scholarly journals Is Consultation-Liaison Psychiatry ‘Getting Old’? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years

2020 ◽  
Vol 17 (20) ◽  
pp. 7389
Author(s):  
Silvia Ferrari ◽  
Giorgio Mattei ◽  
Mattia Marchi ◽  
Gian Maria Galeazzi ◽  
Luca Pingani
Keyword(s):  
Older Patients ◽  
Clinical Training ◽  
University Hospital ◽  
Liaison Psychiatry ◽  
Female Ratio ◽  
Research Activities ◽  
Male Female Ratio ◽  
Health Related ◽  
Consultation Liaison Psychiatry ◽  
Management Changes

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.

scholarly journals Introduction and geographic disparity of consultation-liaison psychiatry in Japan: Retrospective analysis of data from the Japanese National Inpatient database.

2020 ◽  
Author(s):  
Daisuke Shinjo ◽  
Hisateru Tachimori ◽  
Keiko Maruyama-Sakurai ◽  
Kenji Fujimori ◽  
Norihiko Inoue ◽  
...  
Keyword(s):  
National Level ◽  
Analysis Data ◽  
Health Coverage ◽  
Liaison Psychiatry ◽  
Female Ratio ◽  
Geographic Disparity ◽  
Male Female Ratio ◽  
Wide Availability ◽  
Consultation Liaison Psychiatry ◽  
Inpatient Database

Abstract Background: Consultation-liaison psychiatry (CLP)—professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders—was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to identify the clinical features and geographic disparity of CLP provided in Japan.Methods: We retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data with descriptive statistics according to region. Results: Data from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75–84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2% and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7% and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services.Conclusions: Our study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although five years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.

Association between the timing of consultation-liaison psychiatry interventions and the length of stay in general hospital

2019 ◽  
pp. 1-6 ◽  
Author(s):  
Hélène Vulser ◽  
Victoire Vinant ◽  
Victoria Lanvin ◽  
Gilles Chatellier ◽  
Frédéric Limosin ◽  
...  
Keyword(s):  
General Hospital ◽  
Disease Severity ◽  
Psychotic Disorders ◽  
Linear Models ◽  
Large Population ◽  
University Hospital ◽  
Liaison Psychiatry ◽  
Lengths Of Stay ◽  
Health Related ◽  
Consultation Liaison Psychiatry

Background Psychiatric comorbidities are frequent in patients admitted in general hospital and are associated with greater lengths of stay (LOS). Early consultation-liaison psychiatry (CLP) interventions may reduce the LOS but previous studies were underpowered to allow subgroup analyses and have generally not considered the severity of the condition for which patients were admitted (‘disease severity’). Aims To investigate the association between the timing of CLP interventions and LOS in a general hospital. Method We retrospectively included 4500 consecutive patients admitted in non-psychiatric wards of a university hospital between 2008 and 2016 who had a first CLP intervention. We used general linear models to examine the association between the referral time, defined as log(days before the consultation)/log(LOS), and log(LOS), adjusting for age, gender, year of admission, place of residence, main psychiatric diagnosis, admission to the intensive care unit (ICU), main physical condition and disease severity. Results Referral time was associated with log(LOS) (β = 0.31; P <0.001), notably for older patients (β = 0.43; P <0.001) and those admitted to the ICU (β = 0.50; P <0.001), but not for those with psychotic disorders (β = −0.20; P = 0.10). The association was confirmed when considering the expected LOS for each patient. For instance, for an expected LOS of 10 days, a CLP intervention on day 3 compared with day 6 was associated with a reduction of the actual LOS of 2.4 days. Conclusions Earlier CLP interventions were associated with a clinically significant shorter LOS in a large population even after adjusting for disease severity. Early CLP interventions may have benefits for both patients and health-related costs.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

scholarly journals Stability of Psychiatric Diagnoses in Candidates to Liver Transplantation Referred to a Consultation-Liaison Psychiatry Service

2019 ◽  
Vol 8 (6) ◽  
pp. 800 ◽  
Author(s):  
Giorgio Mattei ◽  
Maria Moscara ◽  
Jessica Balducci ◽  
Silvia Cavana ◽  
Melissa Cherubini ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Depressive Disorder ◽  
Psychiatric Service ◽  
Stability Index ◽  
University Hospital ◽  
Psychiatric Diagnoses ◽  
Liaison Psychiatry ◽  
Diagnostic Stability ◽  
Consultation Liaison Psychiatry ◽  
The Stability

Objective: To investigate the stability over time of the psychiatric diagnoses among candidates to liver transplantation referred to a consultation-liaison psychiatric service. Method: Descriptive study, carried out at the Consultation-Liaison Psychiatry Service (CLPS) placed at the Modena (Italy) General University Hospital. All patients waiting for liver transplantation and repeatedly referred to the CLPS were enrolled. The observation period was from 1 January 2008 to 31 December 2013. Pearson’s coefficients were calculated to measure diagnostic stability (index referral vs. last referral). Results: One hundred patients were assessed (males 67%; mean age 53 ± 7 years old). The mean number of referrals for patients was 3 ± 2. The stability rate of psychiatric diagnosis was 64%. The following diagnoses or conditions were all significantly stable (i.e., all featured by r > 0.5 and p < 0.05): Adjustment disorder, depressive disorder, comorbid anxiety/depressive disorder, substance use disorder (including alcohol), absence of any disorder, and presence of any disorder. Conclusions: The good level of diagnostic stability displayed in the sample may be a function of the clinical and organizational “style” of the CLPS, namely the focus on identifying the prevailing personality traits, defensive mechanisms, and relational patterns.

scholarly journals Mycosis Fungoides in Iranian Population: An Epidemiological and Clinicopathological Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Farahnaz Fatemi Naeini ◽  
Bahareh Abtahi-Naeini ◽  
Hamidreza Sadeghiyan ◽  
Mohammad Ali Nilforoushzadeh ◽  
Jamshid Najafian ◽  
...  
Keyword(s):  
Mycosis Fungoides ◽  
Disease Onset ◽  
Clinical Information ◽  
University Hospital ◽  
Histologic Diagnosis ◽  
Female Ratio ◽  
Male Predominance ◽  
Female Predominance ◽  
Single Center Study ◽  
Male Female Ratio

Background. Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. Extensive studies on Iranian MF patients are absent. The present study aimed to produce updated clinical information on Iranian MF patients.Methods. This was a retrospective, descriptive, single-center study, including all cases of MF seen in the Department of Dermatology, University Hospital of Isfahan, Iran, between 2003 and 2013. Data systematically recorded for each patient included clinical, biological, histological, and molecular findings.Results. Eighty-six patients with clinical and histologic diagnosis of MF were included in the study. Thirty-nine patients (45.3%) were male. Female predominance was observed in patients (male : female ratio is 1 : 1.2). Patients were between 7 and 84 years of age (median: 41). The interval from disease onset to diagnosis ranged from 0 to 55 years (median: 1 year). Eighteen cases (20.9%) had unusual variants of MF. The most common types included hypopigmented and poikilodermatous MF. Childhood cases of MF constituted 5.8% (5/86) of all patients. The early stages were seen in 82 cases (95.34%).Conclusion. The major differences in epidemiologic characteristics of MF in Iran are the lack of male predominance and the lower age of patients at the time of diagnosis.

The Sex Ratio and Rate of Reoperation for Dupuytren’s Contracture in Men and Women

1999 ◽  
Vol 24 (4) ◽  
pp. 456-459 ◽  
Author(s):  
S. WILBRAND ◽  
A. EKBOM ◽  
B. GERDIN
Keyword(s):  
Sex Ratio ◽  
Recurrent Disease ◽  
Hand Surgery ◽  
University Hospital ◽  
Early Age ◽  
Dupuytren’S Contracture ◽  
Female Ratio ◽  
Men And Women ◽  
Male Female Ratio ◽  
Repeated Surgery

We identified all patients treated by local fasciectomy at the Department of Hand Surgery, Uppsala University Hospital between 1965 and 1996. A total of 2375 operations were performed on 1600 patients. We found a male: female ratio of 5.9:1. Women had a higher mean age at first operation (62.4 years) than men (59.8 years). One-third of the men required repeated surgery and one-quarter of the women. Early age at first operation was associated with recurrent disease.

scholarly journals Clinical Profile and Length of Hospital Stay in a Sample of Psychogeriatric Patients Referred to Consultation Liaison Psychiatric Unit

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 256
Author(s):  
Bernardo J. Barra ◽  
Luis F. Varela ◽  
José R. Maldonado ◽  
Pilar Calvo ◽  
Anna Bastidas ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Features ◽  
Older Patients ◽  
Oldest Old ◽  
Length Of Hospital Stay ◽  
Patient Discharge ◽  
Liaison Psychiatry ◽  
Cross Sectional ◽  
Discharge Disposition ◽  
Consultation Liaison Psychiatry

Background and objectives: There has been a recent increase in older patients admitted to general hospitals. A significant percentage of hospitalized older patients are ≥75 years old, which differ from the patients aged 65 to 74 years old in terms of functional status at patient discharge. This study aims to compare sociodemographic, clinical features, and factors associated with length of hospital stay in youngest-old and oldest-old populations of inpatients referred to the consultation liaison psychiatry unit. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to a general hospital and referred from different services (medicine, surgery, etc.) to the consultation liaison psychiatry unit. The sample was divided into two groups of patients: youngest-old (65–74 years) and oldest-old (≥75 years). Psychiatric evaluations were performed while the patients were on wards at the hospital. Psychopharmacs were started as needed. A comparative analysis was carried out and predictive factors related to length of hospital stay were calculated. Results: The reference rate to consultation liaison psychiatry unit was 1.45% of the total older patients hospitalized. Our study demonstrates differences between the groups of older people: the oldest-old group were mainly female (p < 0.001), had more previous psychiatric diagnoses (p < 0.001), physical disabilities (p = 0.02), and neurocognitive disorders (p < 0.001), they used more antipsychotics (p < 0.001), and more frequently had a discharge disposition to a nursing home (p = 0.036). The presence of physical disability (beta = 0.07, p < 0.001) and logtime to referral to consultation liaison psychiatry unit (beta = 0.58, p < 0.001) were associated with increased length of hospital stay. Conclusions: Youngest-old and oldest-old people should be considered as two different types of patients when we consider clinical features. The time to referral to consultation liaison psychiatry unit seems to be a relevant factor associated with length of hospital stay.

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