Acute Wards Research Articles

Frequency of Indications for Transthoracic Echocardiography (Tte) in Non-Cardiac Patients in Peshawar, Pakistan

OBJECTIVES This study aimed to find the frequency of indications for Transthoracic echocardiography and its impact on non-cardiac patient management in Peshawar, Pakistan. METHODOLOGY A cross-sectional study was conducted in Medical B Ward, Department of Internal Medicine at Hayatabad Medical Complex, Peshawar, Pakistan, over six months from July to 31st December 2020. A non-consecutive probability sampling technique was used. The sample size was calculated using an Openepi calculator, keeping 25.9 % as the frequency of requesting heart failure as an indication of echocardiography, 6.15 % as the confidence limit, and 95 % as a confidence interval. RESULTSA total of 195 patients were included in the study. The mean age of the patients was 483 years, with 59% females and 41% males. The major indication for TTE was assessing left ventricular systolic function in 146 (75%) patients and then finding the cause of the observed arrhythmias in 15 (7.5%) patients. A major proportion (95%) of the evaluated patients had no major change in the ongoing management plan following TTE. The working diagnosis in evaluated patients was changed by 12.7%, whereas new management plans were devised in only 4.9% of the cases. CONCLUSION Designing a randomized study to fully elaborate on the utility of TTE in patients admitted to acute medical wards while trying to address all confounding variables is an extremely difficult task.

Cases presentation and relapse rates associated with specific risk factors

AbstractThis section will be destinated to the presentation of specific cases of patients with bipolar disorder admitted to our acute psychiatric ward. For each case, sociodemographic, clinical and environmental characteristics will be described and pharmacological treatment discussed. In addition, predictive and protective factors for mood relapses will be identified, and then, prospective information regarding their clinical prognosis will be provided in order to discuss with the attendees the impact of the mentioned factors on clinical outcomes.Disclosure of InterestNone Declared

Development of an enhanced scoring system to predict ICU readmission or in-hospital death within 24 hours using routine patient data from two NHS Foundation Trusts

RationaleIntensive care units (ICUs) admit the most severely ill patients. Once these patients are discharged from the ICU to a step-down ward, they continue to have their vital signs monitored...

Feasibility of a screening and prevention procedure for risks associated with dysphagia in older patients in geriatric units: the DYSPHAGING pilot study protocol

BackgroundDysphagia, particularly sarcopenic dysphagia, is frequent in frail older patients. Sarcopenic dysphagia is a swallowing disorder caused by sarcopenia, corresponding to a loss of muscle mass and strength. It frequently...

A pragmatic randomised controlled non-inferiority trial of open-door policy versus treatment as usual in urban psychiatric inpatient wards

IntroductionOpen-door policy (ODP) is an approach to reduce coercion in psychiatric wards recommended by the World Health Organization and the Council of Europe. Observational studies from Switzerland and Germany have shown promising results in reducing coercion, but no RCTs have been conducted. Skeptics have been concerned the observational evidence could mask that ODP could increase risks and harms and / or increase the use of coercive measures staff use to assist patients with psychoses, while proponents have argued that de-escalation and alliance-building will result in no such increase.ObjectivesTo evaluate open-door policy in an openly randomised, ethical-board approved trial of all patients referred to ward care at the Lovisenberg Diaconal Hospital in Oslo, Norway.MethodsA 12-month pragmatic, randomised-controlled non-inferiority trial comparing two ODP and three TAU acute psychiatric wards. The trial was pre-registered (ISRCTN16876467) and conformed to CONSORT. Ethical committee exemption enabled waiver of consent rules for the study, meaning all regular patients were included. Patients were randomly assigned (2:3 ratio) by a clinical admissions team using an open list. The non-inferiority margin was 15 % on the primary outcome: the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation/seclusion, and physical and mechanical restraints. Primary and safety analyses were based on intention-to-treat. Safety analyses included suicides and violent events against staff. Secondary outcomes were individual coercive measures, intensive care, resource use, and patient feedback.ResultsN=556 patients were included and randomised and were similar on all pre-admission demographics: Around 75% of patients were diagnosed with a psychotic disorder and were involuntarily admitted. Primary outcome: Use of coercive measures was within the non-inferiority margin (see table 1). Safety outcomes: No suicides occurred during ward care in any group. Violence against staff did not differ between study wards. Secondary outcomes: Use of intensive care (‘skjerming’) and number of days admitted was significantly less on open-door policy wards. Patients on open-door policy wards rated their experience of coercion and ward atmosphere better than patients on control wards.Table 1.Absolute and relative risk of being subjected to coercion on open-door policy or usual-treatment wards.Number (%) Main outcome Absolute Risk ODP wards (n=245) Absolute Risk TAU wards (n=311) Relative Risk (95% CI) Risk Difference (95% CI) Primary hypothesis confirmedOne or more coercive measures during the admission65 (26.5%)104 (33.4%)1.3 (0.97 to 1.6)6.9% (-0.7 to 14.5)YesConclusionsThis first RCT found open-door policy does not increase use of coercion or resource use. It does not harm staff or patients and is experienced as better by patients.Disclosure of InterestNone Declared

Home Treatment and Perinatal Psychiatry: An Alternative to Acute Psychiatric Wards

IntroductionWomen experiencing severe perinatal mental health problems require specialized services and care. Perinatal mental disorders are common and can contribute to maternal mortality, affecting neonatal, infant, and child outcomes. Home treatment can prevent hospital admissions and promote strategies within the patient’s support network.ObjectivesOur aim is to describe a clinical case in perinatal psychiatry managed by a Psychiatric Home Treatment Unit.MethodsWe present a case of perinatal psychotic depression in a 26-year-old pregnant woman.ResultsWe describe the case of a patient with no prior history of mental health issues. She was 25 weeks pregnant when she first sought psychiatric help in July 2023 and was diagnosed with depressive disorder with psychotic symptoms. She reported symptoms such as low mood, psychomotor inhibition, delusional guilt thoughts, and auditory hallucinations beginning three weeks before her initial visit. Due to her clinical presentation, the patient was admitted to the hospital, where pharmacological treatment was initiated with Olanzapine 5 mg, Sertraline 50 mg, and Lorazepam 1.5 mg. She remained in the hospital for four days, during which she showed gradual improvement but did not achieve full recovery.Considering the improvement observed, home treatment was proposed and accepted by the patient and her relatives. During home treatment, she continued to exhibit persistent depressive and psychotic symptoms, including low mood, inhibition, and delusional thoughts of ruin and catastrophe. Therefore, her treatment was adjusted, with Olanzapine increased to 10 mg, Sertraline raised to 100 mg, and Lorazepam reduced to 0.75 mg. Over time, significant improvement in her clinical symptoms was noted. Throughout the follow-up period, she reported no significant side effects from the pharmacological treatment. After a month of follow-up in our department, she was discharged with outpatient care provided by a specialized community perinatal psychiatric unit.ConclusionsWe illustrate the possibility of home treatment for perinatal psychiatric disorders. The potential benefits of remaining close to one’s support network and developing coping strategies can be advantageous during the course of illness. Further studies should be conducted to explore these potential benefits.Disclosure of InterestNone Declared

Enhancing patient care: a quality improvement initiative for effective handover from acute medical ward for the elderly to downstream wards

Enhancing patient care: a quality improvement initiative for effective handover from acute medical ward for the elderly to downstream wards

Evaluating the impact of team formulation on staff perceptions of patients and impact on care in an acute inpatient setting

Team formulation is a widely used method of conceptualising mental health needs and aims to develop staff understanding of the complex challenges and behaviours that can occur when providing care; however, research understanding application to acute wards is limited. This study assessed whether team formulation using the Comprehend Cope Connect model in an acute inpatient setting impacted staff perceptions of patients, and whether it influenced subsequent care. A mixed- methods study with a primary repeated-measures, quantitative questionnaire design was used with staff self-rating their knowledge, understanding, confidence and motivation pre- and post-team formulation meetings and providing feedback about the helpfulness of the formulation. Patient notes were examined for evidence of formulation plan action points. Staff ratings increased significantly on all areas of knowledge (t = 10.89;p <0.001), understanding (t = 7.96;p <0.001), confidence (t = 7.74;p <0.001) and motivation (t = 11.12;p <0.001) following team formulation, with a significantly greater increase in confidence reported by less experienced staff. Feedback was positive, with the opportunity to learn and share information particularly valued. An inspection of clinical notes two weeks later found evidence of completion for almost 40% of actions identified in the plan from the formulation meeting (a 65% completion rate if actions which were unlikely to have been recorded in clinical notes within two weeks were excluded from the calculation). The results provide evidence of a positive impact on staff perceptions and patient care, and suggests that team formulation may particularly help less experienced staff to feel more confident.

Effectiveness of exercise intervention on physical and health outcomes in patients admitted to an acute medical ward: A systematic review and meta-analysis

Objective To evaluate the effectiveness of inpatient medical ward exercise on physical and health outcomes in adults compared with usual care. Data sources Medline, CINAHL and EMBASE were searched from inception to 20 April 2023. Review methods Randomised-controlled trials in English that reported physical and health outcomes of adults who received an exercise intervention on an acute medical ward were included. Two reviewers independently extracted data. Methodological quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed the quality of evidence to evaluate the certainty of effect. Meta-analyses were performed where possible. Results Thirteen studies were included, with 1273 unique participants (mean [SD] age, 75.5 [11] years), which compared exercise intervention with usual care. Low quality evidence demonstrated a significant improvement in aerobic capacity ([MD], 1.39 m [95% CI, 0.23, 2.55], p = 0.02) and maximum isometric strength ([MD], 2.3 kg [95% CI, 2.2, 2.4], p < 0.001) for the exercise intervention compared with usual care. Low quality evidence demonstrated no difference for in-hospital falls count ([OR], 1.93 [95% CI, 0.61, 6.12] p = 0.27) or mortality ([OR], 0.77 [95% CI, 0.48, 1.23], p = 0.27). Moderate quality evidence demonstrated no difference for length of stay ([MD], −0.10 days [95% CI, −0.31, 0.11] p = 0.36). Conclusion Exercise prescribed during an acute medical ward stay improves aerobic capacity and maximum isometric strength but may not reduce length of stay, in-hospital falls or mortality.

Like cheese and chalk or cross-fertilization? A qualitative exploration of how addiction patients perceive treatment in a general psychiatry ward

Background Addiction has historically been conceptualized and treated differently to other conditions. Studies suggest that healthcare staff perceive patients with substance use disorders (SUD) as a specific subgroup with distinct and challenging needs yet SUD patients frequently receive treatment in general psychiatry settings. Notwithstanding, knowledge of how SUD patients view themselves compared to other psychiatric patients and how they experience treatment in general psychiatry settings is lacking. Methods We conducted semi-structured interviews with 22 SUD patients voluntarily hospitalized in the acute psychiatric unit of a general hospital to explore the lived experiences of SUD patients receiving detoxification in an acute psychiatry ward. Data were analyzed using Thematic Content Analysis. Results Two primary themes and five subthemes emerged: (A) Patient perceptions of the problem and its consequences’, which includes the subcategories (i) Patient views of addiction, (ii) Staff perception of the patients; and (B) Lived experiences within the specific setting with subthemes (i) Interaction with the specific setting, (ii) Interaction with fellow patients, and (iii) Perception of staff by patients. Conclusions Overall, SUD patients had mixed perceptions; while many appreciated aspects of their hospitalization, others faced challenges in having all their needs met. Implementing policy-level interventions, like integrating SUD patient needs into psychiatry ward design and ensuring adequate resource allocation and staff training, could improve care quality for addiction patients in general psychiatry settings.

Effect of a person-centred goals-of-care form and clinical communication training on shared decision-making and outcomes in an acute hospital: a prospective longitudinal interventional study.

Patients with a life-limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12-month mortality. To avoid non-aligned care, we need to understand our patients' goals and values. To describe the association between the implementation of a shared decision-making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI. A prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person-centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90-day mortality. 1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01-2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4-14) to 6 days (IQR, 3-11) (adjusted estimate effect, -0.38; 95% CI, -0.64 to -0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78-0.97; P value = 0.01). Documented treatment preference of high-dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73-0.89; P value < 0.001), and ward-based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14-1.36; P value < 0.001). The implementation of a SDM programme was associated with increased documentation of person-centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation.

Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway

Open-door policy is a recommended framework to reduce coercion in psychiatric wards. However, existing observational data might not fully capture potential increases in harm and use of coercion associated with open-door policies. In this first randomised controlled trial, we compared coercive practices in open-door policy and treatment-as-usual wards in an urban hospital setting. We hypothesised that the open-door policy would be non-inferior to treatment-as-usual on the proportion of patients exposed to coercive measures. We conducted a pragmatic, randomised controlled, non-inferiority trial comparing two open-door policy wards and three treatment-as-usual acute psychiatric wards at Lovisenberg Diaconal Hospital in Oslo, Norway. An exemption from the consent requirements enabled inclusion and random allocation of all patients admitted to these wards using an open list (2:3 ratio) administrated by a team of ward nurses. The primary outcome was the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation or seclusion, and physical and mechanical restraints. The non-inferiority margin was set to 15%. Primary and safety analyses were assessed using the intention-to-treat population. The trial is registered with ISRCTN registry and is complete, ISRCTN16876467. Between Feb 10, 2021, and Feb 1, 2022, we randomly assigned 556 patients to either open-door policy wards (n=245; mean age 41·6 [SD 14·5] years; 119 [49%] male; 126 [51%] female; and 180 [73%] admitted to the ward involuntarily) or treatment-as-usual wards (n=311; mean age 41·6 [4·3] years; 172 [55%] male and 138 [45%] female; 233 [75%] admitted involuntarily). Data on race and ethnicity were not collected. The open-door policy was non-inferior to treatment-as-usual on all outcomes: the proportion of patient stays with exposure to coercion was 65 (26·5%) in open-door policy wards and 104 (33·4%) in treatment-as-usual wards (risk difference 6·9%; 95% CI -0·7 to 14·5), with a similar trend for specific measures of coercion. Reported incidents of violence against staff were 0·15 per patient stay in open-door policy wards and 0·18 in treatment-as-usual wards. There were no suicides during the randomised controlled trial period. The open-door policy could be safely implemented without increased use of coercive measures. Our findings underscore the need for more reliable and relevant randomised trials to investigate how a complex intervention, such as open-door policy, can be efficiently implemented across health-care systems and contexts. South-Eastern Norway Regional Health Authority and The Research Council of Norway.

RETRACTED: Reduced self-harm on acute mental health wards following the implementation of a vision-based patient monitoring system: Evidence from five NHS trusts.

WHAT IS KNOWN ON THE SUBJECT?: Inpatient mental health settings pose unique challenges for patient safety, in part because psychiatric disorders are well-known risk factors for self-harm and suicide. Ward staff follow protocols to try and keep patients safe including carrying out in-person safety checks, usually every 15 min, but patients unfortunately still find opportunities to harm themselves. A vision-based patient monitoring system (VBPMS) is a contact-free technology that can help mental health nurses to monitor patients in hospital more effectively. For example, the tool alerts staff to situations where a patient might need assistance, like when they spend a long period of time in their ensuite bathroom. Research has shown that the VBPMS can support staff to prevent safety incidents from occurring and a recent study found a decrease in self-harm after the tool was implemented at one NHS mental health trust. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This paper presents data from five NHS mental health trusts and suggests that the VBPMS can consistently help staff to prevent self-harm on acute mental health wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Managing self-harm behaviours is a challenge for mental health nursing staff. Standard safety protocols are not effective enough - staff need new ways to monitor patients. In general hospitals, technology is used every day to support care. This research shows that the VBPMS can be used to improve patient safety in mental health hospitals. ABSTRACT: Introduction Self-harm is sadly relatively common in mental health inpatient settings, and the effectiveness and appropriateness of strategies used to prevent it have long been disputed. The use of vision-based patient monitoring systems (VBPMS) has been shown to improve various safety outcomes. Their potential to support staff in preventing inpatient self-harm warrants further exploration. Aim This research investigated whether implementing a VBPMS-as an adjunct to existing clinical practice-within acute inpatient services at five NHS England mental health trusts led to reductions in self-harm. Method Five quasi-experimental studies assessed the number of bedroom self-harm incidents, across 12 adult wards, before and 5-12 months after a VBPMS was deployed. Percentage changes were calculated. Four studies used control groups and were included in a fixed-effect meta-analysis. Results In the meta-analysis, a significant inverse-weighted average relative risk percentage change of -38.9% was recorded. For the study with no control groups, reductions in self-harm were seen across all wards (range: -9.1% to -29.8%). Discussion This research demonstrates that VBPMS can support clinicians to create safer ward environments by preventing incidents of self-harm from occurring. Implications for Practice The results provide preliminary support for wider rollout of the technology on acute mental health wards.

Moderating effect of age on the relationship between physical health loss and emotional distress post-acute care in Japanese older hospitalized patients

BackgroundAt present, there are no consistent findings regarding the association between physical health loss and mental health in older adults. Some studies have shown that physical health loss is a risk factor for worsening of mental health. Other studies revealed that declining physical health does not worsen mental health. This study aimed to clarify whether the relationship between physical health loss and emotional distress varies with age in older inpatients post receiving acute care.MethodsData for this study were collected from 590 hospitalized patients aged ≥ 65 years immediately after their transfer from an acute care ward to a community-based integrated care ward. Emotional distress, post-acute care physical function, and cognitive function were assessed using established questionnaires and observations, whereas preadmission physical function was assessed by the family members of the patients. After conducting a one-way analysis of variance (ANOVA) and correlation analysis by age group for the main variables, a hierarchical multiple regression analysis was conducted with emotional distress as the dependent variable, physical function as the independent variable, age as the moderator variable, and cognitive and preadmission physical function as control variables.ResultsThe mean GDS-15 score was found to be 6.7 ± 3.8. Emotional distress showed a significant negative correlation with physical function in younger age groups (65-79 and 80-84 years); however, no such association was found in older age groups (85-89, and ≥ 90 years). Age moderated the association between physical function and emotional distress. Poor physical function was associated with higher emotional distress in the younger patients; however, no such association was observed in the older patients.ConclusionsAge has a moderating effect on the relationship between physical health loss and increased emotional distress in older inpatients after acute care. It was suggested that even with the same degree of physical health loss, mental damage differed depending on age, with older patients experiencing less damage.

Challenges and solutions for discharge support of elderly people in the acute care ward: Interviews with community-based integrated care supporters and patients in Tokyo, Japan.

Japan, which has become the country with the longest-living people in the world due to rapid population aging, has an insurer function for each local government and socialized long-term care under a public system. Japan aims to build a Community-based Integrated Care System (CICS) for each municipality with the goal of integrating medical care and long-term care. However, despite the policy and management studies, the challenges and solutions for discharge support by the parties have not yet been clarified. This study aimed to obtain suggestions on challenges and solutions for discharge support in the acute care wards for the elderly for community-based integrated care support providers and patients in Kita Ward, Tokyo. Semi-structured interviews were conducted, and the obtained data were a priori analyzed by a deductive thematic analysis using a conceptual framework for integrated care based on the integrative functions of primary care. The challenges were found to include: i) disparity between medical and lifestyle perspectives, ii) competencies of medical and care workers at homes, iii) discharge support challenges related to the elderly themselves, iv) nursing care dependent on family; and v) the impact of payment of medical service in the health insurance system and payment of long-term care services. The solution that can be applied at the local government level was community connection. While aiming to build a CICS for each local government, there was a contradiction in that the challenges and solutions required examination at the national and prefectural levels.

Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa.

Aggression of patients in hospital wards has become an endemic problem and professional nurses are particularly at high risk. This article presents the types of patient aggression experienced by professional nurses working in an acute psychiatric ward in Vhembe District, South Africa. Vhembe District, South Africa. A qualitative approach using exploratory, descriptive and contextual research design was used. Four hospitals were purposively selected and 10 professional nurses were conveniently sampled to participate in the study. Individual interviews were used to collect data, which were then analysed through Tesch Open Coding Method. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. This study shed some light on the professional nurses' lived experiences regarding the types of aggression from patients in an acute psychiatric ward in Vhembe District. The types of aggression are physical aggression, destructive behaviour and verbal aggression. The findings show that the types of aggression to which professional nurses are exposed are overwhelming and the consequences are shocking. As a result, the health of professional nurses is compromised. Therefore, this study recommends further studies to determine the kind of support needed by professional nurses working in an acute psychiatric ward and to investigate the impact of aggression from patients in acute psychiatric ward with regard to the quality of care. This article contributes to the body of knowledge regarding patients' aggression in acute wards in Vhembe District, South Africa.

Predictors of 2-Year Post-Discharge Mortality in Hospitalized Older Patients.

Understanding prognostic factors for adverse health outcomes is clinically relevant for improving treatment decision-making processes, potentially leading to enhanced patient prognosis. This secondary analysis of a prospective observational study aimed to identify independent factors associated with 2-year post-discharge mortality in acutely hospitalized older patients. All-cause mortality and date of death of 115 patients (83.3 ± 6.3 years, females: n = 75, 65.2%) admitted to acute geriatric wards were determined two years after hospital discharge through telephone interviews. Potential prognostic factors measured at hospital admission included demographic and clinical characteristics, nutritional, cognitive, and psychological status, Fried frailty phenotype, functioning in activities of daily living, locomotor capacity, and 24 h in-hospital mobility and objectively measured physical activity (PA) behaviors. The 2-year mortality rate was 36.7% (n = 41). Univariate and multivariate Cox proportional hazards regression models revealed that mean daily PA level (hazards ratio (HR) = 0.59, 95% confidence interval (CI) 0.90-1.00; p = 0.042), frailty (HR = 3.39, 95% CI 1.20-9.51; p = 0.020), and underweight, in contrast to overweight (HR = 3.10, 95% CI 1.07-9.01; p = 0.038), at hospital admission were independently predictive of post-discharge mortality. PA, frailty, and underweight at hospital admission should be considered when evaluating long-term survival prognosis, establishing risk profiles, and developing personalized care pathways in acute hospital care of older adults.

"Too soft for real psychiatry"? Gendered boundary-making between coercion and dialog in Italian wards.

Psychiatric practice has always entailed a coercive dimension, visible not only in its formal expressions (e.g. compulsory treatment) but in many informal and implicit forms. In fact, contemporary psychiatric practices are characterized by an interplay of coercion and dialog to be interpreted not as binary categories but as extremes of a spectrum. Within this perspective, it becomes crucial to draw boundaries attributing meaning to professional identities and practices in psychiatric work. This is particularly relevant in acute wards: to explore this issue, we selected two cases according to a most-different-cases design, one ward with a mechanical-restraint approach compared to one with no-mechanical-restraint. We argue that gender, mobilized to performatively draw distinctions and hierarchies in order to define and justify different approaches to psychiatric crises along the continuum between coercion and dialog, is a key dimension in the boundary-making process. The analysis identifies two main dimensions of drawing gendered boundaries: inter-gender boundaries (overlapping the binary distinction between masculinity and femininity with a more coercive or relational-dialogic approach to crisis) and intra-gender boundaries (distinguishing and ranking of different masculinities and femininities), associating a less coercive orientation with a devirilized masculinity.

Quiet Time Means No Screen Time: A Project Aiming to Increase Restful Sleep within the Pediatric Acute Care Unit

AbstractThe use of blue-light-emitting smart devices prior to bedtime has been identified as one of the reasons of increased pediatric sleep disturbances and poor sleep quantity. Interrupted sleep is a risk factor for healing and well-being in the pediatric acute ward. The aim of this project was to promote high-quality sleep within our pediatric ward by implementing a standardized protocol that eliminated exposure to electronic blue light prior to bedtime, per recommendations from the American Academy of Pediatrics. Our objective was to promote enhanced quantity of sleep and healing by restricting and removing all smart devices during nighttime hours in the pediatric acute ward. We utilized the Bedtime issues, Excessive daytime sleepiness, night Awakenings, Regularity and duration of Sleep, and Snoring validated screening tool, Children Sleep Habit Questionnaire, and included a survey question regarding smart device use to evaluate patients' sleep routine. After the implementation of “no screen time” innovation, patients' and parents' quantity of sleep and total restful hours was reassessed and pre/post results analyzed. The pilot project evaluated 57 patients aged 18 months to 19 years with varying admitting diagnoses. The quiet time innovation results demonstrated improved length and reported uninterrupted sleep among patients. Eliminating electronic screens during evening (sleeping) hours in the acute care setting was associated with improved sleep among pediatric patients, enhancing potential for recovery, promoting well-being, and modeling effects of limiting screen time for participants.

Destination Matters More: Relapse following Hospital-Based Treatment of Substance Use Disorders With and Without Co-Occurring Disorders

Objectives Addressing substance use in psychiatric care encounters significant barriers, but the emergence of specialized services offers an opportunity to advance and scale up the integration of addiction services within psychiatric settings. However, research gaps still exist in this field, particularly in understanding the substance relapse rates of people with co-occurring disorders after a psychiatric hospitalization. This study aimed to investigate and compare the relapse rates of patients under inpatient care with exclusively addiction-related issues and those with co-occurring disorders after a hospitalization in a psychiatric ward and gain insights into differences in outcomes for these two patient groups. Methods This retrospective analysis examined electronic medical records of patients admitted to the Acute Psychiatry Ward of the Hospital Clinic of Barcelona with a substance use disorder diagnosis between January 2019 and February 2021. Cox regression was used to identify variables independently associated with the first relapse episode. Results From a total of 318 admissions (79.2% with psychiatric comorbidity), 76.1% relapsed during the study follow-up, with a median survival time of 54 days. Younger age, female gender, voluntary admission, and outpatient follow-up were independently associated with relapse. The presence of a co-occurring disorder was not associated with relapse. Conclusion This study highlights the need for interventions aimed at improving post-discharge abstinence rates for addiction-related hospitalizations. It also challenges the notion that co-occurring disorders automatically imply a worsened prognosis and emphasizes the importance of addressing addiction and psychiatric comorbidity in a comprehensive, integrated, and specialized manner.