Longer Periods Of Admission Research Articles

An examination of service user satisfaction in forensic mental health settings.

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.

Jumping to conclusions at first onset of psychosis predicts longer admissions, more compulsory admissions and police involvement over the next 4 years: the GAP study.

Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case-control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years. One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning 'Beads' Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment - the Mental Health Act (MHA) - and inpatient days). FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92-83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68-83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91-13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions. JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.

Patterns of illness and care over the 5\xa0years following onset of psychosis in different ethnic groups; the GAP-5 study

PurposePrevious research has not provided us with a comprehensive picture of the longitudinal course of psychotic disorders in Black people living in Europe. We sought to investigate clinical outcomes and pattern of care in Black African and Black Caribbean groups compared with White British patients during the first 5 years after first contact with mental health services for psychosis.Methods245 FEP cases aged 18–65 who presented to psychiatric services in 2005–2010 in South London (UK). Using the electronic psychiatric clinical notes in the South London and Maudsley NHS Foundation Trust (SLaM), extensive information was collected on three domains—clinical, social, and service use.ResultsDuring the 5-year follow-up (mean = 5.1 years, s.d. = 2.4; 1251 person years) after first contact with mental health services, a higher proportion of Black African and Black Caribbean ethnicity had compulsory re-admissions (χ2 = 17.34, p = 0.002) and instances of police involvement during an admission to a psychiatric unit (χ2 = 22.82, p < 0.001) compared with White British ethnic group. Patients of Black African and Black Caribbean ethnicity did not differ from the ethnic group in overall functional disability and illness severity, or frequency of remission or recovery during the follow-up period. However, patients of Black ethnicity become increasing socially excluded as their illness progress.ConclusionsThe longitudinal trajectory of psychosis in patients of Black ethnicity did not show greater clinical or functional deterioration than white patients. However, their course remains characterised by more compulsion, and longer periods of admission.

Length of admission into psychiatric hospitals according to diagnoses

IntroductionIn recent years, psychiatry in the United Kingdom has faced an important challenge due to the shortage of beds for patients with increased lengths of stay. Available resources have been saturated due to the reduced capability of psychiatric hospitals to provide spaces for patients needing access to psychiatric care.ObjectivesThis research provides a figure of length of stay linked to psychiatric pathology at discharge.AimTo establish the length of admission of psychiatric patients.MethodsThe sample comprised 137 discharges from a general adult psychiatric ward distributed over the first 8 months of 2016. Results were analyzed by descriptive statistics and meta-analysis.ResultsOverall, longer periods of admission were recorded for psychoses and shorter periods for adjustment disorders. Psychoses had a median length of admission of 28 days (range = 3–374); borderline personality disorders, 10 days (range = 1–249); mood disorders, 14 days (range = 2–74); drug addictions, 6 days (range = 1–222); and adjustment disorders, 5 days (range = 1–55). Meta-analysis (Fig. 1) provided a confidence interval estimate for the whole model of 24.314 days (95% CI = 13.00–35.621) with P &lt; .001. Meta-analysis results also provided t2 = 101.061, Cochrane's Q (df = 4) = 14.327, I2 = 72.081, with P = .006.ConclusionsPsychoses are conditions that require longer admissions, whereas adjustment disorders are more transient pathologies. Borderline personality disorder is somewhat of a hybrid condition. Overall, patients remain in hospital for about a month (24 days).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antimicrobial resistance patterns of phenotype Extended Spectrum Beta-Lactamase producing bacterial isolates in a referral hospital in northern Tanzania

Background: Production of Extended Spectrum Beta-Lactamase (ESBL) by bacteria is a chronic problem in a health care set up. In order to have adequate information for treatment of bacterial infections especially ESBL producing isolates, it is crucial to understand the trends in the antibiotic-resistance pattern, occurrence and their geographical spread. The objective of this study was to determine the antimicrobial resistance pattern among phenotype ESBL producing isolates in northern Tanzania. Methods: From July 2013 to January 2014, urine, pus and blood samples were collected from patients suspected to have bacterial infections at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. The isolates were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs as per the recommendations of Clinical Laboratory Standard Institute. Results: A total of 330 specimens were collected. They consisted of 46 urine, 264 pus (from wound) and 20 blood samples. Among isolated bacteria, ESBL producers were 29.7% (98) and non-producers were 70.5% (232). Escherichia coli and Klebsiella pneumoniae were the most isolated bacteria and dominant ESBL producers. ESBL production was highly associated with moderate condition at discharge and longer periods of admission. More than 60% of the ESBL producing E. coli were resistant to ceftazidime, cefpodoxime, cefotaxime, amoxycilin, ciprofloxacin, and gentamycin. More than 80% of ESBL producing K. pneumonia and Proteus mirabilis were resistant to ceftazidime and cefotaxime. Fifty four percent of ESBL producing K. pneumonia were resistant to gentamycin. Conclusion : This study shows that ESLB phenotypes among Gram-negative bacteria are common among patients attending a tertiary hospital in northern in Tanzania. The findings suggest that clinical microbiology laboratories should take into account the diagnosis of ESBL producers in order to define the degree of the problem so as to establish a proper treatment protocol.

Antimicrobial resistance patterns of phenotype Extended Spectrum Beta-Lactamase producing bacterial isolates in a referral hospital in northern Tanzania

Background: Production of Extended Spectrum Beta-Lactamase (ESBL) by bacteria is a chronic problem in a health care set up. In order to have adequate information for treatment of bacterial infections especially ESBL producing isolates, it is crucial to understand the trends in the antibiotic-resistance pattern, occurrence and their geographical spread. The objective of this study was to determine the antimicrobial resistance pattern among phenotype ESBL producing isolates in northern Tanzania.Methods: From July 2013 to January 2014, urine, pus and blood samples were collected from patients suspected to have bacterial infections at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. The isolates were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs as per the recommendations of Clinical Laboratory Standard Institute.Results: A total of 330 specimens were collected. They consisted of 46 urine, 264 pus (from wound) and 20 blood samples. Among isolated bacteria, ESBL producers were 29.7% (98) and non-producers were 70.5% (232). Escherichia coli and Klebsiella pneumoniae were the most isolated bacteria and dominant ESBL producers. ESBL production was highly associated with moderate condition at discharge and longer periods of admission. More than 60% of the ESBL producing E. coli were resistant to ceftazidime, cefpodoxime, cefotaxime, amoxycilin, ciprofloxacin, and gentamycin. More than 80% of ESBL producing K. pneumonia and Proteus mirabilis were resistant to ceftazidime and cefotaxime. Fifty four percent of ESBL producing K. pneumonia were resistant to gentamycin.Conclusion: This study shows that ESLB phenotypes among Gram-negative bacteria are common among patients attending a tertiary hospital in northern in Tanzania. The findings suggest that clinical microbiology laboratories should take into account the diagnosis of ESBL producers in order to define the degree of the problem so as to establish a proper treatment protocol.

Endoscopic treatments of gastric mucosal lesions are not riskier in patients with chronic renal failure or liver cirrhosis

Little is known about the feasibility of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for patients with chronic renal failure (CRF) or liver cirrhosis (LC). This study aimed to assess the safety, efficacy, and clinical outcomes of EMR or ESD in patients with CRF or LC compared to those in patients without. Between February 2003 and November 2009, a total of 1016 gastric neoplastic lesions in 928 patients were treated by using EMR or ESD. Among them, 18 patients had LC and 17 patients had CRF. Their medical records were reviewed retrospectively. En bloc resection rate, histological complete resection rate, operation time, and complications were compared between patients with CRF or LC and those without (control group). Baseline characteristics were not significantly different between the CRF, LC, and control groups except for a high rate of comorbidities in the CRF group and prolonged prothrombin time in the LC group. Operation time and therapeutic outcomes such as en bloc and complete resection rates did not differ significantly between the groups. Immediate bleeding tended to occur more frequently in the CRF+LC group than in controls (47.5 vs. 33.9%, p=0.077). There was no significant difference in the incidence of perforation between the CRF, LC, and control groups. The hospital stay was longer in the CRF+LC group than in the control group (6.4±3.53 vs. 4.9±3.15 days, p=0.012). EMR and ESD for the treatment of early gastric neoplasia may be equally effective and tolerable in the CRF or the LC group compared to the control group, although patients with CRF or LC might need the longer admission period than the control group.

Total Hip Arthroplasty in Patients with Diabetes Mellitus

Purpose: The purpose of present study is to analyze the incidence and the predisposing factors for postoperative complications that diabetes mellitus (DM) patients suffer after undergoing total hip arthroplasty. Materials and Methods: Among the 379 patients who underwent primary cementless total hip arthroplasty from September 1998 to February 2007, fifty-nine patients (62 hips) who had DM were selected and the other 320 patients (378 hips) without DM were set as a control group to perform comparative analysis. The mean follow up period was 36 months (range, 12-117 months) and the mean age of patients was 55.5 years (range, 16-79 years). The preoperative and annual postoperative Harris Hip Score (HHS) and the postoperative complications were checked. We analyzed the factors that were associated with the incidence of postoperative complications in DM patients. Results: The DM group had a higher incidence of urinary tract infection and a longer admission period than did non-DM group (p=0.001 and p=0.002). The HHS was 52 and 53 (p=0.185), respectively, for the DM patients and the non-DM patients preoperatively, and it was 93 and 95 (p=0.467), respectively, at the last follow up. The predisposing factors for postoperative complications in DM patients are a high hemoglobin A1c (HbA1c) level and comorbidities. Conclusion: Total hip arthroplasty in DM patients is associated with a higher incidence of postoperative complications and a prolonged admission period. A high HbA1c level and comorbidities are considered to have significant associations with these complications.

Audit of diabetes care by caseload

OBJECTIVETo investigate the relationship between clinic provision, consultant and nursing caseload, and processes and outcomes of diabetes care in children.DESIGNRetrospective audit in the South Western region of England of 801...