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At least 19 recordsLinked to original sources

Provision of care for older people with co-morbid mental illness in general hospitals: general nurses' perceptions of their training needs.

INTRODUCTION: There are high levels of co-morbid mental illness amongst older people in general hospitals; this study explored the training needs of general nurses to care for this group. METHOD: Focus groups with general nurses were analysed using framework analysis. FINDINGS AND CONCLUSION: Nurses wanted training, but did not believe that training alone was sufficient to improve care, expressing that more integrated working between acute and mental health services was also needed. Liaison mental health services provide a way to deliver both training and a more integrated service.

Aged↗

[Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. 3. Current status of tuberculosis patient care in university hospitals and general hospitals in Japan].

A recent epidemiological survey has revealed that the incidence of Mycobacterium tuberculosis (TB) patients in Japan has just increased again after four decades of decline. In fact, recently there have been numerous reports of TB outbreaks in health-care facilities. Although our medical school hospital does not have TB isolation rooms, we have to take care of more than a few TB patients, most of whom have been transferred from primary care clinics. Although, some of these TB patients have highly infectious (sputum smear positive), most of them have not been diagnosed as having highly infectious TB, and therefore, some of their patients ultimately have to be retransferred to a TB hospital. This indicates that most physicians in primary care clinics have little knowledge about TB. This may be partly because of lack of training regarding TB during their medical student days and residencies. To elucidate current TB patient care status in university hospitals in Japan, a survey of physicians working in such hospitals was conducted from September 1997 to January 1998. The survey (questionnaire) revealed that the majority (76%) of these hospitals do not have TB isolation rooms. However, these hospitals have to take care of TB patients in their outpatient clinics and sometimes on their wards because the patients have serious complications that can not be treated in ordinary TB hospitals. The survey also showed that for this reason and from an educational point of view, the majority of the physicians (90%) working in these hospitals thought that university hospitals should have isolation rooms for such patients. Another questionnaire revealed that few physicians and nurses in university hospitals have sufficient experiences in taking care of TB patients. This situation may have been responsible for producing physicians with little knowledge about TB. Recent scientific advances have made it possible to construct TB isolation rooms in ordinary wards by means of separate ventilation systems. Although combatting TB requires a variety of strategies, appropriate education for both medical students and residents using isolation rooms in university hospitals may be an effective means of preventing spread of TB, and this approach may also increase awareness concerning the prevention of TB outbreaks in hospitals and health-care facilities.

Hospitals, General↗

Development of a screening questionnaire for the general hospital and general practices.

The purpose of this study was to develop a sensitive as well as brief screening questionnaire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test (MAST) in detecting patients with alcohol dependence or abuse in general hospitals and general practices. The number of items was reduced by means of logistic regression and item analysis based on data of 1,167 consecutive admissions of a general hospital who completed both questionnaires. Further data were derived from a sample of 774 patients from 10 randomly selected general practices. A solution with nine items was validated in a second sample of 436 hospital inpatients. In all three samples, cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-III-R or DSM-IV diagnosis. In addition, 103 subjects with negative screening results were interviewed in the second general hospital sample. On grounds of the data of all three samples, a solution of seven items was chosen. This instrument comprises two CAGE and five MAST questions (Leubeck Alcohol Dependence and Abuse Screening Test; LAST) and was significantly higher in sensitivity than CAGE and SMAST. Data were robust in all three samples. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice.

Adolescent↗

[Malaria. Experience at a general hospital].

General hospitals should not ignore tropical diseases, even if they are not directly concerned with them. In our area, 3 and 6 instances of malaria have been diagnosed per year, 13 cases having been observed during the last 3 years. Prognosis is related with the quickness in achieving the diagnosis after the onset of symptoms; in our series it ranged from 4 days and one month. The outcome was good in all cases. To keep a reasonable good suspicion level, it should be remembered that the latency period between the infection and the development of symptoms may be very long. In 4 patients, the symptoms began 6 or more months after the patient had returned from the endemic zone. Chemoprophylaxis does not prevent the development of the disease in all individuals, although it is an effective prophylactic measure. Eight of these 13 patients had not undergone chemoprophylaxis or it had been incorrect. There was a remarkably high rate of patients infected by Pl. falciparum strains with in vivo resistance to antimalarial agents (chloroquine and fansidar).

Animals↗

Characteristics of psychiatric discharges from nonfederal, short-term specialty hospitals and general hospitals with and without psychiatric and chemical dependency units: the Hospital Discharge Survey data.

Hospitalization for mental disorders (Major Diagnostic Categories 19 and 20) was examined using the 1980 Hospital Discharge Survey (HDS) data. We added to the HDS data by noting whether each hospital had a specialized psychiatric and/or chemical dependency unit, especially noting short-term specialty psychiatric and chemical dependency hospitals. Of the approximately 1.7 million episodes with MDC-19 and -20 diagnoses in the nation's nonfederal short-term hospitals in 1980, 13.5 percent were in specialty hospitals. Of the remaining general hospital episodes: 31 percent occurred in hospitals with only psychiatric units, 5 percent in hospitals with only chemical dependency units, 31 percent in hospitals with both types of specialized treatment units, and 33 percent in hospitals with neither type of unit. The last figure is much less than previously thought. The five hospital types may be arrayed on a continuum of resource utilization and severity of cases treated, with general hospitals with no special units at one end, specialty hospitals at the other, and general hospitals with psychiatric or chemical dependency units intermediate. Presence or absence of a chemical dependency unit influences a hospital's profile in this regard, particularly for MDC-20. Future studies should take into account the presence of a chemical dependency unit.

Adolescent↗

Specialty hospitals: can general hospitals compete?

The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of "fair" competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals provided information to help assess their potential effect on health care delivery. This issue brief discusses the research on specialty hospitals, including their payments under Medicare's hospital inpatient payment system, the quality and cost of care they deliver, their effect on general hospitals and on overall health care delivery, and the regulatory and legal environment in which they have proliferated. It concludes with open issues concerning physician self-referral and the role of general hospitals in providing a range of health care services.

Centers for Medicare and Medicaid Services, U.S.↗

Factors predictive of referral to psychiatric hospital among general hospital psychiatric consultations.

The aim of this paper was to explore the factors necessitating psychiatric hospital care in a Finnish multi-centre study of general hospital in-patients referred for psychiatric consultation. The study group consisted of 1251 patients referred to psychiatric hospital (n = 181) and a comparison group (n = 1070) consisting of subjects who were not referred. Differences between groups were studied by univariate analysis. Logistic regression analysis was used both to assess the factors contributing to referral to psychiatric hospital and to create predictive models. The validity of the models was analysed by means of receiver operating characteristic (ROC) curves in an independent sample. Psychiatric hospital care during the previous 5 years was associated with a 3.7-fold (odds ratio) increased risk of hospitalization. A diagnosis of psychosis was associated with a 2.9-fold increased risk, and attempted suicide as a reason for consultation was associated with a 2.1-fold increased risk. Not being married doubled the risk, and the odds ratio was also high in cases of poor psychosocial functioning (as assessed by Global Assessment of Functioning (GAF) score). The predictive model differentiated reasonably well between those patients who were hospitalized and the other patients. In conclusion, this multi-centre study of factors predictive of referral to psychiatric hospital among general hospital patients revealed that the most important determinants were previous psychiatric care, diagnosis of psychosis or severe depression, attempted suicide, being unmarried, and poor psychosocial functioning as assessed by GAF score.

Adult↗

From district general hospital to local general hospital.

Much debate has centred around the future of acute services in the NHS in the UK with particular reference to the role and function of the District General Hospital. This paper explores a new model of hospital development--the 'Local General Hospital' which lies somewhere between the DGH and the cottage or community hospital. The paper uses the case study of Neath General Hospital in South Wales which moved to a LGH model. The paper explores the functional content of the LGH balancing accessibility with cost and clinical effectiveness. The paper makes particular reference to the development of clinical networks which cross organisational boundaries and the support of GPs and consultant medical staff as key success factors in the transition from DGH to LGH.

Comprehensive Health Care↗

Mental hospital and general hospital psychiatric units: a comparison of services within the same geographic area.

A comparison was made between the characteristics of patients admitted to the only psychiatric hospital in Newfoundland, Canada, and those admitted to general hospital psychiatric units within the same area. Patients were compared on demographic characteristics, diagnosis, incidence of violence and suicidal attempts, treatment, length of stay and previous admissions. The results suggest that patients admitted to the mental hospital are more likely to be single, male, of lower socio-economic status and to suffer from more chronic conditions. There is also a higher incidence of violence among patients admitted to the mental hospital. These findings have implications for the types of changes that will be required in general hospital units if the role of mental hospitals continues to decline.

Delivery of Health Care↗

The perception of problem drinkers by general hospital staff, general practitioners and alcoholic patients.

A sample of 275 subjects (general hospital staff, general practitioners and alcoholic patients) was investigated regarding their perception of problem-drinkers. A set of semantic differential scales was used, and subjects were asked to evaluate the concepts of "problem drinker," "self" and "ideal self." Psychological distance was measured in terms of bipolar personality constructs between each of the above concepts. Significant differences were found between the groups in terms of concept evaluation and psychological distance. The implications of these findings for both research and treatment are discussed.

Alcoholism↗

Integration of general hospital psychiatric services with freestanding psychiatric hospitals.

General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.

Hospital Bed Capacity, 100 to 299↗