Number Of Previous Admissions Research Articles

Sleep disturbances in hospitalized children: a wake-up call

Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1–12 years, admitted to a tertiary center, and compared this with home 6–8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital.Conclusion: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.

Role of Expressed Emotions and Its Impact on Relapse in Bipolar Affective Disorder

Abstract Background: The role of expressed emotions (EEs) in relapse is poorly understood in bipolar affective disorder (BPAD). Understanding the association between EE and relapse will be useful in predicting further relapse and improving the prognosis. Aims and Objectives: The present study was conducted with the objectives of assessing the relationship between EEs of caregivers and relapse of the illness in patients with BPAD on regular medication and to assess the relationship between severity of illness and EEs. Materials and Methods: Fifty consecutive bipolar disorder patients diagnosed as per the International Classification of Diseases-10 criteria, who were admitted into the department of psychiatry with relapse while on regular medication, and their caregivers were recruited into the study. Data were collected using a semi-structured pro forma designed for the study. Clinical details of illness were obtained from the informant and the records. The severity of the current episode was assessed with the rating scales (Young Mania Rating Scale and Hamilton Depression Rating Scale). The Expressed emotions(EE) among the caregivers were assessed using the Family Attitude Scale, association between EE and relapses as well as the severity of illness was analyzed with appropriate tests. Results: The mean age of the patients was 43.8 ± 15.4. Majority of them were male and married (68% and 68%). The mean age of the caregivers was 47.1 ± 10.5. The majority of the caregivers were female (60%). Sixty-four percent of the caregivers had high EEs. The mean age of onset of illness was 26.2 ± 4.6, and the number of previous episodes was 3.9 ± 2.5. The total duration of illness was 17.7 ± 13.4 years, and the number of previous admissions was 3.3 ± 2.2. Among clinical variables of patients and caregivers with high EEs, a significant association was found between duration of illness (Chi-square test: 11.82, P = 0.003), previous episodes (Chi-square test: 12.26, P < 0.01), and the number of previous admissions (Chi-square test: 9.79, P = 0.002). Conclusion: There was a significant association between high EE and relapse.

Predictors of inpatient suicide in an Irish psychiatric service, a longitudinal case-control study.

Inpatient suicide remains difficult to predict. This study aimed to identify individual patient predictors to help identify those at greater risk. This case-control study was undertaken in an independent mental health service in Ireland. Cases were drawn from all admissions to the service between March 2004 and February 2019. Controls were matched for date of admission. Univariate and multivariate analyses were conducted. Thirty-three cases of inpatient suicide were compared to 132 controls. The inpatient suicide rate was 76.2 per 100,000 admissions. The rate of inpatient suicide fell in line with national rates despite less restrictive practices being implemented in the service. Males accounted for 66% of cases. Hanging was the most common method of suicide overall and among male patients, and drowning was the most common among females. Male gender, tertiary referral, an adverse psychosocial event during admission, a period of absence without leave and expressing hopelessness were identified as independent risk factors for inpatient suicide. Substance use, involuntary detention, family history of suicide, and number of previous admissions were not significant. While not highly sensitive, a period of absence without leave, tertiary referral and hopelessness are important predictors of inpatient suicide risk that treating teams should consider in care planning.

P1100 A multivariate time-dependent proportional hazard model to predict development of intestinal failure from Crohn’s Disease

Abstract Background Intestinal Failure (IF) is a rare but severe complication of Crohn’s disease (CD). Advancement in therapy has not eliminated incident IF from CD (CDIF), and risk factors for developing IF from CD are not well characterised. The Copenhagen Intestinal Failure Database contains one of the largest, comprehensively described adult CDIF cohort1 from 1973 to 2018, which can be linked with a Danish nationwide CD cohort2 to explore healthcare utilisation patterns associated with developing IF from onset of CD. Methods CDIF patients from Copenhagen Intestinal Failure Database and a nationwide CD cohort without IF were followed from CD diagnosis until IF, death, or censoring on 31/12/2018. Hospital contacts, surgeries, medication use and employment status were extracted from multiple Danish population-based registries. Unplanned hospitalisation or emergency department attendance (inpatient-contact), CD-related abdominal surgery, and stopping work for 6 months or more (in working-age CD patients, excluding full-time study and parental leave) were considered time-dependent covariates and tested for significance (p<0.05) in univariate proportional hazard models. Significant covariates were then modelled together with additional non-time-dependent clinical and demographic variables in multivariate proportional hazard models. Backward variable selection was performed to derive a final predictive model. Results 175 CDIF and 22845 CD patients from whom data was available were followed for 2283.1 and 293536.5 patient-years, respectively. Univariate time-dependent proportional hazard models showed that every instance of unplanned IBD inpatient contact, CD-related abdominal surgery, and stopping work was significantly associated with increased hazard of developing IF, with a hazard ratio of 4.91 (95% CI 3.54-6.80, p<0.001), 29.79 (95% CI 9.70-91.48, p<0.001) and 1.61 (95% CI 1.15-2.26, p=0.005). In multivariate analysis, earlier decade of IBD onset, unplanned IBD inpatient contacts, length of stay of the inpatient contact, CD-related abdominal surgery, complicated surgery, number of previous admissions and surgeries and previous median-long term unemployment increased the rate of developing IF (Table), whereas age and comorbidity level at CD onset, non-IBD inpatient contacts, type of surgery, biologics use, and current employment status were not found to be significantly associated with IF development. Conclusion This is the first study to demonstrate significantly increased risks of developing IF from CD from increased healthcare utilisation patterns.

Factors Associated with Unplanned Hospital Readmission after Discharge: A Descriptive and Predictive Study Using Electronic Health Record Data

Hospital readmission involves the unplanned emergency admission of patients within 30 days from discharge after the previous admission. According to the Canadian Health Institute (CIHI), 1 in 11 patients were readmitted within 30 days of leaving the hospital in 2021. In the USA, nearly 20% of Medicare patients were readmitted after discharge, where the average cost of readmission was approximately USD 15,000, as reported by the Agency for Healthcare Research and Quality (AHQR) in 2018. To tackle this issue, we first conducted a descriptive analysis study to understand the risk factors associated with hospital readmission, and then we applied machine learning approaches to predict hospital readmission by using patients’ demographic and clinical data extracted from the Electronic Health Record of the MIMIC-III clinical database. The results showed that the number of previous admissions during the last 12 months, hyperosmolar imbalance and comorbidity index were the top three significant factors for hospital readmission. The predictive model achieved a performance of 95.6% AP and an AUC = 97.3% using the Gradient Boosting algorithm trained on all features.

1228 Predictors of Re-Intervention Following Index Cholecystectomy

Abstract Aim Index Cholecystectomy (IC) is safe and reduces patient morbidity. However, IC can be challenging due to inflammation of hepatocystic triangle, increasing the risk of postoperative complications. Study was conducted to evaluate factors influencing postoperative complications following IC. Method Retrospective review of consecutive IC performed as a primary procedure was carried out between February 2021 and July 2022 in our trust. Primary outcome was postoperative Grade 3 Clavien-Dindo (CDC) complication, in comparison to patients with uncomplicated recovery. Pre-operative factors including age, CRP, WBC, LFT, surgeon grade, modality (laparoscopic/open) and number of previous admissions were included for analysis. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value <0.05 was statistically significant. Results 100 IC were included. Most IC were consultant-led [80/100(80%)]. 11/100(11%) patients developed Grade 3 CDC complication; 4/100(4%) bile leak requiring ERCP and stent insertion, 3/100(3%) post-operative collection requiring radiological-assisted drainage, 2/100(2%) retained bile duct stones requiring ERCP, 1/100(1%) incision and drainage of port site seroma and 1/100(1%) biloma requiring laparoscopic washout. Re-intervention was common in older patients (61±18years vs 55±22years,p = 0.04) and higher median peak CRP levels (312±178 vs 154±284,p = 0.01). There were no differences in LFT parameters, number of previous admissions or timing of operation from day of admission between the two groups. Conclusions Age>65 and higher pre-operative CRP were associated with increased risk of postoperative procedural intervention. Larger prospective studies are needed to confirm these findings. Surgeons should consider these factors for consenting and risk assessment purposes.

FTP5.10 Predictors of re-intervention following index cholecystectomy

Abstract Aim Index Cholecystectomy (IC) is safe and reduces patient morbidity. However, IC can be challenging due to inflammation of hepatocystic triangle, increasing the risk of postoperative complications. Study was conducted to evaluate factors influencing postoperative complications following IC. Method Retrospective review of consecutive IC performed as a primary procedure was carried out between February 2021 and July 2022 in our trust. Primary outcome was postoperative Grade 3 Clavien-Dindo (CDC) complication, in comparison to patients with uncomplicated recovery. Pre-operative factors including age, CRP, WBC, LFT, surgeon grade, modality (laparoscopic/open) and number of previous admissions were included for analysis. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value <0.05 was statistically significant. Results 100 IC were included. Most IC were consultant-led [80/100(80%)]. 11/100(11%) patients developed Grade 3 CDC complication; 4/100(4%) bile leak requiring ERCP and stent insertion, 3/100(3%) post-operative collection requiring radiological-assisted drainage, 2/100(2%) retained bile duct stones requiring ERCP, 1/100(1%) incision and drainage of port site seroma and 1/100(1%) biloma requiring laparoscopic washout. Re-intervention was common in older patients (61±18years vs 55±22years, p=0.04) and higher median peak CRP levels (312±178 vs 154±284, p=0.01). There were no differences in LFT parameters, number of previous admissions or timing of operation from day of admission between the two groups. Conclusion Age>65 and higher pre-operative CRP were associated with increased risk of postoperative procedural intervention. Larger prospective studies are needed to confirm these findings. Surgeons should consider these factors for consenting and risk assessment purposes.

A Pragmatic Approach to define “DIFFICULT TO TREAT” patients

IntroductionMultiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.ObjectivesTo identify and haracterize DTP patients admitted in acute ward, based on practical criteria.MethodsThrough the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.ResultsThree clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.ConclusionsThese findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.Disclosure of InterestNone Declared

What Is A “Difficult To Treat” Schizophrenia Patient

IntroductionThe Portuguese Plan for Mental Health envisaged the development of teams dedicated to the support of “difficult” patients. However, it was not clarified who these patients were, nor in which dimensions they could be supported. In this regard, there is a need for an objective and pragmatic definition to understand who these patients are.Objectives To characterize the “difficult” patient with Schizophrenia.MethodsThrough the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected since 2017, with the diagnosis of Schizophrenia (ICD10: F20 – n: 1448). Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive analysis of these patients was made, regarding age, gender, destination at discharge, and to the “difficult to treat” patients, whether they attend a medical consultation prior to admission, if they were complying with the therapy and if they were using psychoactive substances.ResultsCluster analysis identified 3 clusters: (G1) a larger, uncharacteristic one; (G2) one of users with many PA; and one with a high number of days of admission (G3).The average age is similar (46 years old), as well as gender (male). Regarding hospitalization days, G1 and G2 presented similar average values (16 days), higher for G3 (60 days). Comparing PA in G2, 47% of patients have between 6 and 10 PA and 25% have between 11 and 20 PA. For the same intervals, G3 has values of 10% and 2% respectively. About the destination after discharge, about 2/3 of both groups were referred for follow-up consultation; in G2, 5% were discharged by abandonment and in G3, 5% were referred to a Rehabilitation service and 6% integrated in Residential homes. Approximately 2/3 of the patients in G2 and G3 did not go to a medical consultation in the three months prior to their admission. Regarding the therapeutic plan, in G2 73% were not following it and in G3 this rate was 66%. Only 5% of G2 and 2% of G3 were in involuntary treatment. Injectable medication was used by 42% of patients in G2 and 23% in G3. Regarding substance use, alcohol was present in 9% of G2 and in 6% of G3; cannabinoids in 18% of G2 and in 11% of G3; and other psychoactive substances were present in 8% of G2 and in 4% of G3.ConclusionsThe findings of this study allow us to outline two profiles of “difficult to treat” patients with Schizophrenia. On the one hand those with multiple relapses (G2), on the other those with prolonged hospitalizations (G3). Both have poor adherence to consultations and are erratic in therapeutic compliance. Injectable medication, although present in G2 and in a lower percentage in G3, and the infrequent involuntary treatment in both, may be considered as possible intervention points. An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures and rehabilitation centers), will be the key to their treatment.Disclosure of InterestNone Declared

Does intensive home treatment change treatment trajectories of psychiatric disorders?

IntroductionIntensive home treatment (IHT) for people experiencing a mental health crisis has been progressively established in many western countries as an alternative to in-ward admission. But is this a real alternative? We previously reported that patients treated in our IHT unit only differ from those voluntarily admitted to hospital in suicidal risk and severe behaviour disorders (not in other factors such as clinical severity) (Martín-Blanco et al., Rev Psiquiatr Salud Ment 2022;15:213-5). Now we are interested in disentangle if those patients who used to require inward management can be successfully treated at home.ObjectivesTo describe subsequent treatment trajectories of the first 1000 admissions to our IHT unit and to compare clinical characteristics among the different groups of trajectories.MethodsRetrospective cohort study. Subsequent treatment trajectories were collected from December 2016 to October 2022 and classified: absence, hospital, IHT, and mixed (hospital and IHT). Statistical significance was tested by means of ANOVA or Kruskal-Wallis test for quantitative variables (corrected for multiple comparisons) and chi-square tests for qualitative variables.Results Tables 1 shows the characteristics of the whole sample. Of the 1000 IHT admissions, 12.1% needed subsequent hospital admission(s), 12.7% IHT admission(s), and 9.3% mixed admission(s). There were no differences among these groups in median severity at IHT admission, but there were differences in the number of previous admissions (p=0.0001): the group with no subsequent admissions had less previous admissions than the other groups (pBonf<0.0001), and the group with subsequent IHT admissions had less than the group with mixed admissions (pBonf=0.0123). There were differences between groups regarding distribution of diagnoses (p<0.0001) (Fig. 1). When considering subsequent admissions by diagnosis, there were differences in severity at IHT admission (p=0.0068) and in number of previous hospitalizations (p<0.0001) (Fig. 2).Table 1.Clinical characteristics of the whole sample (N=1000)meanSDAge (years)47.0717.02CGI-s at admission *54-5N%Sex (female)54854.8%Psychotic disorders46346.3%Affective disorder25725.7%Bipolar disorder12812.8%Other disorders15215.2%Hospital admission in the previous 5 years31331.3%CGI-s: clinical global impression - severity. * median and IQRImage:Image 2:ConclusionsPatients that used to require inward management can now be treated at home when suffering an acute episode. Therefore, IHT has changed treatment trajectories for some patients with psychiatric disorders.Disclosure of InterestNone Declared

Association of Hospital Characteristics and Previous Hospitalization-Related Experiences with Patients' Perceptions of Hospital Care in China.

Patients’ perceptions of healthcare vary over time and by setting, and previous studies have rarely focused on these factors. We aimed to measure patients’ perceptions of hospital care in China and to examine how patients’ perceptions of hospital care vary by hospital characteristics (differences in setting) and previous hospitalization-related experiences (changes with time). We conducted a national cross-sectional survey of 7267 inpatients between July 2014 and April 2015 in China. Hospital characteristics measured were hospital technical level, hospital type, teaching status, and the ratio of doctors/nurses to ward beds. Previous hospitalization-related experiences measured were current admission length, number of previous admissions, and hospital selection (hospital advertisements or personal recommendations). Patients’ perceptions of hospital care included perceptions of doctors, nurses, and hospital organization. Scores were highest for perceptions of nurses, followed by perceptions of doctors, and hospital organization. Of the five hospital characteristics rated, the technical level was most strongly associated with patient perceptions of healthcare. The effect of hospital admission length and frequency of hospitalization on patients’ perceptions was represented by a √-shaped dose–response curve (scores were initially high, then decreased, then rebounded to higher than the initial scores). Patients who selected a hospital with hospital advertisements gave lower scores than those without hospital advertisements, and patients who selected a hospital with personal recommendations gave higher scores than those without If the observed √-shaped dose–response curves indicate a causal relationship between patients’ perceptions and hospital admission length or frequency of hospitalization, this may help to guide the timing of patient satisfaction assessments. The negative association between patient perception and advertising, and the positive association with personal recommendations (word-of-mouth) and hospital technical level, could provide important information for clinicians and hospital administrators.

118 EVALUATION OF PATIENTS ADMITTED UNDER GERIATRICS FROM SEPTEMBER TO NOVEMBER 2020: GUIDE TO ESTABLISHING A HOSPITAL AT HOME SERVICE

Abstract Background Studies have shown that home hospital care is as effective as hospital management and improve patient satisfaction. Up to date guidelines recommends that patients who do not require care uniquely proved in hospitals should be treated at home when possible. We aim to assess the need for a new Hospital At Home (HAH) with Comprehensive Geriatric Assessment (CGA) pathway under Integrated Care Programme for Older People (ICPOP). Methods We conducted a retrospective medical chart review of all patients admitted under Geriatrics from September 2020 to November 2020. Demographic data and admission notes were used to assess the patient’s eligibility. Information on dementia and delirium, length of stay, discharge destination, readmission rates, number of previous admissions, length of time at home prior to readmission, use of multidisciplinary team members during admission was also collected. Results Over the 3 months 358 patients were admitted and 36 patients met the inclusion criteria. The average age is 84.9 years, 33% were males. 10 patients had a diagnosis of Mild Cognitive Impairment and 5 with Dementia. No patients were delirious on admission, but 7 developed delirium as an inpatient. The average length of stay was 14.8 days, with a total of 534 bed days. Discharge destination was home for 91.7%, 1 patient passed away and 2 were discharged to Long Term Care. 22 patients were readmitted. The average time to readmission was 55 days, with a median of 35 days. Conclusion Given the aging population, and continued bed shortage in acute hospitals, the development of a HAH service will aim to alleviate some of this pressure. We aim to provide a holistic service to our patients, focused on medical care, but also improved quality of life, reduction in delirium, continued home living and reduced carer stress.

Predicting 30-Day Readmissions: Evidence From a Small Rural Psychiatric Hospital.

To improve quality of care and patient outcomes, and to reduce costs, hospitals in the United States are trying to mitigate readmissions that are potentially avoidable. By identifying high-risk patients, hospitals may be able to proactively adapt treatment and discharge planning to reduce the likelihood of readmission. Our objective in this study was to derive and validate a predictive model of 30-day readmissions for a small rural psychiatric hospital in the northeast. However, this model can be adapted by other rural psychiatric hospitals-a context that has been understudied in the literature. Our sample consisted of 1912 adult inpatients (1281 in the derivation cohort and 631 in the validation cohort), who were admitted between August 1, 2014, and July 31, 2016. We used deidentified data from the hospital's electronic medical record, including physician orders and discharge summaries. These data were merged with community-level variables that reflected the availability of care in the patients' zip codes. We first considered the correlates of 30-day readmission in a regression framework. We found that the probability of readmission increased with the number of previous admissions (vs. no readmissions). Moreover, the probability of readmission was much higher for patients with a depressive disorder (vs. no depressive disorder), with another mood disorder (vs. no other mood disorder), and/or with a psychotic disorder (vs. no psychotic disorder). We used these associations to derive a predictive model, in which we used the regression coefficients to construct a score for each patient. We then estimated the predicted probability of 30-day readmission on the basis of that score. After validating the model, we discuss the implications for clinical practice and the limitations of our approach.

Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals.

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

A prospective study of prognostic factors predicting outcome of surgery in chronic pancreatitis at a tertiary care centre in India

Identification of factors predicting the outcome of surgery for chronic pancreatitis and preparation of a scoring system to predict the outcome following surgery. A total number of 76 patients who had undergone surgery for chronic pancreatitis were prospectively followed at Department of General Surgery, S.C.B. Medical College, Cuttack during the period from 2010-2013. Data on demographic details, pain score, opioid addiction, exocrine and endocrine insufficiency, insulin requirement and morphology of pancreas on imaging were recorded. On follow up, improvement in pain score and exocrine and endocrine insufficiency were recorded. Factors affecting surgical outcome were determined and a scoring system was done. The mean age of patients was 39.7±7.9 years (range 18-58 years). Chronic alcohol intake was the predominant cause accounting for 56% (n=34) cases. Mean pain score at admission on Visual Analogue Scale (VAS) was 5.98. Twenty-six patients (43.3%) were found to have endocrine insufficiency and 22 (36.6%) patients had exocrine insufficiency. Forty-two patients underwent Partington-Rochelle procedure, and 18 patients underwent Frey’s procedure. Eighty percent of patients (n=48) had significant pain relief. On logistic regression, preoperative VAS score, number of previous admissions, opioid dependence, main pancreatic duct (MPD) diameter, number and site of calcifications were found to be significant in predicting pain relief. Cohort of patients with chronic pancreatitis likely to get benefit from surgery can be predicted preoperatively.

Pre-discharge factors associated with early readmission to psychiatric inpatient services within 90 days

AimsThe aim of this study was to identify pre-discharge risk factors associated with early inpatient readmission in general adult service users, with a particular focus on modifiable factors. We hypothesised that stability prior to discharge would reduce readmission to inpatient services within 90 days.BackgroundEarly readmission to inpatient psychiatric services is a poor outcome for service users, staff and the healthcare system. A variety of clinical, demographic and system factors, mostly non-modifiable, have been investigated previously. The identification of pre-discharge and particularly modifiable factors associated with readmission would give an opportunity for intervention and changes in policy.Method272 medical records of all admissions within an 8 month period to a NHS inner city psychiatric inpatient service were reviewed to identify factors associated with readmission within 90 days of discharge. The data were analysed by simple comparison, calculation of odds ratios and logistic regression.Result26% of service users were readmitted to the mental health trust within 90 days of discharge. Incidents (OR = 3.86; 95% CI 1.39–10.75) and psychotropic medication change in the week before discharge (OR = 2.94; 95% CI 1.43–6.03) were significantly associated with readmission, as were the number of previous admissions, and comorbid substance misuse. Successful overnight leave was found to be significantly protective against readmission (OR = 0.29; 95% CI 0.11–0.72).ConclusionThe ability to predict those at high risk for readmission means they can be targeted for interventions and it can also help develop best practice around inpatient care and the discharge process. The novel findings in this study of pre-discharge modifiable risk factors such as stability and successful overnight leave could have significant implications in discharge planning policy.

Psychosocial characteristics influence the duration of hospitalization in patients with psychotic disorders

IntroductionSchizophrenia spectrum disorders are related with prolonged stay in hospital and high cost for treating them. As a consequence, the determination of the factors that affect the duration of hospitalization is essential.ObjectivesThe purpose of the study is the determination of the psychosocial characteristics of inpatients in a public psychiatric hospital and their association with the duration of hospitalization.MethodsA total of 103 patients with a diagnosis of Schizophrenia (according to ICD-10) participated in the study. The socio demographic characteristics were recorded and the following psychometric tools were used: NEO- Five Factor Inventory, Connor-Davidson Resilience Scale (CD-RISC25), Multidimensional Scale of Perceived Social Support, Multidimensional Scale of Perceived Social Support (MSPSS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning scale (GAF).All instruments were adapted to greek population. All statistical analysis was performed using SPSS v.25.ResultsThe median length of hospital stay was 40,7 days. The number of previous admissions (p=0,010), the type of admission (compulsory or voluntary) (p=0,017), the physical restrain (p=0,043), the duration of restrain (p=0,002) as well as the existence of social support networks and in particular social support from friends (p=0,018), seem to affect the duration of hospitalization.ConclusionsThe present study underlines the signification of the psychosocial factors that could contribute to the prediction of longer hospitals stays, the planning of appropriate interventions and as a result the reduction of hospital costs.

Clinical characteristics and rehospitalization in patients with schizophrenia with or without history of amphetamine abuse

Objective: In this study, we intended to study the differences of the clinical characteristics between patients with schizophrenia with or without history of amphetamine abuse and risk factors of rehospitalization. Methods: We used medical records and reviewed electronic database to collect the two schizophrenia groups discharged from the Taoyuan Psychiatric Center from January 1, 2012, to December 31, 2015. Patients with and without amphetamine abuse were defined as case group and control group, respectively. The patients' demographic data and clinical variables were extracted and examined. Results: We identified 80 patients in the case group and 142 patients in the control group. Up to 32.5% of the case group patients still showed a positive urine amphetamine test. The univariate analysis showed that significant differences existed in gender (p < 0.001), age (p < 0.001), marriage (p < 0.05), education (p < 0.001), psychiatric comorbidity (p < 0.05), family history of schizophrenia (p < 0.01), family history of illicit substance use (p < 0.001), history of suicide (p < 0.01), history of violence (p < 0.001), hospitalization days (p < 0.001), and rehospitalization rate (p < 0.05). The result of the logistic regression showed that the number of previous admissions was a positive predictor of rehospitalization and that with family history of schizophrenia was a negative predictor of rehospitalization. The Cox proportional hazards regression model analysis showed that the number of previous admissions was still a positive predictive factor for the rehospitalization. Conclusion: In this study, the characteristics of two study patient groups were different. Patients with schizophrenia and with a history of amphetamine abuse had a tendency of amphetamine abuse and a higher rate of rehospitalization. Further treatment for amphetamine abstinence in the community for this population is warranted to strengthen the study results.

Understanding Recurrent Admissions for People with Heart Failure in New Zealand

Conventional time-to-first event analyses do not fully represent burden of a chronic disease such as heart failure (HF). Extending analyses to subsequent recurrent events is required for improved understanding of risk factors associated with repeated hospital admissions over the course of the disease. We examined occurrence and risk factors of all-cause hospital readmissions through 4 years of follow-up period for adults admitted to a NZ hospital for the first-time with HF in 2013 or 2014. Several extended Cox models were assessed that differed in how they dealt with intra-subject correlation, and in how they modelled the time between hospitalisations. Of 23,736 patients discharged alive from index hospitalisation, 88% had ≥1 readmission and/or died from CVD during 4 years of follow-up. A standard time-to-first-event Cox model would have ignored 74% of total events experienced. The hazard ratios of predictors in the time-to-first-event model differed from those in the recurrent events models, including shifts in the statistical significance of key variables (ethnicity, HF aetiology). For most variables, smaller hazard ratios and narrower confidence intervals were observed from the Cox models which account for an increase in risk of event with number of previous admissions. Recurrent events analysis should be considered to understand longer-term impact of progression of HF and the true burden of long-term conditions. We demonstrated that the type of recurrent events model may affect the estimated covariate effects and its interpretation.

Predicting rehospitalisation in older inpatients with a psychotic disorder.

The objective of this study was to predict rehospitalisation in a psychiatric clinic in older inpatients with a psychotic disorder. In this prospective, observational study, all eligible inpatients aged 55 years and over with a primary psychotic disorder, admitted to a specialised ward for older psychotic patients in a large psychiatric inpatient clinic in the Netherlands, were asked to participate. Whether or not patients were rehospitalised and time to rehospitalisation were assessed 1 year after discharge from the ward. We recorded age, gender, living arrangement, psychiatric diagnosis, severity of psychotic symptoms, duration of index episode, age of onset of psychotic disorder, number of previous admissions, involuntary admission and use of depot medication at discharge. All patients underwent a neuropsychological assessment. Of the 90 patients that were included, 32 (35.6%) had been readmitted within 1 year after discharge. None of the demographic or clinical variables predicted rehospitalisation or the time to rehospitalisation. Factors that predict rehospitalisationin younger adult patients with schizophrenia may not predict rehospitalisationin older patients with a psychotic disorder, of which the majority suffered from schizophrenia. We expect that other factors than those investigated may be of greater importance to predict rehospitalisation, as for example social support and coping mechanisms.