Length Of Hospitalization Time Research Articles

Lobotomy at a state mental hospital in Sweden. A survey of patients operated on during the period 1947–1958.

This retrospective survey aims at describing patients subjected to prefrontal lobotomies and the general treatment conditions at Umedalen State Mental Hospital during the period 1947–1958. Data collected from psychiatric and surgical medical records was analysed using quantitative and qualitative content analysis. A total of 771 patients subjected to lobotomy during the years 1947–1958 were identified. From these, a sample of 105 patients was selected for the purpose of obtaining detailed data on socio-economic status, diagnosis, symptomatology, other psychiatric treatments applied before the pre-frontal lobotomy operation, time spent in hospital before operation, praxis of consent and mortality. The diagnosis of schizophrenia was found in 84% of the 771 lobotomized patients. The post-operative mortality was 7.4% (57 deaths), with the highest rate in 1949 (17%). The mean age of the patient at the time of operation was 44.8 years for females and 39.5 years for male patients. The average length of pre-operative time in hospital for females was 10.7 years and for males 3.5 years. It remains unclear why this mental hospital conducted the lobotomy operation to such a comparatively great extent. Factors such as overcrowding of wards and its status as a modern mental hospital may have contributed.

Effects of risperidone in overdose

This study was a 13-month prospective, descriptive case series of risperidone overdose reported by telephone to a regional poison control center (PCC) serving Philadelphia, PA. Patients were seen in local Philadelphia-area emergency departments. The variables examined were medical history, therapeutic use of risperidone, time postingestion, reported coingestants, clinical findings, decontamination and treatment, electrocardiograph results, laboratory data, standard toxicologic screen results, and length of time in hospital. Thirty-one patients (29 adult/adolescent, 2 pediatric) with reported risperidone overdose were identified. Risperidone was the sole ingestant in 15 cases (1 mg to 180 mg). The major observed effects in this group included lethargy (7), spasm/dystonia (3), hypotension (2), tachycardia (6), and dysrhythmia (1). Sixteen cases involved coingestants, including benzodiazepines, selective serotonin reuptake inhibitors, ethanol, tricyclic antidepressants, lithium, anticonvulsants, diphenhydramine, ibuprofen, and anticholinergic agents. Major effects in these patients included lethargy (10), coma (1), seizure (1), tachycardia (7), bradycardia (1), hypotension (4), and a syndrome of muscle spasms, diaphoresis, and fever. Treatment provided for patients in this study included antiarrhythmics (1), diphenhydramine (2), anticonvulsant (1), vasopressor agent (1), endotracheal intubation/assisted ventilation (5), and supportive care. One patient who coingested imipramine died of medical complications. In the remaining patients, symptoms resolved within 24 hours in the majority, with all patients asymptomatic at 72 hours postingestion. These data show that risperidone toxicity manifests primarily as mild central nervous system effects and reversible neuromuscular and cardiovascular effects.

Randomised double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncytial virus bronchiolitis.

BACKGROUND: Experimental and clinical evidence suggests that respiratory syncytial virus (RSV) bronchiolitis is an immune mediated disease. Corticosteroids might therefore be effective in the treatment of RSV bronchiolitis. METHODS: A...

Does case management reduce the rehospitalization rate?

It was expected from deinstitutionalization that outpatient care could replace hospital care. But many empirical studies proved that the number of admissions to psychiatric hospitals rose when community-based care developed. This might be due to the lack of coordination and cooperation of extramural services. The concept of case management therefore originated in the last few years. In this study the effect of case management on the rehospitalization rate is examined by analyzing the data of 4 social-psychiatric services responsible for defined catchment areas. During the evaluation period of 2.5 years, 162 patients dismissed from psychiatric hospitals were referred to those services. For each of these index patients a matched control patient was identified, each identical in diagnosis, sex, age, living conditions and number of previous inpatient episodes. The results of a survival analysis show that there are no significant effects of case management on the rate of rehospitalization nor on the length of time in hospital in case of a rehospitalization.

Towards a comprehensive Mayo psychiatric service: a preliminary survey of longstay patients

AbstractA group of 183 longstay psychiatric patients were evaluated regarding their immediate and future discharge potential in order to assist in the future planning of the Mayo Psychiatric Services. Comparisons were made between new longstay patients, who were defined as those who had been in hospital for greater than one but less than five years, and old longstay patients who were in hospital for greater than five years. Age and sex comparisons were also made.While 28% of those included in the survey were thought fit for immediate discharge, a further 18% were thought to require further active rehabilitation before discharge into the community within one year. The accommodation requirements of those needing continuing inpatient care are discussed. Age and length of time in hospital were found to be associated with discharge potential. Sex difference was not found to be significant. Implications for the development of the service are dicussed on the basis of the findings.

Death as a Result of Asthma in Wayne County Medical Examiner Cases, 1975–1987

All deaths ascribed to asthma in the 5-to-40-year age group at the Wayne County Medical Examiners' Office were reviewed from 1975 to 1987 inclusive. Fifty-eight deaths were attributed solely to asthma, and the annual number increased fivefold in the 1980s to a rate of approximately 0.5 per 100,000 per year when extrapolated to the Wayne County population. Blacks were overrepresented to double their proportion in the general population. Almost all cases were known asthmatics, and many had received previous emergency care. Most fatalities occurred at night and did not demonstrate any seasonal variation. The onset of the fatal attack was apparently very rapid in most cases, with many engaged in routine activities and few surviving any length of time in hospital or having sought treatment earlier. Our data reveal a significant increase in sudden death in previously well asthmatics in Wayne County in the 1980s. Similar increases in deaths as a result of asthma have been noted previously in other countries for reasons that remain unclear.

Specificity of the salivary cortisol dexamethasone suppression test across psychiatric diagnoses

One hundred forty-eight psychiatric inpatients, 12 outpatients, and 17 normal controls were given the 1.0-mg overnight Dexamethasone Suppression Test (DST), with salivary cortisol concentrations being measured as the dependent variable. Based on the Structured Clinical Interview for DSM-III, the patients were diagnosed as having major depression with melancholia ( n = 21), nonmelancholic major depression ( n = 50), mania ( n = 15), schizophrenia ( n = 32), dementia ( n = 6), substance dependence/abuse ( n = 18), and miscellaneous ( n = 18), Neither the melancholic major depressives nor the entire group of major depressives had significantly higher salivary cortisol pre- or postdexamethasone as compared with all the other patients combined, nor did the melancholic patients have significantly higher cortisol than the nonmelancholic depressives. The inpatients as a group had significantly higher pre- and postdexamethasone cortisol values than the normal controls; cortisol values for the outpatients were intermediate between these two groups. Illness severity (in the depressives), length of time in hospital before the DST, and medication regimen were all unrelated to DST outcome. Thus, in this study, the salivary cortisol DST showed little clinical utility in discriminating major depressives with and without melancholia from other patients with a broad range of psychiatric diagnoses. The test did distinguish between hospitalized psychiatric patients and normal control subjects and between depressed inpatients and depressed outpatients, indicating that hospitalization-related variables contributed to DST outcome.

Pediatric patients malnutrition and its relation to hospitalization times and causes

The Protein Energy Malnutrition (PEM) status of 1378 children, hospitalized in the infirmary of the Pediatrics Department of a Medical School in Campinas (Brasil), was evaluated using a weight for age criterion with four classes: Eutrophic (E), first, second and third degree malnutrition (M1, M2, M3) with limits Mean (M) minus one Standard Deviation (SD), M-2.5SD and M-4SD. The prevalence of PEM was 66.6% (40.7% Ml, 17.7% M2 and 8.20%/M3). Infectious Pathologies of the Lower Respiratory Tract (IPLRT) and diarrheas are responsible for 24.7% and 18.48% of the Definitive Hospitalization Diagnostic (DHD), being the two groups of pathologies with greatest prevalence. Length of Hospitalization Time (LHT) increases markedly with malnutrition, specially for diarrheas, but E and M1 patients have similar behavior, as well as M2 and M3 ones. M-2.5SD (weight for age) could then be a limit to distinguish high risk patients. †Address: Luis M. Guimarey. Rua Benjamim Constant no. 1657 (Santa Casa). Depto. de Pediatria,...

Fractures of the hip: a three-year survey in one hospital, including experience with the Pugh nail procedure.

Records were reviewed on 445 patients with fracture of the hip admitted to St. Paul's Hospital, Vancouver, Canada, during the period 1973--1975 inclusive. The epidemiologic factors were analyzed: age, sex, where and when the accident occurred, site of the fracture, the treatment procedure, length of time in hospital, complications, associated conditions, and final placement of the patient. Of the patients, 286 (64 percent) were more than 70 years of age. Among the 260 causal accidents in the patients' home living space or in the hospital, 35 involved toileting. The great majority of the fractured hips (330) were treated by open operation and internal fixation with the Pugh nail; the remainder were treated by conservative methods, various other devices, or arthroplasty. Within 30 days, 121 patients were discharged to their own homes and 68 to a major rehabilitation hospital. A total of 289 patients eventually returned to their own homes. The Pugh nail method of fixation permits early physiotherapy and early walking exercises, beginning within the first few days postoperatively. This largely accounts for the low complication rate, rapid achievement of functional status, and reduced hospital stay. Among the 445 patients there were 43 deaths, including 10 which occurred before operation could be undertaken.

A review of digital injuries

Summary A review of acute finger injuries presenting at a Plastic Unit over a two-year period is presented. The length of time off work has been compared in the various forms of treatment and it has been found that following amputation patients are off work longer than those treated by split-skin grafts or cross-finger flaps. The average length of time in hospital can be reduced by adequate out-patient facilities for dressings and physiotherapy.

The Prevention and Treatment of Infection in Burns by Dibrompropamidine

Summary 1.The value of M & B 1270 as a local application to burns for controlling infection has been investigated. The results do not show any definite superiority of M & B 1270 over penicillin. Thirteen per cent. of cases acquired a streptococcal infection. 2.M & B 1270 failed to eliminate or prevent pyogenic Gram-negative infections. No one preparation is best for all burns—a variety must be used according to the clinical and bacteriological findings. 3.M & B 1270 formed a dry eschar in about one-third of the cases. This forms a sterile supple protective covering to the burn and healing progresses beneath it. It is, however, rather slow in separating, and may obscure the true depth of the burn. 4.M & B 1270 forms an ideal first-aid dressing and would be a very satisfactory application for self-treatment in mass atomic burn casualties. 5.The only toxicity seen was one mild dermatitis in this series. A 0·15 per cent. preparation in a carbo-wax base was the most suitable preparation tried. For the exposure method 1 per cent. M & B 1270 in lactose was very satisfactory. 6.The investigation has also shown the difficulties in treating burns scattered in different hospitals. Special burn centres in a general hospital are required to lower the present mortality and to reduce the length of time in hospital.

The prevention and treatment of infection in burns by dibrompropamidine

Summary 1.The value of M & B 1270 as a local application to burns for controlling infection has been investigated. The results do not show any definite superiority of M & B 1270 over penicillin. Thirteen per cent. of cases acquired a streptococcal infection. 2.M & B 1270 failed to eliminate or prevent pyogenic Gram-negative infections. No one preparation is best for all burns—a variety must be used according to the clinical and bacteriological findings. 3.M & B 1270 formed a dry eschar in about one-third of the cases. This forms a sterile supple protective covering to the burn and healing progresses beneath it. It is, however, rather slow in separating, and may obscure the true depth of the burn. 4.M & B 1270 forms an ideal first-aid dressing and would be a very satisfactory application for self-treatment in mass atomic burn casualties. 5.The only toxicity seen was one mild dermatitis in this series. A 0·15 per cent. preparation in a carbo-wax base was the most suitable preparation tried. For the exposure method 1 per cent. M & B 1270 in lactose was very satisfactory. 6.The investigation has also shown the difficulties in treating burns scattered in different hospitals. Special burn centres in a general hospital are required to lower the present mortality and to reduce the length of time in hospital.

Atebrin, plasmoquine and quinine in the treatment of malaria

Various aspects of immunity in malaria are discussed with particular reference to the Report of the Malaria Commission of the League of Nations. The view that there exist strains of malaria parasite which vary in their virulence is endorsed; but the principle that it is better not to begin treatment in subtertian malaria at once but to defer it, in order to encourage the development of an acquired immunity, is challenged on the ground that it is dangerous and impracticable. It is considered to be doubtful whether Europeans ever develop a useful immunity to sub-tertian malaria. The validity of conclusions drawn from clinical tests made in applying malaria therapy to para-syphilitics is questioned on the ground that these subjects are pathological. Evidence is put forward in support of the view that small doses of quinine (15 grains a day) are less efficacious than moderate ones (30 grains a day). Parallel series of cases were treated with atebrin and quinine. In some of the atebrin cases plasmoquine simplex or plasmoquine compound was given as well. The length of time in hospital was a day less on atebrin than on quinine, but the time for the temperature to return to normal was slightly longer. There was not much difference in the rates at which parasites were eliminated from the peripheral blood by the two drugs. The incidence of crescents in all groups of cases was unusually high but in those cases in which plasmoquine was given they disappeared from the peripheral blood in 87 1 2 per cent. as against figures of 20 per cent. with atebrin and 29 per cent. with quinine. Atebrin was used successfully in three cases of blackwater fever complicated by sub-tertian malaria; and in several, cases where a haemolysis threatened, without that event occurring after the exhibition of the drug. Atebrin is cheaper in European practice than is quinine, and although in treating Africans in hospital it appears to be less economical to use atebrin, it would almost certainly prove to be cheaper in the long run and in any case its use would enable a given number of beds to be utilised by 14 per cent. more patients.