Audit of the Use of Nurses' Holding Power under Section 5(4) of the Mental Health Act 1983

1998 ◽  
Vol 38 (3) ◽  
pp. 227-232 ◽  
Author(s):  
Emad Salib
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
Psychiatric Patients ◽  
Length Of Hospital Stay ◽  
Psychiatric Nurses ◽  
Mental Health Act ◽  
Holding Power ◽  
Review Period ◽  
Significant Difference ◽  
Maximum Period

Emergency detention of psychiatric patients by doctors under s. 5(2) of the Mental Health Act 1983 is not always preceded by the use of nurses' holding power under s. 5(4). In this review of patients in North Cheshire, all applications of s. 5(4), allowing the emergency detention of voluntary in-patients by registered psychiatric nurses for a maximum period of six hours, were reviewed to examine the extent of its use and to assess its effect on s. 5(2) outcome. Of the 877 detentions under s. 5(2) implemented during the 11-year review period, 140 (16%) were preceded by s. 5(4). There was no significant difference in age, sex, clinical diagnosis, day of the week, reason for detention and length of hospital stay before section application between those who had s. 5(4) applied before 5(2) and those who did not. The latter were less likely to be converted to other sections (53%) compared to a much higher rate of 80% if s. 5(4) preceded s. 5(2). The review has also found that time of section application and length of hospital stay prior to detention may have influenced the use of nurses' holding power. It suggests that s. 5(4) may be a useful predictor of s. 5(2) outcome.

Detention of In-Patients under Section 5(2) of the Mental Health Act 1983

1998 ◽  
Vol 38 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Emad Salib ◽  
Boni Iparragirre
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
Clinical Diagnosis ◽  
Length Of Hospital Stay ◽  
The Other ◽  
Short Term ◽  
Time Of Application ◽  
Mental Health Act ◽  
Equal Chance

All applications of s.5(2) of the Mental Health Act 1983, allowing the emergency detention of voluntary in-patients in North Cheshire between 1985 and 1995, were reviewed to examine general trends in its use and to assess variables likely to influence its outcome. Of the 877 applications implemented (4% of all admissions), 500 (57%) were converted to longer-term detention under the Act, 396 (45%) were converted to s.2 and 104 (12%) to s.3. The other 377 (43%) detained patients under s.5(2) regained informal status. The review found that time of application of section, length of hospital stay prior to application, medical officer's grade, use of s.5(4) and clinical diagnosis are best predictors of s.5(2) outcome. The results are similar to other published studies and seem to reflect a national pattern, possibly implying that patients detained under this short-term detention order have an almost equal chance of either regaining their voluntary status or being detained under another section by the end of the 72 hours. This may raise questions about the purpose of s.5(2) as expressed by the Mental Health Act Commission.

Correlates of lengthy stay in a mental health hospital

2018 ◽  
Vol 11 (1) ◽  
pp. 13-31
Author(s):  
Mostafa Mohamed Al Sayed ◽  
Michael Elnemais Fawzy
Keyword(s):  
Mental Health ◽  
Linear Regression ◽  
Hospital Stay ◽  
Mental Hospital ◽  
Length Of Hospital Stay ◽  
Content Type ◽  
Significant Difference ◽  
Group A ◽  
Inpatient Group ◽  
Main Factors

Purpose The purpose of this paper is to study the role of social factors that determine the length of stay in a mental hospital and also understand the main factors leading to the phenomena as a step to solve it. Design/methodology/approach A case-control cross-sectional observational study is performed which studies correlates for the lengthy stay in a mental hospital. The study population consists of two groups: Group A (94 patients), taken from the patients hospitalized for more than one year, further subdivided into schizophrenia and schizoaffective inpatient group and bipolar affective inpatient group; and Group B (94 patients), receiving their treatment at the outpatient clinic after being admitted for less than six months, this group was further subdivided into same categories as Group A. Findings The study showed that the positive score in positive and negative symptoms scale (PANSS) showed highly statistically significant (p<0.01) correlation with the length of hospital stay for the schizophrenic and schizoaffective patients in the inpatient group. The results showed no statistically significant difference (p>0.05) between the inpatient schizophrenic cases and the inpatient affective cases regarding the length of hospital stay. Research limitations/implications The linear regression model was used to understand the predictors of increased length of hospital stay. The linear regression analyzing the scale data of schizophrenic and schizoaffective patients found that the length of hospital stay for the schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. On the other hand, linear regression model for bipolar affective patients in the study found no statistically significant attributes of the length of hospital stay. Practical implications The study found that the length of hospital stay for schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. Social implications The need for this study stems from the large numbers of mental inpatients who have been lengthily admitted in mental health hospitals in Egypt, while trying to understand main factors leading to the phenomena as a step to solve it. The study found that there is a highly significant difference between inpatient group and outpatient group regarding the marital status, education level, and psychosocial class, with inpatient group having more single, illiterate, and very low social class cases. Originality/value Research in the area of chronic psychiatric hospitalization and its effect on the course and prognosis of mental illness is still scarce, especially in the Arab world; therefore, the research will open the door for further research efforts in the future with a larger sample of patients to study the pros and cons of deinstitutionalization taking into account the past experience of health systems in other countries.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Wound Complications ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Fresh Frozen ◽  
Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

The Practice of Community Psychiatric Nursing and Mental Health Social Work in Salford Some Implications for Community Care

1988 ◽  
Vol 152 (6) ◽  
pp. 783-792 ◽  
Author(s):  
K. Wooff ◽  
D. P. Goldberg ◽  
T. Fryers
Keyword(s):  
Mental Health ◽  
Psychiatric Symptoms ◽  
Psychiatric Patients ◽  
Psychiatric Nurses ◽  
Health Staff ◽  
Mental Health Staff ◽  
Term Care ◽  
Community Psychiatric ◽  
Wide Range

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.

scholarly journals Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4997
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E. F. Timmer ◽  
Bart Geboers ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Hospital Stay ◽  
Colorectal Liver Metastases ◽  
Local Treatment ◽  
Length Of Hospital Stay ◽  
Progression Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

scholarly journals Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Obese Group ◽  
Obese Patients ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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