Number Of Previous Hospitalizations Research Articles

20 year picture of a heart failure clinic: changes in the patients profiles' and 2-year mortality

Abstract Background Heart failure (HF) is one of the most prevalent diseases. Improvements in cardiac disease management in the last two decades and in HF itself might have influenced the referral of patients with HF to a specialised HF clinic. Purpose To evaluate changes in the profile of patients referred to an outpatient HF clinic over the span of 20 years, and to analyse trends in 2-year mortality. Methods A retrospective analysis of a prospective registry of HF patients in a specialised ambulatory HF clinic was conducted, from January 1st 2002 to December 31st 2021. We divided the 20 years of the study into five periods of four years each, in order to compare the clinical characteristics of patients at admission. The variables analysed include age, sex, aetiology, HF type (preserved - HFpEF, reduced - HFrEF, mildly-reduced - HFmrEF), NYHA class, left ventricle ejection fraction (LVEF), NT-proBNP level, number of previous hospitalizations, and treatment at referral (first visit). Two-year mortality was also analysed. Results A total of 2973 patients were included (mean age 67.1± 12,9, 69.7% men). Age remained stable across the five periods, p=0.43), while the referral of women increased throughout the study period (27.7% in 2002-2005 vs 32.9% in 2018-2021, p-for-trend=0.037). Patients with HFpEF were also increasingly referred (12.3% first period vs. 27.6% last period, p-for-trend<0.001) and LVEF tended to be higher (33.09% vs. 40,9%, p<0.001). The main aetiology of the referred patients was ischaemic heart disease, although it progressively decreased in favour of other aetiologies (Table 1) (p<0.001). NYHA class tended to improve (NYHA 3-4 40.3% vs. 21.3%, p-for-trend <0.001) and NT-proBNP levels tended to decrease, predominantly in the last period (p-for-trend=0.025), as well as hospitalisation rates in the previous year (p-for-trend<0.001). Treatment with ACEi/ARB was progressively less frequent (p<0.001), at least partially due to replacement by ARNi (p<0.001). Treatment with digoxin and loop diuretics also diminished (p<0.001 and p=0.04 respectively), whereas treatment with betablockers, ARM, ivabradine and SGLT-2i increased during the study periods (all p<0.001) (Table 2); Patients carrying ICD and CRT also increased (p=0.014 and p<0.001 respectively). Adjusted 2-year mortality significantly decreased, mainly in the last period (p<0.001) (Figure 1). Conclusion The profile of HF patients referred to a tertiary HF ambulatory Clinic changed along 20 years of study. HFrEF remained the most common, but is declining in favour of HFpEF. Ischaemic aetiology also remained the most frequent but, again, showed a decreasing trend. Two-year mortality has globally decreased, markedly in the last period.Figure 1

Prediction of risks and odds of rehospitalization of patients with eating disorders in anxiety-depressive disorders

The article represents the results of a study aimed on predicting the risks and odds of rehospitalization among patients with eating disorders in anxiety-depressive disorders. In total, 147 patients with anxiety and depressive disorders were examined. Patients were divided into a main group of 82 and a comparison group of 65 patients. The main group consisted of 21 (26%) men with a mean age of 38.33 (SD 11.53) and 61 (74%) women with a mean age of 43.15 (SD 11.44). The comparison group consisted of 19 (29%) men, mean age 37.53 (SD 9.75) and 46 (71%) women, mean age 45.22 (SD 12.17). At the time of the initial examination in the main group, 35 (43%) patients were hospitalized for the first time, 47 (57%) – rehospitalized; in the comparison group, 23 (35%) patients – for the first time hospitalized, and 42 (65%) – rehospitalized. It was found that 27 patients were rehospitalized within the next year after the intervention and treatment. Clinical-anamnestic, clinical-psychopathological and psychodiagnostic study supplemented by psychometric scales (PHQ-9 health questionnaire, Dutch Eating Behaviour Questionnaire (DEBQ), State-Trait Anxiety Inventory (STAI; C.D. Spielberger), Methodology for assessing the integrative Quality of Life Index (QLI; J.E. Mezzich)) was conducted. As a result of the study, it was found that patients in the main group had a 3.6 times lower risk of rehospitalization over the next year than patients in the comparison group. When constructing a unipolar regression model, the best predictive power and discriminative ability was demonstrated by the number of previous hospitalizations (p<0.01, AUC 0.75 (0.67-0.82)) and the intervention in the main group, which reduced the odds of rehospitalization over the next year by 4.8 times. The highest discriminative ability was demonstrated by the multiple logistic regression model (AUC 0.83 (0.76-0.88)), according to which intervention in the main group reduced the odds of rehospitalization in the next year by 5.9 times. The results of the study became the basis for the development of differentiated treatment and correctional measures for eating disorders in patients with anxiety-depressive disorders to improve the quality of care, prevent psychosocial maladjustment and improve the quality of life of this population.

Sociodemographic profile and prescribing pattern of antipsychotic medication in patients with Schizophrenia

IntroductionSchizophrenia is a complex psychiatric disorder that changes the patient’s life by influencing how they think, behave, express emotions, percept reality and their interpersonal relationships.ObjectivesThe aim of this study was to evaluate sociodemographic and therapeutic factors that act as risk and protective factors in the clinical outcomes of patients diagnosed with schizophrenia.MethodsThis was an observational retrospective study including patients diagnosed with schizophrenia, treated at the “Xhavit Gjata” Psychiatric Hospital, Tirane, Albania, who were discharged between May 1- October 30, 2022. The follow-up period was six months. Data on further hospitalizations during the follow-up were obtained from the Department of Statistics, QSUT, and confirmed by family members for hospitalizations in other psychiatric hospitals in the country. Univariate and multivariate analyses were conducted to identify potential factors associated with emergency room stays, length of stay, and time until the next admission.ResultsA total of 158 patients were included in the study, 63 women and 95 men (p=0.03). The average age of the patients was 42.9 years, with women averaging 45.3 years and men 40.6 years (p=0.01). 43.7% of them had elementary education. The average age of disorder onset was 24.7 years. Haloperidol was the ambulatory therapy used in 54.3% of patients, while atypical antipsychotics were used in 75.1% of patients. The most commonly used atypical antipsychotic was Risperidone in 34.1% of patients, followed by Olanzapine in 17% of cases. Depo antipsychotics were used in 35.1% of patients. Clozapine was administered to 29.3% of patients, where 12.8% for the first time. 54.2% of patients starting Clozapine for the first time had three or more admissions. Clozapine was more frequently used in men, showing a significant difference from women (p=0.05). In 44.7% of cases, monotherapy was prescribed. The average hospital stay was 21.9 days, ranging from 2-68 days. Living with a family member, male gender, and being “married” helped reduce the length of hospital stay. In the 6-month follow-up period, 31.4% were re-hospitalized. Significant factors affecting the reduction of time spent outside the hospital until the next hospitalization were social problems, the number of previous hospitalizations, civil status “not married,” living arrangements, negative symptoms, and alcohol use (nearly significant). Protective factors included Clozapine, which reduced the prevalence of hospitalization by 57% compared to patients not taking it. Additionally, the use of Clozapine and Haloperidol increased the time spent outside the hospital.ConclusionsSocial and family support, positive compliance, and antipsychotic therapy such as Clozapine serve as protective factors for patients diagnosed with schizophrenia.Disclosure of InterestNone Declared

Development and validation of a prediction model for rehospitalization among people with schizophrenia discharged from acute inpatient care.

Relapses and rehospitalization prevent the recovery of individuals with schizophrenia or related psychoses. We aimed to build a model to predict the risk of rehospitalization among people with schizophrenia or related psychoses, including those with multiple episodes. This retrospective cohort study included individuals aged 18 years or older, with schizophrenia or related psychoses, and discharged between January 2014 and December 2018 from one of three Japanese psychiatric hospital acute inpatient care ward. We collected nine predictors at the time of recruitment, followed up with the participants for 12 months, and observed whether psychotic relapse had occurred. Next, we applied the Cox regression model and used an elastic net to avoid overfitting. Then, we examined discrimination using bootstrapping, Steyerberg's method, and "leave-one-hospital-out" cross-validation. We also constructed a bias-corrected calibration plot. Data from a total of 805 individuals were analyzed. The significant predictors were the number of previous hospitalizations (HR 1.42, 95% CI 1.22-1.64) and the current length of stay in days (HR 1.31, 95% CI 1.04-1.64). In model development for relapse, Harrell's c-index was 0.59 (95% CI 0.55-0.63). The internal and internal-external validation for rehospitalization showed Harrell's c-index to be 0.64 (95% CI 0.59-0.69) and 0.66 (95% CI 0.57-0.74), respectively. The calibration plot was found to be adequate. The model showed moderate discrimination of readmission after discharge. Carefully defining a research question by seeking needs among the population with chronic schizophrenia with multiple episodes may be key to building a useful model.

Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction.

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.

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&lt;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&lt;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&lt;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

Clinical and Demographic Factors Associated with Receiving an Opioid Prescription following Admission to the Pediatric Intensive Care Unit.

Opioids are commonly used to treat pain in the pediatric intensive care unit (PICU), and many children receive opioid prescription(s) at discharge. The frequency of opioid prescriptions at discharge and associations with individual characteristics and clinical factors are unknown. This study aimed to identify (1) the number of children who receive an opioid prescription at PICU discharge and (2) the demographic and clinical factors associated with receiving an opioid prescription. Data were collected via the electronic medical record. The sample was 3345 children (birth to 18 years) admitted to the PICU and discharged to home or an inpatient rehabilitation setting. In total, 23.7% of children were prescribed an opioid at discharge. There were group differences in who received opioid prescriptions (yes/no) related to PICU diagnosis, length of hospital stay, number of days on mechanical ventilation, number of previous hospitalizations, organ dysfunction score, and admission type (surgical versus non-surgical). Binary logistic regression models examined predictors of opioid prescription at discharge for the total sample and diagnostic subgroups. Older age and surgical admission type were the most consistent predictors of receiving an opioid prescription. Future research should examine prescription usage patterns and how use of opioids is associated with pain and functional outcomes over time.

A telemonitoring programme in patients with heart failure in France: a cost-utility analysis

BackgroundCertain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF.MethodsA Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model.ResultsThe number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800.ConclusionsEnrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

Vaccination rates against COVID-19 in patients with severe mental illness attending community mental health services in rural Greece.

Patients with severe mental illness (SMI) may be at increased risk for COVID-19-related severe morbidity and mortality. There is limited research on the vaccination rates against COVID-19 in patients with SMI. The objective of the present study is to explore vaccination rates and co-relations in patients with SMI, attending community mental health services, namely the Mobile Mental Health Units (MMHUs) in rural Greece. All treatment engaged patients with SMI (schizophrenia-spectrum or bipolar disorder) with two MMHUs (MMHU of Kefalonia, Zakynthos and Ithaca, [MMHU KZI] and MMHU of the prefectures of Ioannina and Thesprotia [MMHU I-T]) in rural Greece were enrolled prospectively over a six-month period. The MMHU I-T had adopted a more proactive approach to patients' vaccination, by informing patients and caregivers for its benefits. Data were analyzed for 197 patients with SMI. The overall vaccination rate was 68.5% and did not differ from the respective rates in the general population. There were no differences in vaccination rates among patients attending the two MMHUs, nor among patients with different diagnoses (schizophrenia spectrum disorders or bipolar disorder). Vaccination was not associated with gender, educational level, history of alcohol and substance abuse, illness duration, or number of previous hospitalizations, whereas the effect size of age was moderate. In more than half non-vaccinated patients the refusal to get vaccinated was associated with fears and concerns as well as false beliefs that are encountered in the general population. In the present sample of treatment-engaged rural patients vaccination rates against COVID-19 appear to be satisfactory. There were no differences in vaccination rates with regard to the interventions that were applied to enhance vaccination. It seems that other forms of intervention should be applied to reluctant patients to modify their attitudes toward vaccination.

Association of brain white matter microstructure with cognitive performance in major depressive disorder and healthy controls: a diffusion-tensor imaging study

Cognitive deficits are central attendant symptoms of major depressive disorder (MDD) with a crucial impact in patients’ everyday life. Thus, it is of particular clinical importance to understand their pathophysiology. The aim of this study was to investigate a possible relationship between brain structure and cognitive performance in MDD patients in a well-characterized sample. N = 1007 participants (NMDD = 482, healthy controls (HC): NHC = 525) were selected from the FOR2107 cohort for this diffusion-tensor imaging study employing tract-based spatial statistics. We conducted a principal component analysis (PCA) to reduce neuropsychological test results, and to discover underlying factors of cognitive performance in MDD patients. We tested the association between fractional anisotropy (FA) and diagnosis (MDD vs. HC) and cognitive performance factors. The PCA yielded a single general cognitive performance factor that differed significantly between MDD patients and HC (P < 0.001). We found a significant main effect of the general cognitive performance factor in FA (Ptfce-FWE = 0.002) in a large bilateral cluster consisting of widespread frontotemporal-association fibers. In MDD patients this effect was independent of medication intake, the presence of comorbid diagnoses, the number of previous hospitalizations, and depressive symptomatology. This study provides robust evidence that white matter disturbances and cognitive performance seem to be associated. This association was independent of diagnosis, though MDD patients show more pronounced deficits and lower FA values in the global white matter fiber structure. This suggests a more general, rather than the depression-specific neurological basis for cognitive deficits.

Predictors of long-acting injectable antipsychotic prescription at discharge in patients with schizophrenia and other psychotic disorders.

Long-acting injectable antipsychotics (LAIs) increase drug compliance and offer a reliable treatment option with stable pharmacokinetics. The aim of our study is to examine the rate and predictors of LAIs' prescription at discharge in inpatients with schizophrenia and other psychotic disorders. This retrospective study included 400 inpatients. Sociodemographic and clinical characteristics of the patients, the treatments applied in the past and prescribed at discharge were obtained from the hospitalization files. We compared these characteristics of those who were given LAI treatment at discharge to the patients who were given oral treatments. Thirty-nine percent of the patients were prescribed a LAI at discharge. Duration of illness was longer, and number of previous hospitalizations was higher in the LAI group. Nonadherence to the antipsychotics before the hospitalization, the previous history of LAI use, lack of insight at the admission and no previous antidepressant use were found as independent contributors to LAI prescription as the treatment of discharge in logistic regression analysis. Our study showed that LAIs are used at a high rate in our clinic; however, they are still initiated at a later stage, mostly in chronic patients with a lack of insight and compliance at admission.

Longitudinal changes in total and regional body composition in patients with chronic obstructive pulmonary disease.

Background and objectiveLow fat‐free mass (FFM) is common in patients with chronic obstructive pulmonary disease (COPD) and contributes to morbidity and mortality. Few studies have evaluated longitudinal changes in body composition in patients with COPD compared with non‐COPD controls. This study aimed to compare longitudinal changes in total and regional body composition between patients with COPD and non‐COPD controls and investigate predictors of changes in body composition in COPD.MethodsPatients with COPD and non‐COPD controls participating in the Individualized COPD Evaluation in relation to Ageing (ICE‐Age) study, a single‐centre, longitudinal, observational study, were included. Subjects were assessed at baseline and after 2 years of follow‐up. Among other procedures, body composition was measured by dual‐energy X‐ray absorptiometry scan. The number of exacerbations/hospitalizations 1 year before inclusion and during follow‐up were assessed in patients with COPD.ResultsA total of 405 subjects were included (205 COPD, 87 smoking and 113 non‐smoking controls). Patients with COPD and smoking controls presented a significant decline in total FFM (mean [95% CI]: −1173 [−1527/−820] g and −486 [−816/−156] g, respectively) while body composition remained stable in non‐smoking controls. In patients with COPD, the decline in FFM was more pronounced in legs (−174 [−361/14] g) and trunk (−675 [−944/406] g) rather than in arms (54 [−19/126] g). The predictors of changes in total and regional FFM in patients with COPD were gender, number of previous hospitalizations, baseline values of FFM and BMI.ConclusionPatients with COPD present a significant decline in FFM after 2 years of follow‐up, this decline is more pronounced in their legs and trunk.

Facteurs individuels et contextuels participant à l’apparition de comportements violents en cours d’hospitalisations psychiatriques

BackgroundThe prevention of Physical Violent Behavior (VB) toward others during psychiatric hospitalization is a major concern of clinicians. These VBs can have a deleterious impact on the victims, inpatients or caregivers, as well as on the therapeutic milieu. Such violence can also have negative consequences for the assailant patients, such as repeatedly being hospitalized under restraint, stigmatization, and difficulties reintegrating into the community. ObjectivesThis study explored individual (age, gender, marital status, living status, diagnostic) and institutional (type of admission, length of stay, number of previous hospitalizations) risk factors, and how their interactions could increase the risk of VB during psychiatric hospitalizations. MethodThe study was carried out over a period of four years in the psychiatry department of the Lausanne University Hospital, on the 15 wards (219 beds) specialized in acute psychiatric care for adults. All the patients admitted to one of these wards during this period (n=4518), aged between 18 and 65 years, were included in the study. The sample was divided in two groups: non-violent patients (NVPs) and violent patients (VPs). VBs, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale – Revised (SOAS – R). Only physical assaults, associated or not with other types of violence, involving hospitalized patients were analyzed. Personal and institutional factors were extracted from the hospital database. Chi2 independence tests were used to assess differences between groups. Logistic regression models were used to identify the links between each factor and the VB. Classification and regression trees were used to study the hierarchical effect of factors, and combinations of factors, on VBs. ResultsDuring the study period, 414 VBs were reported involving 199 patients (4.40 % of all patients). VPs were significantly younger, male, more likely to be unmarried and living in sheltered housing before hospitalization. In this group, the proportion of patients with diagnoses of schizophrenia, and/or schizophrenia with comorbid substance abuse and cognitive impairment, were higher compared to NVPs. VPs were more frequently admitted involuntarily, had a longer average length of stay and a greater number of previous hospitalizations. The logistic regression model performed on individual factors have shown a significant link between age (OR=0.99; CI: 0.97–1.00; P-value=0.024), living in sheltered housing before admission (OR=2.46; CI: 1.61–3.75; P-value<0.000), schizophrenic disorders (OR=2.18; CI: 1.35–3.57; P-value=0.001), schizophrenic disorders with substance abuse comorbidity (OR=2.00; CI: 1.16–3.37; P-value=0.016), cognitive impairment (OR=3.41; CI: 1,21–8.25; P-value=0.010), and VBs. The logistic regression model on institutional factors have shown a significant link between involuntary hospitalization (OR=4.38; CI: 3.20–6.08; P-value<0.000), length of previous stay (OR=1.01; CI: 1.00–1.01; P-value<0.000), number of previous hospitalizations (OR=1.06; CI: 1.00–1.12; P-value=0.031), and VBs. The logistic regression model on individual and institutional factors have shown a significant link between age (OR=0.99; CI: 0.97–1.00; P-value=0.008), living in sheltered housing before admission (OR=2.46: CI: 1.61–3.75; P-value=0.034), cognitive impairment (OR=3.41; CI: 1.21–8.25; P-value=0.074), involuntary hospitalization (OR=3.46; CI: 2.48–4.87; P-value<0.000), length of previous stay (OR=1.01; CI: 1.00–1.01; P-value<0.000), and VBs. The classification and regression trees have shown that the relationship between long length of stay and repeated hospitalizations mainly potentiate the risk of violence. ConclusionThe results of this study have shown the existence of a small group of vulnerable patients who accumulate constrained hospital stays during which violence occurs. Exploring the clinical profiles and institutional pathways of patients could help to better identify these patients and promote a more appropriate mode of support, such as intensive clinical case management. This model could facilitate the development of a clinical network and the links between the structures and partners caring for a patient. This would create a continuous support, avoiding or limiting the lack of continuity of care and care disruption.

EFFECTIVENESS OF MUSIC PLAYBACK ON INTRAVENOUS CANNULATION PAIN AMONG CHILDREN

A quasi experimental study was conducted to assess the effectiveness of music playback on intravenous cannulation pain among children in a selected hospital. Objectives: to assess the mean posttest pain score among children in the experimental and control group, to find out the effectiveness of music playback on intravenous cannulation pain among children and to find out the association between posttest pain score and selected socio demo graphic variables of children in control group. Quasi experimental posttest only controls group design and convenience sampling technique was used to select 60 children in a selected hospital at Alappuzha district. Conceptual framework: Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory (1969). Posttest was conducted in the control and the experimental group by using FLACC Behavioral Pain Scale and Socio demographic proforma. Music playback was played to the experimental group for 10 minutes during intravenous cannulation. The data were tabulated and analysed using descriptive and inferential statistics. The mean posttest pain score of children in the experimental group was 4.1 with SD 1.33 which was significantly lower than the mean posttest pain score of children in the control group which was 7.8 with SD 1.27 with a mean difference of 3.6. The calculated ‘t’ value 10.910 was greater than the table value 2.00, is significant at p&lt;0.05 level with degree of freedom 58. Hence, we can conclude that the music playback was effective in reducing the pain level of children during intravenous cannulation. The analysis showed that the calculated chi square value for family monthly income, number of previous hospitalisations, previous exposure of cannulation were greater than that of the table value at p &lt; 0.05 level of significance. Hence null hypothesis (H02) can be rejected and research hypothesis (H2) can be accepted. So, it can be concluded that there was significant association between posttest pain score an

Factores asociados con la presencia de patógenos productores de betalactamasas de espectro extendido en infecciones urinarias en una clínica privada, Lima (Perú)

Introducción: las infecciones del tracto urinario (ITU) son el segundo motivo más frecuente de atención médica, y la resistencia a los antibióticos entre las enterobacterias gramnegativas ha aumentado de manera importante en todo el mundo, dada la aparición de organismos productores de betalactamasa de espectro extendido (BLEE). Se busca identificar factores asociados a la presencia de ITU por patógeno productor de BLEE. Materiales y métodos: se realizó un estudio trasversal analítico, un análisis de la base de datos de urocultivos de una clínica privada y una evaluación de los factores posiblemente asociados a la presentación de ITU por el microorganismo BLEE, como el sexo, la edad, el número de hospitalizaciones e ITU previas. Resultados: se estudiaron 1405 urocultivos positivos y se encontró que el 85.48 % fueron de sexo femenino. La edad media de la población fue de 39.98 ± 24.51 años, el 24.13 % de edad mayor a 60 años, y el 55.56 % habían sido atendidos ambulatoriamente. El 49.18 % de los cultivos fue positivo para ITU BLEE, de los cuales el 96,58 % no habían presentado una ITU previa. Se encontró que existe una asociación estadísticamente significativa (0,007; p ≤ 0,05) entre el sexo y el desarrollo de ITU por microorganismo productor de BLEE. El masculino es el de mayor asociación (OR 1,224; IC95 %: 1,035-1,448). También se encontró una asociación con la edad, el número de hospitalizaciones previas y haber estado en UCI. No se encontró ninguna asociación entre la presencia de ITU previas. Conclusiones: existe una elevada frecuencia de ITU BLEE, y los factores asociados a dicha infección fueron tener sexo masculino, una edad mayor a 60 años y hospitalizaciones previas.

Dynamic evaluation of the comparative effectiveness of an integrated program for heart failure care.

An integrated care program for heart failure (HF) was developed in the Basque Country in 2013. The objective of this research was to evaluate its effectiveness through the number of hospital admissions in three integrated healthcare organizations (IHOs), taking into account the longitudinal nature of the disease and the intensity of the implementation. A retrospective observational study was carried out, based on data entered in administrative and clinical databases between 2014 and 2018 for a total population of 230 000. In addition to conventional statistical analyses, Andersen-Gill models for recurrent events were used, incorporating dynamic variables that allowed assessment of the intervention's intensity before each hospitalization. A total of 6768 patients were analysed. Age (hazard ratio [HR] = 1.016; 95% confidence interval [CI] 1.011-1.022), the Charlson index (HR = 1.067, 95% CI 1.047-1.087), and the number of previous hospitalizations (HR = 1.632, 95% CI 1.557-1.712) were risk factors for readmission. Differences between IHOs were also statistically significant. Greater intervention intensity was associated with a lower hospitalization rate (HR = 0.995, 95% CI 0.990-1.000). As indicated by the interaction between intervention intensity and IHO, differences between IHOs disappeared when intensity rose. No inequities in hospitalization were found as a function of deprivation index or sex. Nonetheless, inequity in the implementation of the program by sex was clear, women with HF receiving less intense intervention than men with the same level of comorbidity and age. The extent of program implementation measured by intervention intensity is a main driver of the effectiveness of an educational and monitoring program for HF. The evaluation of HF program effectiveness on readmissions must take into account the entire natural history of the disease. Implementation intensity explains differences between IHOs.

Retrospective Evaluation of the Correlation Between Previous Hospitalizations, the Type of Current Living Space, and Quality of Family Function.

Background and AimThere are important public health issues involving rehabilitation of patients living with schizophrenia in the community. The purpose of this study was to analyze the correlations between number of previous hospitalizations, living space and quality of family function in the rehabilitation of patients living with schizophrenia in the community. The study attempts to determine the potential ways to use beneficial factors in recurrent hospitalization for improving treatment and rehabilitation efforts for patients living with long-term chronic schizophrenia.MethodsThe study included 281 rehabilitations of patients living with schizophrenia in the community. A homemade general questionnaire was used to collect information about the number of previous hospitalizations and the living space of the participants. A family assessment device was used to evaluate the quality of family function of the patients.ResultsThe number of previous hospitalizations of persons living with schizophrenia in the community was negatively correlated with the quality of family function (B = 0.063), and there was no statistical difference in the number of previous hospitalizations and the quality of family function of patients in different living spaces.ConclusionsThe number of previous hospitalizations had a negative impact on family function in the rehabilitation of patients living with schizophrenia in the community. Living space may not have a significant positive effect on family function or the number of previous hospitalizations.

Determinants of Length of Stay in a Psychiatric Ward: a Retrospective Chart Review.

Considering the limited resources for providing inpatient services, identification of the factors influencing length of stay (LOS) is of great importance. The current study is a retrospective chart review which was planned to investigate the determinants of LOS in two gender-specific psychiatric wards within Baqiatallah Hospital (BQH) located in Tehran. The observation period was between March 21, 2011 and March 19, 2016. 3203 patients were recruited in terms of inclusion and exclusion criteria. Next, required data on 25 explanatory variables were extracted from their case-files. Descriptive measures were used for analysis and Independent Samples T-test, one-way ANOVA, Pearson's correlation coefficient and Bonferroni's post-hoc test for inferential analysis. Lastly, a multiple linear regression model was run to determine significant predictors of psychiatric LOS. Variables significantly correlated with patients' LOS included gender, age, employment status, marital status, number of divorces, disability rate, discharge diagnosis, physical comorbidity, number of previous hospitalizations, suicide ideation, number of suicide attempts, history of assault, tobacco consumption, a history of narcotic drug abuse and number of ECT sessions. Through the analysis of multiple linear regression, it came to light that significant predictors of LOS in the final model could account for 37.9% of the variance in LOS. From the findings of current study, it can be inferred that clinical aspects as well as treatment procedures have major effects on LOS. Although the factors examined here could not explain an acceptable variance in LOS, the results are useful for the treatment team when they want to devise a care plan or give discharge to a patient.

Levels and Correlates of Disability in Life Skills among Patients with Schizophrenia

Background: Schizophrenia is a severe mental disability disorder that affects all life aspects, including life functioning, general well-being, and overall life skills resulting in prominent impairments in life functioning. Objectives: The objective of the study was to assess life skills and disabilities and its correlates among Jordanian patients with schizophrenia. Methods: A cross-sectional correlational design was used. A convenience sampling technique was used to recruit 250 hospitalized patients with schizophrenia. Data were collected using a questionnaire that consisted of demographic variables, Life Skills Profile, Global Assessment of Functioning, and Positive and Negative Syndrome Scale. Results: The level of disability in life skills was 89.23. The highest disability level was observed in social contact and in communication domains, and the lowest level was in the responsibility domain. The disability levels regarding family history of psychiatric illness, marital and employment status, and the number of previous hospitalizations were statistically different (p &lt; .05). The presence of negative symptoms, global assessment of functioning, psychopathology symptoms, duration of treatment, and positive symptoms were identified as predictors of the disability in life skills and accounted for 65% of the total variance. Conclusions: Planning and conducting life skills programs that help enhance the communication and social interaction are required to improve life skills.

Add-on benzodiazepines for psychosis-induced aggression.

In severely psychotic, violent patients, add-on benzodiazepines are often prescribed with antipsychotic agents. We examined aggression, suicidality, and self-harm among psychotic patients treated with antipsychotic monotherapy, compared with those treated with add-on benzodiazepines, during the first 2 weeks of psychiatric hospitalization to clarify the association of add-on benzodiazepines and aggression. Electronic medical records of 400 patients consecutively admitted to Abarbanel Mental Health Center from 2012 to 2014 for psychosis, and remained hospitalized for at least 2 weeks were evaluated. Violence toward staff, patients, and property, physical restraints, seclusion, self-harm, and suicidal thoughts, were examined. Falls and referrals to general hospital indicated adverse medication effects, and were recorded. No significant between-group differences were found for sex, age, psychiatric diagnosis, compulsory admissions, antipsychotic dosages, number of previous hospitalizations, or hospitalization days were detected. Maximum dosage for antipsychotics in the monotherapy group did not reveal a statistically significant difference from the add-on benzodiazepine group (2.2 ± 1.4 vs. 2.2 ± 1.3, respectively), expressed in defined daily dose. There were no between-group differences in frequency of any violent event, incidence of self-harm, suicidal thoughts, frequency of falls, and/or referrals to a general hospital. Addition of benzodiazepines might be unnecessary. Benzodiazepine addition to antipsychotic drugs for patients with severe psychosis should be with caution.