Mood Stabilizer Loading Versus Titration in Acute Mania: Audit of Clinical Practice

2008 ◽  
Vol 42 (11) ◽  
pp. 955-962 ◽  
Author(s):  
Amanda Wheeler ◽  
Gail Robinson ◽  
Allen Fraser
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Effects ◽  
Legal Status ◽  
Clinical Decision Making ◽  
Average Length ◽  
Mood Stabilizer ◽  
Serum Levels ◽  
High Serum ◽  
Routine Practice

Objective: The aim of the present study was to investigate whether the use of a loading strategy with lithium or valproate followed recommended practice and second, whether this had any impact on indicators of outcome in acutely manic inpatients. Method: A 12 month retrospective review of admissions to two adult psychiatric units in Auckland, New Zealand, was conducted. Demographic, legal status, psychiatric admissions, outcome indicators (length of stay, intensive care and seclusion use) and medication data were collected for all patients with a diagnosis of acute bipolar mania who started mood stabilizer treatment within 3 days of admission (n=93). Serum levels and adverse effects were also recorded. Results: In 46.2% of admissions a loading strategy was prescribed, and lithium was the treatment choice in two-thirds of admissions. Serum levels were taken inconsistently, particularly for valproate. No difference was found between loading and titrating for the assessed outcomes in routine practice; average length of stay was 30.2 days; most patients (71.0%) spent time in intensive care (average 8.4 days) and 33.3% spent time in seclusion. More adverse effects occurred with loading (51.2%) compared to titrating (36.0%), particularly with lithium. Conclusion: The literature supports a strong link between rapidly attained high serum levels and positive outcomes. The present study found inconsistent and infrequent measurement of levels, which was not in accord with recommended practice. Frequent monitoring of serum levels to support dosing decisions is important to inform better clinical decision making, especially when a loading strategy is used. This may explain the less than optimal outcomes (with respect to rapid resolution of mania and hospital discharge) that were found, irrespective of dosing strategy.

Use of lithium in acute mania in adolescents

2016 ◽  
Vol 33 (S1) ◽  
pp. S328-S328
Author(s):  
C. Aksoy Poyraz ◽  
A. Özdemir ◽  
G. Günay ◽  
B.Ç. poyraz ◽  
S. Enginkaya ◽  
...  
Keyword(s):  
Serum Level ◽  
Length Of Stay ◽  
Average Length ◽  
Lithium Treatment ◽  
Manic Episode ◽  
Serum Levels ◽  
High Serum ◽  
Hospital Length Of Stay ◽  
Dose Titration ◽  
Daily Dose

The aim of the present study was to investigate whether the use of lithium followed recommended practice in acutely manic adolescent inpatients. This study was a 12-month retrospective review of patients with manic episode admitted to Bakırköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital. Length of stay, medication data, serum levels and adverse effects were recorded for patients who started lithium treatment within average of 7 days of admission (n = 52). Average length of stay was 23.63 (SD = 17.6). The maximum dose prescribed within 24 h of starting treatment was 721.15 mg (SD = 239.5). The maximum daily dose was reached in an average of 7 days to 1136.5 mg (SD = 336.4). The average time after starting treatment until the first recorded serum level was 5 days. The average serum level reached was 0.5 mEq/L (SD = 0.22), which was raised to 0.6 mEq/L (SD = 0.3) at discharge with an average daily dose of 1038.46 mg (SD = 460). In 8 admissions (15.4%), one adverse effect was recorded that could have been related to lithium treatment but adverse events did not lead to discontinuation of drug. The literature supports that rapidly attained high serum levels are associated with positive outcomes. In this current study, clinicians used a relatively slow dose titration and lower serum levels were obtained suggesting that lithium was not considered as a primary agent for treating mania. Taking advantage of lithium especially for the maintenance treatment of bipolar disorder and tolerability may have driven these findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Biased and unbiased estimation of the average length of stay in intensive care units in the Covid-19 pandemic

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nathanael Lapidus ◽  
Xianlong Zhou ◽  
Fabrice Carrat ◽  
Bruno Riou ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Parametric Method ◽  
Estimation Methods ◽  
Unbiased Estimation ◽  
Bed Occupancy ◽  
Average Length Of Stay ◽  
Discharged Patients ◽  
First Admission

Abstract Background The average length of stay (LOS) in the intensive care unit (ICU_ALOS) is a helpful parameter summarizing critical bed occupancy. During the outbreak of a novel virus, estimating early a reliable ICU_ALOS estimate of infected patients is critical to accurately parameterize models examining mitigation and preparedness scenarios. Methods Two estimation methods of ICU_ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). Methods were compared on a series of all COVID-19 consecutive cases (n = 59) admitted in an ICU devoted to such patients. At the last follow-up date, 99 days after the first admission, all patients but one had been discharged. A simulation study investigated the generalizability of the methods' patterns. CPE and DPE estimates were also compared to COVID-19 estimates reported to date. Results LOS ≥ 30 days concerned 14 out of the 59 patients (24%), including 8 of the 21 deaths observed. Two months after the first admission, 38 (64%) patients had been discharged, with corresponding DPE and CPE estimates of ICU_ALOS (95% CI) at 13.0 days (10.4–15.6) and 23.1 days (18.1–29.7), respectively. Series' true ICU_ALOS was greater than 21 days, well above reported estimates to date. Conclusions Discharges of short stays are more likely observed earlier during the course of an outbreak. Cautious unbiased ICU_ALOS estimates suggest parameterizing a higher burden of ICU bed occupancy than that adopted to date in COVID-19 forecasting models. Funding Support by the National Natural Science Foundation of China (81900097 to Dr. Zhou) and the Emergency Response Project of Hubei Science and Technology Department (2020FCA023 to Pr. Zhao).

HUBUNGAN LAMA HARI RAWAT DENGAN TINGKAT KECEMASAN KELUARGA PASIEN DI RUANG INTENSIVE CARDIAC CARE UNIT

2021 ◽  
Vol 5 (2) ◽  
pp. 74
Author(s):  
Nifa Viranda Amelia
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Emotional Reactions ◽  
Cardiac Care ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
The Family ◽  
Anxiety Levels ◽  
Cardiac Care Unit

Selama pasien dirawat di ruang Intensive Cardiac Care Unit (ICCU), keluarga pasien mengalami kesulitan dan ketidakberdayaan. Bagi keluarga pasien, ruang rawat intensif merupakan tempat yang tidak menyenangkan.  Keluarga masuk dalam kondisi yang tidak terduga dan dibutuhkan ketepatan keluarga dalam mengambil keputusan guna keberlangsungan hidup terkait kondisi pasien yang membutuhkan penanganan.Lama perawatan pasien di ruang ICCU sangat beragam.  Lama rawat pasien ICCU berdampak langsung terhadap kualitas hidup pasien dan keluarga, risiko terjadinya di masa depan, dan besarnya pembiayaan dampak dari perawatan. Selama keluarga mendampingi perawatan pasien di ruang ICCU, keluarga akan mengalami berbagai reaksi emosional seperti kecemasan. Tujuan: Mengetahui hubungan lama hari rawat dengan tingkat kecemasan keluarga pasien di ruang ICCU. Metode: Korelasi dengan pendekatan cross sectional dengan sampel 42 responden di ruang ICCU, yang dipilih dengan menggunakan metode purposive sampling. Instrumen penelitian ini menggunakan kuesioner HARS.  Data dianalisis dengan uji korelasi Spearman. Hasil: Lama hari rawat pasien rata-rata 3,14 hari.  Kecemasan keluarga pasien ICCU paling banyak berada pada tingkat kecemasan berat (33,3%). Terdapat hubungan yang bermakna antara lama hari rawat dengan tingkat kecemasan keluarga pasien (p=0,0003) dengan keeratan hubungan yang sedang (r=0,532) di ruang ICCU. Diskusi: Semakin lama pasien dirawat di ruang ICCU maka semakin tinggi tingkat kecemasan yang dirasakan keluarga pasien karena kondisi pasien yang tidak stabil ataupun semakin parah. Kesimpulan: Keluarga pasien perlu diberikan informasi dan edukasi yang jelas terkait kondisi pasien dalam sehari atau saat ada perburukan kondisi.Kata kunci: kecemasan, keluarga, lama hari rawat, perawatan intensif, perawatan kritis. Correlation Between Length of Stay and Anxiety Levels of Patients’ Family in Intensive Cardiac Care Unit Room ABSTRACTWhile a patient is being treated in the Intensive Cardiac Care Unit (ICCU), the patient's family experiences difficulties and helplessness. For the patient's family, the intensive care unit is an unpleasant place. The family enters into unexpected conditions and is required to make proper decisions for survival related to patient conditions. The patient's length of stay in the ICCU room is very diverse. The length of stay of ICCU patients directly impacts patients' quality of life and their families, the risk of future incidence, and the extent of the treatment cost. While the family accompanies the patient treated in the ICCU room, the family will experience various emotional reactions such as anxiety. Objective: To reveal the correlation between length of stay and the anxiety levels of the patient’s family in the ICCU room. Methods: Correlation with cross-sectional approach with a sample of 42 respondents in the ICCU room, who were selected using a purposive sampling method. The research instrument used the HARS questionnaire. Data were analyzed using the Spearman correlation test. Results: The average length of the patient's stay was 3.14 days. Family anxiety of ICCU patients was mostly at the level of severe anxiety (33.3%). There was a significant correlation between length of stay and anxiety levels of the patient’s family (p=0.0003) with a moderate correlation coefficient (r=0.532) in the ICCU room. Discussion: The longer the patient is treated in the ICCU room, the higher the anxiety level felt by the patient’s family due to the patient's unstable or worsened condition. Conclusion: Clear information and education should be given to the patient's family regarding the patient's condition within one day or when the condition worsens.Keywords: anxiety, family, length of stay, intensive care, critical care

scholarly journals Biased and unbiased estimation of the average length of stay in intensive care units in the COVID-19 pandemic

2020 ◽  
Author(s):  
Nathanael Lapidus ◽  
Xianlong Zhou ◽  
Fabrice Carrat ◽  
Bruno Riou ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Parametric Method ◽  
Estimation Methods ◽  
Unbiased Estimation ◽  
Bed Occupancy ◽  
Average Length Of Stay ◽  
Discharged Patients ◽  
First Admission

BackgroundThe average length of stay (LOS) in the intensive care unit (ICU_ALOS) is a helpful parameter summarizing critical bed occupancy. During the outbreak of a novel virus, estimating early a reliable ICU_ALOS estimate of infected patients is critical to accurately parameterize models examining mitigation and preparedness scenarios.MethodsTwo estimation methods of ICU ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). Methods were compared on a series of all COVID-19 consecutive cases (n=59) admitted in an ICU devoted to such patients. At the last follow-up date, 99 days after the first admission, all patients but one had been discharged. A simulation study investigated the generalizability of the methods’ patterns. CPE and DPE estimates were also compared to COVID-19 estimates reported to date.FindingsLOS ≥ 30 days concerned 14 out of the 59 patients (24%), including 8 of the 21 deaths observed. Two months after the first admission, 38 (64%) patients had been discharged, with corresponding DPE and CPE estimates of ICU_ALOS (95%CI) at 13.0 days (10.4–15.6) and 23.1 days (18.1–29.7), respectively. Series’ true ICU_ALOS was greater than 21 days, well above reported estimates to date.InterpretationDischarges of short stays are more likely observed earlier during the course of an outbreak. Cautious unbiased ICU_ALOS estimates suggest parameterizing a higher burden of ICU bed occupancy than that adopted to date in COVID-19 forecasting models.FundingSupport by the National Natural Science Foundation of China (81900097 to Dr. Zhou) and the Emergency Response Project of Hubei Science and Technology Department (2020FCA023 to Pr. Zhao).

Associations between gender and outcome of acute psychiatric admission, looking specifically at length of stay and type of admission

2017 ◽  
Vol 41 (S1) ◽  
pp. s901-s901
Author(s):  
J. Beezhold ◽  
U. Farooq ◽  
J. Isaac ◽  
A. Shepherd
Keyword(s):  
Length Of Stay ◽  
Gender Bias ◽  
Legal Status ◽  
Average Length ◽  
Psychiatric Inpatient ◽  
Published Data ◽  
Psychiatric Admission ◽  
Average Length Of Stay ◽  
Significant Difference ◽  
Competing Interest

IntroductionThere is little published data regarding the association between gender and outcomes in acute inpatient psychiatry. We present outcomes from a study of 5601 acute psychiatric admissions.ObjectiveThe objective of this study was to identify associations between gender and outcome of acute psychiatric admission, looking specifically at length of stay and at whether they were detained in hospital.MethodsThe relationship between gender and acute psychiatric inpatient length of stay and detention status was analyzed for all admissions over 90 months from Sept 2002 to Feb 2010. There were 5601 consecutive admissions included in this study, 2862 of which were male and 2739 were female. There were no exclusions. Data was complete for more than 99% of subjects, and was extracted from part of routine service data on an anonymous- basis. The subjects were admitted into two acute inpatient wards in central Norfolk. Data was analyzed using SPSS. Ethics consent was granted by the research ethics committee.ResultsThe study showed no significant difference in average length of stay (female = 32.98, male = 32.11; P = 0.595). Additionally, no significant difference was found linking gender to detention status (26% female, 25% male; P = 0.517) as opposed to informal or voluntary admission.ConclusionThe study found no evidence of a gender bias regarding overall length of stay and legal status in acute admissions. Further research should be conducted in this area to examine whether there is any gender bias in outcomes relating to diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Nutrition challenges in polytrauma patients. New trends in energy expenditure measurements

2019 ◽  
Vol 2 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Barbara Kołakowska
Keyword(s):  
Wound Healing ◽  
Intensive Care ◽  
Length Of Stay ◽  
Average Length ◽  
Risk Of Infection ◽  
Icu Patients ◽  
Inflammatory Reactions ◽  
Average Length Of Stay ◽  
Specialized Care ◽  
Polytrauma Patients

AbstractPatients hospitalized in Intensive Care Units (ICU) are in severe general condition and they need specialized care, rehabilitation and proper nutrition to improve their condition and recover as soon as possible. Therefore, it is very important that nutrition consists of all necessary elements that will cover their daily demand for nutrients. However, malnutrition among ICU patients is very common. According to statistics, up to 50% is malnourished. It enhances average length of stay, risk of infection, prolongs ventilator days, delays wound healing and translates into an increased hospital cost. It may end in multi-organ failure, what in consequence increases mortality. Polytrauma pa tients lost their energy because of intensified catabolism, due to neuroendocrine changes and inflammatory reactions, which may worsen already existing malnutrition.

scholarly journals Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

2016 ◽  
Vol 50 (0) ◽  
Author(s):  
Rosane Sonia Goldwasser ◽  
Maria Stella de Castro Lobo ◽  
Edilson Fernandes de Arruda ◽  
Simone Aldrey Angelo ◽  
José Roberto Lapa e Silva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Rio De Janeiro ◽  
Average Length ◽  
Patient Flow ◽  
The State ◽  
System Stability ◽  
Ministry Of Health ◽  
Average Length Of Stay

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

Chlorpropamide Poisoning in Non-Diabetics

1972 ◽  
Vol 17 (9) ◽  
pp. 305-309 ◽  
Author(s):  
R. C. Dowell ◽  
A. H. Imrie
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Plasma Insulin ◽  
Serum Levels ◽  
High Serum ◽  
The Other ◽  
Dominant Feature ◽  
Hypoglycaemic Coma

Two non-diabetic girls were observed following self-poisoning with chlorpropamide. The dominant feature was prolonged hypoglycaemic coma, which lasted 3 days in one case, and led to death in the other. High serum levels of chlorpropamide were demonstrated and this was correlated with sustained high levels of plasma insulin. In the light of the results obtained, the role of glucagon in the management of such cases is discussed, and the requirement for observation in an intensive care unit is emphasised.

scholarly journals Successful Treatment of Neonatal Respiratory Transitional Disorder with Pulmo/Vivianit comp. in 2 Cases

2017 ◽  
Vol 24 (3) ◽  
pp. 172-174
Author(s):  
Benedikt M. Huber ◽  
Dirk Bassler
Keyword(s):  
Intensive Care ◽  
Case Report ◽  
Adverse Effects ◽  
Therapeutic Approach ◽  
Newborn Infants ◽  
Routine Practice ◽  
Off Label ◽  
Therapeutic Measures ◽  
High Level

Background: Disorders of the respiratory transition at birth are major reasons for neonates being admitted to intensive care units and separated from their mothers. This has potential long-lasting consequences for the mother-infant interaction as well as the long-term development of the child. There is an urgent need for effective preventive and therapeutic measures for this frequent disorder. Case Report: We report the cases of 2 newborn infants with respiratory transitional disorder treated off-label with the anthroposophic medicament Pulmo/Vivianit comp. based on pathophysiological considerations and on particular parental request. In both cases, an immediate and sustainable response could be documented without adverse effects. Conclusion: This new therapeutic approach merits further attention in clinical research but cannot be recommended for routine practice before more high-level evidence is available.

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