scholarly journals Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

2016 ◽  
Vol 209 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Rashmi Patel ◽  
Edward Chesney ◽  
Alexis E. Cullen ◽  
Alex D. Tulloch ◽  
Matthew Broadbent ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Clinical Outcomes ◽  
Psychiatric Hospital ◽  
Hospital Admissions ◽  
Mental Healthcare ◽  
Psychiatric Hospitals ◽  
Healthcare Services ◽  
Clinical Population ◽  
Minority Ethnic Group ◽  
Increased Risk

BackgroundStudies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals.AimsTo investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes.MethodData were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week.ResultsThere were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient –21.1 days, 95% CI –24.6 to –17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.ConclusionsBeing admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.

scholarly journals Effect of ambient fine particulates (PM2.5) on hospital admissions for respiratory and cardiovascular diseases in Wuhan, China

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhan Ren ◽  
Xingyuan Liu ◽  
Tianyu Liu ◽  
Dieyi Chen ◽  
Kuizhuang Jiao ◽  
...  
Keyword(s):  
Air Pollution ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Conditional Logistic Regression ◽  
Warm Season ◽  
Central China ◽  
Air Pollution Control ◽  
Short Term ◽  
Short Term Exposure ◽  
Increased Risk

Abstract Background Positive associations between ambient PM2.5 and cardiorespiratory disease have been well demonstrated during the past decade. However, few studies have examined the adverse effects of PM2.5 based on an entire population of a megalopolis. In addition, most studies in China have used averaged data, which results in variations between monitoring and personal exposure values, creating an inherent and unavoidable type of measurement error. Methods This study was conducted in Wuhan, a megacity in central China with about 10.9 million people. Daily hospital admission records, from October 2016 to December 2018, were obtained from the Wuhan Information center of Health and Family Planning, which administrates all hospitals in Wuhan. Daily air pollution concentrations and weather variables in Wuhan during the study period were collected. We developed a land use regression model (LUR) to assess individual PM2.5 exposure. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate cardiorespiratory hospitalization risks associated with short-term exposure to PM2.5. We also conducted stratification analyses by age, sex, and season. Results A total of 2,806,115 hospital admissions records were collected during the study period, from which we identified 332,090 cardiovascular disease admissions and 159,365 respiratory disease admissions. Short-term exposure to PM2.5 was associated with an increased risk of a cardiorespiratory hospital admission. A 10 μg/m3 increase in PM2.5 (lag0–2 days) was associated with an increase in hospital admissions of 1.23% (95% CI 1.01–1.45%) and 1.95% (95% CI 1.63–2.27%) for cardiovascular and respiratory diseases, respectively. The elderly were at higher PM-induced risk. The associations appeared to be more evident in the cold season than in the warm season. Conclusions This study contributes evidence of short-term effects of PM2.5 on cardiorespiratory hospital admissions, which may be helpful for air pollution control and disease prevention in Wuhan.

scholarly journals Fatal opioid overdoses during and shortly after hospital admissions in England: A case-crossover study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003759
Author(s):  
Dan Lewer ◽  
Brian Eastwood ◽  
Martin White ◽  
Thomas D. Brothers ◽  
Martin McCusker ◽  
...  
Keyword(s):  
Drug Use ◽  
Hospital Admission ◽  
Crossover Study ◽  
Hospital Admissions ◽  
Conditional Logistic Regression ◽  
Early Discharge ◽  
Odds Ratios ◽  
Drug Poisoning ◽  
Case Crossover ◽  
Increased Risk

Background Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death. Methods and findings We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; p = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; p < 0.001) for days 15 onwards. 1,088/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; p < 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; p < 0.001) on days 3 to 14. 11,629/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results. Conclusions Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.

scholarly journals Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study

2011 ◽  
Vol 199 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Lars Vedel Kessing ◽  
Gunnar Hellmund ◽  
John R. Geddes ◽  
Guy M. Goodwin ◽  
Per Kragh Andersen
Keyword(s):  
Bipolar Disorder ◽  
Cohort Study ◽  
Clinical Practice ◽  
Hospital Admission ◽  
Psychiatric Hospital ◽  
Hospital Admissions ◽  
Observational Cohort Study ◽  
Hazard Ratio ◽  
Daily Clinical Practice ◽  
Observational Cohort

BackgroundValproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse.AimsTo compare the effect of valproate v. lithium for treatment of bipolar disorder in clinical practice.MethodAn observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.ResultsA total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder. The rate of switch/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59–2.16). The rate of psychiatric hospital admissions was increased for valproate v. lithium (HR = 1.33, 95% CI 1.18–1.48) and regardless of the type of episode leading to a hospital admission (depressive or manic/mixed). Similarly, for participants with a depressive index episode (HR = 1.87, 95% CI 1.40–2.48), a manic index episode (HR = 1.24, 95% CI 1.01–1.51) and a mixed index episode (HR = 1.44, 95% CI 1.04–2.01), the overall rate of hospital admissions was significantly increased for valproate compared with lithium.ConclusionsIn daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate.

scholarly journals Impact of childhood trauma on risk of relapse requiring psychiatric hospital admission for psychosis

2016 ◽  
Vol 209 (2) ◽  
pp. 169-170 ◽  
Author(s):  
N. Petros ◽  
E. Foglia ◽  
E. Klamerus ◽  
S. Beards ◽  
R. M. Murray ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Psychiatric Hospital ◽  
Childhood Trauma ◽  
Financial Burden ◽  
Negative Relationship ◽  
Positive Association ◽  
Current Evidence ◽  
Increased Risk ◽  
Significant Difference ◽  
Service Exposure

SummaryRelapse in psychosis typically necessitates admission to hospital placing a significant financial burden on the health service. Exposure to childhood trauma is associated with an increased risk of psychosis, however, the extent to which this influences relapse is unclear. This report summarises current research investigating the influence of childhood trauma on relapse requiring psychiatric hospital admission for psychosis. Seven studies were included; two revealed a positive association between childhood trauma and relapse admission, two studies found a negative relationship and three found no significant difference. Inconsistent current evidence suggests a need for further research in this area.

Cardiovascular Disease-related Hospital Admissions of Patients with Inflammatory Arthritis

2014 ◽  
Vol 42 (2) ◽  
pp. 188-192
Author(s):  
Jennie Ursum ◽  
Mark M.J. Nielen ◽  
Jos W.R. Twisk ◽  
Mike J.L. Peters ◽  
François G. Schellevis ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admission ◽  
Inflammatory Arthritis ◽  
Hospital Admissions ◽  
High Rate ◽  
Hospital Data ◽  
Cvd Risk ◽  
Dutch Hospital ◽  
Services Research ◽  
Increased Risk

Objective.Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care–based population of patients with IA and controls.Methods.All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data.Results.There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2–2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0–4.9).Conclusion.Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.

scholarly journals Effects of Metformin on Clinical outcomes in Patients with Type 2 Diabetes and Covid-19

2021 ◽  
Vol 5 (3) ◽  
pp. 01-04
Author(s):  
Nasser Mikhail
Keyword(s):  
Type 2 Diabetes ◽  
Lactic Acidosis ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Retrospective Studies ◽  
English Literature ◽  
Population Based ◽  
Increased Risk ◽  
Pubmed Search

Background: The effects of metformin therapy on the prognosis of patients with coronavirus disease 2019 (COVID-19) are unclear. Objective: To review effects of metformin on clinical outcomes, particularly mortality, in patients with type 2 diabetes and COVID-19. Methods: Review of English literature by PUBMED search until April 20, 2021. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, and consensus guidelines are reviewed. Results: All available studies in this area are retrospective. Two population-based studies did not find significant association between metformin use and susceptibility to COVID-19. Most, but not all studies, suggest that metformin use prior to hospital admission might be associated with significant decrease in mortality in patients with type 2 diabetes and COVID-19. Continuing metformin use after hospital admission did not have significant impact on COVID-19 related death but may decrease risk of acute respiratory distress syndrome (ARDS). Meanwhile, in-hospital metformin administration may be associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking ≥2 gm/d of metformin, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Conclusions: Although most retrospective studies suggest that metformin administration may be associated with decreased risk of COVID-19 mortality, these data should be confirmed by randomized trials. In patients with type 2 diabetes and COVID-19 admitted to the hospital, metformin use should be avoided in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73m2), and in daily doses of ≥ 2 gm due to increased risk of lactic acidosis.

scholarly journals Effect of Ambient Fine Particulate (PM2.5) on Hospital Admissions for Respiratory and Cardiovascular Diseases in Wuhan, China

2020 ◽  
Author(s):  
Zhan Ren ◽  
Xingyuan Liu ◽  
Tianyu Liu ◽  
Dieyi Chen ◽  
Kuizhuang Jiao ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cardiovascular Diseases ◽  
Hospital Admission ◽  
Respiratory Diseases ◽  
Hospital Admissions ◽  
Conditional Logistic Regression ◽  
Central China ◽  
Air Pollution Control ◽  
Short Term ◽  
Increased Risk

Abstract Background: The positive associations between ambient PM2.5 and cardiorespiratory disease have been well demonstrated during the past decade. However, few studies have examined the adverse effects of PM2.5 based on an entire population of megalopolis. In addition, due to the lack of accurate methods of assessing individual PM2.5 exposure, further studies are still necessary to be launched in China.Methods: The study was conducted in Wuhan, a megacity in central China with about 10.8929 million population. Daily hospital admission records, from October 2016 to December 2018, were obtained from Wuhan Information center of Health and Family Planning, which administrates all the hospitals in Wuhan. The daily air pollution concentration and weather variable in Wuhan during the study period were collected. We developed Land use regression model (LUR) to assess individual PM2.5 exposure. Time-stratified case-crossover design and conditional logistic regression models were adopted to estimate cardiorespiratory hospitalization risks associated with short-term exposures to PM2.5. We also conducted stratification analyses by age, sex and season.Results: A total of 2,806,115 hospital admissions records were collected during the study period, from which we identified 332,090 for total cardiovascular diseases and 159,365 for total respiratory diseases. We found short-term PM2.5 exposure was associated with increased risk of cardiorespiratory hospital admission in Wuhan. Per 10 μg/m3 increase of PM2.5 at lag0~2 days was associated with 1.23% (95%CI: 1.01–1.45%) and 1.95% (95%CI: 1.63–2.27%) elevated risk of admission from cardiovascular and respiratory diseases respectively. The elderly were at higher PM-induced risks. The associations appeared to be more evident in the cold season than in the warm season.Conclusions: This study contributed evidence to support the short-term effects of PM2.5 on cardiorespiratory hospital admission, which may be helpful for air pollution control and disease prevention in Wuhan.

A 25-year dynamic ecological analysis of psychiatric hospital admissions and prison committals: Penrose’s hypothesis updated

2018 ◽  
pp. 1-4 ◽  
Author(s):  
C. J. O’Neill ◽  
B. D. Kelly ◽  
H. G. Kennedy
Keyword(s):  
Psychiatric Hospital ◽  
Hospital Admissions ◽  
Psychiatric Hospitals ◽  
Causal Connection ◽  
Inverse Association ◽  
Cross Sectional ◽  
Time Dynamic ◽  
Dynamic Measures ◽  
Over Time ◽  
Static Cross

AimsThere is renewed interest in the inverse association between psychiatric hospital and prison places, with reciprocal time trends shown in more than one country. We hypothesised that the numbers of admissions to psychiatric hospitals and committals to prisons in Ireland would also correlate inversely over time (i.e. dynamic measures of admission and committal rather than static, cross-sectional numbers of places).MethodPublicly available activity statistics for psychiatric hospitals and prisons in Ireland were collated from 1986 to 2010.ResultsThere was a reciprocal association between psychiatric admissions and prison committals (Pearson r=−0.788, p&lt;0.001), an increase of 91 prison committals for every 100 psychiatric hospital admissions foregone.ConclusionPenrose’s hypothesis applies to admissions to psychiatric hospitals and prisons in Ireland over time (dynamic measures), just as it does to the numbers of places in psychiatric hospitals and prisons in Ireland and elsewhere (static, cross-sectional measures). Although no causal connection can be definitively established yet, mentally disordered prisoners are usually known to community mental health services. Psychiatric services for prisons and the community should be linked to ensure that the needs of those currently accessing care through prisons can also be met in the community.

scholarly journals Clinical outcomes of theophylline use as add-on therapy in patients with chronic obstructive pulmonary disease: A propensity score matching analysis

2018 ◽  
Vol 16 ◽  
pp. 147997311881569 ◽  
Author(s):  
Preyanate Wilairat ◽  
Kirati Kengkla ◽  
Chaiyawat Thayawiwat ◽  
Phongsathorn Phlaisaithong ◽  
Supakorn Somboonmee ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Propensity Score ◽  
Hospital Admission ◽  
Pulmonary Disease ◽  
Clinical Outcomes ◽  
Large Scale ◽  
Airflow Obstruction ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk

To examine clinical outcomes of theophylline use in patients with chronic obstructive pulmonary disease (COPD) receiving inhaled corticosteroids (ICS) and long-acting beta-2 agonists (LABA). Electronic data from five hospitals located in Northern Thailand between January 2011 and December 2015 were retrospectively collected. Propensity score (PS) matching (2:1 ratio) technique was used to minimize confounding factors. The primary outcome was overall exacerbations. Secondary outcomes were exacerbation not leading to hospital admission, hospitalization for exacerbation, hospitalization for pneumonia, and all-cause hospitalizations. Cox’s proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence interval (CI). After PS matching, of 711 patients with COPD (mean age: 70.1 years; 74.4% male; 60.8% severe airflow obstruction), 474 theophylline users and 237 non-theophylline users were included. Mean follow-up time was 2.26 years. Theophylline significantly increased the risk of overall exacerbation (aHR: 1.48, 95% CI: 1.11–1.96; p = 0.008) and exacerbation not leading to hospital admission (aHR: 1.47, 95% CI: 1.06–2.03; p = 0.020). Theophylline use did not significantly increase the risk of hospitalization for exacerbation (aHR: 1.11, 95% CI: 0.79–1.58; p = 0.548), hospitalization for pneumonia (aHR: 1.28, 95% CI: 0.89–1.84; p = 0.185), and all-cause hospitalizations (aHR: 1.03, 95% CI: 0.80–1.33; p = 0.795). Theophylline use as add-on therapy to ICS and LABA might be associated with an increased risk for overall exacerbation in patients with COPD. A large-scale prospective study of theophylline use investigating both safety and efficacy is warranted.

Architecture as change-agent? Looking for innovation in contemporary forensic psychiatric hospital design

2020 ◽  
pp. medhum-2020-011887
Author(s):  
Rebecca Mclaughlan ◽  
Codey Lyon ◽  
Dagmara Jaskolska
Keyword(s):  
Psychiatric Hospital ◽  
Mental Healthcare ◽  
Psychiatric Hospitals ◽  
Advisory Panel ◽  
Design Practice ◽  
Hospital Design ◽  
Hospitalised Patients ◽  
The Usa ◽  
Forensic Psychiatric ◽  
The Uk

History suggests that departures from accepted design practice can contribute to positive change in the delivery of mental healthcare, the daily experience of hospitalised patients and public perceptions of mental illness. Yet the question of how architecture can support the therapeutic journey of patients remains a critical one. The availability of evidence-based design literature to guide architects cannot keep pace with growing global demand for new forensic psychiatric hospital facilities. This article reports a global survey of current design practice to speculate on the potential of three new hospitals to positively improve patient experience. A desktop survey was conducted of 31 psychiatric hospitals (24 forensic, 7 non-forensic) constructed or scheduled for completion between 2006 and 2022. This was supplemented by advisory panel sessions with clinical/facilities staff, alongside architectural knowledge obtained through workshops with architects from the UK and the USA, and the inclusion of Australian architects on the research team. Data analysis draws on knowledge from architectural practice, architectural history and environmental psychology, arguing that there is a responsibility to integrate knowledge from across these disciplines in respect of such a pressing and important problem.

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