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PubMed2003

Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients.

Neuroleptic malignant syndrome (NMS) is a potentially lethal antipsychotic drug (APD)-induced thermoregulatory disturbance. We hypothesized that several precautionary measures taken after administeration of APDs might prevent progression to definite NMS. The study group included 657 consecutively admitted drug-free schizophrenia inpatients who received various typical APDs for 28 days. Specific predefined precautionary measures were employed for this group. The comparison group (n=192) consisted of typical APD-treated schizophrenia inpatients in whom such precautionary measures were not imposed. The study group exhibited a significantly lower incidence of definite NMS (1/657=0.2% versus 4/192=2.1%; P=0.01, odds ratio=13.96; 95% confidence interval 1.55-125.63). Antipsychotics were discontinued in 28 patients (28/657=4.3%) from the study group due to NMS (n=1) or early detection of potential NMS-related signs (probable abortive NMS) (n=27). Our findings suggest that specific precautionary measures can effectively reduce the incidence of definite NMS by approximately one order in newly medicated schizophrenia inpatients.

Adult↗
PubMedDate not supplied

Comparison of inpatient and outpatient traction in developmental dislocation of the hip.

We studied 83 hips in 72 children being treated for developmental hip dislocation to assess the influence of home traction upon the incidence and severity of avascular necrosis (AVN). We compared two types of traction prior to closed or open reduction: inpatient Bryant's skin traction (40 hips), and outpatient (home) Bryant's skin traction (43 hips). No routine in-traction radiographs were taken in either group. After traction, a stable closed reduction was achieved in 55 hips (66%). Open reduction was performed on 28 hips (34%). The rate of severe AVN involving growth disturbance and resultant deformity (Bucholz types II, III, and IV) was low in both traction groups (inpatient, three out of 40, outpatient, one out of 43). These results demonstrate that an outpatient traction program without attention to radiographic hip station is as safe as identically instituted inpatient programs, as well as those that emphasize achievement of a traction reduction or a predetermined hip station.

Ambulatory Care↗
PubMed2005

Milk-alkali syndrome is a major cause of hypercalcaemia among non-end-stage renal disease (non-ESRD) inpatients.

OBJECTIVE: Milk-alkali syndrome, once a common cause of hypercalcaemia, is now considered rare. Our aim was to estimate the prevalence of milk-alkali syndrome among hypercalcaemic, non-end-stage renal disease (non-ESRD) inpatients of a University Hospital and identify patients' and syndrome characteristics. DESIGN AND PATIENTS: In this retrospective chart review study, we identified patients hospitalized with possible hypercalcaemia between November 1998 and October 2003 by a computer search of admission, discharge and consultation diagnoses. Patients with renal transplantation, stage 5 chronic kidney disease (CKD-5) and those admitted for parathyroidectomy were excluded. The remaining patients' charts were reviewed for confirmation of hypercalcaemia and identification of the cause. In patients with milk-alkali syndrome, additional historical, clinical, laboratory and imaging data were collected. RESULTS: We identified 125 patients with hypercalcaemia, 11 (8.8%) of whom had milk-alkali syndrome, 42 (33.6%) had malignancy and 37 (29.6%) hyperparathyroidism. Thirty-five patients had severe hypercalcaemia, defined as corrected serum calcium 3.5 mmol/l. Malignancy accounted for 13 of those patients (37.1%) and milk-alkali for nine (25.7%). Conditions prevalent among the milk-alkali inpatients were female gender, hypertension, chronic kidney disease, osteoporosis, upper gastrointestinal diseases, diuretic treatment and vitamin D derivative supplementation. Five of the patients with milk-alkali syndrome were treated with bisphosphonates and all five developed hypocalcaemia, compared to one of the five who received conventional treatment (P = 0.047). CONCLUSION: Milk-alkali was the third leading cause of hypercalcaemia of any degree and the second cause of severe hypercalcaemia among inpatients without ESRD. In milk-alkali syndrome, treatment with bisphosphonates contributes to post-treatment hypocalcaemia.

Adult↗
PubMed2005

The Newcastle Satisfaction with Nursing Scales: a valid measure of maternal satisfaction with inpatient postpartum nursing care.

AIM: To test the validity of The Newcastle Satisfaction with Nursing Scales as measures of patient satisfaction with nursing care in an inpatient postpartum unit. BACKGROUND: The Newcastle Satisfaction with Nursing Scales (Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale) were developed to measure the satisfaction of medical-surgical inpatients with nursing care. METHODS: The Newcastle Satisfaction with Nursing Scales were administered by interviewers to 189 postpartum women prior to hospital discharge. We tested the construct validity of the scales by making five a priori predictions: mothers who were more satisfied would be more likely to have one nurse caring for them and to recommend the postpartum unit to a friend. We also predicted that the Experience of Nursing Care and Satisfaction with Nursing Care Scales would be positively correlated with each other, with a global question about satisfaction with nursing care, and with a global question about satisfaction with overall postpartum stay. RESULTS: Four of the five a priori predictions were supported by the data. The mean Newcastle Satisfaction with Nursing Scale scores of mothers who would recommend the unit to a friend were higher (more satisfied) than those who would not (P < 0.001). The Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale were positively and significantly correlated with each other (r = 0.9, P < 0.001). There was a positive and significant correlation between the scales and global ratings of nursing care (Experience Scale r = 0.79, P < 0.001; Satisfaction Scale r = 0.82, P < 0.001) and overall postpartum stay (Experience Scale r = 0.64, P < 0.001; Satisfaction Scale r = 0.68, P < 0.001). CONCLUSION: The Newcastle Satisfaction with Nursing Scales are valid measures of maternal satisfaction with inpatient postpartum nursing care.

Adolescent↗
PubMed2006

Patient satisfaction with psychiatric inpatient care.

AIM: This paper reports a study of psychiatric inpatient satisfaction with care in one Finnish psychiatric hospital, and explores the factors associated with satisfaction. BACKGROUND: Patient satisfaction is a central indicator for healthcare quality. Previous literature has shown that psychiatric inpatients are quite satisfied with their care in general, but have reported dissatisfaction in the areas of information access and compulsory care. Changes in the structure of Finnish mental health services due to dehospitalization have increased interest in exploring psychiatric patients' treatment experiences and general satisfaction. METHOD: Data were collected in inpatient settings using a self-rating patient satisfaction questionnaire. A total of 316 patients leaving the study units during a 1-year period (May 2000-April 2001) was recruited. The response rate was 61% (n = 313). FINDINGS: In general, patients were quite satisfied with their care. Of seven different satisfaction areas, they were most satisfied with staff-patient relationships, and reported most dissatisfaction in the areas of information, restrictions, compulsory care and ward atmosphere/physical milieu. Younger and female patients were less satisfied with staff-patient relationships than older patients and men. manova (five factors, main effects and two-way interactions in the model) showed that male patients with occasional symptoms or symptoms persisting for less than a month were more satisfied with staff than were women. Further, when symptoms persisted for a month or up to 1 year or more, women were more satisfied with staff than men. CONCLUSION: General patient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be paid to collaboration with young adults (18-24 years) and female patients with mental health problems of short duration.

Adolescent↗
PubMed2004

Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units?

BACKGROUND: When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services. METHOD: All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area. RESULTS: Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out-of-area residential placement. CONCLUSIONS: Specialist units are an effective care option for this group of people.

Adult↗
PubMed2005

Best practice from admission to discharge in acute inpatient care: considerations and standards from a whole system perspective.

Best practice from admission to discharge in acute inpatient care: considerations and standards from a whole system perspective Effective mental health care and promotion involves numerous agencies and individuals. Hence, practice development for people with acute mental health needs requires a systemic (or whole system) perspective. Whilst a policy imperative, this is unfamiliar practice for many health and social care workers. In a previous paper published within this journal, the authors argued that admission to acute inpatient care may sometimes be occasioned by the need to contain worker anxiety within the whole system, rather than being clinically justified or necessary. In this paper the authors seek to follow up this premise with proposals for purposeful admission and standards to assure the quality throughout the patient journey, into and out of acute inpatient wards.

Hospitalization↗
PubMed2005

Smoking in a forensic psychiatric service: a survey of inpatients' views.

Smoking in a forensic psychiatric service: a survey of inpatients' views Very little is known concerning the views and beliefs of psychiatric inpatients about smoking in hospital. We conducted a survey of inpatients from the forensic wards of a large independent psychiatric hospital using a structured interview to collect data about their views on smoking. Of 102 patients eligible to participate, 45 (44.1%) agreed to do so. Most participants (34, 75.6%) were current smokers. Most smokers thought it was just too difficult to give up smoking (25, 73.5%). They cited seeing staff and other patients smoking, as well as the smoky atmosphere on the ward, as barriers to quitting. The majority of participants (35, 77.8%) thought that staff should be allowed to smoke with patients. Smokers held more liberal views about smoking than non-smokers. A smaller proportion of non-smokers than smokers were happy with the hospital smoking policy, as reflected in the ward rules about smoking. The results of this survey suggest that a change in attitude and culture towards smoking may be needed in psychiatric units. Smokers should be regularly offered help and encouragement to quit. Psychiatric care staff should carefully consider whether their own smoking behaviour undermines their patients' attempts to stop smoking. More attention should be given to the views and needs of non-smokers.

Adult↗
PubMed2007

Comparison of inpatient bed rest and home convalescence following split thickness skin grafting to the lower leg.

There has been a substantial move towards care of patients in an outpatient setting. This study was performed to determine if discharge home following split thickness skin grafting to the lower leg compromised graft results or morbidity compared with admission to hospital. Cases were reviewed retrospectively from the dermatology department's surgical records. All split thickness skin grafts to the lower legs over a 12-month period were included. All clinical notes were reviewed and phone calls made to patients and relatives. A total of 61 cases were included: 31 admitted as inpatients, 30 discharged home. There was no significant difference between the two groups' age, sex or comorbidities. A trend was seen in inpatients towards increased infection (P = 0.19) and venous thrombosis (P = 0.34). There is a lack of significant difference between admitted and discharged patients in all outcomes including bleeding, number of dressing clinic follow ups and graft loss. These results suggest that home convalescence after split thickness skin grafting to the lower legs compares favourably with inpatient care.

Aged↗
PubMed2005

The role of the registered nurse in an acute mental health inpatient setting in New Zealand: perceptions versus reality.

Following the closure of the large psychiatric institutions in New Zealand, there is an increasing demand for limited beds in acute inpatient facilities for acutely mentally ill patients. This change in location and downsizing of acute inpatient beds has challenged traditional roles of mental health nursing, resulting in confusion over what roles mental health nurses should now perform in the new context of care. This study compared the perceptions that registered psychiatric nurses have of their roles with their actual practice. This qualitative descriptive exploratory study observed nursing practice on three selected wards and used focus group interviews to establish from registered nurses what they perceived their roles to be. A key finding of this study was that many of the nursing roles related to delivering care from a crisis management perspective, which covers aspects such as assessment, stabilization of symptoms and discharge planning. Participants also believed that the therapeutic relationship was a fundamental role in inpatient care. Nurses used any opportunity to make it a reality such as kitchen organization, medications, or dealing with a challenging patient. This study highlighted the complexity of the roles that nurses performed and went some way to give voice to what at times seems an invisible practice.

Acute Disease↗
PubMed2006

Lifetime posttraumatic stress disorder in Turkish alcohol-dependent inpatients: relationship with depression, anxiety and erectile dysfunction.

The aim of the present study was to evaluate the prevalence of lifetime posttraumatic stress disorder (PTSD) in Turkish male alcohol-dependent inpatients, and to investigate the relationship of lifetime PTSD diagnosis with anxiety, depression, hopelessness, erectile dysfunction and psychosocial problems related with alcohol dependency. Eighty-two male inpatients who met DSM-IV criteria for alcohol dependence and 48 subjects without substance use disorder as a control group were included in the study. Subjects were applied the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Michigan Alcoholism Screening Test (MAST), the Beck Hopelessness Scale (BHS) and the International Index of Erectile Function (IIEF). Rate of lifetime PTSD diagnosis was found to be 26.8% among alcohol-dependent inpatients. The mean age of patients with lifetime PTSD was lower than in patients without this diagnosis, while there were no significant differences between these two groups in terms of age of first alcohol use, lifetime major depression, current depression, presence and severity of erectile dysfunction. Mean scores of HAM-D, HAM-A, BHS and MAST in the group with lifetime PTSD were significantly higher than the group without this diagnosis. There was a positive relationship between lifetime PTSD diagnosis and depression, anxiety, hopelessness and severity of psychosocial problems related to alcohol dependency, while there was no relationship between lifetime PTSD comorbidity and erectile dysfunction in alcohol-dependent patients.

Adult↗
PubMed2006

Guiding the transition of nursing practise from an inpatient to a community-care setting: a Saudi Arabian experience.

The purpose of this paper is to provide an overview of the Transitional Practise Model, which was used as the educational learning program to guide the transition of two Saudi nurses from an acute inpatient environment into a community setting. This model was informed by Benner's "novice to expert" concept and is grounded in experiential learning and critical thinking. The aim was to enhance knowledge and skills by providing opportunities for learning in order to make an effective transition from an acute inpatient environment into community nursing. The model was effective in guiding and bridging the gap for nurses to undertake a transition from a hospital inpatient environment into a community setting. The use of preceptors was invaluable in providing an understanding of the nature of professional practise through learning opportunities, mentoring, and support.

Attitude of Health Personnel↗
PubMed2006

Serious untoward incidents and their aftermath in acute inpatient psychiatry: the Tompkins Acute Ward study.

Serious untoward incidents, or sentinel events (suicide, homicide, suicide attempt, serious assault, and absconding of high-risk patients) occur from time to time in association with acute psychiatric inpatient wards. The aim of this study was to discover the impact of serious untoward incidents on inpatient wards. Doctors, nurses, and occupational therapists at three hospitals were interviewed about these events and their impact on their wards. Staff reported feelings of shock, depression, demoralization, upset, loss, and grief, followed by ruminations, guilt, and anxiety. Levels of containment increased, as did the focus on risk assessment. Processing of the emotional impact was hindered by the pace of ward life, a lack of external support, and management investigations. Patient responses were largely ignored. A few staff responded negatively, hindering service improvements. Much more attention needs to be given to the needs of the patient group following incidents. Substantial planning, organization, and investment are required to properly prepare for such events and manage their outcome. Without this planning and action, acute inpatient work has the capacity to be damaging to staff.

Acute Disease↗
PubMed2005

Medicare beneficiaries and the impact of gaining prescription drug coverage on inpatient and physician spending.

OBJECTIVE: To assess whether gaining prescription drug coverage produces cost offsets in Medicare spending on inpatient and physician services. DATA SOURCE: Two-year panels constructed from 1995 to 2000 Medicare Current Beneficiary Survey, a dataset of Medicare claims and health care surveys from the Medicare population. STUDY DESIGN: We estimated a series of fixed-effects panel models to calculate adjusted changes in Medicare spending as drug coverage was acquired (Gainers) relative to the spending of beneficiaries who never had drug coverage (Nevers). Explanatory variables in the model include age, calendar year, income, and health status. PRINCIPAL FINDINGS: Assessments of inpatient and physician services spending provided no evidence of overt selection behavior prior to the acquisition of drug coverage (i.e., there were no preswitch spikes in Medicare spending for Gainers). After enrollment, the medical spending of Gainers resembled those of beneficiaries who never had drug coverage. Overall, the multivariate models showed no systematic postenrollment changes in either inpatient or physician spending that could be attributed to the acquisition of drug coverage. CONCLUSIONS: We found no consistent evidence that drug coverage either increases or reduces spending for hospital and physician services. This does not necessarily mean that drug therapy does not substitute for or complement other medical treatments, but rather that neither effect predominates across the Medicare population as a whole.

Aged↗
PubMed1994

Case-management of AIDS clients as a predictor of total inpatient hospital days.

AIDS has shifted from an acute short-term terminal illness to a progressive, chronic disorder. Evaluation of AIDS case-management is imperative due to both the increasing numbers of cases and the lengthened survival of those with the disease. In 1988 the Missouri Department of Health (MDOH) initiated the first statewide system of AIDS case-management in the United States. This study was done to determine if deceased AIDS clients who received MDOH case-management services had fewer inpatient hospital days than clients who did not receive these services, during the last six months of life. Death certificates and Medicaid records were merged for 100 case-managed and 99 control, non-case-managed AIDS clients. No significant difference between groups was found in number of inpatient hospital days. Further, neither age, ethnicity, gender, cause of death, nor specific AIDS risk factors were associated with total number of inpatient hospital days. The client-centered philosophy of the program may have encouraged case managers to utilize all available service, including hospitalization, without considering cost-containment issues. Future evaluation efforts will investigate both cost-containment and quality-of-life indicators, such as satisfaction with care, of case-managed AIDS clients.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Physician views on caring for hospitalized patients and the hospitalist model of inpatient care.

We surveyed 241 board-certified internists affiliated with a large teaching hospital (Boston, Mass) before implementing a hospitalist service to determine attitudes towards providing inpatient care and the hospitalist model. Of physicians surveyed, 66% responded. Most disagreed that inpatient care is "an inefficient use of my time," only 10% felt a hospitalist service would improve patient satisfaction, and 54% felt it would hurt patient-doctor relationships. Multivariable analyses suggest that physicians physically furthest from their inpatient site were had more favorable attitudes toward the hospitalist model; more experienced and busier physicians were more negative. Future investigations should determine strategies for implementing the hospitalist model which address physicians' concerns.

Academic Medical Centers↗
PubMed2006

Effect of the inpatient general medicine rotation on student pursuit of a generalist career.

BACKGROUND: Entry into general internal medicine (GIM) has declined. The effect of the inpatient general medicine rotation on medical student career choices is uncertain. OBJECTIVE: To assess the effect of student satisfaction with the inpatient general medicine rotation on pursuit of a career in GIM. DESIGN: Multicenter cohort study. PARTICIPANTS: Third-year medical students between July 2001 and June 2003. MEASUREMENTS: End-of-internal medicine clerkship survey assessed satisfaction with the rotation using a 5-point Likert scale. Pursuit of a career in GIM defined as: (1) response of "Very Likely" or "Certain" to the question "How likely are you to pursue a career in GIM?"; and (2) entry into an internal medicine residency using institutional match data. RESULTS: Four hundred and two of 751 (54%) students responded. Of the student respondents, 307 (75%) matched in the 2 years following their rotations. Twenty-eight percent (87) of those that matched chose an internal medicine residency. Of these, 8% (25/307) were pursuing a career in GIM. Adjusting for site and preclerkship interest, overall satisfaction with the rotation predicted pursuit of a career in GIM (odds ratio [OR] 3.91, P<.001). Although satisfaction with individual items did not predict pursuit of a generalist career, factor analysis revealed 3 components of satisfaction (attending, resident, and teaching). Adjusting for preclerkship interest, 2 factors (attending and teaching) were associated with student pursuit of a career in GIM (P<.01). CONCLUSIONS: Increased satisfaction with the inpatient general medicine rotation promotes pursuit of a career in GIM.

Career Choice↗
PubMed1993

Inpatient community-based geriatric assessment reduces subsequent mortality.

OBJECTIVE: To evaluate the effect of an Inpatient Geriatric Consultation Team on patient outcome. DESIGN: Randomized controlled clinical trial. SETTING: A non-academic-affiliated 503-bed community hospital. PATIENTS: All inpatients over the age of 70 years. Sixty-two patients received multidimensional geriatric assessment, and 58 patients received no intervention. INTERVENTION: Team assessment, leading to formal recommendations to the attending physician. MEASUREMENTS: Data were collected on hospital length of stay, referrals to community service, discharge destination, hospital readmissions in 6 months, number of post-discharge physician visits, and change in functional status. Mortality at 6 months and at 1 year was determined for each patient. MAIN RESULTS: At 6 months, 12/58 patients (21%) had died in the control group versus 3/62 (6%) patients in the experimental group (P = 0.01). During hospitalization, the length-of-stay was 10.1 days for the control group versus 9.0 days for the experimental group (P = 0.20). The control group had significantly more readmissions (0.6 per patient vs 0.3 per patient, P = 0.02). A higher number of experimental patients, 22% (13/59), showed improvement in ADL scores compared with 7% (4/46) of control patients, P = 0.07. At one year for all randomized patients, 7/68 (10%) of experimental patients and 13/64 (20%) of control patients had died. CONCLUSIONS: Short-term mortality can be reduced in community inpatient acute hospital settings by comprehensive geriatric consultation teams. Important differences in mortality remain at 1 year of followup. Trends towards improved functional status and fewer hospital readmissions favor the intervention group.

Activities of Daily Living↗