Outcomes of involuntary hospital admission. Satisfaction with treatment and the effect of involuntary admissions on patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S328-S329 ◽  
Author(s):  
T. Reshetukha ◽  
N. Alavi ◽  
E. Prost ◽  
D. Groll ◽  
R. Cardy ◽  
...  
Keyword(s):  
Mentally Ill ◽  
Psychiatric Ward ◽  
Involuntary Admission ◽  
Involuntary Hospitalization ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Satisfaction With Treatment ◽  
Competing Interest

IntroductionInvoluntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.MethodAll patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.ResultsAlthough psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.DiscussionThe results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Early Aneurysm Surgery and Preventive Therapy with Intravenously Administered Nimodipine: A Multicenter, Double-Blind, Dose-Comparison Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 458-464 ◽  
Author(s):  
Joachim M. Gilsbach ◽  
Hans J. Reulen ◽  
Bengt Ljunggren ◽  
Lennart Brandt ◽  
Hans v. Holst ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Neurological Dysfunction ◽  
Comparison Study ◽  
Double Blind ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Dose Comparison ◽  
Significant Difference ◽  
Low Incidence

Abstract A European, multicenter. prospective, randomized. double-blind, dose-comparison study on preventive therapy with intravenously administered nimodipine was performed to evaluate the efficacy and tolerability of two different doses: 2 and 3 mg/h. Two hundred four patients fulfilled the criteria for enrollment in the study; surgery within 72 hours after the last subarachnoid hemorrhage, and age between 16 and 72 years. All patients who had Hunt and Hess grades of I to III were operated upon: patients who had poor Hunt and Hess grades (IV-V) were operated on according to the surgeon's choice. This treatment regimen was associated with a low incidence of delayed neurological dysfunction with no significant difference between the two dosage groups: three patients (1.5%) remained severely disabled and two (1%) moderately disabled due to vasospasm with or without additional complications. Among the patients with Hunt and Hess grades of IV or V. the long-term outcome was favorable (good-fair) for 40% and unfavorable for 60%. Among the patients with grades of I to III, the long-term outcome was favorable for 89% and unfavorable for 11%.

scholarly journals Hypospadias: clinical approach, surgical technique and long-term outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pier Luca Ceccarelli ◽  
Laura Lucaccioni ◽  
Francesca Poluzzi ◽  
Anastasia Bianchini ◽  
Diego Biondini ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Surgical Repair ◽  
Adult Life ◽  
Clinical Approach ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Initial Surgery ◽  
Significant Difference ◽  
Corrective Procedures

Abstract Background Hypospadias is one of the most common congenital abnormalities in male newborn. There is no universal approach to hypospadias surgical repair, with more than 300 corrective procedures described in current literature. The reoperation rate within 6–12 months of the initial surgery is most frequently used as an outcome measure. These short-term outcomes may not reflect those encountered in adolescence and adult life. This study aims to identify the long-term cosmetic, functional and psychosexual outcomes. Methods Medical records of boys who had undergone surgical repair of hypospadias by a single surgical team led by the same surgeon at a single centre between August 2001 and December 2017 were reviewed. Families were contacted by telephone and invited to participate. Surgical outcome was assessed by combination of clinical examination, a life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5). Outcomes were compared according to age, severity of hypospadias, and respondent (child, parent and surgeon). Results 187 children and their families agreed to participate in the study. 46 patients (24.6%) presented at least one complication after the repair, with a median elapsed time of 11.5 months (6.5–22.5). Longitudinal differences in surgical corrective procedures (p < 0.01), clinical approach (p < 0.01), hospitalisation after surgery (p < 0.01) were found. Cosmetic data from the PPS were similar among children and parents, with no significant differences in child’s age or the type of hypospadias: 83% of children and 87% of parents were satisfied with the cosmetic result. A significant difference in functional outcome related to the type of hypospadias was reflected responses to HOSE amongst all groups of respondents: children (p < 0.001), parents (p=0.02) and surgeon (p < 0.01). The child’s HOSE total score was consistently lower than the surgeon (p < 0.01). The HOSE satisfaction rate on functional outcome was 89% for child and 92% for parent respondents. Conclusion Surgeons and clinicians should be cognizant of the long-term outcomes following hypospadias surgical repair and this should be reflected in a demand for a standardised approach to repair and follow-up.

Short and Long Term Outcome In Patients with Calcified Lesions Requiring Rotational Artherectomy

2021 ◽  
Vol 35 (2) ◽  
pp. 140-146
Author(s):  
Lima Asrin Sayami ◽  
Al Fazir Omar ◽  
Sheikh Ziarat Islam ◽  
Subasni Govindan ◽  
Zulaikha Zainal ◽  
...  
Keyword(s):  
P Value ◽  
Success Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Operator Experience ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Short And Long Term ◽  
Procedural Success

Objective: Despite the evolution of interventional techniques and operator experience, percutaneous revascularization of complex coronary lesions especially calcified lesions remains challenging because of lower procedural success and higher restenosis rates. Limited data are available on the effect of rotational atherectomy (RA) plus stenting in the treatment of complex calcified lesions of coronary artery disease. This study was aimed to investigate the characteristics, short and long term outcomes in patients undergoing RA. Material and Methods: A database search was performed from the year 2008 to 2013 in National Heart institute, Malaysia. A total of 16009 patients who underwent PCIs were enrolled in 2 groups, RA group (258 patients) and non RA group (15751 patients). The Chi square test and Kaplan - Meier analysis were used. Results: Male patients (73.6%) and elderly population (63.2%) were predominant in this study.The RA group had more co-morbidities such as diabetic on insulin (34%) and chronic kidney disease (57%). The lesions in RA group were more complex with higher Type C lesion (68.8%) and longer lesion (20.6%) compared to non RA group. Despite higher patient risk profile, the success rate of revascularization remains high in RA group (99.3%) as in non RA group (97%) (p value 0.89%). More importantly there were no significant difference in in-hospital mortality, myocardial infarction and stent thrombosis in both group (p value 0.1). In 1 year Kaplan - Meier survival graph, there were better survival noted in non RA group (97.7%) compare to RA (89.6%) (p value <0.005), Conclusion: The use of RA allows debulking of a calcified lesion and possibly explains the higher acute procedural success rates. However, the lower 1-yearsurvival in the RA group highlights the higher associated baseline comorbitidity in this group. Therefore, besides coronary intervention, this RA group requires aggressive medical therapy through a multi-disciplinary approach. Bangladesh Heart Journal 2020; 35(2) : 140-146

Long-Term Follow-Up Analysis of HD9601 Trial Comparing ABVD Versus Stanford V Versus MOPP/EBV/CAD in Patients With Newly Diagnosed Advanced-Stage Hodgkin's Lymphoma: A Study From the Intergruppo Italiano Linfomi

2011 ◽  
Vol 29 (32) ◽  
pp. 4227-4233 ◽  
Author(s):  
Teodoro Chisesi ◽  
Monica Bellei ◽  
Stefano Luminari ◽  
Antonella Montanini ◽  
Luigi Marcheselli ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Disease Free Survival ◽  
Hodgkin's Lymphoma ◽  
Advanced Stage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Free Survival ◽  
Significant Difference

Purpose The Intergruppo Italiano Linfomi HD9601 trial compared doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) versus doxorubicin, vinblastine, mechloretamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V [StV]) versus the combination of mechlorethamine, vincristine, procarbazine, prednisone (MOPP) with epidoxorubicin, bleomycin, vinblastine (EBV), lomustine, doxorubicin, and vindesine (CAD) (MOPP/EBV/CAD [MEC]) for the initial treatment of advanced-stage Hodgkin's lymphoma to select which regimen would best support a reduced radiotherapy program (limited to two or fewer sites of either previous bulky or partially remitting disease). Superiority of ABVD and MEC to StV was demonstrated. We report analysis of long-term outcome and toxicity. Patients and Methods Patients with stage IIB, III, or IV were randomly assigned among six cycles of ABVD, three cycles of StV, and six cycles of MEC; radiotherapy was administered in 76, 71, and 50 patients in the three arms, respectively. Results Currently, the median follow-up is 86 months; in the prolonged observation period, eight additional failures, including two relapses, both in the StV arm, and six additional deaths in complete response were recorded. The 10-year overall survival rates were 87%, 80%, and 78% for ABVD, MEC, and StV, respectively (P = .4). The 10-year failure-free survival was 75%, 74%, and 49% in the ABVD, MEC, and StV arms, respectively (P < .001). The 10-year disease-free survival of patients treated or not with radiotherapy (RT) showed no difference for ABVD or MEC (85% v 80% and 93% v 68%), and a statistically significant difference for StV (76% v 33%; P = .004). No significant long-term toxicity was recorded. Conclusion The long-term analysis confirmed ABVD and MEC superiority to StV. The use of RT after StV was established as mandatory. ABVD is still to be considered as the standard treatment with a good balance between efficacy and toxicity.

P2267CTEPH patients long term follow-up: results from a single center

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mladoniczky ◽  
M Szegedi ◽  
Z S Piroth ◽  
J Nemeth ◽  
L Ablonczy ◽  
...  
Keyword(s):  
Nyha Class ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Walking Distance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Post Surgery ◽  
Significant Difference ◽  
Long Term Follow Up

Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a thrombotic pulmonary disease associated with pulmonary vasculopathy. Pulmonary endarterectomy (opus, PEA) is the first treatment choice in CTEPH, and specific PAH medication when there is a contraindication for surgery or residual pulmonary arterial hypertension (rPAH) occurs. In the presence of PAH balloon pulmonary angioplasty (BPA) might be also recommended if available. Objective We investigated the long term outcome of our CTEPH patients. Methods CTEPH from our institution retrospectively analyzed (data between 2003 and 2018). Baseline, treatment and outcome data were documented. We compared the outcome, together with mortality in those with and without surgery (PEA vs. non PEA group). NYHA class, 6 minutes walking distance (6MWD) and NT-proBNP were also reported during follow-up. Results Of 29 CTEPH patients (mean age was 62±19 years, 52% male) 16 (55%) were accepted for PEA, and further 12 of them had a long term follow-up post surgery (n=3 periop exit, n=1 waiting for surgery). Half of the PEA patients were cured (n=6) and the other half (n=6) required specific PAH treatment (n=1, in combination with BPA) for rPAH. All patients from the non-PEA group (n=13) were started on specific PAH treatment (n=1 in combination with BPA). Patients with or without PEA did not differ hemodynamically. At the late follow-up there was a significant improvement in PEA group for NYHA class and NT-proBNP (p<0,001, and p=0,046), and in non PEA group for NYHA class and the 6MWD (p=0,012, and 0,006). We found significant difference in mortality at 1,3,5 year (Kaplan-Meier survival analysis) follow-up, for PEA group 100%-100%-100% and non PEA group 100%-85%-78% (p=0,013), respectively. Conclusions 55% of CTEPH patients were suitable for PEA, and those who survived the surgery 50% were cured. Non PEA patients improved functionally on the long term, but had worse survival.

scholarly journals Clinical, procedural and long-term outcome of ischemic VT ablation in patients with previous anterior versus inferior myocardial infarction

2020 ◽  
Vol 109 (10) ◽  
pp. 1282-1291 ◽  
Author(s):  
Kristina Wasmer ◽  
Holger Reinecke ◽  
Marius Heitmann ◽  
Dirk G. Dechering ◽  
Florian Reinke ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Cox Regression ◽  
Nyha Class ◽  
Electrical Storm ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Vt Ablation

Abstract Background Outcome of ischemic VT ablation may differ between patients with previous myocardial infarction (MI) in relation to infarct localization. Methods We analyzed procedural data, acute and long-term outcomes of 152 consecutive patients (139 men, mean age 67 ± 9 years) with previous anterior or inferior MI who underwent ischemic VT ablation at our institution between January 2010 and October 2015. Results More patients had a history of inferior MI (58%). Mean ejection fraction was significantly lower in anterior MI patients (28 ± 10% vs. 34 ± 10%, p < 0.001). NYHA class and presence of comorbidities were not different between the groups. Indication for the procedure was electrical storm in 43% of patients, and frequent implantable cardioverter defibrillator (ICD) therapies in 57%, and did not differ significantly between anterior and inferior MI patients. A mean of 3 ± 2 VT morphologies were inducible, with a trend towards more VT in the anterior MI group (3.1 ± 2.2 vs. 2.6 ± 1.9, p = 0.18). Procedural parameters and acute success did not differ between the groups. During a mean follow-up of 3 ± 2 years, more anterior MI patients had undergone a re-ablation (49% vs. 33%, p = 0.09, Chi-square test). There was a trend towards more ICD shocks in patients with previous anterior MI (46% vs. 34%). After adjusting for risk factors and ejection fraction, multivariable Cox regression analyses showed no significant difference in mortality (p = 0.78) and cardiovascular mortality between infarct localizations (p = 0.6). Conclusion Clinical characteristics of patients with anterior and inferior MI are similar except for ejection fraction. Patients with inferior MI appear to have better outcome regarding survival, ICD shocks and re-ablation, but this appears to be related to better ejection fraction when compared with anterior MI.

scholarly journals A Comparison of Owner-Assessed Long-Term Outcome of Arthroscopic Intervention versus Conservative Managemento f Dogs with Medial Coronoid Process Disease

2019 ◽  
Vol 32 (01) ◽  
pp. 001-009 ◽  
Author(s):  
Lara Dempsey ◽  
Thomas Maddox ◽  
Eithne Comerford ◽  
Rob Pettitt ◽  
Andrew Tomlinson
Keyword(s):  
Conservative Management ◽  
Intervention Group ◽  
Group Versus ◽  
Brief Pain Inventory ◽  
Older Age ◽  
Coronoid Process ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference

Objectives The purpose of this study was to compare the long-term outcome of dogs with medial coronoid process disease (MCPD) treated with arthroscopic intervention versus conservative management. Materials and Methods Medical records of dogs with MCPD treated by arthroscopic intervention or conservative management over an 8-year period were retrospectively reviewed. Long-term outcome (>12 months) was assessed via owner questionnaire including Liverpool Osteoarthritis in Dogs (LOAD) scores and Canine Brief Pain Inventory scores. Results Data from 67 clinically affected elbow joints (67 dogs) diagnosed with MCPD on computed tomography were included. Forty-four dogs underwent arthroscopic intervention and 23 dogs were treated with conservative management. The median LOAD and Pain Severity Score (PSS) for dogs in the arthroscopic intervention group compared with the conservatively managed group were not significantly different (p = 0.066 and p = 0.10, respectively). The median Pain Interference Score (PIS) was significantly higher in the arthroscopic intervention group versus the conservative management group (p = 0.028). There was no significant difference after controlling for age. For LOAD, PSS and PIS, older age at diagnosis was all significantly associated with higher scores (p = 0.048, p = 0.026 and p = 0.046, respectively) and older age at time of questionnaire completion showed a stronger association with the scores (p ≤0.001 for all). Clinical Significance Arthroscopic intervention showed no long-term benefit over conservative management for dogs with MCPD.

Comparison of the long-term outcome of cemented Charnley low-friction arthroplasty with hybrid arthroplasty in patients with congenital hip disease

2019 ◽  
Vol 101-B (9) ◽  
pp. 1050-1057
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
George Hartofilakidis
Keyword(s):  
Operating Time ◽  
Long Term Results ◽  
Low Friction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Hip Disease ◽  
Group A ◽  
Group B

Aims To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Patients and Methods Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. Results At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). Conclusion We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050–1057.

scholarly journals SAT-LB60 Discordant Biological Parameters of Remission in Acromegaly Do Not Increase the Risk of Hypertension or Diabetes: A Study With the Liege Acromegaly Survey Database

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Vincent Amodru ◽  
Patrick Petrossians ◽  
Annamaria Colao ◽  
Brigitte Delemer ◽  
Luigi Maione ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Biochemical Parameters ◽  
Biological Parameters ◽  
Tertiary Referral ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Active Disease

Abstract Introduction: Acromegaly is a rare disease due to growth hormone (GH)-secreting pituitary adenoma. GH and IGF-1 levels are usually congruent, indicating either remission or active disease, however a discrepancy between GH and IGF-1 may occur. We aimed to evaluate the outcome of acromegalic comorbidities in patients with congruent GH and/or IGF-1 levels vs discordant biochemical parameters. Methods: Retrospective analysis of the data of 3173 patients from the Liège Acromegaly Survey (LAS) allowed to include 190 patients from 8 tertiary referral centers across Europe, treated by surgery, with available data concerning diabetes mellitus (DM) and hypertension (HT) both at diagnosis and at last follow-up. We recorded for all the patients the number of antihypertensive and antidiabetic drugs used at the first evaluation and at last follow-up. Results: Ninety-nine patients belonged to the REM group (Concordant parameters), sixty-five patients were considered as GHdis and 26 patients were considered as IGF-1dis. At diagnosis, 63 patients (33.1%) had HT and 54 patients had DM (28.4%). There was no statistically significant difference in terms of number of anti-HT and anti-diabetic drugs at diagnosis versus last follow-up (mean duration=7.3+/-4.5years) between all 3 groups. Discussion: The results highlight that the long-term outcome of acromegaly does not tend to be more severe in patients with biochemical discordance in comparison with patients considered as in remission on the basis of concordant biological parameters, suggesting that patients with biochemical discordance do not require a closer follow-up.

Meta-analysis of gender effect for first-line chronomodulated 5-fluorouracil-leucovorin-oxaliplatin (ChronoFLO) compared with FOLFOX or constant infusion (conventional delivery, CONV) against metastatic colorectal cancer (MCC) in three international controlled phase III randomized trials (RT)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4112-4112 ◽  
Author(s):  
F. Levi ◽  
P. Innominato ◽  
A. Poncet ◽  
T. Moreau ◽  
S. Iacobelli ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Phase Iii ◽  
Constant Infusion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference

4112 Background: Gender predicted for the most effective schedule in a RT of ChronoFLO vs CONV against MCC: overall survival (OS) was significantly increased in men on chronoFLO vs FOLFOX, whereas the reverse was found in women (Giacchetti, JCO 2006). Methods: To assess the relevance of gender for patient (pt) outcome, meta-analysis was performed on individual pt data (IPD) from 3 RT in 845 MCC pts treated with chronoFLO vs CONV (346 F, 499 M at 36 centers in 1990–2002)(Lévi, JNCI 1994; Lancet 1997). Data bases were merged and updated at 9 y after inclusion of the 1st pt. Main prognostic factors were comparable in each RT according to gender and treatment arm (median age: 61y; PS=0, 46% pts; liver M, 85% pts; liver involvement >25%, 41% pts; lung M, 37% pts; CEA>10, 56% pts). Results: No significant difference was found according to delivery schedule or gender in the whole population for Response Rate (RR), Progression-Free Survival (PFS) and OS. However, men on chronoFLO had highest RR, longest PFS and OS. PFS and OS were highest in women on CONV ( Table ). The rate of complete macroscopic resections of liver metastases (R0+R1) was 12.5% in men on chronoFLO vs 7.8–8.5% in men on CONV or in women on either schedule. A complete histologic response of liver metastases was documented in 2.1% of the men on chronoFLO vs 0–1.1% in the other groups. The relative risk of an earlier death in men vs women was 0.76 [95% CL, 0.91 to 0.94] on chronoFLO and 1.24 [0.99 to 1.56] on CONV. Conclusions: This IPD meta-analysis of 3 RT in MCC with a minimum follow up of 5 years confirms that men benefit from chronoFLO as compared to CONV delivery, with regard to long term outcome and medico-surgical strategy. ChronoFLO should be preferred to conventional oxaliplatin-5-FU-LV schedules in men with MCC. Support: ARTBC Internationale, P. Brousse Hospital, Villejuif, France. [Table: see text] No significant financial relationships to disclose.

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