scholarly journals Multi-center nationwide study on pediatric psychiatric inpatients 2000–2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

2021 ◽  
Author(s):  
Kim Kronström ◽  
Elina Tiiri ◽  
Miika Vuori ◽  
Heikki Ellilä ◽  
Anne Kaljonen ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Inpatient Treatment ◽  
Age Groups ◽  
Global Assessment Scale ◽  
Short Term Treatment ◽  
Continuous Increase ◽  
Nationwide Study ◽  
General Functioning ◽  
Functioning Level ◽  
Recurrent Hospitalization

AbstractInpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13–18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children’s Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13–18. In the 13–18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000–2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

scholarly journals Time trends in hospital discharges in patients aged 85 years and older in Spain: data from the Spanish National Discharge Database (2000–2015)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sergio Palacios-Fernandez ◽  
Mario Salcedo ◽  
Gregorio Gonzalez-Alcaide ◽  
Jose-Manuel Ramos-Rincon
Keyword(s):  
Length Of Stay ◽  
Hospital Admission ◽  
Age Groups ◽  
Percentage Increase ◽  
Very Elderly ◽  
Hospital Discharges ◽  
Data Set ◽  
Common Causes ◽  
Discharged Patients ◽  
Hospital Systems

Abstract Background The aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015. Methods Retrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends. Results There were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000–2003 and 10.42% in 2012–2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85–89 years, 7.79% in those aged 90–94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001). The proportion of patients that died during hospital admission decreased from 14.64% in 2000–2003 to 13.83% in 2012–2015 (p < 0.001), and mean length of stay from 9.98 days in 2000–2003 to 8.34 days in 2012–2015. Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%). Conclusions Discharges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge.

scholarly journals Dilated Cardiomyopathy in Children and Adolescents in the South Region of Kyrgyzstan

2021 ◽  
Vol 7 (11) ◽  
pp. 189-194
Keyword(s):  
Dilated Cardiomyopathy ◽  
Inpatient Treatment ◽  
Age Groups ◽  
Clinical Hospital ◽  
Progressive Heart Failure ◽  
Adaptive Mechanisms ◽  
Statistical Studies ◽  
Unclear Etiology ◽  
Severe Degree ◽  
Inflammatory Changes

Research relevance: in recent decades, there has been a significant increase in interest in cardiomyopathies, mainly of the heart muscle, often characterized by an unclear etiology, chronic progressive course and, ultimately, cardiomegaly, progressive heart failure, arrhythmic, thromboembolic syndromes, often ending in sudden cardiac death. Materials and research methods: presentation of results after statistical studies on the clinic, diagnostics of a violation of the conducting system by cardiomyopathy in children aged 1 to 16 years, who underwent inpatient treatment in the cardioreumatology department of the Osh medical children’s clinical hospital from 2016 to 2020, according to clinical material on 67 children with dilated cardiomyopathy. Research objectives: analysis of data on 67 children from 0 to 16 years old who received inpatient treatment for heart disease at the Osh interregional children's clinical hospital from 2016 to 2020. Research results: analysis of the EchoCG data of the study showed that the nature of changes in intracardiac hemodynamics depends on the age of the child: the most pronounced shifts in EchoCG indicators, as a rule, are inherent in young children with inflammatory changes in the myocardium and dilated cardiomyopathy, less pronounced for children of other age groups. Conclusions: indicators reflect severe degree of heart damage in children of this age and indicate, most likely, a weak level of heart compensatory-adaptive mechanisms.

Abstract 141: Trends in Left Ventricle Assist Device Use, Outcomes and Costs among Medicare Beneficiaries, 1999 to 2008.

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Julianna F Lampropulos ◽  
Yun Wang ◽  
Mayur Desai ◽  
Nancy Kim ◽  
Jose A Barreto-Filho ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Left Ventricle ◽  
Hospital Mortality ◽  
Age Groups ◽  
Fee For Service ◽  
Technological Advancement ◽  
Medicare Beneficiaries ◽  
Assist Device ◽  
One Year ◽  
Ventricle Assist Device

Background: Over the last decade, left ventricle assist device (LVAD) technology has improved substantially, resulting in smaller devices requiring less invasive procedures, which has broadened its clinical indications to frail populations. During this time of technological advancement, we examined trends in use, mortality, and associated costs of LVADs among Medicare beneficiaries. Methods: Inpatient Medicare standard analytic files were used to identify 100% of fee-for-service (FFS) patients aged ≥65 years that received LVAD (ICD-9-CM codes 37.60, 37.62, 37.65, 37.66 and 37.68) from 1999 to 2008. We constructed a denominator file from Medicare administrative data to report operative rates per 1,000,000 beneficiary-years. Length of stay, hospital mortality, thirty-day and one-year mortality were ascertained through corresponding vital status files. Costs were defined as hospital payments made by Medicare. Results: Among Medicare FFS patients, the overall LVAD procedure rate increased from 13.8 per million beneficiary-years (365 procedures) in 1999 to 19.8 per million beneficiary-years (548 procedures) in 2008, a relative increase of 44 %. In addition, between 1999 and 2008 overall length of stay increased from 19.1 days to 23.8 days; hospital mortality decreased from 42.5% to 33.4%, 30-day mortality decreased from 38.9% to 30.7% and one-year mortality decreased from 54% to 47.1%. Total CMS payments for the hospitalizations in which LVADs were placed increased from $20,188,880 ($55,312/patient) in 1999 to $71,050,392 ($129,654/patient) in 2008. Over the study period, LVAD use increased in all age groups, most strikingly among the ≥75 years old, in whom incidence increased from 151 procedures in 1999 to 192 procedures in 2008, representing 35% of the LVAD implantation in the Medicare population in 2008. Conclusions: From 1999 to 2008, LVAD use increased substantially with a decrease in hospital, 30-day and one-year mortality.

scholarly journals Comedication and Polypharmacy With ADHD Medications in Adults: A Swedish Nationwide Study

2020 ◽  
pp. 108705472092372
Author(s):  
Le Zhang ◽  
Andreas Reif ◽  
Ebba Du Rietz ◽  
Tyra Lagerberg ◽  
Agnieszka Butwicka ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Alimentary Tract ◽  
Age Groups ◽  
Psychotropic Medications ◽  
Metabolic System ◽  
Nationwide Study ◽  
Objective Evidence ◽  
Potential Benefits ◽  
Adhd Medications ◽  
To Receive

Objective: Evidence regarding comedication among individuals with ADHD is lacking, especially in adults. This study investigated comedication and polypharmacy with ADHD medications in adults. Method: We identified adults dispensed with ADHD medications during 2013 in Sweden and matched them to controls. Logistic regression was used to calculate odds ratios (ORs) of receiving other medications. Results: Individuals receiving ADHD medications had higher risk of receiving any major classes of somatic medications (ORs ranged from 4.1, 95% confidence interval [CI] = [4.0, 4.3], to 7.4, 95% CI = [6.5, 8.5] across age groups). They were more likely to receive respiratory system, alimentary tract and metabolic system, and cardiovascular system medications. In addition, they had higher risk of receiving any other psychotropic medications. The proportion of polypharmacy with five or more medication classes increased from 10.1% to 60.4% from 18 to 64 years. Conclusion: Comedication was more common in adults receiving ADHD medications. Potential benefits and harms of comedication and polypharmacy require further research. (J. of Att. Dis. XXXX; XX[ X] XX-XX)

Use of self-report outcome measures in an acute inpatient CAMHS setting

2019 ◽  
Vol 25 (1) ◽  
pp. 174-188 ◽  
Author(s):  
Claire Helen Salmond
Keyword(s):  
Young People ◽  
Outcome Measures ◽  
Child Anxiety ◽  
Depression Scale ◽  
Self Report ◽  
Global Assessment Scale ◽  
Index Change ◽  
General Functioning ◽  
Inpatient Adolescent ◽  
Core Measures

Outcome measures are increasingly being used to index change in service users’ presentation. However, within Child and Adolescent Mental Health Services (CAMHS), these raise questions around what should be measured, who should be asked to rate outcome and what constitutes progress. This study sought to audit the value of two self-report measures within the inpatient adolescent setting. An admission sample of 67 young people completed the Revised Child Anxiety and Depression Scale (RCADS) and Young Person’s Clinical Outcomes in Routine Evaluation (YP CORE), with clinicians completing the Children’s Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). A follow-up dataset consisted of 20 young people who completed the measures on two occasions, with clinician ratings completed on admission and discharge. The RCADS and YP CORE measures showed discriminant and convergent reliability and appeared to index change in the current inpatient sample of adolescents. Self-report of symptoms and general functioning were closely related. There was little relationship between self-report and clinician ratings, emphasising the importance of collating self-report in addition to clinician ratings.

scholarly journals P077: The health inequalities among foreign patients visiting the emergency room with injury: a nationwide population-based study in South Korea, 2013-2015

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S84-S84
Author(s):  
S. Jung ◽  
H. Lim ◽  
J. Kwon ◽  
N. Kim ◽  
D. Seo
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Room ◽  
Health Inequalities ◽  
Personal Information ◽  
Age Groups ◽  
Population Based ◽  
Emergency Rooms ◽  
Wide Range ◽  
Region Length

Introduction: Foreign patients often do not receive appropriate treatment in the emergency room as compared to locals. This is due to various causes such as language, insurance, and cultural differences. The purpose of this study was to investigate whether there is a wide range of health inequalities among foreigners who visited the emergency room with injury and to find out what causes it. Methods: We analyzed clinical data from the National Emergency Department Information System(NEDIS) database, which visited the emergency room from January 1, 2013 to December 31, 2015, in all age groups. Foreigners are classified based on the personal information described in the NEDIS. We analyzed the number of injuries, serious cases(death, operation, ICU admission), length of stay in ER, and transfer ratio. Results: A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign patients. The incidence rate per 100,000 people per year was 2960.5 from locals and 1659.8 from foreigners. Serious outcomes were higher for foreigners than for locals(31.0% versus 23.2%, p<0.001). There was a further difference in the rural region. Length of stay was longer for foreigners(72 versus 69 minutes, median, p<0.001). The transfer rate was also higher for foreigners(1.9% versus 1.6%, p<0.001). Daegu had the highest ratio of foreigners’ injury compared to locals(ratio=0.998). Jeonnam(0.073) was the highest serious outcome rate in Korea, and Jeonbuk(0.070) was the second. The area with the longest length of stay in the Emergency department was the median 139 minutes for locals and 153 minutes for foreigners in Daegu. The more patients per day, the shorter the time spent in the emergency rooms(Spearman correlation coefficient=-0.388). This phenomenon was more prominent in locals(-0.624 versus -0.175). Multivariable logistic regression was used as a dependent variable for the serious outcomes of foreign patients. The foreign patients(OR=1.413, p<0.001), intention, no insurance, age, sex, urban area, low blood pressure, decreased consciousness, transfer, acuity, and length of stay were statistically significant. Conclusion: This study showed that there is a health inequality for foreigners who came to the emergency room due to injury in Korea. Also, serious outcomes from injury in foreigners have been shown to be related to various causes including factors of the foreigner.

EMDR Integrated With Relationship Therapies for Complex Traumatized Children: An Evaluation and Two Case Studies

2017 ◽  
Vol 11 (2) ◽  
pp. 74-83 ◽  
Author(s):  
Annika Lichtenstein ◽  
Signe Brager
Keyword(s):  
Case Studies ◽  
Complex Trauma ◽  
Case Series ◽  
Well Being ◽  
Trauma Symptoms ◽  
Global Assessment Scale ◽  
Global Functioning ◽  
Traumatized Children ◽  
General Functioning ◽  
Relationship Therapy

This case series investigated the value of integrating eye movement desensitization and reprocessing (EMDR) and relationship therapies for children with histories of complex trauma. The purpose was to evaluate if treatment was associated with well-being, general functioning, and trauma symptoms. Participants were children (n = 15, boys = 7 and girls = 8), aged 6–18 years, who had been exposed to several different kinds of severe traumatic events. Standardized questionnaires were used before and after treatment. The Strengths and Difficulties Questionnaire (SDQ) measured well-being, the Children’s Global Assessment Scale (C-GAS) rated general functioning, and the Trauma Symptom Checklist for Children (TSCC) assessed trauma-related symptoms. After treatment, children presented with significantly less trauma symptoms and a higher degree of general global functioning. Two case studies are included to illustrate how relationship therapy was integrated into treatment. Our results indicate that integrating EMDR and relationship therapy should continue to be offered to complex traumatized children. More research is needed to examine the specific effectiveness of the two treatments.This case series investigated the value of treatment integrating EMDR and relationship therapies for children with histories of complex trauma. Results of a case series with fifteen consecutive participants and two case studies are provided.

Health in hostels: a survey of hostel dwelling women

1997 ◽  
Vol 21 (10) ◽  
pp. 618-621 ◽  
Author(s):  
Sarah V. L. Marriott ◽  
Richard H. Harvey ◽  
Deirdre Bonner
Keyword(s):  
Mental Illness ◽  
Social History ◽  
Substance Misuse ◽  
General Health Questionnaire ◽  
Age Groups ◽  
Direct Access ◽  
Service Needs ◽  
Global Assessment Scale ◽  
Younger Women ◽  
Dependent Variables

Direct access residents in an inner London homeless women's hostel were interviewed and asked to provide information on medical, personal and social history. For each a DSM–III–R diagnosis, General Health Questionnaire, CAGE and Global Assessment Scale score was assigned, and their views on future housing were sought. The effect of severe mental illness (SMI) and age on dependent variables was examined. A third of the sample (n=14) suffered from SMI, and a further quarter from other mental illness (n=10). A quarter had a DSM–III–R substance misuse disorder. The prevalence of SMI was similar across age groups. Younger women had a different pattern of service needs, with greater levels of psychological distress, substance misuse and residential instability, than older residents.

scholarly journals Clinical Practice Associated with a Switch from and to Ziprasidone during Routine Inpatient Treatment of Patients with Schizophrenia

2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Matthias J. Müller
Keyword(s):  
Body Mass Index ◽  
Clinical Practice ◽  
Weight Gain ◽  
Side Effects ◽  
Length Of Stay ◽  
Inpatient Treatment ◽  
Controlled Trials ◽  
Positive Symptoms ◽  
Naturalistic Study ◽  
Clinical Reality

Ziprasidone (ZIP) shows a low propensity for metabolic side effects but can prolong QTc time. It is unclear how these features translate into clinical reality. Charts of inpatients with schizophrenia and switched from (ZIP−,n=27) or to ZIP (ZIP+,n=24) were reviewed. Clinical data including documented switch reasons were anonymously analyzed. Comorbidity, body mass index (BMI) at admission, illness severity, side effects, illness duration, and length of stay were comparable in both groups. About 2/3 ofZIP+were women (1/3 ofZIP−,P=0.035);ZIP+patients were younger (P=0.017), had higher BMI values (P=0.042), and received higher chlorpromazine equivalents before switch (P=0.004) whereas ZIP doses were comparable (136 versus 141 mg/d). More patients inZIP−versusZIP+were switched because of previous weight gain (P=0.006) and depression (P=0.085) whereas single reasons forZIP−versusZIP+were mainly persisting positive symptoms (P=0.089) and patients' choice (P=0.10). The results of the naturalistic study corroborate controlled trials.

Sign in / Sign up

Export Citation Format

Share Document