Short-term Inpatient Unit Research Articles

Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals

BackgroundStroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. ObjectiveTo determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. MethodsA cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. ResultsFrom the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. ConclusionAssuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.

Treatment of Dissociative Identity Disorder: “Tortured Child Syndrome”

Treatment of Dissociative Identity Disorder: “Tortured Child Syndrome”Elizabeth A. WaiessElizabeth A. Waiess1. 4970 Northwind Drive Suite 218B Box 4402 East Lansing, MI 48826Search for more papers by this authorPublished Online:June 2006https://doi.org/10.1521/prev.2006.93.3.477PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. The Traumatic Flashback as One Basis of Misunderstanding Between Patients and Law Enforcement OfficersOnline publication date: 1 January 2012. Go to citation Crossref Google Scholar Volume 93Issue 3Jun 2006 Information© N.P.A.P.PDF download

USE OF A SHORT‐TERM INPATIENT MODEL TO EVALUATE ABERRANT BEHAVIOR: OUTCOME DATA SUMMARIES FROM 1996 TO 2001

Previous outcome studies have provided descriptions of functional analyses conducted in outpatient clinics (Derby et al., 1992), long-term inpatient programs (Iwata, Pace, et al., 1994), and home environments (Wacker et al., 1998). This study provides a description of 138 children and adults with and without developmental disabilities who were evaluated and treated for aberrant behaviors on a short-term inpatient unit. The results indicated that the functional analyses conducted during a short-term inpatient evaluation were successful for 96% of the participants in identifying maintaining reinforcers of aberrant behavior and leading to an 80% or greater reduction in aberrant behavior for 76% of the participants in an average of 10 days.

The impact of hospitalization on clinical assessments of suicide risk.

Clinicians' assessments of patients' suicide risk at admission to and discharge from a psychiatric hospital were examined to learn how clinical estimates of risk changed over the course of hospitalization and to identify which demographic and clinical characteristics were associated with higher estimates of risk at admission and discharge. Seventy-one treating physicians evaluated risk of self-harm of 241 patients at admission to and discharge from a short-term inpatient unit. Risk within the next week (short-term risk) and within the next year (long-term risk) was estimated. At discharge and admission, the physicians also rated patients' symptoms using the Brief Psychiatric Rating Scale. Nurses rated self-directed aggression during hospitalization with the Overt Aggression Scale. Ratings of short-term risk were lower at discharge than at admission, whereas ratings of long-term risk showed relatively little change. At both discharge and admission, the estimated risk of self-harm was associated with a history of suicidal behavior and with acute symptoms, such as depression, anxiety, and emotional withdrawal. At discharge, the estimated risk was also associated with substance abuse, severity of psychosocial stressors, and living alone. Clinicians appeared to view their hospital-based interventions as influencing variables relevant to short-term risk of suicide but as having little impact on long-term risk. Implications are discussed for management of suicide risk and for medicolegal assertions regarding prevailing community practices that are made in litigation alleging negligent release of patients from hospitals.

A combined inpatient and partial hospital program.

This paper describes a combined inpatient and partial hospital program, with a ten-bed short-term inpatient unit and a partial hospital program that can accommodate 24 patients. Inpatients and partial hospital patients are treated together by the same staff in a program located in the partial hospital. The authors highlight features of the program that address the five elements of continuity: place, personnel, program, patient-peers, and plan for treatment. The discussion focuses on the importance of continuity in sustaining a combined unit; potential benefits for patients, families, staff, and trainees; attractiveness to third-party payers; and impediments to fully realizing the potential of the unit.

Exercise patterns of psychiatric patients admitted to a short-term inpatient unit.

Exercise patterns of psychiatric patients admitted to a short-term inpatient unit.

Review of Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit.

Review of Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit.

Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit

Back to table of contents Previous article Next article ArticleNo AccessLess Time to Do More: Psychotherapy on the Short-Term Inpatient UnitGLEN O. GABBARDGLEN O. GABBARDSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.151.8.1237AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 151Issue 8 August 1994Pages 1237-1237 Metrics PDF download History Published online 1 April 2006 Published in print 1 August 1994

Book Review of Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit

Book Review of Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit

Book Review Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit Edited by Ellen Leibenluft, Allan Tasman, and Stephen A. Green. 321 pp. $42.50. 0-88048-512-4

Book Review Less Time to Do More: Psychotherapy on the Short-Term Inpatient Unit Edited by Ellen Leibenluft, Allan Tasman, and Stephen A. Green. 321 pp. $42.50. 0-88048-512-4

Inpatient Treatment of Schizophrenia in General Hospitals

To improve treatment of schizophrenic patients in short-term inpatient units, the authors review studies of interventions that have been implemented with schizophrenic patients during brief hospitalizations and suggest areas for future research. The review is organized around seven general treatment domains, including the therapeutic alliance, continuity of care, family involvement, procurement of community services, psychosocial rehabilitation, medication compliance, and substance abuse treatment. Because schizophrenic patients have traditionally been treated in long-term settings, little literature exists to inform interventions on short-term units. The authors suggest that general hospital staff strengthen the treatment alliance between patients and outpatient clinicians, aggressively pursue community supports, work to ensure patients' follow-up with outpatient care, and consider depot medications and patient education to promote medication compliance.

Inpatient group processes parallel unit dynamics.

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.

A Socio-Psychiatric Profile of Emergency Service Patients

A study of patients using the psychiatric emergency services of the Royal Ottawa Hospital was undertaken to determine their demographic and clinical characteristics, correlations between the two and comparisons with other studies. Special clinical forms of every fifth patient seen were analyzed and the data presented. These data are useful in the planning of and establishing and operating a psychiatric emergency service with an attached short-term inpatient unit, as well as assessing the feasibility and value of crisis intervention and brief psychotherapy in treating patients quickly.

Short-term hospitalization and the medical model.

In recent years there has been a significant decrease in the length of hospital stays for psychiatric patients. The author examines whether the shorter stays are justified by results of controlled studies and, if so, what is the most appropriate hospital milieu for short-term units. He summarizes several studies supporting his opinion that short-term hospitalization is usually indicated for the majority of patients, provided that continuity of care is ensured and that supervised living arrangements are available for patients who require them. He believes a medical-model milieu with a clear structure and delineation of roles is most appropriate for short-term in-patient units.

The Crisis Team: A Handbook for the Mental Health Professional

This is a curious and, in many ways, tantalizing, book. It is curious because, in one brief volume, the authors have attempted to write both a handbook for a mental health crisis team and an abbreviated and not very satisfactory basic textbook of psychiatry. It is tantalizing in that one gets only glimpses of how the crisis team operates, how its members are trained, and how they work together. The opportunities afforded for crisis intervention in a variety of psychiatric and psychophysical illnesses are well described. The history of the Yale-New Haven short-term inpatient unit and the decisions regarding the use of multiple roles by members of the team are interestingly developed and seem to have wide applicability. Particularly noteworthy is the amount of time and effort spent by the team on monitoring interactions among team members as they relate to contacts with the patient and those in his surroundings.