scholarly journals Alcohol withdrawal-related outcomes associated with gabapentin use in an inpatient psychiatric facility

2019 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Taylor A. Nichols ◽  
Sophie Robert ◽  
David J. Taber ◽  
Jeffrey Cluver
Keyword(s):  
Alcohol Withdrawal ◽  
Length Of Hospital Stay ◽  
Control Cohort ◽  
Psychiatric Facility ◽  
Therapeutic Uses ◽  
Significant Difference ◽  
Benzodiazepine Use ◽  
The Impact ◽  
Hospital Stay Duration ◽  
Inpatient Psychiatric Facility

Abstract Introduction Limited evidence exists evaluating the impact of gabapentin in conjunction with benzodiazepines for the management of alcohol withdrawal. A review of outcomes associated with combination gabapentin and benzodiazepine therapy may illuminate new therapeutic uses in clinical practice. Methods This retrospective study evaluated the impact of gabapentin on as-needed use of benzodiazepines in inpatients being treated for acute alcohol withdrawal. The treatment cohort consisted of patients prescribed gabapentin while on a symptom-triggered alcohol withdrawal protocol. The control cohort consisted of patients on symptom-triggered alcohol withdrawal protocol without concurrent gabapentin use. Secondary objectives included length of hospital stay, duration on alcohol withdrawal protocol, frequency of complicated withdrawal, and use of additionally prescribed as-needed or scheduled benzodiazepines. Results The gabapentin cohort was on the alcohol withdrawal protocol for a similar duration, compared with the control cohort (median of 4 [interquartile range: 2,6] days vs 3 [2,4] days, P = .09, respectively). Similarly, the gabapentin cohort required a median of 1 [1,2] benzodiazepine dose for alcohol withdrawal symptoms compared with a median of 1 [1,2] dose in the control cohort, P = .89. No significant difference was found between cohorts for as-needed and scheduled benzodiazepine use. Length of stay in hospital was similar between groups. Discussion These results suggest that gabapentin use, in conjunction with benzodiazepines, impacts neither the time on alcohol withdrawal protocol or the number of benzodiazepine doses required for withdrawal. Larger, prospective studies are needed to detect if gabapentin alters benzodiazepine usage and to better elucidate gabapentin's role in acute alcohol withdrawal.

scholarly journals The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yvette Farrugia ◽  
Bernard Paul Spiteri Meilak ◽  
Neil Grech ◽  
Rachelle Asciak ◽  
Liberato Camilleri ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Mortality ◽  
Obstructive Pulmonary Disease ◽  
Predictors Of Mortality ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Difference ◽  
The Impact

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

scholarly journals Impact of Spectral Severity of Alcoholism on Visual-Evoked Potentials: A Neuropsychiatric Perspective

2018 ◽  
Vol 09 (03) ◽  
pp. 381-390
Author(s):  
Ruchi Kothari ◽  
Praveen Khairkar ◽  
Sneh Babhulkar ◽  
Pradeep Bokariya
Keyword(s):  
Alcohol Withdrawal ◽  
Evoked Potential ◽  
Psychiatric Comorbidity ◽  
Neurological Complications ◽  
Pattern Reversal ◽  
Neuropsychiatric Complications ◽  
Significant Difference ◽  
Axis I ◽  
The Impact ◽  
Visual Evoked

ABSTRACT Background: The deleterious effects of alcohol on the brain are replete in literature. Only a few neurophysiologic measures can pick up the neuronal dysfunctions, one of them being visual-evoked potential (VEP). A very limited amount of data exists on the progression of neural abnormalities related to the spectral severity of alcoholism. Aim of the Study: To evaluate the impact of spectral severity of alcoholism through VEP and to understand the emergence of any specific pattern or morphometric abnormalities related to alcohol-induced neuropsychiatric presentations. Methodology: A total of 90 cases were recruited in addition to 180 age- and sex-matched controls using purposive and random sampling. The Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version and Campbell Neuropsychiatric Inventory were used to evaluate alcohol disorders and its neuropsychiatric complications apart from the mandatory consultant-specific clinical evaluations of all the cases. Of 90 cases of alcohol dependence, 15 patients were currently abstinent for >6 months, 15 had alcohol intoxication, 15 had signs of alcohol withdrawal, 15 had physical complications, 15 had psychiatric comorbidity, and 15 had neurological complications such as epilepsy. VEP recordings were taken using an Evoked Potential Recorder (RMS EMG. EP MARK II) where the stimulus configuration consisted of transient pattern-reversal method in which a black and white checkerboard was generated full field. Results: Mean age of cases was 37.71 ± 11.49 years compared to 39.43 ± 10.67 years in controls (range 18–65 years). VEP abnormalities comprising of prolonged latencies (62.5%) with a statistically significant difference (P < 0.001) from the healthy controls was observed in cases of alcohol withdrawal syndrome. Predominant amplitude reduction with normal latency was obtained in 37.5% cases of withdrawal. Severe VEP abnormalities, i.e., both latency delay and amplitude reduction, were found in 75% patients with psychiatric comorbidity, 66.67% patients with neurological complications, i.e., epilepsy, and 33.34% patients with physical complications. An explicit finding of prominent interocular differences was a prominent feature present in 25% of patients with complications.

scholarly journals Day of surgery: the impact on patient length of stay in a tertiary vascular unit

2020 ◽  
Vol 102 (2) ◽  
pp. 98-103 ◽  
Author(s):  
NC Holford ◽  
C Ní Ghuidhir ◽  
L Hands
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Support Services ◽  
Length Of Hospital Stay ◽  
Abdominal Aortic Aneurysm Repair ◽  
Significant Difference ◽  
Postoperative Length ◽  
The Difference ◽  
Aneurysm Repair ◽  
The Impact

Background Our hypothesis was that patients undergoing surgery earlier in the week would have better access to physiotherapy and other discharge services after surgery and, as a result, would have a shorter length of hospital stay compared with patients undergoing surgery later in the week. This study aimed to assess whether there is a significant difference in postoperative length of hospital stay between the groups with secondary assessment by operation subtype. Methods We identified all patients admitted for vascular surgery in 2015 from a prospectively collected database and divided the week into Monday to Wednesday and Thursday to Friday. Endovascular cases were included but day cases were excluded. Further analysis was performed with a breakdown in both groups by operation type. Statistical analysis was performed using SPSS version 16.0. Results We identified 652 patients who met our criteria. Within the elective patient group, there was a significantly longer length of stay of three days for the late-week group compared with two days for the early-week group (P = 0.016). Femoral artery procedures had a median length of stay of two days for those operated on early in the week compared with four days later in the week (P < 0.005). Open abdominal aortic aneurysm repair showed a trend to longer length of stay in the late-week group (P = 0.06). Conclusion Day of surgery appears to impact on patients’ length of stay following vascular procedures, with the greatest impact on medium-sized procedures. This difference could be explained by the difference in weekend support services, but further evaluation is required following introduction of weekend support services to assess this.

scholarly journals Early Infectious Disease Consultation Is Associated With Lower Mortality in Patients With Severe Sepsis or Septic Shock Who Complete the 3-Hour Sepsis Treatment Bundle

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Theresa Madaline ◽  
Francis Wadskier Montagne ◽  
Ruth Eisenberg ◽  
Wenzhu Mowrey ◽  
Jaskiran Kaur ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
Rank Test ◽  
P Value ◽  
Analysis Model ◽  
Subdistribution Hazard ◽  
Significant Difference ◽  
The Impact

Abstract Objective Severe sepsis and septic shock (SS/SS) treatment bundles reduce mortality, and early infectious diseases (ID) consultation also improves patient outcomes. We retrospectively examined whether early ID consultation further improves outcomes in Emergency Department (ED) patients with SS/SS who complete the sepsis bundle. Method We included 248 adult ED patients with SS/SS who completed the 3-hour bundle. Patients with ID consultation within 12 hours of ED triage (n = 111; early ID) were compared with patients who received standard care (n = 137) for in-hospital mortality, 30-day readmission, length of hospital stay (LOS), and antibiotic management. A competing risk survival analysis model compared risks of in-hospital mortality and discharge alive between groups. Results In-hospital mortality was lower in the early ID group unadjusted (24.3% vs 38.0%, P = .02) and adjusted for covariates (odds ratio, 0.47; 95% confidence interval (CI), 0.25–0.89; P = .02). There was no significant difference in 30-day readmission (22.6% vs 23.5%, P = .89) or median LOS (10.2 vs 12.1 days, P = .15) among patients who survived. A trend toward shorter time to antibiotic de-escalation in the early ID group (log-rank test P = .07) was observed. Early ID consultation was protective of in-hospital mortality (adjusted subdistribution hazard ratio (asHR), 0.60; 95% CI 0.36–1.00, P = .0497) and predictive of discharge alive (asHR 1.58, 95% CI, 1.11–2.23; P-value .01) after adjustment. Conclusions Among patients receiving the SS/SS bundle, early ID consultation was associated with a 40% risk reduction for in-hospital mortality. The impact of team-based care and de-escalation on SS/SS outcomes warrants further study.

Case-cohort study to determine the value of therapeutic touch in preventing radiation dermatitis.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 103-103
Author(s):  
J. Younus ◽  
M. Lock ◽  
J. Malec ◽  
O. Vujovic ◽  
E. Yu
Keyword(s):  
Breast Cancer ◽  
Median Time ◽  
Skin Pigmentation ◽  
Therapeutic Touch ◽  
Radiation Dermatitis ◽  
Breast Cancer Patients ◽  
Control Cohort ◽  
Significant Difference ◽  
Grade Ii ◽  
The Impact

103 Background: Therapeutic touch (TT) is a noninvasive healing technique. There is evidence of value in various clinical areas, but not during radiotherapy (RT) for breast cancer. The TT Cohort was designed to assess the acceptability, compliance, and side effects of TT. The Control Cohort was used compare the impact of TT in preventing radiation dermatitis. Methods: Early breast cancer patients scheduled to undergo post-conservative surgery RT were selected. TT was administered three times per week during RT. Feasibility was defined a priori as 15 of 17 patients completing all treatments. The effectiveness of TT was evaluated by the NCIC CTC V3 dermatitis scale and EORTC Cosmetic Rating. The quality of life (QOL), mood, and fatigue were assessed by EORTC QLQ C30, POMS, and BFI, respectively. These were assessed at baseline and weekly during treatment. Results: 17 stage I/II breast were prospectively identified for the TT Cohort and 31 patients were prospectively assessed in the Control Cohort. Median age was 63 years (47-79). TT was considered feasible as all 17 patients completed treatment. In the TT Cohort, the worst grade of radiation dermatitis was grade II in 9 patients. One patient did not develop any dermatitis. Median time to develop the worst grade was 20 days. QOL, mood and energy, and fatigue levels were consistent with the previous published studies. In the Control Cohort, the worst grade of radiation dermatitis was grade III in 1 patient. The most common toxicity grade was II in 15 patients. Three patients did not develop any dermatitis. Median time to develop the worst grade was 29 days. There was no statistical difference in the overall cosmetic score and grade II/III toxicity. There was a statistically significant difference in skin pigmentation and edema. Conclusions: This study represents the first evaluation of TT in patients with EBC using objective measures. TT is a feasible addition for the management of dermatitis to a tertiary clinic. TT neither improved overall cosmesis nor grade II/III toxicity.

scholarly journals Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil

2003 ◽  
Vol 61 (2A) ◽  
pp. 188-193 ◽  
Author(s):  
Norberto L. Cabral ◽  
Carla Moro ◽  
Giana R. Silva ◽  
Rosana Herminia Scola ◽  
Lineu César Werneck
Keyword(s):  
Hospital Stay ◽  
Stroke Unit ◽  
Survival Curve ◽  
Clinical Status ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
General Ward ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.

scholarly journals Prolonged postoperative ileus after elective colorectal cancer surgery

2018 ◽  
Vol 75 (8) ◽  
pp. 780-786
Author(s):  
Milica Nestorovic ◽  
Goran Stanojevic ◽  
Branko Brankovic ◽  
Vanja Pecic ◽  
Ljiljana Jeremic
Keyword(s):  
Prospective Study ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Postoperative Ileus ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Significant Difference ◽  
Prolonged Postoperative Ileus ◽  
The Impact

Background/Aim. Postoperative ileus is a frequent and frustrating occurence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p < 0.001), complications grade III (_2 = 23.43; p < 0.001) and reoperations (_2 = 15.724; p <0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.

scholarly journals Crisis resolution and home treatment teams for older people with mental illness

2008 ◽  
Vol 32 (7) ◽  
pp. 268-270 ◽  
Author(s):  
Claire Dibben ◽  
Humera Saeed ◽  
Konstantinos Stagias ◽  
Golam Mohammed Khandaker ◽  
Judy Sasha Rubinsztein
Keyword(s):  
Mental Illness ◽  
Older People ◽  
Hospital Admissions ◽  
Length Of Hospital Stay ◽  
Home Treatment ◽  
Crisis Resolution ◽  
Admission Rates ◽  
People With Mental Illness ◽  
Significant Difference ◽  
The Impact

Aims and MethodWe examined the impact of a crisis resolution and home treatment teams (CRHTT) on hospital admission rates, bed days and treatment satisfaction among older people with mental illness and their carers. We compared these factors in the 6 months before the service started and 6 months after its introduction.ResultsThe CRHTT significantly reduced admissions (P<0.001), but there was no significant difference in the length of hospital stay as compared before and after the introduction of this service. There was a trend towards carers, but not patients, being more satisfied with treatment after the introduction of the CRHTT.Clinical ImplicationsThe CRHTT reduced hospital admissions for older people by 31% and carers preferred the service. Further research on crisis teams in older people with mental illness is needed using randomised controlled methodology.

Earlier Initiation of Postoperative Physical Therapy Decreases Opioid Use after Total Knee Arthroplasty

2020 ◽  
Author(s):  
Tal Frenkel Rutenberg ◽  
Haim Izchak ◽  
Yoav Rosenthal ◽  
Uri Barak ◽  
Shai Shemesh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Therapy ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Osteoarthritis Of The Knee ◽  
Opioid Use ◽  
Significant Difference ◽  
Total Knee ◽  
The Impact

AbstractFor patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.

scholarly journals The Effect of Follow-up Contact in Reoccurrence of Psychiatric Readmission

2019 ◽  
Author(s):  
David Mallo ◽  
Ian E. Wickramasekera
Keyword(s):  
Case Management ◽  
Intervention Strategies ◽  
Psychiatric Facility ◽  
Readmission Rates ◽  
Psychiatric Readmission ◽  
Inpatient Facility ◽  
The Impact ◽  
Number Of Individuals ◽  
Inpatient Psychiatric Facility

This study examined if clinical contact with clients within one week of discharge from an inpatient psychiatric facility had an influence on their readmission. One of the factors explored in this study was whether the impact of clinical contact could reduce readmission rates after discharge used to develop intervention strategies to reduce readmission. The study found that those individuals who had a case management appointment set within the first seven days of discharge from an inpatient psychiatric facility was approximately eight times more likely than non-clinical referrals, 32 % vs. 4 %, to be not readmitted to an inpatient psychiatric facility. When this was examined even more closely, it was determined that case management appointments attended within the first day following discharge from an inpatient psychiatric facility was significantly associated with attendance following discharge. The number of individuals who attended case management appointments dropped approximately 50% within 24 hours of discharge, as compared with the number of individuals who attended appointments following two days after discharge (18 % to 8 %). This trend continued as time progressed for the first two to seven days following discharge from an inpatient psychiatric facility, where the attendance of a clinical appointment dropped to 4% within seven days following discharge. These findings have implications on what type of clinical contact should be pursued following discharge from an inpatient facility, and how soon that appointment should be accomplished in order to decrease readmissions.

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