Healthcare Patients Research Articles

Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study

There is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE. To examine the associations between SCCE and health care utilization. This population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022. SCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement). Health care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home). A total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95% CI, 1.12-1.60) and dental care (OR, 1.73; 95% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95% CI, 0.44-0.60). These findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

Psychotropic stewardship: Advancing patient care.

Board Certified Psychiatric Pharmacists (BCPPs) practice in a variety of inpatient and outpatient health care settings as part of collaborative, multidisciplinary teams. The American Association of Psychiatric Pharmacists (AAPP) has promoted the expansion of psychiatric pharmacy through the development of psychotropic stewardship programs (PSPs). Based on the standards developed during the creation and expansion of antimicrobial stewardship programs, psychotropic stewardship promotes the safe and appropriate use of psychotropic medications. AAPP envisions every patient with a psychiatric diagnosis will have their medication treatment plan reviewed, optimized, and managed by a psychotropic stewardship team with a psychiatric pharmacist as a co-leader. Because of variations in practice site resources, patient populations, and provider collaboration, the creation and implementation of PSPs should be based on site-specific needs and opportunities. Initial patient identification could prioritize those prescribed multiple medications, high-risk psychotropics, or comorbid medical diagnoses. However, every patient prescribed a psychotropic medication should have the opportunity to work with a PSP. Incremental implementation may be required during the planning stages of stewardship teams. Use of clinical practice-related core outcomes will allow for the optimization of program resources, increased recognition, and improved patient outcomes. PSPs should be patient-focused and integrate patients' preferences and access to recommended treatment options. The eventual goal of PSP implementation is official recognition by key regulatory agencies as a standard of care for patients who receive a diagnosis of a psychiatric or substance use disorder.

Mental Health Diagnoses, Health Care Utilization, and Placement Stability on Antipsychotic Prescribing Among Foster Care Youth.

This study sought to examine how mental health diagnoses, health care utilization and foster care placement instability affect antipsychotic prescribing and how these factors may contribute to disproportionate antipsychotic prescribing among youth in foster care. This retrospective cohort study utilized EHR data that were linked to administrative child welfare data. Two outcome variables were analyzed: 1) any antipsychotic prescription documented and 2) number of antipsychotic prescriptions documented. Predictor variables included foster care status, number of unique mental health diagnoses, counts of health care encounters over the study period, and counts of foster care placements. Covariates included gender, persons of color, and age in years. Models were estimated using logistic regression for the dichotomous outcome and Poisson regression for the count outcome. Increased antipsychotic prescribing among children in foster care persists even after accounting for mental health diagnoses and health care utilization. However, the number of placements modified the effect of foster care involvement on antipsychotic prescribing such that after 2 placement changes, the odds of being prescribed an antipsychotic surpassed the effect of foster care involvement. More mental health diagnoses, more inpatient and emergency health care encounters, and more foster care placements were associated with an increased odds of being prescribed an antipsychotic and an increased count of antipsychotic prescriptions. Decreased primary care encounters were associated with increased odds of antipsychotic prescriptions, and decreased specialty encounters were associated with higher counts of antipsychotic prescriptions. Placement instability is associated with disproportionate antipsychotic prescribing among youth in foster care.

PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY Naeem Bhojani, Brian Eisner, Rutugandha Paranjpe, Benjamin Cutone, Manoj Monga, and Ben H. Chew Naeem BhojaniNaeem Bhojani More articles by this author , Brian EisnerBrian Eisner More articles by this author , Rutugandha ParanjpeRutugandha Paranjpe More articles by this author , Benjamin CutoneBenjamin Cutone More articles by this author , Manoj MongaManoj Monga More articles by this author , and Ben H. ChewBen H. Chew More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-ureteroscopy sepsis is a morbid condition that requires significant healthcare utilization. We investigated all-cause inpatient mortality, rates of intensive care unit (ICU) and inpatient admissions and readmissions. We also examine the yearly trends in sepsis and inpatient mortality in patients undergoing ureteroscopy (URS) in the United States (US). METHODS: Retrospective analyses were conducted using the IBM MarketScan Database to identify patients ≥18 years who underwent URS. Three cohorts were analyzed: non-sepsis (control), non-severe sepsis, and severe sepsis (sepsis + organ dysfunction). All-cause inpatient mortality and healthcare utilization including ICU admissions, inpatient admissions and readmissions were reported. Annual trends for sepsis events and inpatient mortality post-URS were examined from 2015-2019. RESULTS: 109,496 URS patients were identified. 5.6% developed sepsis within 30 days of URS. Of the 5.6%, 4.1% developed non-severe sepsis and 1.5% developed severe sepsis. The 30-day all-cause inpatient mortality for the non-sepsis, non-severe sepsis and severe sepsis cohorts was 0.03%, 0.27% and 2.5%, respectively (p<0.001). Severe sepsis substantially increased the risk of 30-day all-cause inpatient mortality compared to patients who did not develop sepsis (HR: 49.5; 95% CI: 28.9-84.7; p<0.001). ICU admission rates were 1.5%, 19.8% 52.4% for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively (p<0.001). Inpatient admissions were 18.3%, 74.9%, and 76.9% (p<0.001), while readmissions were 7.1%, 12.0%, and 15.9% (p<0.001), for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively. From 2015 to 2019, the annual prevalence of sepsis post URS increased significantly yearly from 4.7%, 5.1%, 5.7%, 6.0%, to 6.6% (p<0.001), however the rate of inpatient mortality remained stable (Figure 1). CONCLUSIONS: Sepsis post-URS significantly increases the risk of 30-day all cause inpatient mortality and leads to a significant increase in hospital admissions, ICU admissions, and readmissions. Over the 5-year study period, the prevalence of sepsis post-URS increased by 40%. Urologists should be aware of the increasing prevalence of this potentially deadly post-operative complication. Source of Funding: Boston Scientific © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e924 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naeem Bhojani More articles by this author Brian Eisner More articles by this author Rutugandha Paranjpe More articles by this author Benjamin Cutone More articles by this author Manoj Monga More articles by this author Ben H. Chew More articles by this author Expand All Advertisement PDF downloadLoading ...

Psychiatric Inpatient Healthcare Resource Utilization and Treatment Patterns Among Patients With Predominant Negative Symptoms in Schizophrenia

AbstractIntroductionCurrently approved treatments for schizophrenia (antipsychotics) have demonstrated effectiveness for treating positive symptoms; however, these agents are largely ineffective in treating other domains. Negative symptoms, including avolition, alogia, blunted affect, and asociality, are difficult to treat, and often persist despite adequate control of positive symptoms. Additionally, some patients experience “predominant” (moderate-to-severe negative symptoms that have greater relative severity than co-occurring positive symptoms) or “prominent” (severity of negative symptoms [moderate-to-severe] without any reference to positive symptoms) negative symptoms. These symptoms are known to have great impact on patient social functioning and quality of life, and are associated with poorer clinical course and outcomes for patients. Here, we examined inpatient healthcare resource utilization in patients with schizophrenia experiencing predominantly negative symptoms (PNS).MethodsDe-identified data were extracted from electronic health records in the NeuroBlu Database across 25 US mental healthcare providers. Positive and negative symptom data were derived from free-text records using natural language processing. PNS was defined as the presence of three or more negative symptoms and three or fewer positive symptoms at first clinical contact following schizophrenia diagnosis. Groups were balanced for baseline demographic and clinical characteristics by minimizing the generalized Mahalanobis distance and compared using chi-square and t-tests. Treatment patterns were visualized using Sankey diagrams.ResultsA total of 4444 patients with schizophrenia were identified and 8% were classified as PNS. A balanced cohort of 720 patients (50% PNS) was generated. Patients with PNS were more likely to be hospitalized in the 12 months following diagnosis (PNS: 76%, non-PNS: 60%, χ2: 22.5, p &lt; 0.001) and were switched to a second-line antipsychotic after a shorter first-line treatment duration. The most frequently prescribed antipsychotics differed between groups (PNS: risperidone, aripiprazole, haloperidol; non-PNS: risperidone, olanzapine, other atypical).DiscussionThis study demonstrates that negative symptoms in schizophrenia may be associated with worse illness course and higher healthcare resource utilization. There remains a need for new treatment options for patients with persistent, prominent, or predominant negative symptoms which specifically improve this historically hard-to-treat and assess symptom domain.FundingSunovion Pharmaceuticals, Inc.

The Relationship between Maternal Knowledge of Complementary Foods with the Nutritional Status of Toddlers

The results of data obtained from the Tangeban Inpatient Health Center of Masama District in the last three years, namely in 2015 showed that out of 269 toddlers, the prevalence of toddlers who weighed below normal was 32 people (11.9%), height below normal was 53 people (19.8%). In 2016, out of 489 under-fives, the prevalence of under-fives who weighed below normal was 73 people (14.9%), height below normal was 73 people (14.9%). Whereas in 2017 there were 493 toddlers, the prevalence of toddlers whose weight was below normal was 73 people (14.8%), height below normal was also 75 people (15.3%). From the target to be achieved by health workers Tangeban Inpatient Health Center Masama District is &lt;1.0%. Or even 0%. The research design used is Analytical Observational Research, where the researcher only makes observations or observations of the research subject and looks for data related to the research without intervening in the variables to be studied. The type of research design used is Cross sectional design, namely by conducting data collection, measurement or observation of data on independent and dependent variables only once at one time at the same time. the number of samples used was 60 mothers of toddlers. The results of the study There is a relationship between maternal knowledge variables and children's nutritional status at Tangeban Health Center. This is evidenced from 41 respondents whose nutritional status is good, there are 33 respondents who have good knowledge and there are 8 respondents who have poor knowledge. While out of 19 people whose nutritional status is not good, there are 4 respondents who have good knowledge and there are 15 respondents whose nutritional knowledge is still classified as low or not good.

Individual Approach аnd Standards in the Sphere оf Healthcare

The author illustrates the necessity of creating a patient-oriented healthcare system, presupposing an individual patient treatment approach with a choice and the observance of the standard of providing assistance. The individual approach to the patient is based on an integrated and coordinated approach to the analysis of the occurrence and course of the disease for each patient. The main criteria of a personal approach are the development of personalized treatment methods in compliance with health care standards, prevention and combination of diagnosis and treatment, followed by treatment monitoring. An individual approach makes it possible to predict which treatment methods will be safe and effective for each patient, and which will not. It can be seen as an extension of traditional approaches to understanding and treating diseases, enabling doctors to choose a therapy or treatment protocol that can not only minimize side effects, but also ensure a more successful treatment outcome. The author has analyzed different approaches for the standardization and hallmarked the advantages and disadvantages of the individual approach of treating each patient. The author has outlined the main directions of the individual approach of patient treatment.

Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act method.

It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40mg diazepam equivalents) to post (14.61mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.

Growth Hormone Deficiency following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning from Pediatric to Adult Services.

Traumatic brain injury (TBI) is increasingly recognized, with an incidence of approximately 110 per 100,000 in pediatric populations and 618 per 100,000 in adolescent and adult populations. TBI often leads to cognitive, behavioral, and physical consequences, including endocrinopathies. Deficiencies in anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropins, and growth hormone [GH]) can negatively impact health outcomes and quality of life post-TBI. This review focuses on GH deficiency (GHD), the most common post-TBI pituitary hormone deficiency. GHD is associated with abnormal body composition, lipid metabolism, bone mineral density, executive brain functions, behavior, and height outcomes in pediatric, adolescent, and transition-age patients. Despite its relatively frequent occurrence, post-TBI GHD has not been well studied in these patients; hence, diagnostic and treatment recommendations are limited. Here, we examine the occurrence and diagnosis of TBI, retrospectively analyze post-TBI hypopituitarism and GHD prevalence rates in pediatric and adolescent patients, and discuss appropriate GHD testing strategies and GH dosage recommendations for these patients. We place particular emphasis on the ways in which testing and dosage recommendations may change during the transition phase. We conclude with a review of the challenges faced by transition-age patients and how these may be addressed to improve access to adequate healthcare. Little information is currently available to help guide patients with TBI and GHD through the transition phase and there is a risk of interrupted care; therefore, a strength of this review is its emphasis on this critical period in a patient's healthcare journey.

Are AI language models such as ChatGPT ready to improve the care of individuals with epilepsy?

Are AI language models such as ChatGPT ready to improve the care of individuals with epilepsy?

Using Machine Learning and Deep Learning Algorithms to Predict Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion.

A retrospective cohort study from a multisite academic medical center. To construct, evaluate, and interpret a series of machine learning models to predict outcomes related to inpatient health care resource utilization for patients undergoing anterior cervical discectomy and fusion (ACDF). Reducing postoperative health care utilization is an important goal for improving the delivery of surgical care and serves as a metric for quality assessment. Recent data has shown marked hospital resource utilization after ACDF surgery, including readmissions, and ED visits. The burden of postoperative health care use presents a potential application of machine learning techniques, which may be capable of accurately identifying at-risk patients using patient-specific predictors. Patients 18-88 years old who underwent ACDF from 2011 to 2021 at a multisite academic center and had preoperative lab values within 3 months of surgery were included. Outcomes analyzed included 90-day readmissions, postoperative length of stay, and nonhome discharge. Four machine learning models-Extreme Gradient Boosted Trees, Balanced Random Forest, Elastic-Net Penalized Logistic Regression, and a Neural Network-were trained and evaluated through the Area Under the Curve estimates. Feature importance scores were computed for the highest-performing model per outcome through model-specific metrics. A total of 1026 cases were included in the analysis cohort. All machine learning models were predictive for outcomes of interest, with the Random Forest algorithm consistently demonstrating the strongest average area under the curve performance, with a peak performance of 0.84 for nonhome discharge. Important features varied per outcome, though age, body mass index, American Society of Anesthesiologists classification >2, and medical comorbidities were highly weighted in the studied outcomes. Machine learning models were successfully applied and predictive of postoperative health utilization after ACDF. Deployment of these tools can assist clinicians in determining high-risk patients. III.

Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff.

Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient's care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.

An outpatient model of care for COVID-19 infected kidney transplant patients - The hospital-at-home.

The COVID-19 pandemic is protracted and episodic surges from viral variants continue to place significant strain on healthcare systems. COVID-19 vaccines, antiviral therapy and monoclonal antibodies have significantly reduced COVID-19 associated morbidity and mortality. Concurrently, telemedicine has gained acceptance as a model of care and a tool for remote monitoring. These advances allow us to safely transit our inpatient-based care for COVID-19 infected kidney transplant recipients (KTRs) to a hospital-at-home (HaH) model of care. KTRs with PCR-proven COVID-19 infection were triaged by teleconsult and laboratory tests. Suitable patients were enrolled into the HaH. Remote monitoring via teleconsults were conducted daily until patients were de-isolated based on a time-based criterion. Monoclonal antibodies were administered in a dedicated clinic where indicated. Eighty-one KTRs with COVID-19 were enrolled into the HaH between February and June 2022, 70 (86.4%) completed HaH recovery without complications. Eleven (13.6%) patients required inpatient hospitalization for medical issues (n=8) and weekend monoclonal antibody infusion (n=3). Patients requiring inpatient hospitalization had longer transplant vintage (15 years vs. 10 years, p=.03), anaemia (haemoglobin 11.6g/dL vs. 13.1g/dL, p=.01), lower eGFR (39.8 vs. 62.9mL/min/1.73 m2 , p < .05) and lower RBD levels (<50 AU/mL vs. 1435 AU/mL, p=.02). HaH saved 753 inpatient patient-days with no deaths observed. Hospital admission rates from the HaH programme was 13.6%. Patients who required inpatient care had direct access admission without utilization of emergency department resources. Selected KTRs with COVID-19 infection can be safely managed in a HaH programme; alleviating strain on inpatient and emergency healthcare resources.

Productivity loss outcomes and costs among patients with cholangiocarcinoma in the United States: an economic evaluation

BackgroundCholangiocarcinoma (CCA) is associated with poor prognosis. Healthcare-related management likely presents a substantial economic burden associated with time away from work in patients with CCA.ObjectivesTo assess productivity loss, associated indirect costs, and all-cause healthcare resource utilization and costs owing to workplace absenteeism, short-term disability, and long-term disability in CCA patients with work absence and disability benefits eligibility in the United States.MethodsUS retrospective claims data from Merative MarketScan Commercial and Health and Productivity Management Databases. Eligible patients were adults with ≥1 non-diagnostic medical claim for CCA in the index period (1 January 2011–31 December 2019) and had ≥6 months of continuous medical and pharmacy benefit enrolment before and ≥1 month of follow-up and full-time employee work absence and disability benefits eligibility after the index date. Outcomes were assessed in patients with CCA, intrahepatic CCA (iCCA), and extrahepatic CCA (eCCA) in absenteeism, short-term disability, and long-term disability cohorts (measured per patient per month [PPPM] for a month of 21 workdays), with costs standardized to 2019 USD.ResultsOne thousand and sixty-five patients with CCA were included (iCCA: n = 624 [58.6%]; eCCA: n = 380 [35.7%]). The mean age was 51.9–53.9 years across cohorts. In patients with iCCA and eCCA, respectively, the number of mean all-cause days absent PPPM for illness was 6.0 and 4.3, and 12.9 and 6.6% had ≥1 CCA-related short-term disability claim. Median indirect costs PPPM owing to absenteeism, short-term disability, and long-term disability, respectively, in patients with iCCA were $622, $635, and $690, and $304, $589, and $465 in patients with eCCA. Patients with iCCA vs. eCCA had higher inpatient, outpatient medical, outpatient pharmacy, and all-cause healthcare costs PPPM.ConclusionsPatients with CCA had high productivity losses, indirect costs, and medical costs. Outpatient services costs contributed greatly to the higher healthcare expenditure observed in patients with iCCA vs. eCCA.

Pengaruh Budaya Oragnisasi, Motivasi Intrinsik, Motivasi Ekstrinsik Dan Kepuasan Kerja Terhadap Kinerja Karyawan Pada UPTD Puskesmas Rawat Inap Kotagajah

Companies definitely need competent and qualified employees, especially in this era ofglobalization. All business organizations are the driving force in decisions to achieveorganizational goals. Organizational development is determined by the work of HR in theorganization. This study aims to determine 1) To find out whether organizational culture has aneffect on employee performance. 2) To find out whether Extrinsic Motivation has an effect onemployee performance. 3) To find out whether Intrinsic Motivation has an effect on employeeperformance. 4) To find out whether job satisfaction has an effect on employee performance. 5)To find out whether organizational culture, extrinsic motivation, intrinsic motivation, and jobsatisfaction together affect employee performance. This study uses a quantitative approach. Thesurvey method was chosen as the primary data source. The survey method focuses on collecting data from respondents who have certain information, thus enabling researchers to solveproblems. In this study, the population of this study were employees and some students who wereintern at the UPTD Inpatient Health Center Kotagajah were 84 people. The results showed that1) there was a positive and significant influence between organizational culture on employeeperformance. 2) there is a positive and significant influence between Extrinsic Motivation onemployee performance. 3) there is a positive and significant influence between intrinsicmotivation on employee performance 3) there is a positive and significant influence between jobsatisfaction on employee performance 4) there is a positive and significant influence betweenorganizational culture, extrinsic motivation, intrinsic motivation, and job satisfaction onperformance employee.

“It’s the discharge and what comes after that” – a phenomenological analysis of peer support workers’ lived experiences of transitioning from psychiatric care

PurposeTransition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.Design/methodology/approachA qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.FindingsAfter being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.Research limitations/implicationsA deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.Practical implicationsMental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.Originality/valueThis is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.

Perceptions of Saudi psychiatric mental health nurses’ roles in the inpatient mental health care setting

PurposeThe aim of this study is to investigate the roles of psychiatric mental health nurses during their work experiences in inpatient clinical settings.Design/methodology/approachA focus group of 10 graduate psychiatric nurses with more than two years’ practice in inpatient psychiatric settings reflected on their last six months’ work placements and continuous employment. The transcripts and field notes were analyzed through thematic analysis of inductive data.FindingsTwo main themes emerged: management roles and clinical roles. The participants reflected on caring activities and obstacles encountered in fulfilling their professional roles.Originality/valueMultiple practice issues emerged. The participants perceived that psychiatric nurse specialists are required to perform more caring functions than practicable in the inpatient setting due to an excess of noncaring duties, structural minimization of the caring role and inadequate training. They felt that many of the functions performed were not within their expectations of the caring role of a psychiatric nurse specialist and believed that changes in nurse education and attention to clarification of nurses’ roles might enhance the role they play in patient care.

The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial.

Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).

Wildfire Threat to Inpatient Health Care Facilities in California, 2022.

Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California's total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. 2023;113(5):555-558. https://doi.org/10.2105/AJPH.2023.307236).

Family experiences of inpatient mental health care for people with dementia.

This study investigates family carers experiences of inpatient mental health care for people with dementia. A mental health inpatient admission for a person with dementia is usually considered when a person is distressed and this distress leads to behaviours that are assessed to be risky for the person or others. Participants included seven family carers whose relative with dementia had been cared for within a mental health ward in the United Kingdom UK within the last 5 years. Interviews were used to explore the circumstances that led to the admission, expectations of mental health care, and perceptions of care during the admission and support received by family carers. Participants described their distress at the time of admission and how the process of admission sometimes added to their distress. Carers often felt excluded from their relatives care in hospital and many felt a loss of their rights. Participants felt that the mental health admission had a negative impact on their relative with dementia. Mental health law and legislation was difficult to navigate and carers were concerned about how much knowledge and understanding of dementia staff have. Findings suggest that family carers may benefit from targeted support during their relatives admission. Mental health wards could do more to recognise the expertise in care and knowledge of the person with dementia of family carers and involve them in planning care. More research is needed to explore the experiences and outcomes of people with dementia during such admissions.