Long-stay Group Research Articles

Factors associated with long hospitalisation for psychotic disorder patients in an acute ward: Tertiary care hospital.

The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care. To identify factors associated with a long stay in an acute psychiatric unit. A tertiary hospital. A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted. In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support. Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation. Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay.

Prediction of Postoperative Length of Hospital Stay Based on Differences in Nursing Narratives in Elderly Patients with Epithelial Ovarian Cancer.

The current study sought to evaluate whether nursing narratives can be used to predict postoperative length of hospital stay (LOS) following curative surgery for ovarian cancer. A total of 33 patients, aged over 65 years, underwent curative surgery for newly diagnosed ovarian cancer between 2008 and 2012. Based on the median postoperative LOS, patients were divided into two groups: long-stay (>12 days; n = 13) and short-stay (≤12 days; n = 20). Patterns in nursing narratives were examined and compared through a quantitative analysis. Specifically, the total number (TN) of narratives pertaining to care and the standardized number (SN), which was calculated by dividing the TN by the LOS, were compared. Experts evaluated the relevance of the phrases extracted. LOS was then predicted using machine learning techniques. The median postoperative LOS was 18 days (interquartile range [IQR]: 16-24 days) in the long-stay group and 9.5 days (IQR: 8-11.25 days) in the short-stay group. In the long-stay group, surgery duration was longer. Overall, patients in the long-stay group showed a higher volume of nursing narratives compared with patients in the short-stay group (SN: 68 vs. 46, p = 0.021). Thirty-two of the most frequently used nursing narratives were selected from 998 uniquely defined nursing narratives. Multiple t-tests were used to compare the TN and real standardized number (RSN; minimum p < 0.1). Mean and standard deviation of classification results of long-short term memory recurrent neural networks for long and short stays were 0.7774 (0.105), 0.745 (0.098), 0.739 (0.107), and 0.765 (0.115) for F1-measure, precision, recall, and area under the receiver operating characteristic, respectively. Agreement between the differential narratives as assessed by statistical methods and the expert response was low (52.6% agreement; McNemar's test p = 0.012). Statistical tests showed that nursing narratives that utilized the words "urination," "food supply," "bowel mobility," or "pain" were related to hospital stay in elderly females with ovarian cancer. Additionally, machine learning effectively predicted LOS. The current study sought to determine whether elements of nursing narratives could be used to predict postoperative LOS among elderly ovarian cancer patients. Results indicated that nursing narratives that used the words "urination," "food supply," "bowel mobility," and "pain" significantly predicted postoperative LOS in the study population. Additionally, it was found that machine learning could effectively predict LOS based on quantitative characteristics of nursing narratives.

Which factors are associated with length of stay in older patients with acute decompensated heart failure with preserved ejection fraction?: AURORA study.

In heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with long stays. In contrast, acute decompensated heart failure (ADHF) in older patients is associated with a high risk of a long stay. To manage older ADHF patients with HFpEF, it is important to reveal the risk factors for a long stay on admission. We enrolled consecutive older patients (aged >75 years) with HFpEF (ejection fraction ≥50%) who were admitted to control ADHF from May 2014 to April 2016 using the acute heart failure registry in Osaka Rosai Hospital. We compared various factors, including age; sex; body mass index; heart rate; systolic blood pressure (SBP); atrial fibrillation; atherosclerotic risk factors, including dyslipidemia, diabetes mellitus, hypertension, smoking and chronic kidney disease; laboratory data, including brain natriuretic peptide and albumin; and medications, including loop diuretics, on pre-admission between short-stay (<14 days) and long-stay groups. The long-stay group consisted of 122 patients (59.5%). Multivariate analysis showed that male sex, SBP and albumin were independent predictors for long stays. According to the classification and regression tree and receiving operating characteristic curve analysis, all three factors on admission, including male sex, relatively low SBP (<155 mmHg) and hypoalbuminemia (<3.4 g/dL) could well predict the patients that would require long stays (area under curve 0.738). Among older ADHF patients with HFpEF, male patients with relatively low SBP and hypoalbuminemia on admission should initially undergo more intensive management to reduce the length of stay. Geriatr Gerontol Int 2019; 19: 1084-1087.

Determinants Associated with Prolonged Hospital Stays for Patients Aged 65 Years or Older with a Vertebral Compression Fracture in a Rural Hospital in Japan.

Japan is an aging society, and the incidence of diseases related to aging, such as pneumonia, heart failure, vertebral compression fracture (VCF), is increasing. Prolonged hospital stays are becoming a serious social problem, leading to elevated medical expenses. Thus, shortening the period of hospitalization is important. This study aimed to reveal determinants associated with prolonged hospital stays for patients with VCF. Our institution is the primary hospital in a rural area in the Kanto region of Japan. Altogether, 110 patients with a VCF, aged 65 years or older, including 79 women, were divided into two groups according to the average hospital stay period of 28 days: the long-stay group (mean stay 40.0 ± 11.6 days, n = 39) and the short-stay group (mean stay 20.6 ± 4.4 days, n = 71). Notably, the short-stay group included 55 women. Multivariate logistic regression analyses in male showed no variates significantly associated with prolonged hospitalization. By contrast, multivariate logistic regression analyses in female showed requiring emergency transportation to hospital was significantly associated with prolonged hospitalization [odds ratio 7.69, 95% confidence interval 1.13-52.29, P = 0.04]. In conclusion, this study implies that patients with better levels of activities of daily living are able to walk alone sooner and are easily discharged. Furthermore, the patient requiring emergency transportation might be in a poor social living environment, such as living alone. These results may give us a good opportunity to re-consider fundamental problems surrounding the elderly.

Risk factors of long hospital stay for immunoglobulin A vasculitis: Single-center study.

Immunoglobulin A (IgA) vasculitis is a common, systemic childhood disease that occasionally interferes with oral intake of food and necessitates hospitalization. In Japan, there are no reports on the length of hospitalization or factors related to long-term hospitalization in children with IgA vasculitis. In this study, we investigated the factors related to long-term hospitalization. We reviewed the medical records of children aged ≤15years with IgA vasculitis who were admitted to the National Center for Child Health and Development (Tokyo, Japan) between March 2008 and April 2017. We reviewed their gender, age, previous episodes, digestive symptoms, fever, laboratory data, urine analysis, ultrasound, and use of glucocorticoid on admission day. We compared the long-stay (≥10days) group (L) and the short-stay (≤9days) group (S) on logistic regression analysis. Of the 68 children included in the analysis, 34 were male, and the average age was 71.9 ± 26.4months. The median period of hospitalization was 10.5days (range, 0.5-75days), and 36 children were allocated to group L. In the logistic regression model including age, gender, gastrointestinal (GI) bleeding, and use of glucocorticoid, male sex (OR: 4.2; 95%CI: 1.3-13.5) and GI bleeding (OR: 7.6; 95%CI: 1.4-41.5) were significantly associated with hospitalization ≥10days. In children with IgA vasculitis, male patients and those with GI bleeding were more likely to have a hospital stay ≥10days.

O47-4 - Which Factors Are Correlated with Length of Stay in Elderly Patients with Acute Decompensated Heart Failure with Preserved Ejection Fraction?

Background: In heart failure (HF) with reduced ejection fraction (EF), systolic dysfunction is an established factor for long-stay, but in heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with length of stay, especially in the elderly patients. Methods: We enrolled consecutive elderly patients (>75 y.o.) with HFpEF (EF>50%) who admitted to control ADHF form May 2014 to April 2016. We compared various factors on admission including gender, body mass index (BMI), heart rate, systolic blood pressure (SBP), atrial fibrillation, anemia and coronary risk factors between short- (<14 days) and long-stay groups. Results: Table. Conclusion: In elderly ADHF patients with HFpEF, the male patients with low BMI and low SBP on admission should initially perform more aggressive management to reduce length of stay.

Evaluation of cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health: a large-scale, multi-institutional observational study

Purpose: We comprehensively evaluated cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health.Method: We surveyed 1967 patients receiving long-term inpatient psychiatric care. Patients were further categorized into an old long-stay group (n = 892, >5 years in hospitals) and a new long-stay group (n = 1075, 1–5 years in hospitals). We obtained responses for all the International Classification of Functioning, Disability, and Health items in domain b (Body Functions) and domain d (Activities and Participation). We estimated weighted means for each item using the propensity score to adjust for confounding factors.Results: Responses were received from 307 hospitals (response rate of hospitals: 25.5%). Cognitive and social functioning in the old long-stay group was more severely impaired than in the new long-stay group. No statistically significant differences were observed regarding the International Classification of Functioning, Disability, and Health items associated with basic activities of daily living between the two groups.Conclusion: Combined therapy consisting of cognitive remediation and rehabilitation on social functioning for this patient population should be started from the early stage of hospitalization. Non-restrictive, independent environments may also be optimal for this patient population.Implications for rehabilitationRehabilitation of cognitive and social functioning for patients requiring long-term inpatient psychiatric care should be started in the early stages of hospitalization.In psychiatric fields, the International Classification of Functioning, Disability, and Health checklist could facilitate individualized rehabilitation planning by allowing healthcare professionals to visually assess the comprehensive functioning of each patient using graphics such as radar charts.

Economic Evaluation of Intensive Inpatient Treatments for Severely Obese Children and Adolescents

Background: Considering the large economic consequences of severe childhood obesity for the society, we aimed to conduct an economic evaluation comparing two intensive 1-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to standard deviation score BMI (SDS-BMI) and quality-adjusted life years (QALYs). Methods: An economic evaluation from a societal perspective accompanying a randomized controlled trial with a 24-month follow-up. 80 participants (8-19 years) with severe obesity were included. Participants received an intensive 1-year lifestyle treatment with an inpatient period of 2 months (short-stay group) or 6 months (long-stay group). Data were collected at baseline, 6, 12 ,and 24 months and included SDS-BMI and QALYs. Results: SDS-BMI decreased in the first 6 months of treatment, stabilized in the second 6 months, and increased during the 2nd year in both groups. After 24 months, SDS-BMI was similar in both groups, but remained lower than baseline values (mean difference -0.24, 95% CI -0.42; -0.06). There was no difference in QALYs between the groups after 24 months. For SDS-BMI, the probability of the short-stay treatment being cost-effective in comparison with the long-stay treatment was 1 at a willingness-to-pay of 0 EUR/unit of effect, which slowly decreased to 0.54 for larger willingness-to-pay values. Conclusions: Based on the results of this study, the short-stay treatment is considered to be more cost-effective from the societal perspective in comparison with the long-stay treatment. Future research should provide insight in whether the short-stay treatment is cost-effective in comparison with usual care.

One-year effects of two intensive inpatient treatments for severely obese children and adolescents.

BackgroundIntensive inpatient lifestyle treatment may be a suitable alternative for severely obese children and adolescents who do not benefit from ambulatory obesity treatment.The aim was to evaluate the effectiveness of two intensive one-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to SDS-BMI and cardiometabolic risk factors.MethodsThe study was designed as a randomized controlled trial with two active treatment groups.Eighty participants (8–19 years) with severe obesity received treatment at a specialized childhood obesity center in the Netherlands. Severe obesity was defined as a SDS-BMI ≥ 3.0 or a SDS-BMI ≥ 2.3 in combination with obesity-related comorbidity.Participants received an intensive one-year lifestyle treatment with an inpatient period of either two months and biweekly return visits during the next four months (short-stay group) or six months (long-stay group), both followed by six monthly return visits.Outcomes were assessed at baseline, six and 12 months and included SDS-BMI as primary outcome and cardiometabolic risk factors such as SDS-waist circumference, systolic- and diastolic blood pressure, and blood measurements as secondary outcomes.To evaluate differences in the course of the primary- and secondary outcomes over time between the two treatment groups, Generalized Estimating Equations (GEE) were performed.ResultsNo differences in the course of SDS-BMI or secondary outcomes over time were found between the two treatment groups after one year of treatment. SDS-BMI decreased statistically significantly after one year of treatment compared with baseline in both groups (0.33 (0.48) in the short-stay and 0.52 (0.49) in the long-stay group). Similar results were found for SDS-waist circumference, diastolic blood pressure and HDL-cholesterol.ConclusionsSince there were no significant differences in effects between the short- and long-stay treatment and considering the burden of the long-stay treatment for children and families, we recommend implementation of the short-stay treatment.Trial registrationNetherlands Trial Register NTR1678, registered 20-Feb-2009

요양병원 장기입원 현황과 관련 노인 및 기관 특성 비교 연구

Background: This study examined patient and hospital factors related to long-stay admissions in long-term care hospitals (LTCHs) among older people in Korea. Methods: We analyzed health insurance claims data, entitlement data, and institutional administrative data from the National Health Insurance Service databases between 2010 and 2012. At the patient level, we compared characteristics of patients staying in LTCHs for over 180 days (the long-stay group) with those staying in LTCHs for less than 90 days during a calendar year. At the hospital level, we examined the general characteristics and staffing levels of the top 10% of hospitals with the highest proportion of patients whose length of stay (LOS) was 180+ days (the hospitals with long-stay patients) and compared them with the top 10% of hospitals with the highest proportions of patients whose LOS was less than 90 days (hospitals with shorter-stay patients). Results: The long-stay group accounted for about 40% of all LTCH patients. People in the group were more likely to be women, aged 80+, living alone, and experiencing more than two health conditions. Compared to the hospitals with shorter-stay patients, those with long-stay patients were more likely to be occupied by patients with behavior problems and/or impaired cognition, owned by corporate or local governments, have more beds and a longer period of operation, and deliver services with lower staffing levels. Conclusion: This study found long-stay older people in LTCHs and those in LTCHs with high proportions of long-stay older patients had several distinct characteristics compared to their counterparts designated in this study. Patient and hospital characteristics need to be considered in policies aiming to resolve long-stay admissions problems in LTCHs.

Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair

After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days in the Cardiac Intensive Care Unit (CICU) while some may stay longer. We undertook this study to investigate the factors associated with shorter vs. longer length of stay in the CICU to help manage resources effectively. Patients who underwent ToF repair at Aga Khan University, Pakistan, between July 2006 and December 2011 were studied in a case-control design. Clinical parameters were compared between short stay group (SSG) (≤2 days) and long stay group (LSG) (>2 days). Odds ratios were calculated, and regression was performed. Ninety-eight patients (LSG 65, SSG 33) were included. Patients with lower preoperative saturation were 2.67 times more likely to be in the LSG group (P = .02). At 4 hours postoperatively, patients with a higher inotropic score (odds ratio [OR] = 3.03, confidence interval [CI] = 1.19-7.7, P = .02), higher central venous pressure (OR = 3.04, CI = 1.27-7.32, P = .013), and significant tachycardia at 4 hours (OR = 3.5, CI = 1.19-10.3. P = .02) were at risk for having a prolonged CICU stay. On multivariate analysis, significant postoperative tachycardia at 4 hours (z-score ≥3) was highly specific (sensitivity = 38.5%, specificity = 84.9%) for predicting the chances of being in the LSG. Other predictors included preop O(2) saturation ≤82.5% (sensitivity = 61.1%, specificity = 63.0%) and CVP ≥10 mm Hg at 4 hours (sensitivity = 55.4%, specificity = 71.9%). Patients who end up staying longer in the CICU have features that are distinctive in the immediate postoperative period, and this can help clinicians in identifying patients who may need more support.

Influence of patient characteristics on care time in patients hospitalized with schizophrenia.

BackgroundIn the current Japanese payment system for the treatment of psychiatric inpatients, the length of hospital stay and nurse staffing levels are key determinants of the amount of payment. These factors do not fully reflect the costs of care for each patient. The objective of this study was to clarify the relationship between patient characteristics and their care costs as measured by “care time” for patients with schizophrenia.MethodsPatient characteristics and care time were investigated in 14,557 inpatients in 102 psychiatric hospitals in Japan. Of these 14,557 inpatients, data for 8,379 with schizophrenia were analyzed using a tree-based model.ResultsThe factor exerting the greatest influence on care time was ”length of stay”, so subjects were divided into 2 groups, a “short stay group” with length of stay ≦104 days, and “long stay group” ≧105 days. Each group was further subdivided according to dependence with regard to “activities of daily living”, “psychomotor agitation”, “verbal abuse”, and “frequent demands/repetitive complaints”, which were critical variables affecting care time. The mean care time was shorter in the long-stay group; however, in some long-stay patients, the mean care time was considerably longer than that in patients in the short-stay group.ConclusionThe results of this study suggest that it is necessary to construct a new payment system reflecting not only length of stay and nurse staffing levels, but also individual patient characteristics.

Factors predictive of length of stay for women in medium secure settings

Attempts to understand determinates of length of stay in secure settings has been given increased impetus by minimum standard setting and payment by results initiatives. Factors predictive of length of stay in the extant literature include, index offence, previous engagement in therapy, symptomatology, personality pathology and need. These factors were assessed for their predictive validity in a sample of 70 consecutive admissions to a women's medium secure service. Patients were divided into short- and long-stay groups A loglinear analysis of intake variables indicated that the highest order interaction (duration of stay × diagnosis × index offence/previous engagement in therapy) was significant. Analysis of dynamic variables indicated that longer stays were associated with total symptomatology, paranoid pathological personality scale scores and Camberwell Assessment of Need Forensic Version need items of psychotic symptoms and psychological distress. Short-stay patients showed higher levels of therapy engagement. Findings are confirmatory of some of the key variables to be considered when estimating length of stay and when planning treatment.

Factors Influencing the Postpartum Length of Hospital Stay in Eclamptic Women

To determine which variables are associated with postpartum length of hospital stay in eclamptic patients. The study sample comprised 98 eclamptic patients who were admitted to our perinatology unit during the period between January 1998 and May 2003. The study sample was divided into two postpartum length-of-stay groups: the short-stay group (1-3 days) consisted of 33 patients and the long-stay group (4 days and longer) consisted of 65 patients. The groups were compared with respect to the demographic characteristics, clinical and laboratory variables, and complications. The mean hospitalization periods for the short-stay and long-stay groups were 2.48 +/- 0.79 and 5.60 +/- 2.12 days, respectively ( p = 0.010). The mean prepartum follow-up period after the onset of eclampsia was longer in the long-stay group than in the short-stay group (12.11 +/- 27.63 vs. 5.08 +/- 6.08 hours). The proportion of patients receiving magnesium sulfate therapy longer than 12 hours was higher in the long-stay group ( p = 0.014). The long-stay group had higher diastolic arterial blood pressure than that of the short-stay group ( p = 0.006). The total cesarean delivery rate for the short-stay group was 48.5%, compared with 67.7% in the long-stay group ( p = 0.081). The duration of magnesium therapy, the timing, and the mode of delivery should be individualized to reduce the length of hospital stay in eclamptic patients.

Do bilinguals have different concepts? The case of shape and material in Japanese L2 users of English

An experiment investigated whether Japanese speakers' categorization of objects and substances by shape or material is influenced by acquiring English. Based on Imai and Gentner (1997), subjects were presented with an item such as a cork pyramid and asked to choose between two other items that matched it for shape (plastic pyramid) or for material (piece of cork). The hypotheses were that for simple objects the number of shape-based categorizations would increase according to experience of English and that the preference for shape- and material-based categorizations of Japanese speakers of English would differ from monolingual speakers of both languages. Subjects were 18 adult Japanese users of English who had lived in English-speaking countries between six months and three years (short-stay group), and 18 who had lived in English-speaking countries for three years or more (long-stay group). Both groups achieved above criterion on an English vocabulary test. Results were: both groups preferred material responses for simple objects and substances but not for complex objects, in line with Japanese monolinguals, but the long-stay group showed more shape preference than the short-stay group and also were less different from American monolinguals. These effects of acquiring a second language on categorization have implications for conceptual representation and methodology.

Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment.

To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted. All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort. There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years. Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.

Childhood asthma admissions: Determinants of short stay

The objective of this study was to identify the determinants of short hospital stay (< 24 h) among children admitted because of an acute asthma exacerbation. Computerized health records were used to identify children with a discharge diagnosis of asthma (ICD code 493.0) at the Hospital for Sick Children, Toronto, during the period October 1994 to October 1995. Cases were children with a length of hospital stay of < 24 h (short-stay group) and controls were children with a length of stay of > 24 h (long-stay group). Clinical and demographic data were extracted from the medical record. Over the 12-month period, 485 children were hospitalized because of asthma. Of these, 121 (25%) had short-stay admissions (< 24 h), whereas 364 (75%) had long-stay admissions (> 24 h). Simple random sampling was used to select 85 children from each of the two groups. There were no differences between the two groups regarding language, primary care physician, asthma history, management prior to emergency department (ED) presentation, respiratory rate on presentation, use of the observation unit, and time in the ED. Logistic regression analyses identified three variables associated with short hospital stay: milder asthma (adjusted odds ratio [OR] 4.9), male gender (adjusted OR 2.4), and availability of a delivery device at home (adjusted OR 2.0). In conclusion, many children admitted to hospital because of an asthma exacerbation have short, yet expensive, hospital stays. The results of this study highlight the importance of developing alternative models of health care delivery for asthmatic children requiring short hospital contact.

A Register for Patients with Learning Disabilities in General Practice

The shift of people with learning disabilities out of the large mental handicap hospitals mainly into residential homes in the community is now almost complete. This means that almost all people with learning disabilities are registered with general practitioners, both those discharged from long-stay institutions, and those who have always lived with their families in the community. This present paper reports on a study undertaken to assess the amount of disability and the workload by comparing the annual consultation rates of those recently discharged from long-stay institutions with those always in the community, and also against matched controls in a large fundholding practice. This was achieved by the practice learning disability register being imported from the local community learning disability team’s special needs register and checked against the local social education centre and special school records and then with the practice held records. Those whose records showed that they had been discharged from either hospital or specialist school within the last10 years of the study end (April 1996) were assigned as a past long-stay institution group; the remaining patients formed a second group, and both were compared with a matched control group. The study found that out of a total practice list of 14,410 patients, 57 were identified as patients with a known learning disability and constituted the register. They consulted 1.7 times as often and were prescribed 1.8 times as many repeat prescription drugs as matched control patients. However, of the57, the10 patients from long-stay institutions consulted4.9 times as often and took 4.9 times as many repeat prescription drugs as controls. The patients with learning disability who had always lived in the community consulted and took repeat prescription drugs at rates similar to controls. Making a detailed register of patients with learning disabilities highlights the multiple associated disabilities of this patient population and reveals an increase in consultation rate and central nervous system drug consumption. This is mainly due to patients who formerly lived in long-stay institutions and who were discharged to this practice. Similar changes are likely to have occurred in other primary health care teams.

Effects of prolonged stay in hospital on gastric flora.

To find out if a long preoperative stay in hospital results in the introduction of micro-organisms into the gastric flora that are resistant to the usual perioperative chemoprophylaxis. Observational study. Teaching hospital, Greece. 145 consecutive patients admitted for abdominal or pelvic operations. Aspiration of gastric fluid for measurement of pH and culture. Growth and type of pathogens in gastric aspirate. 125 patients spent a mean (range) of 13.6 days (7-69) in hospital preoperatively and 20 patients spent 3.1 (1-7) days. In the long-stay group 103 had a gastric pH of <4 and in 22 it was 4 or more; in 40 patients pathogens were grown from the gastric aspirate but resistant Pseudomonas cepacia was grown from only 2. In the short-stay group 16 patients had a pH of <4 and in 4 it was 4 or more; in 4 patients pathogens were grown from the aspirate. Prolonged stay in hospital preoperatively does not seem to affect the gastric flora, so routine chemoprophylaxis should be sufficient in abdominal operations.

Towards mental hospital closure – a study of a residual long-stay population

AbstractObjectives: To describe an entire long-stay hospita population and examine the differences between the old and new long-stay groups. It outlines the communitybased facilities required for hospital closure to occur.Method: One hundred and twenty-four patients were assessed using the Community Placement Questionnaire (CPQ), a standardised instrument used in service planning.Results: The CPQ revealed a globally disabled group with multiple handicaps. The mean age was 68.7 years and the predominant diagnosis was schizophrenia. Though the old long-stay (74) were more disabled than the new long-stay (50), similar sheltered accommodation was required for both groups. The new long-stay required a more active day-care program.Conclusions: Reprovision for long-stay patients must not only include sheltered accommodation but also appropriate day-care facilities. Assessment of the placement needs of all categories of long-stay patients necessary before hospital closure can take place.