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PubMed2005

[Efficacy of inpatient rehabilitation for chronic back pain in Germany: update of a systematic review].

BACKGROUND: The ninth book of the German social code, SGB IX, has intensified questions on the effectiveness and usefulness of medical rehabilitation, a multimodal multidisciplinary team care model, especially but not exclusively for chronic back pain. In 2002 back pain was the reported leading cause for 29 % of all medical and other rehabilitative services provided by German statutory pension funds. A previous systematic review of all available German studies (January 1980 to June 2001) analysed the effectiveness of inpatient rehabilitation for chronic back pain. The present report provides an update and critical appraisal of the review. METHOD: Again we conducted a systematic search for relevant German studies from between July 2001 and December 2003 using electronic data bases, hand-searching of congress abstracts and postal questionnaires. The quality of relevant studies was assessed according to the recommendations of the Cochrane Back Review Group. For each study effect sizes for up to six central outcome parameters were calculated using pre-post comparisons from short and medium term follow-ups, they were correlated with prognostically relevant characteristics of the studies and samples. The combined weighted intra-group effect sizes were compared with results from international studies. RESULTS: 16 studies, both controlled and uncontrolled, were included. Again we could not identify any study confirming the effectiveness of medical rehabilitation in chronic back pain compared to no treatment or usual care. The methodological quality of the new studies did not seem to exceed that of the earlier ones. Depending on the outcome variable, small effects (e. g. on functional ability) to relevant effects (e. g. vitality) can be observed at or immediately after the end of rehabilitation. Now the effects after three to 12 months seem to be smaller than previously observed. DISCUSSION AND CONCLUSIONS: The small size of medium term effects indicates a basic problem of inpatient rehabilitation for chronic back pain in Germany. This becomes even greater when the results of international controlled studies are used as reference. Possible reasons for the disappointing situation (weak methodology, inappropriate selection of patients, weak intervention) are to be discussed. At present, we have no convincing evidence for a general effectiveness of Germany's system of inpatient rehabilitation for chronic back pain.

Controlled Clinical Trials as Topic↗
PubMed2005

[7-year-follow-up investigations of the geriatric psychiatric inpatient service in a separated care at a state hospital (obligatory service) and an integrated care at a university hospital in Goettingen, Germany -- I. Type of patients].

OBJECTIVE: 7 years after our first investigation we were interested in the stability versus (trends of) change in geriatric psychiatric inpatients while the structure of services was mainly unchanged. METHOD: We performed standardised chart reviews of randomly selected groups of geriatric psychiatric inpatients who had been treated in 1998 and 1999 in the Psychiatric University Hospital (PUK; n = 104) or the Psychiatric State Hospital (LKH; n = 100), which together treat all psychiatric inpatients in the region. With regard to age, the PUK provides integrated and the LKH separated care. RESULTS: Mean patients' age decreased. Compulsory admissions according to state laws decreased significantly. Specialist treatment before admission decreased. Premedication showed a dramatic decrease of antidementia drug treatment and a nearly unchanged high rate of prescriptions of antipsychotics and benzodiazepines. CONCLUSION: With a lower age and lower rate of specialist treatment we could not find signs of a better outpatient care preceding hospital admission during follow-up.

Aged↗
PubMed2006

[On the efficacy of acute psychiatric day-care treatment in a one-year-follow-up. A comparison to inpatient treatment within a randomised controlled trial].

OBJECTIVE: To compare the effectiveness of acute psychiatric day-hospital treatment and inpatient treatment with respect to a one-year follow-up. METHOD: Within a randomised controlled trial, patients and relatives were assessed at different levels of outcome three months and 12 months after patients' discharge using the Brief Psychiatric Rating Scale (24-Item-Version), the Manchester Assessment of Quality of Life (MANSA), the Groningen Social Disabilities Schedule (GSDS), the Berlin Inventory for the Assessment of Needs (BeBI), and the Involvement Evaluation Questionnaire (IEQ). Using estimation and test of contrasts in linear models of analysis of variance with structured covariance matrix, analyses conducted included data of all n = 191 patients having been included into the German centre of the study. RESULTS: With respect to all measures, day-hospital treatment proved to be at least as effective as inpatient care. CONCLUSION: The study supports earlier findings that showed no differences in long-term effectiveness of acute psychiatric day-hospital treatment as compared to inpatient treatment.

Acute Disease↗
PubMed2006

[Improvement of anxiety and depression in women with breast cancer during inpatient oncological rehabilitation-- results of a prospective study].

PURPOSE: Investigation of the influence of an oncological inpatient rehabilitation programme on anxiety and depression in women with breast cancer. PATIENTS AND METHOD: 198 women with breast cancer, aged 25 to 75 years, filled in the Hospital Anxiety and Depression Scale (HADS) German version at the beginning and end of inpatient rehabilitation. Focus was set on the frequency of anxiety and depression. Therefore proportions with 95 % confidence intervals (CI) were built. The before-after comparison of HADS-scores was made using the signed rank test with two-sided level of significance of alpha = 5 %. In addition effect sizes were calculated. Possible relations between the scores at the beginning of rehabilitation and the patients' age or the interval since diagnosis were analysed by calculating correlation coefficients. RESULTS: At the beginning of rehabilitation a state of anxiety was probable in 23.2 % (CI [17.3 %; 29.1 %] of the women and one of depression in 9.1 % (CI [5.8 %; 13.9 %]). In other words, they reached a level of >or= 11 score points on each scale. No correlation was found with the age of the patients or the time interval since diagnosis (|r| <or= 0.192). At the end of rehabilitation 67.5 % (CI [61.0 %; 74.0 %]) and 60.9 % (CI [54.1 %; 67.7 %]), respectively, of the women showed an improvement of anxiety and depression. The before-after difference was a median + 2 points (anxiety) and + 1 point (depression), resp., with a positive value representing an improvement. The changes after rehabilitation were statistically significant with p < 0.0001. The effect sizes ranged from 0.37 to 0.50. CONCLUSIONS: After the end of primary therapy, women with breast cancer frequently suffer from anxiety or depressive disorders, with no correlation to the patients' age or time since diagnosis. By an inpatient oncological rehabilitation programme both anxiety and depression can be improved very successfully. Whether these results represent a long-term effect is currently being evaluated in a randomised prospective study.

Adult↗
PubMed1999

The risk of acute suicidality in psychiatric inpatients increases with low plasma cholesterol.

Several studies suggest that the reduction of total cholesterol in blood by lipid-lowering agents is accompanied by a decrease in the incidence of coronary heart disease, but not in total mortality. Likewise, epidemiological studies show that low total cholesterol concentrations appear to be associated with an increased risk of death from suicide and injuries. There is little information with respect to acute suicidality and cholesterol in psychiatric inpatients; therefore the aim of the present study was to examine exactly this relation between plasma cholesterol and acute suicidality. The study comprised 45 acutely suicidal psychiatric inpatients, 95 nonsuicidal inpatients with affective disorder, and 20 healthy subjects. Psychopathological measures (Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, Beck's Suicide Intent Scale) were established in these patients as well as the plasma concentrations of cholesterol in patients and healthy subjects. The most important finding of this study is that the risk of acute suicidality decreases with increasing total cholesterol levels irrespective of age, gender, and nutritional status (i.e., body mass index). Comparison of total cholesterol levels between age- and sex-matched suicidal and nonsuicidal patients with affective disorder supports this observation: Despite the slightly higher body mass index, suicidal patients have significantly lower cholesterol levels than nonsuicidal patients. Our findings support the notion that acute suicidality is associated with low plasma cholesterol; this observation needs to be further studied in the context of a biological marker for suicide risk.

Adult↗
PubMedDate not supplied

Differences in skin flora between inpatients and chronically ill outpatients.

BACKGROUND: Changes in skin flora have been reported among hospitalized and critically ill patients, but little is known about whether these changes are associated with hospitalization or with chronic, serious illness. The purpose of this survey was to compare skin flora of chronically ill outpatients and inpatients. METHODS: Aerobic skin flora of forearm and midsternum of 250 patients in an intensive care unit and 251 outpatients was sampled by contact plates. RESULTS: Mean colony-forming units were 160.6, forearm; 229. 4, sternum (P <.000). In logistic regression analysis, patients in the medical intensive care unit were significantly more likely to have high counts on the arm (odds ratio, 2.48; 95% confidence interval: 1.34-4.43; P =.004), and blacks were significantly more likely to have higher counts on the sternum when compared with other ethnic groups (odds ratio, 1.92; confidence interval: 1.18-3.11; P =. 009). No differences were noted between inpatients or outpatients in prevalence of methicillin-sensitive Staphylococcus aureus, but inpatients were more likely to carry methicillin-resistant Staphylococcus aureus (arm, P =.007; sternum, P =.02). Outpatients had a higher prevalence of micrococci and gram-negative bacteria at both skin sites (all P <.01) and yeast at the sternal site (P =.007). CONCLUSIONS: This comparison provides data to differentiate between effects of hospitalization and effects of chronic illness on skin flora.

Aged↗
PubMed1987

Family functioning and suicidal behavior in psychiatric inpatients with major depression.

Family functioning was compared between suicide-attempting and nonsuicidal depressed inpatients in order to further understand psychosocial determinants of suicidal behavior. Suicidal behavior was strongly associated with a discrepancy between the patient's perception of his/her family and the perception held by other family members. Suicide-attempting depressed inpatients perceived their family functioning to be worse than did their families. Suicidal patients also viewed their families more negatively than did depressed nonsuicidal inpatients, who actually viewed their family functioning more positively than did their family members. The clinical implications of these findings are discussed.

Adolescent↗
PubMed1998

Recovery and rehabilitation following subarachnoid haemorrhage. Part I: Outcome after inpatient rehabilitation.

BACKGROUND AND PURPOSE: Although subarachnoid haemorrhage (SAH) is a subtype of stroke, functional outcome following rehabilitation for SAH must be considered distinct from that of cerebral infarction because of the younger age and the difference in pathology and resultant neurologic deficits. The purposes of this study were to: (1) describe the demographic and clinical characteristics of SAH patients receiving rehabilitation; (2) describe functional outcomes following inpatient rehabilitation; and (3) investigate possible relationships between patient characteristics and functional outcomes. METHODS: Retrospective chart review of SAH patients admitted to inpatient rehabilitation. Functional Outcomes rated by the Functional Independence Measures (FIM). Analysis with descriptive and nonparametric statistics. RESULTS: Eighty patients with SAH admitted to a rehabilitation unit with a mean age of 54 years. Fifty-seven had identified aneurysms as a cause of SAH. Seventy-four subjects (93%) presented with Hunt and Hess grades of 3-5. The median length of stay was 26 days in acute care and 49 days in rehabilitation. Seventy patients (88%) were discharged home. The mean admission FIM was 59.5 and mean discharge FIM 91.0. The FIM efficiency (aggregate change in FIM/day) was 0.62/day and the average rate of FIM gain 0.97 points/day. Hydrocephalus negatively influenced outcome (p = 0.05). There was a trend for subjects with worse Hunt and Hess scores at onset to have poorer discharge FIM scores. CONCLUSION: SAH patients receiving inpatient rehabilitation make functional gains, although the rate of gain is less than for TBI or stroke. These SAH patients represent a subgroup with more severe SAH at onset than the total population of SAH survivors. The presence of hydrocephalus negatively impacts on outcome. Further detailed study of functional and neuropsychological outcome in SAH survivors is needed.

Activities of Daily Living↗
PubMed1987

Oral rehydration salts and diarrhoeal diseases: effects of changing inpatient management in Tonga.

Methods of inpatient management of children with diarrhoeal diseases (DD) in 1978 and in 1980 were compared to assess the use of oral rehydration salts (ORS) and a national antidiarrhoeal programme (NAP). Inpatient notes of 369 children admitted with DD were reviewed. The management of DD differed significantly but the clinical outcome was similar, with the exception of the case-fatality rate. All deaths occurred within the first 24 h of admission, indicating that this difference was attributable to improved management of DD in the community rather than changes in the inpatient treatment regime.

Child↗
PubMedDate not supplied

Awareness of substance abuse problems among dually-diagnosed psychiatric inpatients.

This study examines the ability to acknowledge the need for treatment of mental illness and substance abuse problems among dually-diagnosed inpatients before and after an inpatient substance abuse treatment program. A cohort of 264 consecutively admitted patients diagnosed with a mental illness and substance use disorder were entered into a dual diagnosis treatment program. Perceptions of patients diagnosed with a substance-induced mental disorder were compared to those of patients with a primary mental illness regarding their problems and need for treatment before and after the dual diagnosis program. Most patients acknowledged a substance abuse or mental illness problem and need for treatment. Patients with substance-induced mental disorders were more likely to acknowledge a substance use problem and need for treatment (p < .001). After treatment, changes in perception of mental illness were greater for substance-induced mental disorder patients compared to patients with a primary mental illness (p < .001). Persons with more severe substance abuse were more likely to acknowledge a problem and need for treatment. The majority of dually-diagnosed patients admitted with a substance use disorder agreed that substance use was a problem, suggesting that inpatient hospitalization presents a prime opportunity to address addiction in dually-diagnosed patients. The type of mental illness and severity of substance use influenced perceptions of illnesses and treatment readiness and must be considered by the clinician.

Adolescent↗
PubMed2006

Antipsychotic treatment and extrapyramidal symptoms amongst schizophrenic inpatients.

Extrapyramidal symptoms (EPS) are seen in 50-75% of patients treated with typical antipsychotics and are a cause of treatment failure in at least 30% of the patients. Using atypical antipsychotics, the EPS incidence is lower, but a low-dosage strategy using typical antipsychotics is also known to cause fewer EPS. What conclusions can be drawn for the daily clinical practice? A naturalistic study including all schizophrenic inpatients in a psychiatric ward (n=123) analysed the effects of treatment concerning positive/negative symptoms, EPS, number of days to re-hospitalization and inpatient-days in the year after baseline admittance, using atypical and typical antipsychotics as recommended by the Danish Society of Psychiatry. The incidence of EPS was significantly higher in patients who were treated with typical antipsychotics in relation to atypical antipsychotics (46% vs. 12%, P<0.001). Patients with EPS had significantly more negative symptoms and a poorer level of function at discharge. Nevertheless, no difference regarding re-hospitalization and inpatient-days was found, whether the patient was treated with typical or atypical antipsychotics. However, it is important to underline that patients treated with atypical oral antipsychotic do as well as patients on typical depot antipsychotics.

Adult↗
PubMed2006

Prophylaxis of venous thromboembolism during early inpatient rehabilitation after acquired brain injury: how guidelines change management.

PURPOSE: To establish guidelines for prophylaxis of venous thromboembolism (VTE) in younger adults undergoing early inpatient rehabilitation following acquired brain injury (ABI). METHOD: A two-phase (phase 1: retrospective; phase 2: prospective) observational study was carried out involving patients admitted to an inpatient neurological rehabilitation unit during a 40-month period. In phase 1, VTE prophylaxis was prescribed on an ad hoc basis. In phase 2, prophylaxis was considered in accordance with guidelines agreed locally. The prescribing behaviour in each phase of the study was compared using a VTE risk stratification tool based on expert opinion and a review of the literature. RESULTS: Data were obtained on 94 patients in phase 1 and 23 patients in phase 2. During phase 1, the prophylactic prescribing behaviour of the referring hospitals and our unit after admission were similar ( p = 0.13). In phase 2, our prescribing behaviour had changed compared with that of the referring hospitals, with a significant increase in the proportion of patients on appropriate treatment ( p = 0.01) and a decrease in the numbers under-treated ( p = 0.002). We were also significantly less likely to under-treat ( p = 0.005) and more likely to over-treat ( p = 0.004) after admission during phase 2 compared with phase 1, whilst practice was variable in patients at moderate risk. CONCLUSIONS: Guidelines modify behaviour. They must stratify risk, particularly to avoid inconsistencies in the management of patients at moderate risk. There is a need to establish national guidelines for VTE prophylaxis during early inpatient rehabilitation after ABI; these guidelines should include a risk stratification tool.

Adolescent↗
PubMedDate not supplied

A retrospective study of weight changes and the contributing factors in short term adult psychiatric inpatients.

INTRODUCTION: The authors endeavored to determine if there is significant weight gain during acute psychiatric inpatient hospitalization for adults and, if so, what are the contributing factors. METHODS: A retrospective chart review was conducted of all patients admitted to the psychiatric inpatient unit of a University Hospital in the year 2001. The study was approved by the Institutional Review Board. RESULTS: Out of 535 charts reviewed, 96 patients met the inclusion criteria. The group on average gained 3.9 +/- 13.3 lbs. (P = 0.005; 95% CI = 1.2, 6.6). Lower admission body weight was associated with more weight gain. Patients with diagnoses of bipolar disorder and schizophrenia gained more compared to those diagnosed with major depressive disorder. Patients who were prescribed atypical antipsychotics gained more compared to those who were not prescribed such medications. Smokers gained more weight than nonsmokers, and males gained more than females. Weight at the time of the admission (inverse relationship) and Axis I diagnosis were the strongest predictors of weight gain. CONCLUSIONS: This study demonstrates that significant numbers of patients are at risk of gaining weight when they are admitted to a psychiatric inpatient unit. Patients with lesser degrees of overweight at the time of admission, patients with diagnoses of bipolar disorder and schizophrenia, and those receiving atypical antipsychotics may be more vulnerable to such effects.

Academic Medical Centers↗
PubMed2002

Outcomes of naltrexone maintenance following ultra rapid opiate detoxification versus intensive inpatient detoxification.

Relapse rates of 30 opiate-addicted social service clients who were given a 9-month course of naltrexone after being rapidly detoxified using naltrexone + clonidine under anesthesia were compared to 33 similar clients detoxified in a 30-day intensive inpatient detoxification but not given naltrexone. Both groups had the same counseling aftercare. Telephone follow-up of 26 of the intensive inpatient detoxification clients and 24 of the rapidly detoxified clients found no significant differences (p = .62) in relapse rates, with 34% of respondents returning to regular opiate use 13.4 (+/- 3.8) months after detoxification. Naltrexone maintenance and counseling following rapid detoxification may be as effective as intensive inpatient detoxification and counseling.

Adult↗
PubMedDate not supplied

Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients.

Spiritual interventions are rarely used in contemporary treatment programs and little empirical evidence is available concerning their effectiveness. The purpose of the present study was to evaluate the effectiveness of a spiritual group intervention for eating disorder inpatients. We compared the effectiveness of a Spirituality group with Cognitive and Emotional Support groups using a randomized, control group design. Participants were 122 women receiving inpatient eating disorder treatment. Patients in the Spirituality group tended to score significantly lower on psychological disturbance and eating disorder symptoms at the conclusion of treatment compared to patients in the other groups, and higher on spiritual well-being. On weekly outcome measures, patients in the Spirituality group improved significantly more quickly during the first four weeks of treatment. This study provides preliminary evidence that attending to eating disorder patients' spiritual growth and well-being during inpatient treatment may help reduce depression and anxiety, relationship distress, social role conflict, and eating disorder symptoms.

Adolescent↗
PubMed2004

Psychological predictors of admission and discharge global assessment of functioning scale scores for geropsychiatric inpatients.

This study examined psychological predictors of Global Assessment of Functioning Scale scores (GAF) at intake and at discharge for geropsychiatric inpatients. A total of 301 predominantly male geropsychiatric inpatients were recruited from the Houston Veterans Affairs Medical Center. Path analysis was used to test a model proposing causal paths of psychological predictors (cognitive status, depression, agitation, general psychiatric status) to GAF scores on admission and discharge. At admission, all four psychological predictors had positive paths to the admission GAF scale scores but at discharge, only two (i.e., cognitive status and general psychiatric status) of the four psychological predictors had positive paths to the discharge GAF scale scores. The admission GAF scale scores also had a positive path to the discharge GAF scale scores. The overall functioning level of geropsychiatric inpatients may be predicted by measures which assess overall cognitive status and general psychiatric functioning during hospitalization. Results prompt consideration of a modified global scale specifically reflecting an older adult's activities during this period of life.

Activities of Daily Living↗
PubMedDate not supplied

Re-admissions to inpatient paediatric pulmonary rehabilitation.

OBJECTIVE: To describe re-admission rates, identify reasons for re-admission and examine characteristics of children requiring re-admission to inpatient pulmonary rehabilitation. METHODOLOGY: Retrospective record review of infants and toddlers (less than three years of age) requiring oxygen or ventilator support discharged from an inpatient paediatric pulmonary rehabilitation programme between 1992 and 1999. RESULTS: Forty-one initial admissions resulted in 45 readmissions with a mean re-admission rate of 1.1 (SD = 1.41) re-admissions per child. Children with re-admissions (n = 22, 54%) required significantly more ventilator support (p = 0.001) and nursing care (p = 0.001) and were transferred to acute care more frequently (p = 0.002) than children without re-admissions. One-half of the children re-admitted to inpatient pulmonary rehabilitation were re-admitted two or more times. CONCLUSIONS: Based on this cohort of children, dependence on supplemental oxygen and/or mechanical ventilation and medical complexity may be indicators that children will require re-admission to rehabilitation following a transfer back to acute care. Further examination of re-admission rates and reasons and children's clinical characteristics may have predictive value and provide practice improvement opportunities.

Boston↗
PubMedDate not supplied

Social function changes in children and adolescents with acquired brain injury during inpatient rehabilitation.

OBJECTIVE: To examine changes in social function capabilities between and within groups of children with six subtypes of acquired brain injury during inpatient rehabilitation. MEASURE: The Pediatric Evaluation of Disability Inventory (PEDI) Social Functional Skills Scale was administered to 139 children with acquired brain injury (mean age=9.28 years; SD = 5.27). METHODS: Scaled summary score changes from hospital admission to discharge for the total group and six diagnostic sub-groups were calculated. One-way ANOVAs were performed for the total group and six sub-groups to determine between group differences in amount of change. Within-group changes were examined by paired t-tests, effect sizes and the proportion of children who made a clinically meaningful change (> or = 10 points). RESULTS: Children with traumatic brain injury demonstrated the greatest amount of change during inpatient rehabilitation, but only significantly greater than children with seizures. Scores were significantly higher at discharge for the total group (p < 0.001) and all sub-groups except for the anoxia group. Forty-five per cent of all children made clinically meaningful changes. CONCLUSIONS: Children with acquired brain injury made significant changes in social functioning from admission to discharge. Varying degrees of change existed for diagnostic sub-groups. Further research is needed to examine clinically meaningful changes and in which areas of social functioning children are changing during inpatient rehabilitation.

Adolescent↗