Number Of Rehospitalizations Research Articles

Rehospitalization after intermittent levosimendan treatment in advanced heart failure patients: a meta-analysis of randomized trials.

AimsIntermittent levosimendan administration has been suggested to improve survival in patients with advanced heart failure (AdHF). Quality of life is a key issue for AdHF patients and is negatively affected by frequent hospitalizations.Methods and resultsCENTRAL, Google Scholar, MEDLINE/PubMed, Scopus, and the Cochrane Central Register of clinical trials (updated 15/1/2017) were searched for randomized controlled trials investigating the effect of intermittent levosimendan administration in patients with AdHF. The primary outcome was the number of patients requiring rehospitalization 3 months after the end of treatment. A total of 319 patients from six trials were included. Overall pooled analysis showed that the use of levosimendan was associated with a significant reduction in the number of rehospitalizations at 3 months: 33/207 (16%) vs. 39/113 (35%), risk ratio 0.40, 95% confidence interval 0.27–0.59, P < 0.001, I 2 = 0%. This result was confirmed by sensitivity analyses.ConclusionsWithin the limitations of this meta‐analysis including also studies in which endpoints were not independently adjudicated and not clearly specified, repetitive or intermittent administration of levosimendan for patients with AdHF was associated with a reduction in the rehospitalization rate at 3 months. Large, high‐quality randomized controlled trials are needed to confirm this finding.

Polymicrobial and Monomicrobial Infections after Spinal Surgery: A Retrospective Study to Determine which Infection is more Severe.

Study DesignA retrospective clinical review.PurposeTo investigate the difference in clinical manifestations and severity between polymicrobial and monomicrobial infections after spinal surgery.Overview of LiteratureSurgical site infections (SSIs) after spinal surgery are a major diagnostic and therapeutic challenge for spinal surgeons. Polymicrobial infections after spinal surgery seem to result in poorer outcomes than monomicrobial infections because of complementary resistance to antibiotics. However, comparison of the clinical manifestations and severity between polymicrobial and monomicrobial infections are limited.MethodsSixty-seven patients with SSIs after spinal surgery were studied: 20 patients with polymicrobial infections and 47 with monomicrobial infections. Pathogenic bacteria identified were counted and classified. Age, sex, and body mass index were compared between the two groups to identify homogeneity. The groups were compared for clinical manifestations by surgical site, postoperative time to infection, infection site, incisional drainage, incisional swelling, incisional pain, neurological signs, temperature, white blood cell count, and the percentage of neutrophils. Finally, the groups were compared for severity by hospital stay, number of rehospitalizations, number of debridements, duration of antibiotics administration, number of antibiotics administered, and implant removal.ResultsPolymicrobial infections comprised 29.9% of SSIs after spinal surgery, and most polymicrobial infections (70.0%) were caused by two species of bacteria only. There was no difference between the groups in terms of clinical manifestations and severity. In total, 96 bacterial strains were isolated from the spinal wounds: 60 strains were gram-positive and 36 were gram-negative pathogenic bacteria. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Enterobacter cloacae were cultured in order of the frequency of appearance.ConclusionsMost polymicrobial infections were caused by two bacterial species after spinal surgery. There was no difference in clinical manifestations or severity between polymicrobial and monomicrobial infections.

Application of nursing case management mode framed by Omaha system in patients with hepatocirrhosis complicated with gastrointestinal bleeding

Objective To explore the application of nursing case management mode framed by Omaha system in patients with hepatocirrhosis complicated with gastrointestinal bleeding, so as to provide evidence-based basis for clinical nursing. Methods A total of 72 hepatocirrhosis complicated with gastrointestinal bleeding patients were collected from July 2014 to July 2016 in our hospital. All the patients were randomized divided into observation group (36 cases) and experimental group (36 cases). The patients of observation group were given case management mode framed by Omaha system, while the patients of control group were given conventional case management model. Analysis and evaluation of scores were implemented before and after the nursing intervention in observation group. The quality of life, hospitalization days and number of hospitalizations after discharge were compared between two groups. Results The nursing problems of observation group during hospitalization were mainly distributed in the environment, social psychology, physiology and health related behaviors. After nursing intervention, there were significant differences in all nursing outcomes for nursing problems (t=12.470, 10.720, 17.520, 7.600, 7.549, 12.146, 16.857, 5.607, 14.683, 7.085, 11.66, 11.024, 12.723; P<0.05) . After intervention in observation group, the activity of daily living was (19.18±5.67), social activity (13.96±3.89), depression symptom (11.69±3.97), anxiety symptom (9.34±2.88), and survival quality (54.17±5.45), which were less than (27.21±3.84) , (18.53±3.58) , (17.64±2.75) , (15.72±2.93) , (79.10±8.63) (t=7.036, 5.187, 7.392, 9.317, 14.654; P<0.05). After intervention, the length of hospitalization was (8.7±3.9) d, the cost (5 419.5±2 539.2)Yuan and the revisit times (0.4±0.2), which were less than (10.8±3.4)d, (7 312.4±4 280.1)Yuan and (0.7±0.3) of control group (t=2.435, 2.282, 4.992; P<0.05). Conclusions Compared with conventional methods, the case management framed by Omaha system can effectively improve the quality of life, reduce hospitalization days, hospitalization cost and number of re-hospitalizations after discharge. Key words: Liver cirrhosis; Omaha system; Case management; Gastrointestinal bleeding

The influence of early psychosocial intervention on the long-term clinical outcomes of people suffering from schizophrenia.

To compare the treatment outcomes of DSM-IV-TR schizophrenia patients in either a Community Treatment Program or an Individual Treatment Program (CTP vs. ITP). The assessment was made after the first hospitalization, and then after three and twelve years. Participants were randomly assigned to CTP (experimental) and ITP (traditional) group, with 40 people in each group. 67 people (84%) participated in all three assessments. The socio-demographic and clinical indicators were the same for both groups. In the first three years only the CTP group participated in day-care treatment, patient and family psychoeducation and community treatment. Later, both groups received this treatment. The following tools were used: Anamnestic and Catamnestic Questionnaire, the GAF scale, the BPRS LA and Lehman's Quality of Life Interview. It was only after twelve years that there was a significant beneficial improvement in the mean GAF score in the CTP group (p = 0.036), which was comparable with the results obtained by Watt and Shepherd for the course of the illness in favorable remission cases (p = 0.038). The difference in the number of relapses was also significantly in favor of the CTP group only after 12 years (p = 0.045), as was the difference in the number of rehospitalizations (p = 0.013). The general severity of symptoms was found to be significantly lower for the CPT group after 3 (p = 0.008) and 12 years (p = 0.030), whereas it was significantly lower in the case of positive syndrome only after 3 years (p = 0.044). 1. A greater number of favorable differences were identified for the CTP group at the twelve-year point than at the conclusion of the experiment. 2. The three-year delay in introducing psycho-social treatment was associated with a poorer long-term outcome for the clinical course of schizophrenia.

(714) - Comparison of 6 Month Hospitalizations in Mechanical Circulatory Support Patients vs Heart Transplant Patients

The benefit of Mechanical Circulatory Support (MCS) versus heart transplant is an ongoing debate. Outcomes can be measured by the number of re-hospitalizations in the first 6 months after each procedure discharge. Cost and quality of life are impaired with increasing number of hospitalizations post-procedure. We sought to assess this question by evaluating our MCS and heart transplant patients for hospitalizations 6 months after the procedure discharge. Between 2010 and 2013 we evaluated 51 MCS patients and 309 heart transplant patients who had at least 6 months follow up. After the initial hospitalizations, re-hospitalization was monitored including the cause for re-hospitalization. The average number of days of re-hospitalization was measured between both groups. There were significantly more re-hospitalizations and a longer average number of hospital days in the MCS group compared to the heart transplant group (see table). The most common cause for hospitalization in the MCS group included: bleeding, infection, GI problem, hematologic, neurologic, planned procedure and heart failure. The most common causes in the heart transplant group included: infection, GI problem, arrhythmia, rejection, neurologic, heart failure, hematologic and renal dysfunction. There was no difference seen in a subgroup comparison between LVAD and TAH patients for average number of readmission days (18.3 ± 16.9 vs. 32.5 ± 30.0, P=0.306) or readmissions in the first 6-months (63.6% vs. 85.7%, P=0.250). Re-hospitalization in the first 6 months in MCS patients is more prevalent compared to heart transplant patients. MCS appears to have greater morbidity leading to re-hospitalization compared to heart transplantation.Tabled 1EndpointsMCS Patients (N=51)Heart Transplant Patients (N=309)P-ValueAny Readmission within 6-Months Post initial Discharge (%)66.7% (34/51)35.9% (111/309)<.001Total Number of Readmissions, Mean ± SD1.4 ± 1.40.6 ± 1.0<.001Average Number of Readmission Days, Mean ± SD20.8 ± 20.011.0 ± 15.50.012 Open table in a new tab

Incidence and Risk Factors Associated With Hospitalization for Variant Angina in Korea.

This study aimed to determine the incidence and the risk factors of hospitalization for variant angina (VA) in Korean patients. Using the National Inpatient Sample (NIS) database, manufactured and released by the Health Insurance Review and Assessment Service (HIRA) in Korea, the incidence of hospitalization and rehospitalization for VA were calculated. The numbers of patients hospitalized for VA were estimated to be 14,362 in 2009, 17,492 in 2010, and 20,592 in 2011. The standardized incidence rates of hospitalization for VA were 31.4% in 2009, 36.5% in 2010, and 41.7% in 2011 (relative increase rate from 2009 to 2011, 33.0%, P for trend < 0.0001). VA patients predominantly belonged to the middle-age group between 40 and 69 years (75.5%), and there were 54.3% male. Based on the hospitalization episodes, the number of rehospitalization was calculated to be 879, 1141, and 1446 patients out of 1867, 2274, and 2677 patients from 2009, 2010, and 2011, respectively. The rates of rehospitalization for VA were 47.1% in 2009, 50.2% in 2010, and 54.0% in 2011 (P for trend < 0.0001). Age was an independent factor associated with rehospitalization for VA. Hospitalization for VA occurred most frequently in fall from 2009 to 2011. In conclusion, hospitalization rates for VA steadily increased from 2009 to 2011 in Korea, and about a half of VA patients was hospitalized more than once a year in 2009 to 2011. Proper health policy and patient education are warranted to control the high rate of hospitalization for VA.

Therapeutic attitudes and clinical global impression: A 2-year follow-up study of 33 outpatients with a mental disorder in treatment with paliperidone palmitate

IntroductionMaintaining antipsychotic therapy in mental disorder is important in preventing relapse, rehospitalization, and suicide. Lack of awareness of illness may be a leading cause for non-adherence. Long-acting depot can prevent non- adherence and thus potentially contribute to better patient outcomes.ObjectiveThe aim of this prospective, observational, non interventional 2-year-long study is to assess severity and post-intervention changes and attitudes toward medication of a group of patients treated paliperidone palmitate (PP).MethodsThirty-three outpatients stabilised with PP during the last 24 months. Inclusion criteria were: patients’ age (&gt; 18 years), a diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder stabilised during the last 12 months with PP, without a diagnostics from axis I or II (except for nicotine of caffeine) and able to sign the inform consent. Data collected: general sociodemographic and clinical data (age, sex, level of education, socioeconomic situation, family support, psychiatric diagnosis, years of evolution, use/abuse of substances, treatment, previous and later number of hospitalisations. Evaluations included disease severity (Clinical Global Impression-Severity (CGI-S) and Drug Attitude Inventory, (DAI)).ResultsThirty-threeoutpatients were followed during 24 months [mean dose 132,58 (44,4) mg], 75,8% were men, age 45,05 years old, 87,8% with a diagnoses of paranoid schizophrenia. Antipsychotic monotherapy increased over the time with PP. Significant improvements were observed on both Clinical Global Impression and Drug Attitude Inventory. The number of rehospitalizations and mean stays decreased from the beginning until the end of these 24 months.ConclusionsOur results suggest an improvement in the patient's clinical vision and attitude towards medication with long-acting depot.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract TMP29: Rehospitalizations Post-stroke: a 10 Year Follow-up

Background and Purpose: Rehospitalizations post-stroke can be considered to represent potential long-term complications of the incidental stroke and are most commonly caused by vascular events, infections, gastrointestinal and immobility related morbidity. The purpose of the study was to define the causes for rehospitalizations as well as their frequency, and to further explore the association between the incidental stroke, the burden of complications within 3 months, and rehospitalization for these long term complications. Methods: A cohort of 244 patients, acutely and consecutively admitted to our stroke unit in 2002/3 with information regarding medical complications over the first 3 months was evaluated in regards to hospitalizations during the ensuing 10 years. 1 patient was lost to follow-up. The hospital records were reviewed, the main admitting diagnosis was verified and assigned to one of 18 predefined categories of illness. Results: 177 of the 243 patients had 1 or more acute hospital readmissions to a total of 831 rehospitalizations. The median number of rehospitalizations was 2 (range 0-24). Proportions (%): ischemic stroke 5.4, hemorrhagic stroke 1.1, cardiac events 10.5, peripheral vascular events 3.0, chest infection 9.0, serious infection 4.1, UTI 4.2, falls with fractures 6.1, falls without fractures 3.2, epileptic seizures 2.9, stroke sequelae 3.4, hemorrhagic events 5.7, thrombotic events 1.2, renal insufficiency 2.0, TIA 2.2, cardiac angina 2.8, cancer 8.5, other 24.7. Rehospitalizations occurred in 73 % of stroke patients and were attributable to vascular causes in 20.0 %, to infections in 17.3 %, to falls with and without fractures in 9.3 % and to peripheral hemorrhagic events in 5.7 % of admissions. Conclusion: Rehospitalizations during 10 years following a stroke are common and have varying etiologies with vascular events and infections as the most frequent causes.

Better prognosis in overweight/obese coronary heart disease patients with high plasma levels of leptin.

Background and aimThe involvement of leptin in atherosclerosis is very complex, including inflammation, the oxidative stress and thrombosis. Leptin has atherogenic and also antiatherogenic actions. In obesity elevated leptin levels are not sufficient to prevent disturbances of energy balance, suggesting that obese people are leptin resistant. The aim of the study was to investigate the relationship between baseline plasma levels of leptin and the incidence of new ischemic events in patients with CHD.MethodsPlasma levels of leptin in fifty nine consecutive patients (29 men and 30 women) with CHD hospitalized in the County Emergency Clinical Hospital of Cluj-Napoca were measured using commercially available ELISA at admission. Patients with active infectious disease, neoplasia, acute coronary syndrome, stroke, hepatic or renal failure and severe heart failure were excluded The relationship between leptin levels and incident cardiovascular events (angina, nonfatal myocardial infarction or heart failure) over two years follow-up was studied using MEDCALC version 9.6.Results73.6% patients with CHD were overweight or suffered of obesity. There were no significant differences between women and men regarding the plasma levels of leptin, the body mass index (BMI), the number of rehospitalizations, rehospitalizations/patient, diabetes mellitus, hypertension or dyslipidemia. Only in women plasma levels of leptin are correlated with BMI. As compared with men with overweight and obesity (BMI≥25kg/m2), plasma levels of leptin were significantly higher in women with overweight and obesity (3905.97±463.91 pg/ml vs 1835.17±533.9 pg/ml) (p<0.002). Patient gender could not be demonstrated to influence prognosis. During the two years we recorded one or more readmissions in 26 patients (44%). The analysis of time till readmission using Kaplan-Meier curves, showed that leptin level (cut-off 2000 pg/ml, HR 0.38, 95% CI 0.17–0.83; p=0.01) and BMI (cut-off 28 kg/m2, HR 0.3164, 95% CI 0.145–0.0689; p<0.01) were significantly associated with prognosis.ConclusionPatients with plasma levels of leptin >2000 pg/ml and BMI >28kg/m2 had a better prognosis, suggesting a protective role of leptin in overweight/mild obesity.

Effects of motivational interviewing-based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial.

BackgroundNon-adherence to antipsychotic medication is commonly found in schizophrenia and other psychotic disorders, thus forming a major obstacle to long-term maintenance treatment and contributing to high relapse rates. With limited evidence on the success of interventions in enhancing medication adherence, this controlled trial was designed to test and evaluate the effectiveness of an adherence therapy (AT) for outpatients with schizophrenia spectrum disorders, based on a motivational interviewing approach over a six-month follow-up period.MethodsA single-blind, randomized controlled trial with a repeated-measures, two parallel groups design was conducted in a random sample of 114 participants with schizophrenia spectrum disorders in one community psychiatric nursing service. After pre-test, the participants were randomly assigned to either an eight-session course of AT plus usual care or usual psychiatric care (n = 57 per group). The main outcomes, including medication adherence, symptom severity, insight into treatment, hospitalization rate, and functioning, were measured at baseline and immediately and six months post-intervention.ResultsA total of 110 participants completed this trial and thus the attrition rate was 3.5 %. Results of repeated-measures analysis of variance followed by Helmert’s contrasts test indicated that the AT participants reported significantly greater improvements in their insight into illness and/or treatment, psychosocial functioning, symptom severity, number of re-hospitalizations, and medication adherence (F = 5.01 to 7.45, P = 0.007 to 0.030) over six months follow-up, when compared with usual care.ConclusionsMotivational interviewing-based AT for people with schizophrenia can be effective to reduce symptom severity and re-hospitalizations, and improve medication adherence, functioning, and insight into illness and/or treatment over a medium term (six months) period of follow-up. Further study on the effects of AT in people with psychotic disorders in terms of diverse sociodemographic and illness characteristics, and a longer term (for example, over 12 months) follow-up period is recommended.Trial registrationThe trial was registered at Clinicaltrials.gov (identifier: NCT01780116) on 6 July 2014.

Impact of childhood adversities on the short-term course of illness in psychotic spectrum disorders

Accumulating evidence indicates an impact of childhood adversities on the severity and course of mental disorders, whereas this impact on psychotic disorders remains to be specified. Effects of childhood adversities on comorbidity, on symptom severity of the Positive and Negative Syndrome Scale and global functioning across four months (upon admission, 1 and 4 months after initial assessment), as well as the course of illness (measured by the remission rate, number of re-hospitalizations and dropout rate) were evaluated in 62 inpatients with psychotic spectrum disorders. Adverse experiences (of at least 1 type) were reported by 73% of patients. Patients with higher overall level of childhood adversities (n=33) exhibited more co-morbid disorders, especially alcohol/substance abuse and dependency, and higher dropout rates than patients with a lower levels of adverse experiences (n=29), together with higher levels of positive symptoms and symptoms of excitement and disorganization. Emotional and physical neglect were particularly related to symptom severity. Results suggest that psychological stress in childhood affects the symptom severity and, additionally, a more unfavorable course of disorder in patients diagnosed with psychoses. This impact calls for its consideration in diagnostic assessment and psychiatric care.

Act (assertive Community Team) – Practice Experiences From Montenegro

Establishing teams for the treatment of mental health in the community is a particular way of organizing services in mental health, and its implementation improves the social integration of patients with severe mental illness. These teams’ work is based on principles of assertive community treatment. They have significantly increased adherence to the treatment process, and reduced the number of readmissions of schizophrenic patients. The dominant target group that we have included in our work consists of patients with a high number of rehospitalization (more than two admissions in a calendar year), and in their cases we start with this mode of treatment right after the stabilization and discharge from hospital This team aims to introduction into avoiding placements in a psychiatric institution by using an integrated multidisciplinary approach and by terrain work. We also aim to: • Increasing capacity and improving the level of cooperation within the primary health care. • Reducing the stigma of mental health. • Performing the treatment of the patient in the least restrictive environment. • Stabilization of social functioning and protection of the patient's position in the community. • Providing better support to families of patients. • Regular medication Introduction of the team for the treatment of mentally ill persons in the community will reduce the number of rehospitalization in institutions of secondary and tertiary level, and will achieve better adherence to the treatment of patients with severe mental illness in Montenegro.

The Impact of the Duration of Untreated Psychosis On the Short-term Outcome in Schizophrenia

Introduction Despite the major developments in the last decades in the treatment of psychotic disorders, schizophrenia is still associated with poor clinical and social outcome. Some studies suggested that duration of untreated psychosis (DUP) is associated with poorer outcome in the long and especially short term evolution. Objectives Studying correlations between longer DUP and social and clinical outcome in schizophrenia Methods Eligible participants are those, who had a first hospitalization in the period from January 2011 to December 2012 Inclusion criteria were: stabilized patients with diagnosis of schizophrenia according to DSM IV criteria, Exclusion criteria: Mental retardation or other neurological or severe medical diseases affecting outcome, neuroleptic medication before hospitalization. DUP is defined as the time separating the first psychotic symptom and first medication contact. The sample was divided into short and long DUP, using a median split. Social functioning was assessed by global assessment of functioning (GAF), working status, number of rehospitalization during the two years after admission and quality of life by responding to SF-36 scale in its Arabic version. Results 28 patients were included (20 men and 8 women) aged from 22 to 50 years old. Median DUP was 39,5 weeks (mean DUP was 65, 86). Even if we noticed that mental and physical scores for the SF-36 were higher in the group with shorter DUP, the score for GAF was comparable for both groups and so was the working status Conclusion The impact of DUP is considerable, future challenge is to short this period as possible.

Psychiatric symptoms and acute care service utilization over the course of the year following medical-surgical ICU admission: a longitudinal investigation*.

To determine if the presence of in-hospital substantial acute stress symptoms, as well as substantial depressive or posttraumatic stress disorder symptoms at 3 months post-ICU, are associated with increased acute care service utilization over the course of the year following medical-surgical ICU admission. Longitudinal cohort study. Academic medical center. One hundred fifty patients who are 18 years old or older admitted to medical-surgical ICUs for over 24 hours. None. Participants were interviewed in-hospital to ascertain substantial acute stress symptoms using the Posttraumatic Stress Disorder Checklist-Civilian version. Substantial depressive and posttraumatic stress disorder symptoms were assessed using the Patient Health Questionnaire-9 and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively, at 3 months post-ICU. The number of rehospitalizations and emergency department visits were ascertained at 3 and 12 months post-ICU using the Cornell Services Index. After adjusting for participant and clinical characteristics, in-hospital substantial acute stress symptoms were independently associated with greater risk of an additional hospitalization (relative risk, 3.00; 95% CI, 1.80-4.99) over the year post-ICU. Substantial posttraumatic stress disorder symptoms at 3 months post-ICU were independently associated with greater risk of an additional emergency department visit during the subsequent 9 months (relative risk, 2.29; 95% CI, 1.09-4.84) even after adjusting for both rehospitalizations and emergency department visits between the index hospitalization and 3 months post-ICU. Post-ICU psychiatric morbidity is associated with increased acute care service utilization during the year after a medical-surgical ICU admission. Early interventions for at-risk ICU survivors may improve long-term outcomes and reduce subsequent acute care utilization.

Reducing the rate of rehospitalization from postacute care: a quality improvement project.

To evaluate rehospitalizations and develop a strategy to reduce the number of individuals sent back to the hospital within 30days of admission from postacute care services including skilled care, long-term care, and home care. Using the Plan, Do, Study, Act (PDSA) format outlined by the Institute for Healthcare Improvement, we implemented and evaluated a quality improvement project. The number of rehospitalizations was calculated and chart audit was used to determine the reasons. Interventions were designed to decrease the number of reasons individuals had to return to the hospital. Five rehospitalizations were deemed preventable. Interventions were designed to improve staff knowledge. The effectiveness of interventions and rehospitalization rates continue to be monitored. The rehospitalization rates from these agencies are low. Low rehospitalization rates are good for clients and improve desirability as a source for care posthospitalization. Understanding causes for rehospitalization, providing skills and knowledge aimed at the root causes of hospitalization, and reducing the rate of rehospitalization improves nursing practice and reimbursement.

Central venous pressure catheter for large-volume paracentesis in refractory ascites.

About 10% of cirrhotic patients are unresponsive to sodium restriction and diuretics and develop refractory ascites. Such patients usually require recurrent large-volume paracentesis and lots of hospital admissions. Hereby, we introduce a method applying a central vein (CV) catheter for large-volume paracentesis in patients with refractory ascites in up to 4days associated with sodium restriction and high dose of diuretics. Non-tunneled triple lumen CV catheter was used to drain the ascites fluid of 30 cirrhotic patients. After precise percussion, the point of highest fluid accumulation was marked for puncture. Then, the skin and subcutaneous tissue were anesthetized. CV catheter set guide wire was entered into the peritoneal cavity and the dilator of the CV catheter set was passed through the guide wire and extracted after some rotations around its insertion site on the skin. The catheter was passed over the guide wire and the guide wire was extracted gradually from one of the lumens and fixed to the skin. Nineteen males and 11 females with mean (±SD) age of 59.4 ± 11.7years old underwent the procedure. A minimum of 9 and maximum of 29L (12 ± 6.6L) ascites fluid drained during a minimum of 2 and maximum of 5days of hospital stay. All catheters were patent during the drainage. None of the patients developed hemodynamic instability. Number of re-hospitalizations for paracentesis was 1.9 times during the following year. No complication occurred. This technique is a simple noninvasive method that can be performed in the endoscopy unit or even at the patient's bedside and may reduce the need for repeated admissions.

EPA-0182 – Community treatment of mentally ill homicidal offenders after conditional release from hospital in turkey

To define treatment adherence and criminal history before and after the mandatory treatment of homicidal patients and_correlation of these variables with the severity of the criminal act. 160 of the 197 cases, we could be able to contact and who were released from the forensic psychiatry clinic of the Bakirkoy Training and Research Hospital for Psychiatric and Neurological Diseases after mandatory inpatient treatment in 2006 were investigated for treatment adherence and criminal history for five years after release. Criminal Violence Rating Scale is used. 30% of the 48 patients who committed homicidal acts, had criminal history prior to the mandatory treatment and these were usually severe violent criminal offenses targeting directly at the victim's life and 14,5 % of them committed more than a criminal act before the homicidal act. After the mandatory inpatient treatment, the homicidal offenders were more likely to be kept in the mandatory outpatient treatment programme in comparison to the non-homicidal patients (87,6 % and 64,3 % respectively). 41,7 % of the homicidal offenders had been rehospitalized. Mean duration of mandatory treatment was 510 days and 148 days for the homicidal and non-homicidal patients respectively. The number of criminal offences and number of re-hospitalizations were not significantly different between the homicidal and nonhomicidal patient groups. As a consequence of risk reduction strategies the homicidal patients were internalized longer in terms of mandatory treatment and after the release, their control assessments were done at shorter intervals.

Continuous-Flow Left Ventricular Assist Device Versus Heart Transplantation: A European Perspective

Purpose Left ventricular assist devices (LVAD) are less utilized in Europe than in the United States, especially in Italy, despite donor shortage and use of older donors that limit the availability and the probability of success of heart transplantation (HTx). The aim of this study is to compare one-year survival rates in consecutive patients treated with continuous-flow LVAD versus HTx in the center with the largest national experience in LVAD therapy. Methods and Materials Preoperative characteristics and one-year survival rates were compared between patients who received a continuous-flow LVAD (n=49) and those who received HTx (n=164) at our hospital from 1/2006 to 2/2012. Patients undergoing HTx after LVAD were considered only in LVAD group, with follow up ending at the date of HTx. Results LVAD patients were more compromised than HTx patients (older age, higher mean pulmonary artery and capillary wedge pressure, larger preoperative use of intra-aortic balloon pump at the time of operation). Average follow up was 12 months (interquartile range 6 to 12 months). A total of 41 deaths occurred: 12 among LVAD patients and 29 among HTx patients. Kaplan Meier survival curves estimated a one-year survival of 75.5% in LVAD vs. 82.3% in HTx patients, which was a non-significant difference (hazard ratio 1.50; 95% confidence interval 0.77-2.94; p=0.24 for LVAD vs. HTx). Peri-operative mortality at 30 days was 16.3% vs. 11.0%, p=0.32 in LVAD vs. HTx. LVAD treatment required longer in-hospital stay and an increased number of re-hospitalizations; nevertheless major complications were relatively rare. Transplantation rate at one-year was 8% in our series receiving LVAD therapy. Conclusions Despite worse preoperative conditions and low transplantation rate, one-year survival is not significantly lower after LVAD than after HTx. Since LVAD is becoming a reliable alternative to HTx at least at medium term, use of LVAD as bridge-to-transplantation should be harmonized between centres sharing the same donor pool.

Rate, causes, and impact on patient outcome of implantable device complications requiring surgical revision: large population survey from two centres in Italy

The long-term impact of implantable device-related complications on the patient outcome has not been thoroughly evaluated. The aims of this retrospective, bi-centre study were to analyse the rate and nature of device-related complications requiring surgical revision in a large series of patients undergoing device implantation, elective generator replacement and pacing system upgrade and to systematically assess the impact of such complications on patient outcome and healthcare utilization. Data from 2671 consecutive procedures (1511 device implantations, 1034 elective generator replacements, and 126 pacing system upgrades) performed between January 2006 and March 2011 were retrospectively analysed. The outcome measures recorded were complication-related mortality, number of re-operations, need for complex surgical procedures, number of re-hospitalizations, and additional hospital treatment days. Over a median follow-up of 27 months, the overall rate of complications was 2.8% per procedure-year [9.5% in cardiac resynchronisation therapy (CRT) device implantation, 6.1% in pacing system upgrade, 3.5% in implantable cardioverter defibrillator implantation, 1.7% in pacemaker implantation, and 1.7% in generator replacement). The procedure with the highest risk of complications was CRT device implantation (odds ratio: 6.6; P < 0.001); these complications primarily involved coronary sinus lead dislodgement and device infection. Patients with complications had a significantly higher number of device-related hospitalizations (2.3 ± 0.6 vs. 1.0 ± 0.1; P < 0.001) and hospital treatment days (15.7 ± 25.1 vs. 3.6 ± 1.1; P < 0.001) than those without complications. Device infection was the complication with the greatest negative impact on patient outcome. Cardiac resynchronisation therapy implantation was the procedure with the highest risk of complications requiring surgical revision. Complications were associated with substantial clinical consequences and a significant increase in the number and length of hospitalizations.

1518 – Demographic and epidemiological profile of outpatients with mental disorders on depot medication in a mental health teaching hospital clinic of marilia/sp/brazil

Schizophrenia is the most severe mental disorder that may affect the individual. Among the proposed treatments it is included the use of medication for symptom control in addition to other therapies and psychoeducation. Often, individuals with schizophrenia suffer numerous hospitalizations when not adhering to the treatment proposed, in these cases depot antipsychotic injections are indicated. The objective of this study was to investigate the demographic and epidemiological profile of outpatients taking antipsychotic injections in a mental health clinic of a teaching hospital in Mar¡lia - SP, Brazil. It is a documentary research with a quantitative approach approved by the Ethics Committee in Research of the institution studied. It was observed that most of these individuals are male, young, white, education level less than 8 years, Catholic, single, unemployed. The drug of choice for treating most of these individuals was the haloperidol decanoate, and only one of the 26 patients studied showed extrapyramidal symptoms, who was also treated with biperiden injections. After the introduction of the treatment with depot medication there was a decrease in the number of rehospitalizations, shorter hospitalizations and bigger spacing between one hospitalization and another after the use of injectable medication. We conclude that these changes provide positive consequences for the patient, family and health sector in the country.