Special Hospital Patients Research Articles

Nurses' Awareness Regarding Care of Stroke Patients in Ain Shams Specialized Hospital

Nurses' Awareness Regarding Care of Stroke Patients in Ain Shams Specialized Hospital

Determinants of sputum culture conversion time in multidrug-resistant tuberculosis patients in ALERT comprehensive specialized hospital, Addis Ababa, Ethiopia: A retrospective cohort study.

The treatment response of multi-drug resistance tuberculosis (MDR-Tuberculosis) patients is mainly dictated by the sputum culture conversion. An earlier culture conversion is a remarkable indicator of the improvement in the treatment response. In this study, we aimed to determine the time to culture conversion and its associated factors among MDR-Tuberculosis patients in All Africa Leprosy, Tuberculosis and Rehabilitation Training Center (ALERT) Hospital, Addis Ababa, Ethiopia. A retrospective cohort study was conducted on 120 MDR-Tuberculosis patients attending ALERT Hospital from 2018-2022. Kaplan-Meier methods were used to determine the time to initial sputum culture conversion. All relevant laboratory, socio-demographic characteristics, and other clinical data were collected by chart abstraction using a structure data extraction form. The log-rank test was used to determine the survival rate. To identify the predictors of culture conversion, bivariate and multivariate Cox proportional hazard regression analysis was used. The hazard ratio (HR) with a 95% confidence interval was used to estimate the effect of each variable on the initial culture conversion. A test with a P value of < 0.05 was considered statistically significant. From the total of 120 study participants, 89.2% (107/120) have shown a successful culture conversion. The median age of the participants was 30 years (IQR = 12). The study participants were followed for 408.6 person-months (34.05 person-years). The median time to initial sputum culture conversion was 80 days. The median time to initial sputum culture conversion among HIV-positive and HIV-negative participants was 61 days (IQR = 58-63.5) and 88 days (IQR = 75-91), respectively. HIV-negative and patients with previous treatment history were shown to be the predictor for a prolonged time to initial sputum culture conversion, (aHR = 0.24 (95% CI: 0.1-0.4), P value <0.001) and (aHR = 0.47 (95% CI: 0.31-0.71), P value <0.001) respectively. The median time to sputum culture conversion for HIV positive was found to be 61 days in our study. Notably, patients with a history of previous anti-tuberculosis treatment, HIV-negative status, and higher bacillary load at baseline exhibited delayed culture conversion. These findings underscore the importance of considering such patient characteristics in the management of MDR-TB cases, as tailored interventions and close monitoring may lead to more favorable treatment outcomes. By identifying individuals with these risk factors early in the treatment process, healthcare providers can implement targeted strategies to optimize patient care and improve overall treatment success rates in MDR-TB management programs.

Incidence of stroke and its predictors among hypertensive patients in Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia, a retrospective follow-up study

BackgroundGlobally, one in three adults has hypertension, a condition that causes 51% of all deaths from stroke. Stroke is becoming a major public health problem and the most common cause of morbidity and mortality among non-communicable diseases in the world and Ethiopia. Therefore, this study assesses the incidence of stroke and its predictors among hypertensive patients in Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia 2021.MethodsA hospital-based retrospective follow-up study design was used, simple random sampling technique was used to select 583 hypertensive patients that had follow-up registration between January 2018 and December 30th, 2020. Data were entered into Epi-data version 3.1 and exported to STATA version 14. The adjusted hazard ratio for each predictor with a 95% confidence interval was calculated using the Cox proportional hazards regression model, and a P-value ≤ 0.05 was used to denote statistical significance.ResultsFrom 583 hypertensive patients 106(18.18%) [95% CI 15–20] were developed stroke. The overall incidence rate was 1 per 100 person-years (95% CI 0.79–1.19). Comorbidities (Adjusted hazard ratio(AHR): 1.88, 95% CI 1.0–3.5), stage two hypertension (AHR = 5.21, 95%CI 2.75–9.8), uncontrolled systolic blood pressure (AHR: 2, 95% CI 1.21–354), uncontrolled diastolic blood pressure (AHR:1.9, 95% CI 1.1–3.57), alcohol consumption (AHR = 2.04, 95%CI 1.2–3.49), age 45–65 (AHR = 10.25, 95%CI 7.47–11.1); and drug discontinuation (AHR = 2.05,95% CI 1.26–3.35) were independent predictors for the incidence of stroke among hypertensive patients.ConclusionThe incidence of stroke among hypertensive patients was high and various modifiable and non-modifiable risk factors highly contributed to its incidence. This study recommends early screening of blood pressure, giving priority to comorbid patients and patients with advanced stage hypertension, and giving health education about behavioral risks and drug adherence.

Determinants of hypertension crisis and stroke among hypertensive patients in South Wollo and Oromia special zones public hospitals

Background: Uncontrolled hypertension results in hypertension crisis, and it is an important public health concern around the world. The incidence of complicating hospitalizations with hypertension continues to grow and is associated with increased mortality and adverse discharge. Hypertension crisis and stroke are caused by numerous factors; however, there is a paucity of studies to identify determinants of hypertension crisis and stroke in Ethiopia, particularly the study area. Objective: To identify determinants of hypertension crisis and stroke among hypertensive patients in South Wollo zone and Oromia special zone public hospitals, 2022. Methods: An institution based cross-sectional study was conducted among 416 participants in South Wollo and Oromia special zones public hospitals. Systematic random sampling technique was used to select study participants. Data were entered into Epidata version 3.1 and analyzed using Statistical package for social sciences version 23. Variables having P&lt;0.25 in binary logistic regression was retained in the multivariable analysis to control the effect of confounding. Finally, determinants were identified based on adjusted odds ratio along with 95% confidence level at p-value less than 0.05. Model fitness was checked using Hosmer-Lemshow test. Results: In this study, the magnitude of hypertensive crisis was 35.6%(95%CI:31.1,40.4). Age(41-60years)(AOR=0.76,95%CI:0.42,0.98), Social support(AOR=0.82,95%CI:0.41,0.93), living in urban(AOR=0.56,95%CI:0.24,0.86) and good medication adherence(AOR=0.48,95%CI:0.29,0.83) were determinants of hypertensive crisis. Another, the magnitude of stroke was 5.0%(95%CI:3.1,7.8). Rural residence (AOR=3.4,95%CI:1.23,9.44), Systolic blood pressure (AOR=9.6,95%CI:2.71,34.06), family history of stroke (AOR=0.26,95%CI:0.07,0.79) were determinants of stroke. Conclusion and recommendation: The magnitude of hypertensive crisis was high, whereas the magnitude of stroke was relatively low. Age 41-60 years, urban residence, having social support and good medication adherence were determinants of hypertensive crisis, while rural residence, systolic blood pressure and family history of stroke were determinants of stroke. Thus, health care providers should screen aged patients and patients with family history of stoke.

Time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital: a retrospective cohort study

BackgroundAnti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross-resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. However, information’s on the time of initial regimen discontinuation and its predictors are not well studied.ObjectiveThis study aimed to assess the time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital, North West Ethiopia.MethodInstitution-based retrospective cohort study was conducted among 418 HIV patients who started HAART from January 1, 2014, to December 31, 2019. Data were collected from the patient chart using a data extraction tool. The Kaplan–Meier curve was employed to compare survival rates. Multivariable Cox proportional hazard regression was applied to identify independent predictors of time to initial regimen discontinuation.ResultA total of 418 patients on anti-retroviral therapy were followed. Incidence of initial HAART discontinuation was 16.7/100 person year. The median survival time was 3.5 years. Predictors showed association for time to initial HAART discontinuation were taking > 1 ART pills/day (AHR = 4.1, 95% CI 3.0–6.5), baseline CD4 count < 100 cells/mm3 (AHR = 2.6, 95% CI 1.5–4.7), 100–199 cells/mm3 (AHR = 2.2, 95% CI 1.2–4.0), baseline WHO clinical stage IV (AHR = 2.68, 95% CI 1.6–4.3) and stage III (AHR = 2.6, 95% CI 1.4–4.3) and TB infection (AHR = 2.3, 95% CI 1.6–3.5).ConclusionMost of the discontinuation occurred after 1 year of initiation of HAART. Baseline WHO clinical stage, TB infection, baseline CD4 count, and taking > 1 ART pill/day were found predictors of initial HAART regimen discontinuation. Work on early detection of HIV before the disease is advanced and initiation of one ART regimen daily is vital for survival on the initial regimen.

Effect of Dialysis Modality on Bone Disease in patient with End Stage Renal Disease

Abstract Background The kidney plays a vital role in the metabolism of minerals and bone health. It is not only the target organ of several regulating hormones such as parathormon (PTH) and fibroblast growth factor-23 (FGF-23), but it is also the main organ that activates vitamin D. Calcium and phosphorus are fundamentally important in a wide array of biological functions. Abnormalities in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism (usually referred to as disordered mineral metabolism) are common in patients with (CKD). Aim of the work Comparing the effect of hemodiafiltration (HDF) versus conventional Hemodialysis on bone markers. Patients and Methods The study was performed on 50 patients in Ain Shams University Specialized Hospital with end-stage renal failure treated by means of chronic hemodialysis (n = 25) and hemodiafiltration (n = 25). Inclusion criteria were end stage renal disease patients on regular hemodialysis for &amp;gt; 6 months, their age&amp;gt; 18 years old, no recent infection (normal CRP), cardiac or vascular access complication, none of the patients had history of bone disease, fracture or malignancy. As regarding blood transfusion and drug intake (affect bone metabolism or hemostasis) had not administered for 1 month perior to study. Results Both groups had lower levels of serum creatinine before and after sessions of HD or HDF but Hemodialysis (HD) patients has higher levels of phosphate and bone ALP, than patients on HDF. Conclusion Hemodiafiltration (HDF) has better effect on bone metabolism than Hemodialysis (HD).

Effect of Dialysis Modality on Bone Disease in Patient with End Stage Renal Disease

Background: The kidney has an important effect on minerals and bone metabolism in humans. Kidney is the target organ of many regulating hormones such as parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23), also it activates vitamin D. Abnormalities in phosphorus, calcium, vitamin D and parathyroid hormone are common in patients with chronic kidney disease (CKD). Objective: To compare the effect of online hemodiafiltration (HDF) dialysis versus high flux hemodialysis on bone markers. Patients and Methods: The study was performed on 50 prevalent hemodialysis (HD) patients in Ain Shams University Specialized Hospital on high flux dialysis and were divided into 2 groups (group 1), 25 patients who continued hemodialysis with high flux dialyzer and (group 2), 25 patients who were shifted to online HDF. Bone specific alkaline phosphatase (BSAP), calcium, phosphorus, blood urea nitrogen (BUN), creatinine, sodium, potassium and blood hemoglobin were measured at the start of this study and after 4 months. Only Parathyroid hormone (PTH) was measured at the end of the study in both groups. Results: there was significant increase BSAP and significant reduction of phosphorus levels after 4 months with online HDF compared to high flux HD; p value 0.036 and <0.001 respectively. Conclusion: Online HDF has significant effect on bone markers and phosphorus clearance than high flux Hemodialysis but we need more prospective with longer durations studies to confirm this effects.

Improvement of IDWG Related to Hypotension Events in Hemodialysis Patients

Hemodialysis which is one of the treatments performed on patients with kidney failure has been done with the help of 15% / minute / 1.73. While hemodialysis is safe and beneficial for patients, it does not mean that it has no side effects, one of which is an increase in IDWG. Increase in body weight between IDWG hemodialysis or Interdialytic Weight Gain has side effects that often occur as well, one of which occurs intradialisis hypotension. The study aims to determine the relationship of increased IDWG with the incidence of hypotension in hemodialysis patients at the Rasyida Kidney Hospital in Medan. Quantitative research design with analytic surveys conducted through cross sectional research. The population in this study were chronic kidney failure patients who performed hemodialysis at the Rasyida Kidney Hospital in Medan, with a total of 380, with a sample of 22 respondents using purposive sampling. The majority of hemodialysis patients in Medan Rasyida Kidney Special Hospital approve&gt; 50 years (50%), and 50% are male and 50% female, 50% of patients can be hypotensive and increase IDWG. Chi square test results obtained p-value of 0,000. So, it can be concluded that there is a relationship between an increase in IDWG and the incidence of hypotension in hemodialysis patients.

Uncontrolled hypertension and associated factors among adult hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia, 2018

BackgroundDespite the availability and improvement in diagnostic and therapeutic interventions with proven benefits in reducing cardiovascular morbidity and mortality, control rates of hypertension remain poor and grossly inadequate. Around one billion individuals are living with uncontrolled hypertension globally. Uncontrolled hypertension among hypertensive patients on treatment in Ethiopia ranges from 11.4 to 69.9%. Therefore, the aim of this study was to determine the magnitude and associated factors of uncontrolled hypertension among hypertensive patients in Ayder comprehensive specialized hospital, Tigray, Ethiopia 2018.Methods and materialsHospital-based cross-sectional study design was conducted from February 16–April 30/2018. Simple random sampling method was used to select 320 participants. Data was collected using interviewer administered standard structured questionnaire. Self-care practice measuring tool was adopted from hypertension self-care activity level effects (H-scale). Data was entered to and cleaned by Epi Info version 7 and it was exported to SPSS version 22 for analysis. Binary logistic regression model (AOR, 95% CI and p-value < 0.05) was used to determine the predictors of uncontrolled hypertension.ResultFrom the total respondents, 164 (51.2%) were females. The mean age of the respondents was 53.83 + 14.52 years. Prevalence of uncontrolled hypertension was found 52.5%. Overweight (AOR = 4.527, 95% CI: 2.247–9.123), co-morbidity (AOR = 2.112, 95% CI: 1.218–3.662), non-adherence to anti-hypertensive medication (AOR = 2.062, 95% CI: 1.030–4.129), non-adherence to physical activity (AOR = 1.931, 95% CI: 1.074–3.470) and non-adherence to alcohol abstinence (AOR = 2.093, 95% CI: 1.109–3.948) are independent predictors of uncontrolled hypertension.Conclusionthe prevalence of uncontrolled hypertension is high. Patients’ adherence to antihypertensive medication, physical exercise and alcohol abstinence should be maximized. Weight reduction and early identification and management of co-morbidities are also crucial.

산부인과 전문병원 내원환자의 난임 특성과 보조생식술 유형이 임신에 미치는 영향

본 연구는 난임 치료 시술 유경험자를 대상으로 난임 특성을 파악하고, 특성에 따른 보조생식술의 치료 결과와의 관계를 분석하였다. 울산 일 산부인과전문병원의 협조를 얻어, 2012년~2013년까지 난임 시술을 받은 344명의 데이터를 수집하여 분석하였다. 분석방법은 교차분석, 로지스틱 회귀분석을 하였고, 통계적 검정은 <TEX>${\chi}^2-test$</TEX>를 하였다. 난임 대상자 특성은 30대(72.1%)가 가장 많았고, 질병은 없는 경우(70.9%), 출산 자녀도 없음(77.0%)이 가장 많았다. 난임 원인은 연령이 높을수록 자궁요인이 많았고, 연령이 낮을수록 난소 요인이 많았다. 보조생식술을 시행한 시술은 IUI(51.5%), IVF(23.0%), IUI+IVF(25.6%) 이었고, 보조생식술 시술은 연령(p<.013), 난임 기간(p<.014), 유산경험(p<.008)이 통계적으로 유의하였다. 보조생식술 시술 결과 임신이 34.9%이었고, 그 중 인공수정은 49.2%, 체외수정은 50.8% 이었다. 성공 시술 평균 횟수는 인공수정 시술은 1.64회, 체외수정 시술은 1.36회로 체외수정이 인공수정보다 0.28회 낮았다. 따라서 보조생식술 유형에 따른 임신 성공률을 높이기 위해서는 인공수정 시술은 연령이 낮고, 난임 기간이 짧을수록, 출산 자녀가 없는 경우, 체외수정 시술은 연령이 높고, 난임 기간이 길수록, 출산 자녀가 있는 경우 선택해야 한다. 본 연구는 보조생식술을 시행한 전체를 대상자로 분석하였다는 연구적 의의가 있으나, 일 광역시라는 지역적 제한으로 일반화 하기는 어렵다. 이를 기초로 지역별 및 전국 난임 치료자를 대상으로 한 후속 연구가 이루어진다면 난임 원인별 특성을 파악하여, 효율적 치료 방안 구축 마련에 도움이 될 것이다. This study was conducted to identify characteristics observed by staff during infertility treatment, and to analyze the relationship between the result of the treatment according to the ART infertility characteristics. In cooperation with an Obstetrics and Gynecology Hospital in Ulsan, data were collected from 344 people receiving infertility treatment from 2012-1013 and evaluated by cross-analysis, logistic regression analysis, and the <TEX>${\chi}^2$</TEX> test. Age 30 subjects (72.1%), no disease (70.9%), and no birth children (77.0%) were most common among patients. Causes of infertility factor is the higher the age, followed by uterine factors, ovarian factors were the lower the age.Were assisted reproduction are IUI (51.5%), IVF (23.0%), IUI + IVF (25.6%), assisted reproduction were age (p<.013) infertility period (p<.014), abortion Experience (p<.008) it was not statistically significant. ART pregnancies result was 34.9%, IUI was 49.2%, IVF was 50.8%. The average number of successful IVF treatment was 1.64, while it was 1.36 for IVF. IVF is 0.28 times lower than the IUI. Thus, low in order to increase the success rate of pregnancy according to the assisted reproduction age, nanim period is short, and if you do not have birth children choose artificial fertilization, and high age, IVF If there are nanim period is longer and birth child treatment and you must choose. This study analyzed all subjects who underwent fertility treatment to have research significance. However, it is difficult to generalize, locally called Sun City limits. If this one based on regional and national follow-up study of infertility therapist made it will help to prepare the way of effective treatment for infertility causes.

Etiology and prognosis of fulminant hepatitis and late‐onset hepatic failure in Japan: Summary of the annual nationwide survey between 2004 and 2009

To summarize the annual nationwide survey on fulminant hepatitis (FH) and late-onset hepatic failure (LOHF) between 2004 and 2009 in Japan. The annual survey was performed in a two-step questionnaire process to detail the clinical profile and prognosis of patients in special hospitals. Four hundred and sixty (n = 227 acute type; n = 233 subacute type) patients had FH and 28 patients had LOHF. The mean age of patients with FH and LOHF were 51.1 ± 17.0 and 58.0 ± 14.4 years, respectively. The causes of FH were hepatitis A virus in 3.0%, hepatitis B virus (HBV) in 40.2%, other viruses in 2.0%, autoimmune hepatitis in 8.3%, drug allergy-induced in 14.6% and indeterminate etiology in 29.6% of patients. HBV reactivation due to immunosuppressive therapy was observed in 6.8% of FH patients. The short-term survival rates of patients without liver transplantation (LT) were 48.7% and 24.2% for the acute and subacute type, respectively, and 13.0% for LOHF. The prognosis was poor in patients with HBV reactivation. The implementation rate for LT in FH patients was equivalent to that in the previous survey. The short-term survival rates of total patients, including LT patients, were 54.2% and 40.8% for the acute and subacute type, respectively, and 28.6% for LOHF. The demographic features and etiology of FH patients has gradually changed. HBV reactivation due to immunosuppressive therapy is problematic. Despite advances in therapeutic approaches, the prognosis of patients without LT has not improved.

P-1202 - Frequency of drug abuse in schizophrenic patients

Educational objectives Abuse of alcohol and other substances is a very common problem of schizophrenic patients. Schizophrenic patients consumes alcohol and other substances to reduce stress, anxiety, boredom, emptiness. Purpose To determine the prevalence of drug abuse in hospitalized schizophrenic patients. Methods This retrospective study included hospitalized patients in Special Hospital for Psychiatric Disease “G.Toponica” the twelve-month period, the diagnosis categories F20 by MKB-10 classification. Data were obtained from medical records and based on special structured questionnaire. Results The data will be presented on the poster. Conclusions Frequency of consumptions psychoactive substance in schizophrenic patients is high, and consumption of alcohol between is much higher then other substance.

Mentally disordered offenders in Zimbabwe and in England and Wales: a socio-demographic study

Our aim was to compare socio-demographic, clinical and criminal characteristics of mentally disordered offender patients in a special institution in a developing and a developed country. Zimbabwe data from 1980-1990 was obtained from a hospital patient survey, in a written semistructured format. The English special (high security) hospital patients' data for the same period was obtained from the case register. The sample size for Zimbabwe was 367 patients (337 males, 30 females) and for England and Wales it was 1,966 patients (1,643 males, 323 females). The average age for Zimbabwean patients was 36 years, with standard deviation of 9.7; for England and Wales the average age was 29.7 with standard deviation of 9.6. There was significant difference in marital status in the two countries. Seventy-eight per cent of patients were single in England and Wales, compared with 49% in Zimbabwe. There were 20% illiterate patients in Zimbabwe, compared with 4% in England and Wales. Thirty-seven per cent of the patients in England and Wales had a diagnosis of personality disorder, compared with 6% in Zimbabwe. There were 53% of homicides in Zimbabwe, compared with 20% in England and Wales. Employment in the two countries was similar: 34% in Zimbabwe and 33% in England and Wales. There were differences in the socio-demographic characteristics in the two countries, except for employment status. Differences were also noticed in the diagnoses of the patients, types of crime and the methods of assault.

Functional consistency across two behavioural modalities: fire‐setting and self‐harm in female special hospital patients

Fire-setting and self-harm behaviours among women in high security special hospitals may be understood using Shye's Action System Theory (AST) in which four functional modes are recognized: 'adaptive', 'expressive', 'integrative', and 'conservative'. To test for relationships between different forms of fire-setting and self-harm behaviours and AST modes among women in special hospital, and for consistency within modes across the two behaviours. Clinical case files evidencing both fire-setting and self-harm behaviours (n = 50) were analysed for content, focusing on incident characteristics. A total of 29 fire-setting and 22 self-harm variables were analysed using Smallest Space Analysis (SSA). Chi-square and Spearman's rho (rho) analyses were used to determine functional consistency across behavioural modes. Most women showed one predominant AST mode in fire-setting (n = 39) and self-harm (n = 35). Significant positive correlations were found between integrative and adaptive modes of functioning. The lack of correlation between conservative and expressive modes reflects the differing behaviours used in each activity. Despite this, significant cross-tabulations revealed that each woman had parallel fire-setting and self-harm styles. Findings suggest that, for some women, setting fires and self harm fulfil a similar underlying function. Support is given to AST as a way of furthering understanding of damaging behaviours, whether self- or other-inflicted.

A comparison of special hospital patients and other admissions to a regional low security unit

This study aimed to assess if there were any identifiable characteristics that could predict a length of inpatient stay of greater than 2 years. This was in respect to patients admitted to the low security Tayside Regional Forensic service, over the course of 10 years, from high security and other sources. A comparison of risk characteristics was also conducted between the two groups. The authors conducted a retrospective cohort study. The control group were formed from the next consecutive admissions to the unit following an admission from a high secure setting. A full case note review and HCR-20's were carried out on all subjects. Regression analysis was utilized to distinguish if a single factor was significant in predicting a length of inpatient stay of more than 2 years. Patients transferred from special hospitals were more likely to have a diagnosis of Schizophrenia, have more serious index offence and more previous convictions. Patients from the high security group had a higher mean HCR-20 score and a significantly earlier age of onset of illness. We were unable to identify a single factor that would predict a length of inpatient stay of more than 2 years. We did identify that patients discharged from high security settings may require a longer inpatient stay and outpatient contact than patients admitted from other sources. We hope to add to the discussion concerning the requirement for long term low and medium secure care.

A Re-Conviction Study of Special (High Security) Hospital Patients

Reliable patient re-conviction data after leaving high security hospitals are of public interest, but official statistics are without context and sometimes incomplete. Some patient sub-groups are rarely studied. Our study describes re-convictions for a complete national annual high security hospital discharge cohort. We hypothesized that: established community living would precede re-conviction and that more people with personality disorder would be re-convicted, with a higher rate, than people with other disorders, even allowing for community time. Cases were identified using the special hospitals' case register; follow-up data were from multiple records sources. Seventy-four patients (38 per cent) were convicted after discharge, 26 per cent of serious offences. All 10 multiple reoffenders (>9 offences) were men. Fourteen per cent of those re-convicted had offended during institutional residence. Median time to first community re-conviction was under two years. Logistic regression analysis confirmed that people with personality disorder were seven times more likely than people with mental illness to be convicted of a serious offence after discharge. Methodological procedures that maximize validity of findings are discussed.

Childhood-onset neuropsychiatric disorders among adult patients in a Swedish special hospital

Childhood-onset neuropsychiatric disorders among adult patients in a Swedish special hospital

The treatment and security needs of patients in special hospitals: views of referring and accepting teams.

Various studies suggest that 20-30% of patients in England and Wales in high security could be safely managed in medium security but there are no objective criteria and little attention has been paid to differences of opinion. The authors compare the views of the referring and receiving team on the security needs of all special hospital patients from two London health authorities. Disagreements were found in only 8% of cases, and they were more likely to occur in patients detained under the legal category of psychopathic disorder. Between 21% and 33% of patients were rated as misplaced by one or other team but these figures include patients who were either already on trial leave in another hospital or on the waiting list for an identified placement. Patients for whom there was agreement on misplacement, with no identified route out of high security, account for 9% of the total. Most patients with treatment-resistant schizophrenia were not receiving atypical anti-psychotic medication. It may be more realistic to plan future services on the basis that only 9% of patients are misplaced, rather than the previous estimates that appear to have guided current policy. Patients detained under the legal category of psychopathic disorder present particular problems and there is a need to develop appropriate facilities at medium secure level. In the meantime, no patients should be admitted to high security without consultation with the catchment area service and a jointly agreed plan for future rehabilitation.

Psychosis in high-security and general psychiatric services: report from the UK700 and special hospitals' treatment resistant schizophrenia groups.

Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services. To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services. Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services. Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African-Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African-Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group. Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.

The use of trial leave for restricted special hospital patients.

INTRODUCTION: For England and Wales, Section 17 of the Mental Health Act 1983 allows for compulsorily detained patients to have trial leave (TL) between hospitals or from hospital to community to allow a period of testing readiness for a change in residency and/or legal status. The aim of this study was to document the use of TL for the largest sub-group of such patients within two discharge cohorts from one high security hospital and to test for correlates. METHOD: Data were collected from the special hospitals' case register for two Broadmoor Hospital discharge cohorts, 1984 and 1990-94, of offender patients with hospital orders under Home Office restrictions on discharge (Section 37/41). RESULTS: In 1984, only two of the 29 people leaving special hospital did so under trial leave arrangements, but by 1990 to 1994, 71% of restricted hospital order departures were under trial leave (92/130), a significant change in practice. Focusing on only the later cohort, women were disproportionately more likely to leave in this way. Trial leave was used more for patients with an index offence of homicide, similarly for violent offences but less so for sex offences. Nature of disorder did not have any bearing on the use of trial leave. Use of trial leave did not significantly shorten length of stay within the special hospital. CONCLUSION: Trial leave has become the most usual route out of special hospital, and is the departure route used almost exclusively for women patients, yet there appears to be no obvious advantage for the patient in shortening length of stay in high security. However, there is no way of knowing how long patients would have stayed had the option of trial leave not been available to them. Furthermore, no advantage for the public was found in the preferential use of TL for discharges to the community.