Substance Use/Dependence in Psychiatric Emergency Setting Leading to Hospitalization: Predictors of Continuity of Care

Background: Poor adherence to treatment is a common clinical problem in individuals affected by mental illness and substance use/dependence. In Italy, mental care is organized in a psychiatric service and addiction unit (SERD), characterized by dual independent assets of treatment. This difference, in the Emergency Room setting, leads to a risk of discontinuity of treatment in case of hospitalization. In this study we clinically characterized individuals who decided to attend hospital post-discharge appointments at SERD, in accordance with medical advice. Methods: This is a retrospective study, based on two years of discharged records of patients entering “Versilia Hospital” (Viareggio, Italy) emergency room, with urinalyses testing positive for substance use, and hospitalization after psychiatric consultation. The sample was divided according to the presence or absence of SERD consultation after discharge. Results: In the 2-year period of the present study, 1005 individuals were hospitalized. Considering the inclusion criterion of the study, the sample consisted of 264 individuals. Of these, 128 patients attended post-discharge appointments at SERD showing urinalyses positive to cocaine, opiates, and poly use; they were more frequently diagnosed as personality disorder and less frequently as bipolar disorder. The prediction was higher for patients that had already been treated at SERD, for patients who received SERD consultation during hospitalization, and for patients with positive urinalyses to cocaine and opiates at treatment entry. Conversely, patients who did not attend SERD consultation after discharge were affected by bipolar disorders. Limitations: Small sample size. Demographical data are limited to gender and age due to paucity of data in hospital information systems. SERD is located far from the hospital and is open only on weekdays; thus, it cannot ensure a consultation with all inpatients. Conclusions: Mental illness diagnosis, the set of substance use positivity at hospitalization, and having received SERD consultation during hospitalization appeared to have a critical role in promoting continuity of care. Moreover, to reduce the gap between the need and the provision of the treatment, a more effective personalized individual program of care should be implemented.

Download Full-text

Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT

Gerontology ◽

10.1159/000510903 ◽

2020 ◽

Vol 66 (6) ◽

pp. 542-548

Author(s):

Wendy L. Cook ◽

Penelope M.A. Brasher ◽

Pierre Guy ◽

Stirling Bryan ◽

Meghan G. Donaldson ◽

...

Keyword(s):

Hip Fracture ◽

Small Sample Size ◽

Controlled Trial ◽

Geriatric Care ◽

Small Sample ◽

Community Dwelling ◽

Post Discharge ◽

Mobility Performance ◽

Discharge Care ◽

Comprehensive Geriatric Care

Background: Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. Objective: To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. Methods: A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3–12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0–12) at 12 months. Results: We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (n = 26) and usual care (UC, n = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI –0.3 to 2.0, p = 0.13). Adverse events were similar in the 2 groups. Conclusion: The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.

Download Full-text

The Cottage: providing medical respite care in a home-like environment for people experiencing homelessness

Housing Care and Support ◽

10.1108/hcs-08-2018-0020 ◽

2018 ◽

Vol 22 (1) ◽

pp. 54-64

Author(s):

Angela Gazey ◽

Shannen Vallesi ◽

Karen Martin ◽

Craig Cumming ◽

Lisa Wood

Keyword(s):

Case Studies ◽

Small Sample Size ◽

Treatment Compliance ◽

Small Sample ◽

Health Conditions ◽

Hospital Inpatient ◽

City Hospital ◽

Post Discharge ◽

Content Type ◽

The Usa

Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia. Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage. Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support. Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality. Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions. Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

Download Full-text

MicroRNAs as Diagnostic Tools in Hepatocellular Carcinoma

Gastrointestinal Disorders ◽

10.3390/gidisord3040022 ◽

2021 ◽

Vol 3 (4) ◽

pp. 237-246

Author(s):

Jessica Evangelista ◽

Elisa Zaninotto ◽

Annalisa Gaglio ◽

Michele Ghidini ◽

Lucrezia Raimondi

Keyword(s):

Hepatocellular Carcinoma ◽

Small Sample Size ◽

Expression Patterns ◽

Critical Role ◽

Measurement Techniques ◽

Small Sample ◽

Diagnostic Tools ◽

Migration And Invasion ◽

Altered Expression ◽

Liver Cancers

Liver cancer is the fourth leading cause of cancer-related deaths worldwide, with hepatocellular carcinoma (HCC) accounting for approximately 80% of all liver cancers. The serum concentration of alpha-fetoprotein (AFP) is the only validated biomarker for HCC diagnosis. MicroRNAs (miRNAs) are small non-coding RNAs of 21–30 nucleotides playing a critical role in human carcinogenesis, with types of miRNAs with oncogenic (oncomiRs) or tumor suppressor features. The altered expression of miRNAs in HCC is associated with many pathological processes, such as cancer initiation, tumor growth, apoptosis escape, promotion of migration and invasion. Moreover, circulating miRNAs have been increasingly investigated as non-invasive biomarkers for HCC diagnosis. MiRNAs’ expression patterns are altered in HCC and several single miRNAs or miRNAs panels have been found significantly up or downregulated in HCC with respect to healthy controls or non-oncological patients (cirrhotic or with viral hepatitis). However, any of the investigated miRNAs or miRNAs panels has entered clinical practice so far. This has mostly to do with lack of protocols standardization, small sample size and discrepancies in the measurement techniques. This review summarizes the major findings regarding the diagnostic role of miRNAs in HCC and their possible use together with standard biomarkers in order to obtain an early diagnosis and easier differential diagnosis from non-cancerous liver disease.

Download Full-text

Testing the Integrative Quality Care Assessment Tool (INQUAT)

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-03-2018-0065 ◽

2019 ◽

Vol 33 (1) ◽

pp. 120-144

Author(s):

Rebecca Amati ◽

Tommaso Bellandi ◽

Amer A. Kaissi ◽

Annegret F. Hannawa

Keyword(s):

Quality Improvement ◽

Continuity Of Care ◽

Assessment Tool ◽

Small Sample Size ◽

Quality Care ◽

Small Sample ◽

Content Type ◽

Care Assessment ◽

Quality Aspects ◽

The Us

Purpose Identifying the factors that contribute or hinder the provision of good quality care within healthcare institutions, from the managers’ perspective, is important for the success of quality improvement initiatives. The purpose of this paper is to test the Integrative Quality Care Assessment Tool (INQUAT) that was previously developed with a sample of healthcare managers in the USA. Design/methodology/approach Written narratives of 69 good and poor quality care episodes were collected from 37 managers in Italy. A quantitative content analysis was conducted using the INQUAT coding scheme, to compare the results of the US-based study to the new Italian sample. Findings The core frame of the INQUAT was replicated and the meta-categories showed similar distributions compared to the US data. Structure (i.e. organizational, staff and facility resources) covered 8 percent of all the coded units related to quality aspects; context (i.e. clinical factors and patient factors) 10 percent; process (i.e. communication, professional diligence, timeliness, errors and continuity of care) 49 percent; and outcome (i.e. process- and short-term outcomes) 32 percent. However, compared to the US results, Italian managers attributed more importance to different categories’ subcomponents, possibly due to the specificity of each sample. For example, professional diligence, errors and continuity of care acquired more weight, to the detriment of communication. Furthermore, the data showed that process subcomponents were associated to perceived quality more than outcomes. Research limitations/implications The major limitation of this investigation was the small sample size. Further studies are needed to test the reliability and validity of the INQUAT. Originality/value The INQUAT is proposed as a tool to systematically conduct in depth analyses of successful and unsuccessful healthcare events, allowing to better understand the factors that contribute to good quality and to identify specific areas that may need to be targeted in quality improvement initiatives.

Download Full-text

Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390319878773 ◽

2019 ◽

Vol 26 (3) ◽

pp. 250-261

Author(s):

Lydia Ould Brahim ◽

Cezara Hanganu ◽

Catherine Pugnaire Gros

Keyword(s):

Mental Illness ◽

Substance Use ◽

Dual Diagnosis ◽

Psychiatric Hospitalization ◽

Critical Role ◽

Nursing Interventions ◽

Semistructured Interviews ◽

Specialized Care ◽

Qualitative Descriptive ◽

Patients Experience

BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse’s role to include evidence-based responses to substance use is recommended.

Download Full-text

Transitional interventions to reduce early psychiatric readmissions in adults: systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.115030 ◽

2013 ◽

Vol 202 (3) ◽

pp. 187-194 ◽

Cited By ~ 107

Author(s):

Simone N. Vigod ◽

Paul A. Kurdyak ◽

Cindy-Lee Dennis ◽

Talia Leszcz ◽

Valerie H. Taylor ◽

...

Keyword(s):

Systematic Review ◽

Small Sample Size ◽

Psychiatric Patients ◽

Absolute Risk ◽

Cost Effective ◽

Small Sample ◽

Future Research ◽

Post Discharge ◽

Psychiatric Readmission ◽

Patient Provider Communication

BackgroundUp to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission.AimsTo describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission.MethodSystematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission.ResultsThe review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias.ConclusionsMany effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.

Download Full-text

Bipolar Disorder and Comorbid Use of Illicit Substances

Medicina ◽

10.3390/medicina57111256 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1256

Author(s):

Ulrich W. Preuss ◽

Martin Schaefer ◽

Christoph Born ◽

Heinz Grunze

Keyword(s):

Bipolar Disorder ◽

Substance Use ◽

Best Practices ◽

Multidisciplinary Approach ◽

Small Sample Size ◽

Basic Research ◽

Small Sample ◽

Epigenetic Alterations ◽

Open Label ◽

Addictive Disorders

Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes. Incidence and management of illicit drug use differ from alcohol use disorders, nicotine use of behavioral addictions. It is not yet clear why people with bipolar disorder are at higher risk of addictive disorders, but recent data suggest common neurobiological and genetic underpinnings and epigenetic alterations. In the absence of specific diagnostic instruments, the clinical interview is conducive for the diagnosis. Treating SUD in bipolar disorder requires a comprehensive and multidisciplinary approach. Most treatment trials focus on single drugs, such as cannabis alone or in combination with alcohol, cocaine, or amphetamines. Synopsis of data provides limited evidence that lithium and valproate are effective for the treatment of mood symptoms in cannabis users and may reduce substance use. Furthermore, the neuroprotective agent citicoline may reduce cocaine consumption in BD subjects. However, many of the available studies had an open-label design and were of modest to small sample size. The very few available psychotherapeutic trials indicate no significant differences in outcomes between BD with or without SUD. Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.

Download Full-text

Tobacco Use and Associated Factors in Patients Presenting to a Psychiatric Emergency Room

Journal of Addiction ◽

10.1155/2018/8102165 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ashely Collins ◽

Oluwadamilare Ajayi ◽

Savannah Diamond ◽

William Diamond ◽

Suzanne Holroyd

Keyword(s):

Mental Illness ◽

Substance Use ◽

Alcohol Use ◽

General Population ◽

Emergency Room ◽

Tobacco Use ◽

Associated Factors ◽

Alcohol Use Disorders ◽

Psychiatric Emergency ◽

Psychiatric Emergency Room

Background. Rates of cigarette smoking among the public and individuals with mental illness have been well documented. Studies have demonstrated that prevalence of smoking among individuals with mental illness remains elevated compared to the general population and as a distinct subgroup, individuals with mental illness consume more than a third of cigarettes sold in the U.S. However, information on rates of smoking among patients presenting to a psychiatric emergency room (ER) is lacking. This study assesses this understudied population for smoking prevalence and associated factors. Methods. A retrospective chart review of 203 distinct psychiatric ER patients was conducted. Demographics, tobacco use, substance use, psychiatric diagnoses, and family history were noted and analyzed with SPSS. Result. Tobacco use rates were noted to be nearly fifty percent and significant associations were found with active suicidal ideation, alcohol use disorders, illicit drug use disorders, and history of prior psychiatric hospitalization. Conclusion. Tobacco use among psychiatric ER patients is much higher than that of the general population and associated with active suicidal ideations, alcohol use disorders, and illicit substance use disorders. These findings should be considered in the evaluation and expectant management of these patients by their clinicians and healthcare providers.

Download Full-text

Conceptualizing the Challenge and Moving to Solutions

Innovations in Psychosocial Interventions and Their Delivery ◽

10.1093/med-psych/9780190463281.003.0010 ◽

2018 ◽

pp. 237-266

Author(s):

Alan E. Kazdin

Keyword(s):

Public Health ◽

Mental Illness ◽

Substance Use ◽

Mental Disorders ◽

Physical Health ◽

Large Scale ◽

Critical Role ◽

Grand Challenges ◽

Substance Use And Abuse

This chapter places the challenge of reducing the burdens of mental illness in broader contexts and progresses from these to concrete recommendations on how to proceed toward next steps. The notions of wicked problems and grand challenges provide two contexts for understanding the challenge. From broad concepts, the chapter moves to means of addressing challenges and making progress in concrete ways to reduce the burdents of mental illness. Illustrations are provided of promising efforts in relation to physical health, mental disorders, and substance use and abuse. The critical role of assessment, especially large-scale surveillance measures from public health, is also discussed.

Download Full-text

Post-Discharge Mortality and Rehospitalization among participants in a Comprehensive Acute Kidney Injury Rehabilitation Program

Kidney360 ◽

10.34067/kid.0003672021 ◽

2021 ◽

pp. 10.34067/KID.0003672021

Author(s):

Gurmukteshwar Singh ◽

Yirui Hu ◽

Steven Jacobs ◽

Jason Brown ◽

Jason George ◽

...

Keyword(s):

Acute Kidney Injury ◽

Small Sample Size ◽

Kidney Injury ◽

Case Manager ◽

Rehabilitation Program ◽

Small Sample ◽

Program Participation ◽

Post Discharge ◽

Mortality And Morbidity ◽

Discharge Disposition

Background: Hospitalization-associated acute kidney injury (AKI) is common and associated with markedly increased mortality and morbidity. This prospective cohort study examined the feasibility and association of an AKI rehabilitation program with post-discharge outcomes. Methods: Adult patients hospitalized from 9/19/19-2/29/20 in a large health system in Pennsylvania with stage 2-3 AKI who were alive, and not on dialysis or hospice at discharge were evaluated for enrollment. The intervention included patient education, case manager services, and expedited nephrology appointments starting within 1-3 weeks of discharge. We examined the association between AKI rehabilitation program participation and risks of rehospitalization or mortality in logistic regression analyses adjusting for comorbidities, discharge disposition, sociodemographic and kidney parameters. Sensitivity analysis was performed using propensity score matching. Results: Among high-risk AKI patients evaluated, 77/183 were suitable for inclusion. Out of these, 52 (68%) patients were enrolled and compared to 400 contemporary non-participant stage 2/3 AKI survivors. Crude post-discharge rates of rehospitalization or death were lower for participants vs. non-participants at 30 days (15.4% vs 34.2%; p=0.01) and at 90 days (30.8% vs 50.5%; p=0.01). After multivariable adjustment AKI rehabilitation program participation was associated with lower risk of rehospitalization or mortality at 30 days (OR 0.41, 95% CI: 0.16-0.93) with similar findings at 90-days (OR 0.52, 95% CI: 0.25-1.05). Due to small sample size, propensity-matched analyses were limited. The participants' rehospitalization or mortality were numerically lower but not statistically significant at 30 days (17.8% vs. 31.1%; p=0.22) or at 90 days (46.7% vs. 57.8%; p=0.4). Conclusions: The AKI rehabilitation program was feasible and potentially associated with improved 30-day rehospitalization or mortality. Our interventions present a roadmap to improve enrollment in future randomized trials.

Download Full-text