Standard Hospital Care Research Articles

Postoperative Energy Intake in Patients after Colorectal Cancer Surgery

In a prospective noninterventional study of 75 consecutive patients (mean age 71 +/- 12 years) undergoing surgery for colorectal cancer, standard postoperative energy intake was evaluated. Seventeen patients expended 40%-60% of estimated basal energy during hospitalization, 33 patients 60%-80%, 22 patients 80%-100% and three patients 100%-125%. Weight loss was observed in 67 patients (mean loss 4.7 +/- 4.4%) during hospitalization. Men had a significantly higher mean total calorie deficit (p < 0.001), and mean weight loss percentage (p < 0.01), compared to women. Preoperative nutritional status, nutrition-associated complications and length of hospital stay did not change the nutritional support and intake. Correlation analyses resulted in significant associations between gender and total calorie deficit (rs = 0.41, p < 0.01), postoperative weight loss and total calorie deficit (rs = -0.32, p < 0.01), and between postoperative weight loss and length of stay (rs = 0.27, p < 0.05). We concluded that the patients' energy intake was insufficient compared to estimated basal energy expenditure. These results suggest a need for individualized nutritional care, based on each patient's energy needs and on registration of daily calorie intake, all with the aim of increasing energy intake postoperatively in standard hospital care.

A cost analysis of early discharge and domiciliary visits versus standard hospital care for low‐risk obstetric clients

This paper presents an economic analysis of three obstetric early discharge schemes operating in western Sydney. The primary objective was to examine the net economic value of health service resources released due to each early discharge scheme. Conventional postnatal obstetric care comprised an inpatient stay of four to five days. Early discharge provided an alternative location. Clients who chose to participate in the scheme were discharged two to three days earlier than usual and visited at home by a midwife for up to seven days. Other studies of early discharge schemes have shown that resulting maternal and infant morbidity were no higher than with conventional care. This study took the form of a cost analysis. The early discharge schemes at Blacktown and Westmead Hospitals used more resources than they released, whereas the scheme at Auburn Hospital released resources in excess of those it used. Sensitivity analysis showed that the results for Westmead and Auburn Hospitals were sensitive to changes in key assumptions used in the analysis. The number of domiciliary visits per client was an important determinant of the ability of schemes to release resources in excess of their costs. The existence of early discharge provides an extra choice to clients in the location of postnatal care. The question for decision makers is whether this choice is worth the extra cost of early discharge schemes.

Post-Traumatic Stress Disorder in Hospitalized Patients with Burn Injuries

The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. Sixty-three percent showed intrusive recollections of the initial trauma (partial diagnostic criteria) and 16 (29.6%) of the sample met full criteria for post-traumatic stress disorder at some point during the hospitalization. None of the patients met the full diagnostic criteria at discharge from the hospital, although one did at follow-up. Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.

The ‘Know Your Midwife’ scheme—a randomised trial of continuity of care by a team of midwives

A team of four midwives provided the majority of care during pregnancy, labour and the puerperium to 503 women at low obstetric risk, over a 2-year period. Compared with standard hospital care randomly allocated to 498 women this 'Know Your Midwife' scheme was associated with greater continuity in all phases of maternity care. The scheme appeared very acceptable to women: they spent less time in the antenatal clinic, and overall, felt more satisfied, better prepared and better able to discuss problems. The scheme was characterised by less obstetric intervention particularly in respect of augmentation of labour and intrapartum analgesia; labours tended to be longer. Neonatal outcome was generally similar in the two groups but the size of the trial did not allow a precise assessment of differential effects in these terms. The 'Know Your Midwife' scheme is feasible. It should now be introduced more widely but in a way which allows continuing evaluation.

Intensive inpatient treatment of young adult chronic patients.

Young adults with chronic mental disorders have become a major concern among mental health professionals during the past decade. Many of these patients require frequent hospitalizations, are noncompliant with treatment, experience behavioral crises that threaten themselves or others, abuse drugs and alcohol, and alienate their families and support systems. The authors describe an intensive inpatient program for young adult chronic patients who have repeatedly failed to respond to community-based and standard state hospital care and appear to need extended institutional care. The program, which integrates psychiatric and rehabilitation strategies, has succeeded in increasing the amount of time these patients remain in the community. Although the goal for such patients remains a community-based treatment program, the value of an extended period of active inpatient treatment for some patients may be overlooked in current planning for them.

The Relatives of the Mentally Ill

One hundred and twenty patients presenting for admission were randomly allocated into two groups. Control patients received standard psychiatric hospital care and aftercare. Experimental patients were not admitted, if possible; they and their relatives were provided with comprehensive community treatment, including a 24-hour crisis service. Patients with a diagnosis of alcohol or drug dependence, organic brain disorder, or mental retardation were excluded. The great majority of patients were diagnosed as suffering from one of the functional psychoses--mainly schizophrenia. During the study year, control patients spent an average of 53.5 days in psychiatric hospitals, experimental patients spent an average of 8.4 days. Psychiatric patients were treated more effectively and economically in the community, without shifting the burden onto the relatives. Nearly all the relatives of experimental patients preferred community treatment; they considered it to be significantly more helpful to the patients and themselves than standard psychiatric hospital care and aftercare.

Community orientated treatment compared to psychiatric hospital orientated treatment

One hundred and twenty patients presenting for admission to a state psychiatric hospital were randomly allocated into two groups. Control patients received standard hospital care and after-care. Experimental patients were not admitted if this could be avoided; instead they and their relatives were provided with comprehensive community treatment and a 24-hour crisis service. Patients with a primary diagnosis of alcohol or drug dependence, organic brain disorder or mental retardation were excluded. Most patients were suffering from psychotic disorders--more than half specifically from schizophrenia. During the 12 months study period 96% of the control patients were admitted--51% more than once. Of the experimental patients 60% were not admitted at all and only 8% were admitted more than once. Control patients spent an average of 53.5 days in psychiatric hospital, experimental patients spent an average of 8.4 days. Community treatment did not increase the burden upon the community, was considered to be significantly more satisfactory and helpful by patients and their relatives, achieved a clinically superior outcome, and cost less than standard care and after-care. The ingredients differentiating comprehensive community-based care from prevailing methods of psychiatric care are discussed.

Effect of Psychosocial Stimulation on Mental Development of Severely Malnourished Children: An Interim Report

The effect of adding psychosocial stimulation to the treatment of severely malnourished children was studied. The study period covered children from the time they left the hospital to 24 months later. The children's developmental levels (DQs) were compared with those of two other groups who were in the hospital--an adequately nourished group with diseases other than malnutrition, and a severely malnourished group who received standard hospital care only. The children receiving intervention had structured play sessions in the hospital and were visited weekly for 2 years after returning home. During the visits paraprofessionals showed mothers how to continue structured play with their children. The malnourished children who did not receive intervention showed a marked deficit in developmental level compared with that of control children throughout the study. The control children showed a decline in developmental level with age, which is characteristic of disadvantaged children. The children receiving intervention showed marked improvements and by 24 months were ahead of the children who did not receive intervention in every subscale and were head of the adequately nourished children in two subscales. Both groups of malnourished children remained behind the control children in nutritional status and locomotor development.

EFFECT OF LONG-TERM PSYCHOSOCIAL STIMULATION ON MENTAL DEVELOPMENT OF SEVERELY MALNOURISHED CHILDREN

The effect of adding psychosocial stimulation to the treatment of severely malnourished children was studied by comparing the developmental levels (DQs) of the children with those of two other groups of children—an adequately nourished group with diseases other than malnutrition and a second malnourished group who received standard hospital care only. The intervention children underwent structured play sessions daily in hospital and weekly for 6 months after discharge; mothers were also shown how to play with them. The non-intervention malnourished group showed a marked deficit in DQ compared with the adequately nourished group throughout the study period. The intervention group made significant improvements in DQ in hospital and continued to do so after discharge. By 6 months they were significantly ahead of the non-intervention malnourished group, and were no longer significantly behind the adequately nourished group.