scholarly journals Perception and Impact of Life Events in Medically Hospitalized Patients With Somatic Symptom and Related Disorders

2018 ◽  
Vol 8 (11) ◽  
pp. 699-705
Author(s):  
Katherine K. Bedard-Thomas ◽  
Simona Bujoreanu ◽  
Christine H. Choi ◽  
Patricia I. Ibeziako
Keyword(s):  
Life Events ◽  
Somatic Symptom ◽  
Functional Disability ◽  
De Novo ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Health Care Use ◽  
Life Event ◽  
Academic Events ◽  
The Impact

OBJECTIVES: We describe the prevalence and perceived impact of life events reported by medically hospitalized patients with somatic symptom and related disorders (SSRD) and highlight patient characteristics and outcomes associated with highly impactful life events. METHODS: Retrospective chart reviews were conducted of patients with SSRD at a tertiary pediatric hospital who were seen by the psychiatry consultation service and completed various instruments while medically admitted, including a de novo life events checklist. Descriptive statistics, correlations, χ2 tests, and internal consistency analyses were used. RESULTS: Charts of 70.2% of patients with SSRD who completed the life events checklist (N = 172; age range 8–25 years) were reviewed. Of those studied, 94% reported at least 1 life event in the last year, with academic events most prevalent, 81% reported life events across multiple domains, and 56% perceived the life event(s) as having a great impact on their lives. Patients who perceived more great impact life events were older, from households with lower median incomes, had higher self-reported somatization, greater functional disability, more comorbid psychiatric diagnoses, required more psychotropic medications, and had longer medical admissions. CONCLUSIONS: Findings reveal that although the majority of medically hospitalized patients with SSRD reported at least 1 relevant life event, it was the patients’ perception of the impact of the life event(s) that correlated with high levels of disability and health care use. An assessment of the perception of life events in patients with SSRD may help hospitalists and interdisciplinary providers identify high-risk patients for whom early psychiatry referrals can be made.

scholarly journals Variation Among Hospitals in the Continuity of Care for Older Hospitalized Patients: a Cross-sectional Cohort Study

2021 ◽  
Author(s):  
James S. Goodwin ◽  
Shuang Li ◽  
Jie Zhou ◽  
Yong-Fang Kuo ◽  
Ann Nattinger
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Regression Model ◽  
Continuity Of Care ◽  
Logistic Regression Model ◽  
Large Degree ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Cross Sectional ◽  
The Impact

Abstract Background: Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital. Methods: We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3-6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model. Results: Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was >84.1%, vs. <24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status. Conclusions: Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.

A Nationwide Study of the Impact of Dysphagia on Hospital Outcomes Among Patients With Dementia

2016 ◽  
Vol 32 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Suchitra Paranji ◽  
Neethi Paranji ◽  
Scott Wright ◽  
Shalini Chandra
Keyword(s):  
Mechanical Ventilation ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Skilled Nursing ◽  
Percutaneous Endoscopic Gastrostomy Placement ◽  
Endoscopic Gastrostomy ◽  
Diagnosis Of Dementia ◽  
The Impact ◽  
New Evidence ◽  
Mean Charge

Objectives: To assess the impact of dysphagia on clinical and operational outcomes in hospitalized patients with dementia. Design: Retrospective cohort study. Setting: 2012 Nationwide Inpatient Sample. Participants: All patients discharged with a diagnosis of dementia (N = 234,006) from US hospitals in 2012. Measurements: Univariate and multivariate regression models, adjusting for stroke and patient characteristics, to assess the impact of dysphagia on the prevalence of comorbidities, including pneumonia, sepsis, and malnutrition; complications, including mechanical ventilation and death; and operational outcomes, including length of stay (LOS) and total charges for patients with dementia. Results: Patients having dementia with dysphagia (DWD) had significantly higher odds of having percutaneous endoscopic gastrostomy placement during the admission (odds ratio [OR]: 13.68, 95% confidence interval [CI]: 12.53-14.95, P < .001), aspiration pneumonia (OR: 6.27, 95% CI: 5.87-6.72, P < .001), pneumonia (OR: 2.84, 95% CI: 2.67-3.02, P < .001), malnutrition (OR: 2.5, 95% CI: 2.27-2.75, P < .001), mechanical ventilation (OR: 1.69, 95% CI: 1.51-1.9, P < .001), sepsis (OR: 1.52, 95% CI: 1.39-1.67, P < .001), and anorexia (OR: 1.29, 95% CI: 1.01-1.65, P = .04). Mean LOS was 2.16 days longer (95% CI: 1.98-2.35, P < .001), mean charge per case was US$10,703 higher (95% CI: US$9396-US$12,010, P < .001), and the odds of being discharged to a skilled nursing, rehabilitation, or long-term facility was 1.59 times higher (95% CI: 1.49-1.69, P < .001) in the DWD cohort compared to patients having dementia without dysphagia. Conclusion: Dysphagia is a significant predictor of worse clinical and operational outcomes including a 38% longer LOS and a 30% increase in charge per case among hospitalized patients with dementia. Although these findings may not be surprising, this new evidence might bring heightened awareness for the need to more thoughtfully support patients with dementia and dysphagia who are hospitalized.

The Effect of Widowhood on the Health Status of Older Persons

1986 ◽  
Vol 21 (1) ◽  
pp. 9-25 ◽  
Author(s):  
Kenneth F. Ferraro
Keyword(s):  
Health Status ◽  
Life Events ◽  
Structural Equation ◽  
Older Persons ◽  
Equation Model ◽  
Life Event ◽  
Long Term Consequences ◽  
The Impact ◽  
The Relationship

Interest in the relationship between stress and the onset of illness has stimulated research on the impact of various life events on health status. This article is an analysis of the health consequences of widowhood—the life event considered to require the most readjustment. Considering both objective and subjective measures of health, a structural equation model is developed and tested with panel data of a sample of elders. The findings indicate that widowhood results in an immediate decrease in perceived health but that the long-term consequences are minimal. Also, certain categories of elders shown to be health optimistic are able to maintain their optimism after widowhood. The results are interpreted as reflecting relativity in medical perceptions and favor a transitional model for explaining the normalization of disability.

A Crisis Assessment Technique for the Evaluation of Life Events: Transition to Retirement as an Example

1982 ◽  
Vol 1 (3-4) ◽  
pp. 28-39 ◽  
Author(s):  
Anne Martin Matthews ◽  
Kathleen H. Brown ◽  
Christine K. Davis ◽  
Margaret A. Denton
Keyword(s):  
Life Events ◽  
Life Event ◽  
Men And Women ◽  
Assessment Technique ◽  
Transition To Retirement ◽  
The Impact

ABSTRACTThis paper describes the design and utility of a ‘Crisis Assessment Technique’ for measuring the impact of selected life events as perceived by individuals who have actually experienced them. Using the transition to retirement as an example, the utility of such a measure for assessing the relative impact of given events, is demonstrated. Analysis of data on 300 recently retired men and women in south western Ontario suggests that retirement from one's work is not as critical a life event as previous measures suggest.

scholarly journals Development and validation of a machine learning model predicting illness trajectory and hospital utilization of COVID-19 patients—a nationwide study

2021 ◽  
Author(s):  
Michael Roimi ◽  
Rom Gutman ◽  
Jonathan Somer ◽  
Asaf Ben Arie ◽  
Ido Calman ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Status ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Hospital Utilization ◽  
Clinical State ◽  
Care Hospital ◽  
System Utilization ◽  
The Impact ◽  
Day By Day

Abstract Objective The spread of COVID-19 has led to severe strain on hospital capacity in many countries. We aim to develop a model helping planners assess expected COVID-19 hospital resource utilization based on individual patient characteristics. Materials and Methods We develop a model of patient clinical course based on an advanced multistate survival model. The model predicts the patient's disease course in terms of clinical states—critical, severe, or moderate. The model also predicts hospital utilization on the level of entire hospitals or healthcare systems. We cross-validated the model using a nationwide registry following the day-by-day clinical status of all hospitalized COVID-19 patients in Israel from March 1st to May 2nd, 2020 (n = 2,703). Results Per-day mean absolute errors for predicted total and critical-care hospital-bed utilization were 4.72 ± 1.07 and 1.68 ± 0.40 respectively, over cohorts of 330 hospitalized patients; AUCs for prediction of critical illness and in-hospital mortality were 0.88 ± 0.04 and 0.96 ± 0.04, respectively. We further present the impact of patient influx scenarios on day-by-day healthcare system utilization. We provide an accompanying R software package. Discussion The proposed model accurately predicts total and critical-care hospital utilization. The model enables evaluating impacts of patient influx scenarios on utilization, accounting for the state of currently hospitalized patients and characteristics of incoming patients. We show that accurate hospital-load predictions were possible using only a patient’s age, sex, and day-by-day clinical state (critical, severe or moderate). Conclusion The multistate model we develop is a powerful tool for predicting individual-level patient outcomes and hospital-level utilization.

scholarly journals Variation among hospitals in the continuity of care for older hospitalized patients: a cross-sectional cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
James S. Goodwin ◽  
Shuang Li ◽  
Jie Zhou ◽  
Yong-Fang Kuo ◽  
Ann Nattinger
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Regression Model ◽  
Continuity Of Care ◽  
Logistic Regression Model ◽  
Large Degree ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Cross Sectional ◽  
The Impact

Abstract Background Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital. Methods We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3–6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model. Results Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was > 84.1%, vs. < 24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status. Conclusions Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.

Abstract 17198: Asymmetric Bifurcation Angle of Common Iliac Artery is Associated With Unilateral Calcified Nodule Lesion of Common Iliac Artery

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Nagataka Yoshihara ◽  
Hirokuni Akahori ◽  
Takahiro Imanaka ◽  
Kenji Kawai ◽  
Kojiro Miki ◽  
...  
Keyword(s):  
Symmetry Group ◽  
Iliac Artery ◽  
De Novo ◽  
Common Iliac Artery ◽  
Patient Characteristics ◽  
Bilateral Symmetry ◽  
Unilateral Lesion ◽  
Bifurcation Angle ◽  
Lesion Pattern ◽  
The Impact

Background and aim: It has been known that bifurcation angles of common iliac artery (CIA) are not always bilateral symmetry. Previous study reported that mechanical stress initiate calcification in aortic valve. The aim of this study was to investigate the impact of CIA anatomical features on lesion characteristic of CIA. Methods and results: This study enrolled 72 patients with intermittent claudication who had undergone endovascular-therapy (EVT) for de novo CIA atherosclerotic lesions in our hospital during April 2012 to March 2017. Anatomical analysis of CIA bifurcation was assessed by frontal view of initial angiography at EVT. We calculated the bilateral CIA angles between axis of terminal aorta and axis of proximal CIA, and bilateral symmetry was expressed as absolute value of the difference between both CIA angles (Δangle). The patients were divided into 2 groups: symmetry group (Δangle≦10 degrees, n=40) and asymmetry group (Δangle>10 degrees, n=32), according to the mean of Δangle. Distribution characteristics were classified into 2 patterns: bilateral lesions pattern and unilateral lesion pattern, furthermore we assessed calcified nodule of CIA lesion using intravascular ultrasound. There was no difference between 2 groups about patient characteristics. Unilateral lesion was observed in asymmetry group much more than symmetry group (63% vs 22%, P<0.05). Calcified nodule lesion was observed in asymmetry group much more than symmetry group (28% vs 5%, P<0.05). Conclusions: These findings suggested that asymmetric bifurcation angle of CIA was associated with unilateral lesion and calcified nodule lesion. Asymmetry of CIA bifurcation might be predictor of unilateral calcified nodule lesion of CIA.

The impact of life events in female patients with fibromyalgia and in female healthy controls

2000 ◽  
Vol 15 (5) ◽  
pp. 295-301 ◽  
Author(s):  
U.M. Anderberg ◽  
I. Marteinsdottir ◽  
T. Theorell ◽  
L. von Knorring
Keyword(s):  
Life Events ◽  
Stressful Life Events ◽  
Negative Life Events ◽  
Negative Life Event ◽  
Healthy Controls ◽  
Life Event ◽  
Common Life ◽  
Economic Problems ◽  
Healthy Women ◽  
The Impact

SummaryThe aim was to investigate if female fibromyalgia patients (FMS) had experienced more negative life events than healthy women. Furthermore, the life events experienced in relation to onset of the FMS were evaluated. Another important area was to investigate the impact of the events experienced in the patients compared to healthy women.A new inventory was constructed to assess life events during childhood, adolescence and in adulthood as well as life events experienced in relation to the onset of the disorder. Forty female FMS patients and 38 healthy age-matched women participated in the study.During childhood or adolescence 51% of the patients had experienced very negative life events as compared to 28% of the controls. Conflict with parents was the most common life event. Before onset, 65% of the patients experienced some negative life event. Economic problems and conflicts with husband/partner were common. During the last year, 51% of the patients had life events which they experienced as very negative, compared to 24.5% of the controls (P < 0.01).Stressful life events in childhood/adolescence and in adulthood seem to be very common in FMS. Furthermore, the life events were experienced as more negative than the life events experienced by healthy controls.

Somatic symptom and related disorders in pediatric patients: Associations with parent psychiatric and substance use histories

2020 ◽  
Vol 25 (4) ◽  
pp. 932-944 ◽  
Author(s):  
Timothy W LaVigne ◽  
Lauren M Laake ◽  
Patricia Ibeziako
Keyword(s):  
Substance Use ◽  
Healthcare Utilization ◽  
Somatic Symptom ◽  
Pediatric Patients ◽  
Functional Disability ◽  
Symptom Presentation ◽  
Parental Response ◽  
Patient Reported ◽  
Medical Healthcare ◽  
The Impact

Parental response to pediatric patients with somatic symptom and related disorders (SSRDs) can impact symptom presentation. However, little is known about the impact of parent psychiatric and substance use disorder (SUD) history on the functional status and medical healthcare utilization of patients with SSRDs. The current study explored the associations between parent psychiatric & SUD history and patient somatic symptoms, functional disability, and hospital course in a medically hospitalized sample of pediatric patients with SSRDs. The electronic medical records of 375 pediatric patients with SSRDs, ages 5 to 18, admitted at a tertiary pediatric hospital were retrospectively reviewed. Parent psychiatric histories were identified in 45.1% of the sample. Parent SUD history and maternal psychiatric history were associated with more patient reported somatization. Parent psychiatric and SUD history were not associated with pediatric patients’ level of functional disability or healthcare utilization during admission, including admission length, number of tests, and number of consultations obtained. This study has implications regarding reduction of potential stigma towards parents with psychiatric or SUD histories whose children are hospitalized with SSRDs. While such histories may provide insights regarding somatization presentation of pediatric patients with these disorders, it may not necessarily impact level of functional disability or hospital course.

The impact of time to metastasis on survival in treatment-naïve prostate cancer patients.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 212-212
Author(s):  
Shusuke Akamatsu ◽  
Kenny Lynch ◽  
Peter Black ◽  
Martin Gleave ◽  
Larry Goldenberg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Median Time ◽  
De Novo ◽  
Patient Characteristics ◽  
Initial Diagnosis ◽  
Significant Difference ◽  
Treatment Naïve ◽  
The Impact

212 Background: With the emergence of novel therapies, the treatment of advanced prostate cancer has evolved. However, patients eventually succumb to their metastatic disease. Nonetheless, little is known about the impact of time to metastasis on survival. To further expand on this, we separated metastatic prostate cancer patients into three groups according to the timing of metastasis and analyzed their survival. Methods: From 2008 to 2013, 157 CRPC patients were identified in our database. Of those, 92 with metastasis and sufficient data were analysed. The patients were classified into three groups according to the timing of metastasis. There were 35 de novo –M (metastasis within three months of initial diagnosis), 26 CSPC-M (initially metastasis free, metastasis found more than 6 months prior to CRPC), and 31 CRPC-M (metastasis found within 6 months of becoming CRPC, or after becoming CRPC). Patient characteristics were analyzed, and survival was calculated. Results: Median follow up were 2.2, 9.6, and 11.8 years for de novo-M, CSPC-M, and CRPC-M. 85 and 84 % in the CSPC-M and CRPC-M respectively had local therapies by surgery and/or radiation. The types of local therapies were similar between the groups. Mean time to PSA recurrence after intial therapy were 3.5 and 2.2 years for CSPC-M and CRPC-M, and median time to metastasis were 4.4 and 11.4 years respectively. Treatments after CRPC included Abiraterone, Enzalutamide, and Docetaxel, and the use of these agents were similar between the groups. Median time to CRPC were 1.4, 6.2, and 8.6 years, and median overall survival after diagnosis were 3.7, 12.3, and 15.8 years for de novo-M, CSPC-M, and CRPC-M. Conclusions: The overall survival and time to CRPC were significantly shorter in de novo-M. Although there was a marked difference in time to metastasis between CSPC-M and CRPC-M, there was no statistically significant difference in overall survival. Either treated with hormone therapy before or after emergence of metastasis, survival of more than 10 years after initial diagnosis is possible.

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