxin assay has the highest yield. Clostridium [correction of Clostridia] difficile testing is most valuable for children with nosocomial gastrointestinal symptoms although other bacterial pathogens do cause nosocomial symptoms in children. More selective stool testing could help us be more efficient with our patient care resources.

Adolescent↗
PubMed1978

Schizophrenic and medical inpatients as informed drug consumers.

Twenty-five schizophrenic inpatients receiving antipsychotic medications were evaluated as informed and/or consenting drug consumers by means of a structured interview, in comparison with a matched group of medical inpatients receiving nonpsychotropic drugs. Medical patients were better informed about positive aspects of medication, such as name, dose, and relationship of drug treatment to a specific diagnosis. Schizophrenic patients, however, were significantly better informed about both side effects and risks. Although both groups felt that their medication had helped them, 93% of the medical patients but only 56% of the schizophrenic patients said they would take the medication if they had the choice. The fact that schizophrenic inpatients readily shared their reluctance to take medication with an interviewer may offer an avenue for detection and intervention to improve prospects for outpatient compliance.

Adult↗
PubMed1998

Changing patterns of psychiatric inpatient care in the United States, 1988-1994.

Using data from the National Hospital Discharge Survey and the Inventory of Mental Health Organizations, this article examines national trends in psychiatric inpatient care from 1988 to 1994 in general hospitals and mental hospitals. We find that discharges with a primary diagnosis of mental illness in general hospitals increased from 1.4 to 1.9 million during this period. The total increase of 1.2 million days of care in general hospitals was small relative to the reduction of 12.5 million inpatient days in mental hospitals. General hospital discharges increased most in private nonprofit hospitals and declined substantially in public hospitals. Length of stay has fallen most substantially in private nonprofit hospitals. Public programs have increasingly replaced private insurance as the major source of payment. These observations suggest that psychiatric inpatient care in general hospitals can be characterized as a process in which patients who would have been clients of public mental hospitals in a prior period replace privately insured patients who, under managed care, are largely treated in community settings. Private nonprofit general hospitals increasingly treat publicly financed patients with more severe illnesses.

Episode of Care↗
PubMed1996

Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort.

OBJECTIVE: To determine the impact of tobacco- and alcohol-related deaths on overall mortality following inpatient treatment for alcoholism and other nonnicotine drugs of dependence. DESIGN: Population-based retrospective cohort study. SETTING: Olmsted County, Minnesota (the Rochester Epidemiology Project), and the Inpatient Addiction Program (IAP) at Mayo Clinic, Rochester. PATIENTS: All 845 Olmsted County residents admitted to an inpatient addiction program for treatment of alcoholism and other nonnicotine drugs of dependence during the period 1972 through 1983. METHODS: Patients were followed up through the medical record linkage system of the Rochester Epidemiology Project through December 1994 to obtain vital status, and death certificates were obtained for those who died. The underlying cause of death was classified as alcohol related, tobacco related, both, or neither based on the classification from the Centers for Disease Control and Prevention. The observed number of deaths by underlying cause were compared with the expected number using cause-specific 1987 death rates for the white population of the United States. All-cause mortality was also compared with that expected for persons in the West North Central Region of the United States of like age, sex, and year of birth. Univariate and multivariate assessments were made to identify predictors of all-cause mortality from baseline demographic information. RESULTS: At admission, the mean (SD) age of the 845 patients was 41.4 (14.5) years, and 35% were women. Altogether, 78% had alcohol as their only nonnicotine drug of dependence and 18% had alcohol and other nonnicotine drugs of dependence, while 4% were classified as having a nonalcohol, nonnicotine drug dependence alone. At admission, 75% were current and 8% former cigarette smokers, 3% were current cigar or pipe smokers, and 2% were current users of smokeless tobacco. Follow-up after the index IAP admission totaled 8913 person-years (mean [SD] of 10.5 [5.6] years per patient). Death certificates were obtained for 96% (214) of the 222 patients who died. Of these 214 deaths, 50.9% (109) had a tobacco-related and 34.1% (73) had an alcohol-related underlying cause (P<.001). The cumulative mortality significantly exceeded that expected (P<.001); at 20 years, the observed mortality was 48.1% vs an expected 18.5%. Multivariate predictors of mortality, even after adjusting for expected mortality, were older age at admission (P<.001) and male sex (P<.001). CONCLUSIONS: Patients previously treated for alcoholism and/or other nonnicotine drug dependence had an increased cumulative mortality that was due more to tobacco-related than to alcohol-related causes. Nicotine dependence treatment is imperative in such high-risk patients.

Adolescent↗
PubMed1997

A preliminary evaluation of treatment outcomes at a veterans' hospital's inpatient psychiatry unit.

This article describes a preliminary effort to evaluate inpatient psychiatric services at the Carl Vinson DVA Medical Center in Dublin, Georgia. The facility annually treats a large number of veterans for a variety of psychiatric disorders. To determine whether these veterans improved following care, a simple pretest-posttest group design was employed, using the SCL-90-R, to assess psychiatric symptomatology before and after inpatient treatment. Both statistically significant and practically meaningful improvements in symptomatology were evident at discharge. While the research design does not permit causal inferences, low-cost evaluations such as this one simply demonstrating that patients get better are important first steps in empirically determining the efficacy of inpatient psychiatric services, and represent one means of demonstrating accountable practice.

Adult↗
PubMed1998

The F(p) Infrequency-Psychopathology scale with chemically dependent inpatients.

This study examines characteristics of Arbisi and Ben-Porath's (1995) MMPI-2 Infrequency-Psychopathology scale, F(p), in a sample of individuals admitted for inpatient treatment of chemical dependency. The F(p) scale, designed to detect deviant response biases in settings characterized by high base rates of psychopathology, was found by Arbisi and Ben-Porath (1995) to have good construct and incremental validity with psychiatric inpatients. Comparisons of the F(p), Infrequency (F), and Infrequency-Back (Fb) scales' means and relationships to indices of psychopathology in the current study provide evidence supporting the F(p) scale's validity in populations of chemically dependent inpatients with and without concurrent psychiatric diagnoses.

Adult↗
PubMed1979

Psychological test comparison of day hospital an inpatient treatment.

Tested hypotheses, empirically generated from rating scales, which predicted that patients treated in partial, day hospital settings improve more in intellectual efficiency and social interaction than patients treated in full-time, inpatient settings. Thirty matched pairs of day hospital and inpatient volunteers were administered a group psychological test battery at the beginning of treatment and then 5 weeks later. The day hospital sample differed significantly on 7 of 24 pre- and posttest measures, the inpatient sample on 2. Gains occurred primarily in increased intellectual efficiency and social interaction. Multiple discriminant function analyses yielded no significant pretest differences, but posttest differences approached significance (p less than .06); day hospital patients registered increased Extraversion (Eysenck Personality Inventory).

Adult↗
PubMed1986

Emotion recognition in schizophrenic and depressed inpatients.

The performance of schizophrenic inpatients (N = 14), depressed inpatients (N = 15), and normal hospital employees (N = 15), all females, was compared on Izard's (1971) test of emotion recognition. Subjects were required to match photographs of facial expressions of emotion with the correct label for the emotion. The average numbers of errors of four types were examined: Positive or neutral emotions mislabelled as other positive or neutral emotions; positive or neutral emotions mislabelled as negative; negative emotions mislabelled as positive or neutral; and negative emotions mislabelled as other negative emotions. The principal findings were (1) the schizophrenics were less accurate than normals, but they were not less accurate than the depressives, nor were they less accurate on negative than positive or neutral emotions; (2) the depressives did not display any form of negative bias in emotion recognition; and (3) both groups of inpatients were less accurate than normals when they labelled an emotion as positive or neutral, but not when they labelled it as negative. Implications of the results for the etiology and maintenance of schizophrenia and depression were noted.

Adjustment Disorders↗
PubMed1993

Construct validity of a new computer-assisted cognitive neuromotor assessment battery in normal and inpatient psychiatric samples.

The construct validity of a computer-assisted battery of neuropsychological tests (CNT) was explored with psychiatric inpatients and normal volunteers. A principal components analysis of inpatient scores revealed simple reaction time, response accuracy, visuomotor skill, and complex processing and memory components. A similar factorial structure was found in normal subjects. However, complex processing and memory measures emerged as separate vigilance and memory components in volunteers. CNT tasks were correlated with nine subtests of the Neurobehavioral Cognitive Status Examination (NCSE). Simple reaction time, and complex processing and memory measures discriminated impaired from nonimpaired inpatients as defined by the NCSE. Recommendations for research on CNT, and computer-assisted tests in general, are made.

Adult↗
PubMed1981

The inpatient psychiatric unit as a system.

A university-affiliated psychiatric inpatient unit in a private general hospital is an organization which serves many purposes. However, the primary purpose is quite evident: to provide various psychiatric therapies to patients with diverse psychopathologies. This becomes extremely complicated if the unit attempts an eclectic approach. Thus, the unit must consider: (1) psychopathological frameworks such as genetic, sociocultural, psychoanalytic, behavioral, and biochemical etiologies; (2) therapeutic interventions such as individual, group, and family therapy; insight-oriented, supportive, and behavioral psychotherapy; milieu therapy; and psychopharmacological treatment; (3) the various philosophies, attitudes, and skills of the multidisciplinary team of psychiatrists, psychologists, nurses, aides, social workers, activities therapists, expressive therapists, and administrative support personnel. General systems theory and general living systems models may further the conceptualization and understanding of the inpatient unit. This, in turn, may improve patient treatment. For the inpatient psychiatric unit, we describe the 19 critical subsystems of general living systems theory, with special emphasis on the decider subsystem.

Hospital Bed Capacity, 300 to 499↗
PubMed1994

Mobile cardiac catheterization: comparison with outpatient and inpatient catheterization at tertiary facilities.

The study group included 1,553 consecutive patients from areas serviced by our mobile catheterization laboratories: 719 procedures were performed in the mobile unit at their local hospitals, 277 were performed at a tertiary hospital with less than a 24 hr hospital stay, and 557 were performed at a tertiary hospital as inpatients. The indications for mobile catheterization were predominantly atypical chest pain, angina pectoris, or positive treadmill stress test, whereas patients with less than 24 hr hospitalization at the tertiary center had their catheterization performed for additional reasons. The majority of the inpatient indications were for recent myocardial infarction or unstable angina. Using the American College of Cardiology/American Heart Association (ACC/AHA) criteria for outpatient catheterization, the mobile catheterizations were performed safely with a complication rate of only 0.7% compared to a complication rate of 3.1% for inpatients demonstrating that a low risk group of patients can be prospectively identified and catheterized safely in the mobile setting. An extremely high risk group of patients with ongoing unstable angina and recent myocardial infarction was also identified which should undergo catheterization only at a tertiary center.

Adult↗
PubMed2001

Recurrent falls are associated with increased length of stay in elderly psychiatric inpatients.

OBJECTIVES: To identify factors which may contribute to prolonged length of stay in an elderly psychiatric inpatient setting. DESIGN: Retrospective case note study. METHODS: A list of all patients over the age of 65 discharged from a private psychiatric hospital over a three-year period excluding those with a length of stay of over 365 days was obtained (n = 1147). A random sample of 150 patients was selected from the study population. A case note study was then performed looking at a number of variables which have been postulated to affect length of stay. The resulting data was analysed using multivariate statistics. RESULTS: There was no statistically significant association found between baseline factors (including age, gender, cognitive impairment, marital status, order of admission and preadmission living arrangement) and length of stay. Having recurrent falls whilst an inpatient was associated with prolonged hospital stay (p = 0.0006). CONCLUSION: Experiencing recurrent falls whilst an inpatient is associated with prolonged length of stay. Recurrent falls in the elderly may be associated with both physical illness and the use of psychotropic medications. A prospective study examining factors contributing to falls would be important in decreasing fall risk and reducing length of stay.

Accidental Falls↗
PubMed2002

Hyponatraemia in elderly psychiatric patients treated with Selective Serotonin Reuptake Inhibitors and venlafaxine: a retrospective controlled study in an inpatient unit.

OBJECTIVE: To determine the prevalence of hyponatraemia associated with selective serotonin reuptake inhibitor (SSRI) and venlafaxine use in elderly patients compared to that in elderly patients not prescribed these drugs, while controlling for age, sex, depression status and illnesses or prescribed medications also associated with hyponatraemia. Design and setting Retrospective controlled analysis in a 36-bed inpatient unit for elderly psychiatric patients in Melbourne. PATIENTS: Inpatients (199) with a mean age of 74.2 years of whom 74 were prescribed an SSRI or venlafaxine. RESULTS: Patients on SSRIs or venlafaxine were 5.6 times as likely as patients not so treated to have hyponatraemia. Thirty-nine percent of patients on an SSRI or venlafaxine had hyponatraemia compared with 10% of controls. Ten of the 14 patients on venlafaxine were hyponatraemic. Controlling for thiazide status did not reduce the odds of these patients having hyponatraemia and taking an SSRI or venlafaxine was still strongly associated with hyponatraemia after also controlling for age, sex, and depression status, consumption of other drugs potentially causative of hyponatraemia and medical illness severity (Odds Ratio (OR) 3.5, p = 0.008). CONCLUSIONS: SSRI and venlafaxine use is strongly associated with the presence of hyponatraemia in a population of elderly psychiatric inpatients and the association is not due to confounding by age, sex, depression status, medical illness severity or consumption of other drugs. Elderly patients on SSRIs or venlfaxine should have sodium levels checked before and after commencement of antidepressant treatment.

Aged↗
PubMed2002

Prevalence of dementia with Lewy bodies in an inpatient psychogeriatric population in Hong Kong Chinese.

OBJECTIVE: To find out the prevalence of dementia with Lewy bodies (DLB) in an inpatient psychogeriatric population in Hong Kong Chinese. METHOD: Clinical notes of all dementia patients admitted to an inpatient psychogeriatric unit between 1 January and 31 December 2000 were reviewed to retrieve information on various subtypes of dementia that have been diagnosed prospectively using NINCDS-ARDRA, NINDS-AIREN, CDLB and DSM-IV by qualified senior psychogeriatricians. RESULT: There were only three cases of dementia with Lewy bodies out of 102 dementia inpatients, giving a prevalence rate of 2.9% over a two-year period. CONCLUSION: The prevalence rate of dementia with Lewy bodies is remarkably lower than figures reported in western studies. Further evaluation using better sampling frame and better-validated diagnostic gold standard is required. Ethnically related biological factors may be implicated to explain the preliminary low prevalence rate in Chinese population.

Aged↗
PubMed2003

Oxygen and ventilator weaning during inpatient pediatric pulmonary rehabilitation.

Rates of oxygen and ventilator weaning, and factors related to successful weaning in inpatient pediatric pulmonary programs for infants and young children, have not been frequently reported in the literature. A retrospective review was conducted of 34 infants and toddlers with either a diagnostic condition of prematurity (PM) or congenital anomalies/neuromuscular disease (CA/NM) discharged from an inpatient pulmonary program. These cases represent 67 hospital admission-discharge episodes over a 6-year period. The rate of successful oxygen weaning (decrease to 0 hr per day) and ventilator weaning (decrease to <12 hr per day) and predictive factors related to successful ventilator weaning per admission-discharge episode were examined. Successful oxygen weaning was achieved during 24% and successful ventilator weaning was achieved during 30% of the admission-discharge episodes. No significant relationships were found between the selected demographic and clinical factors and oxygen weaning. Using a logistic regression model, the major variable associated with successful ventilator weaning per admission-discharge episode was diagnostic condition. Age at admission and the presence of comorbidities added slightly to the prediction model. The overall model yielded 86% accuracy for predicting a decrease in ventilator hours. However, projecting in which episodes children will not be weaned (negative predictive value = 88.9%) was more accurate than projecting in which episodes children will be weaned (positive predictive value = 73.3%). Although the program achieved a relatively low rate of successful ventilator weaning, children with a diagnostic condition of prematurity were more likely to be successfully weaned during inpatient pulmonary rehabilitation.

Bronchopulmonary Dysplasia↗
PubMed1991

Suicidal behavior among psychiatric inpatient children: an estimate of prevalence.

The prevalence of suicidal behavior among pre-adolescent child psychiatric inpatients has been estimated to range between 18 and 80 percent of the inpatient population. This study is a chart review of the documentation of suicidal behaviors displayed by 45 consecutive child psychiatric inpatient admissions. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 31 percent of the sample had recently engaged in some form of suicidal behavior and 9 percent had made a life-threatening attempt.

Adolescent↗
PubMed1996

Short-term child psychiatric inpatient treatment. Place of residence as one-year outcome measure.

In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in Finland were prospectively followed 12 months after discharge from short-term inpatient treatment. It turned out that 50 patients were discharged back to their previous residence and to outpatient treatment, 40 patients were admitted to long-term inpatient treatment and 10 patients were placed in some institution. The child's antisocial behaviour on admission was the strongest determinant for long-term treatment or placement at the 12 month follow-up. Other predictors of long-term treatment or placement in an institution included a high total score in teacher's behaviour ratings, being referred by a psychiatric agency and living in a semi-rural area. No statistically significant relationship was found in the child's age, gender, parents' education level or occupation, family characteristics, total life events, parent's ratings of total behaviour, total life events, parent's ratings of total behaviour, CGAS ratings by a clinician or a wide range of treatment variables.

Adolescent↗