Subacute Unit Research Articles

Providing crisis care in a pandemic: a virtual based crisis stabilization unit.

Winnipeg, Canada operates a 16-bed subacute unit, the Crisis Stabilization Unit (CSU), for voluntary patients in crisis not requiring hospital admission. The virtual CSU (vCSU) launched in March 2020 as an adjunct to the in-person CSU during the COVID-19 pandemic, providing the same resources virtually, allowing patients to remain at home. Program data were collected for vCSU admissions between April 1, 2020 and April 7, 2021 (n = 266) to examine patient characteristics and discharge outcomes. Data were retrieved from the electronic patient record (EPR) for both in-person and vCSU admissions during the same period for comparison (n = 712). vCSU admissions (n = 191) were summarized by patient demographics, clinical factors/outcomes, and compared on the same measures to in-person CSU admissions (n = 521) using binary logistic regression. 30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving all care at home. Clinical symptoms at assessment included depression/anxiety (39.0%), psychosis/mania (2.7%), suicidal behaviour/self-harm (27.4%), psychosocial event/stressor (19.8%). Average stay was 4.9 days. Compared to the in-person CSU, vCSU referrals were associated with the absence of psychosis [odds ratio (OR).40, 95% confidence interval (CI).18-0.89] and no prior 1-year contact with referral site (OR.43, 95% CI.28-0.64). Those living farther away from the referral site were more likely to receive a vCSU referral. The vCSU model is feasible for a diverse group of patients experiencing mental health crises. Future work is needed to better determine who the model is right for and examine longer term outcomes.

Modeling outcome trajectories in patients with acquired brain injury using a non-linear dynamic evolution approach

This study describes a dynamic non-linear mathematical approach for modeling the course of disease in acquired brain injury (ABI) patients. Data from a multicentric study were used to evaluate the reliability of the Michaelis–Menten (MM) model applied to well-known clinical variables that assess the outcome of ABI patients. The sample consisted of 156 ABI patients admitted to eight neurorehabilitation subacute units and evaluated at baseline (T0), 4 months after the event (T1) and at discharge (T2). The MM model was used to characterize the trend of the first Principal Component Analysis (PCA) dimension (represented by the variables: feeding modality, RLAS, ERBI-A, Tracheostomy, CRS-r and ERBI-B) in order to predict the most plausible outcome, in terms of positive or negative Glasgow outcome score (GOS) at discharge. Exploring the evolution of the PCA dimension 1 over time, after day 86 the MM model better differentiated between the time course for individuals with a positive and negative GOS (accuracy: 85%; sensitivity: 90.6%; specificity: 62.5%). The non-linear dynamic mathematical model can be used to provide more comprehensive trajectories of the clinical evolution of ABI patients during the rehabilitation period. Our model can be used to address patients for interventions designed for a specific outcome trajectory.

Croatian Models and Experience in First-Episode Psychosis Treatment

We have witnessed a significant push towards staging in medicine. That trend has not bypassed psychiatry, with realization that early phases of various disorders present the window for early intervention that is most likely to result in preserving every-day functionality and achieving favourable outcomes. First-episode psychosis programs have been developed in order to ensure adequate early interaction with psychiatric services, help achieve faster and quality remission, prevent relapses and ensure better long-term outcomes. There is still, however, no consensus on the format or the most appropriate intervention in the early-course psychosis. Patients in Zagreb, Croatia, are offered a number of first-episode psychosis programs, one of which is housed in the largest Croatian psychiatric institution, University Psychiatric Hospital Vrapce. Specialized early-course treatment model in Vrapce stemmed from first-episode inpatient unit established in 2004, and grew to present in its core integration of care across different organizational units, acuity levels, and specific patient needs. Recognizing that a significant number of first-episode patients first interact with psychiatric services through emergency units, Vrapce’s model fostered early interaction with specialized services staff starting with intensive and emergency care units, allowing for continuity of care and early recruitment into specialized services. Vertical integration meant inpatient acute and subacute units seamlessly linked with day hospital and outpatient services, creating the setting for earlier formation of therapeutic alliance and treatment plans, but also allowing for flexible entry points for users. COVID-19 pandemic, in addition to challenging the initial integrations of services, facilitated transfer of certain services into virtual space.DisclosureNo significant relationships.

The role of speech-language pathology weekend service in inpatient subacute care: A national survey

Purpose Limited evidence is available on speech-language pathology (SLP) weekend services within the subacute inpatient setting. This study aimed to describe Australian SLP weekend services for stroke adult inpatients in subacute units and to explore clinicians’ perspectives on factors that influence the delivery of the service. Method Speech-language pathologists who worked in Australian subacute hospital-based units participated in an online cross-sectional survey. Descriptive statistics and content analysis were undertaken to analyse quantitative and qualitative data. Result From the total of 83 participating clinicians, 20 (24%) worked in rehabilitation units that provided an SLP weekend service. Assessments and reviews were the main clinical activities provided to stroke inpatients by this service. Workforce and evidence were commonly cited as facilitators and barriers to both the implementation of a new service and the continuation of an existing service. The “ideal” SLP weekend subacute service to stroke inpatients was typically described as a combination of assessment, therapy, education and training. Conclusion Findings from this study’s sample indicate that an SLP weekend inpatient rehabilitation service to stroke inpatients was not standard practice. Different perspectives regarding the purpose and need of an SLP weekend service were reported.

Predictors of Low Physical Function in Patients With COVID-19 With Acute Respiratory Failure Admitted to a Subacute Unit

ObjectiveTo document the level of physical function in patients with coronavirus disease 2019 (COVID-19) recovering from acute respiratory failure and investigate which patient clinical characteristics could predict physical function assessed by the Short Physical Performance Battery (SPPB) test. DesignCross-sectional study. SettingSubacute unit of a Rehabilitation Institute. ParticipantsPatients with COVID-19 (N=184; aged 18 years or older) who were admitted to a subacute unit to stabilize their condition and recover from acute respiratory failure due to COVID-19. InterventionsNot applicable. Main Outcome MeasuresAt admission patients underwent the SPPB test, represented by the sum of 3 functional tests, standing balance, 4-meter gait speed, and 5-repetition sit-to-stand motion. Comparisons between 2 SPPB score groups were performed by an unpaired t test; multivariate stepwise linear regression analysis was employed to detect predictors of the SPPB score considering several clinical parameters. ResultsParticipants were 74±12 years old, 52% were men and with more than 2 comorbidities in 43% of cases. SPPB score was 3.02±3.87 denoting patients’ profound physical dysfunction. Normal physical function was detected in only 12% of patients, whereas low, intermediate, and severe impairment was found in 65%, 13%, and 10%, respectively. Age, both invasive and noninvasive ventilation use, and the presence of previous disability were significant predictors of SPPB. Patients without any comorbidities (8%) also exhibited low function (SPPB: 5.67±1.12). ConclusionsThe majority of survivors after COVID-19 experienced acute respiratory failure due to pneumonia and exhibited substantial physical dysfunction influenced by age, mechanical ventilation need, and previous disability. Further studies are needed to evaluate the role of rehabilitation to promote recovery and community reintegration in this population.

Predicting Outcome of Acquired Brain Injury by the Evolution of Paroxysmal Sympathetic Hyperactivity Signs.

In this multi-center study, we provide a systematic evaluation of the clinical variability associated with paroxysmal sympathetic hyperactivity (PSH) in patients with acquired brain injury (ABI) to determine how these signs can impact outcomes. A total of 156 ABI patients with a disorder of consciousness (DoC) were admitted to neurorehabilitation subacute units (intensive rehabilitation unit; IRU) and evaluated at baseline (T0), after 4 months from event (T1), and at discharge (T2). The outcome measure was the Glasgow Outcome Scale-Extended, whereas age, sex, etiology, Coma Recovery Scale-Revised (CRS-r), Rancho Los Amigos Scale (RLAS), Early Rehabilitation Barthel Index (ERBI), PSH-Assessment Measure (PSH-AM) scores and other clinical features were considered as predictive factors. A machine learning (ML) approach was used to identify the best predictive model of clinical outcomes. The etiology was predominantly vascular (50.8%), followed by traumatic (36.2%). At admission, prevalence of PSH was 31.3%, which decreased to 16.6% and 4.4% at T1 and T2, respectively. At T2, 2.8% were dead and 61.1% had a full recovery of consciousness, whereas 36.1% remained in VS or MCS. A support vector machine (SVM)-based ML approach provides the best model with 82% accuracy in predicting outcomes. Analysis of variable importance shows that the most important clinical factors influencing the outcome are the PSH-AM scores measured at T0 and T1, together with neurological diagnosis, CRS-r, and RLAS scores measured at T0. This joint multi-center effort provides a comprehensive picture of the clinical impact of PSH signs in ABI patients, demonstrating its predictive value in comparison with other well-known clinical measurements.

Effectiveness of an infection prevention strategy to limit exposure of high-risk patients to COVID-19 in a hospital-based subacute unit: a descriptive report.

The coronavirus (COVID-19) epidemic has put unprecedented stress on hospitals as well as skilled nursing facilities, where reside some of the most vulnerable individuals at high risk of mortality and complications of this infection. This report highlights the strategy and success of hospital infection prevention efforts to protect the residents of an in-hospital subacute unit with 24 at-risk patients with chronic pulmonary disease in northern California. Specific efforts are detailed, with results of surveillance testing reported, including both viral PCR and serological IgG assays. Implications for other long-term subacute care facilities are discussed, as well as advantages and specific challenges for 'distinct part' versus 'free-standing' subacute care units.

SUBSTITUTE PRESCRIBING WITH ANTIPSYCHOTIC REDUCTION

Introduction The Center for Medicare and Medicaid Services (CMS) has called for a reduction in antipsychotic use in the geriatric population, in large part due to the association of these medications with increased mortality. Antipsychotics have significant side effect profiles, including QTc prolongation, weight gain, diabetes mellitus, hypercholesterolemia, and sedation, and may contribute to overall mortality in ways that are not completely understood. As long term care facilities work to decrease their antipsychotic prescribing rates in line with CMS recommendations, they must contend with the challenge of finding alternative treatments for episodes of acute agitation. This observational study aimed to describe the response to this challenge in a geriatric subacute care facility by examining the Medication Administration Record (MAR) to determine if prescribing rates of other medications commonly used to treat agitation increased when antipsychotics were no longer used for this purpose. Methods The study site was a university-affiliated geriatric care facility, which contains long term chronic hospital units, memory support units, and subacute rehabilitation units. Medications were prescribed by geriatric medicine attendings, nurse practitioners, and physician assistants on each unit, with input at times from consulting psychiatrists. Prescribers were employed as members of the facility's closed medical staff. Nursing and administrative staff were generally stable over the time period study. The total census at both sites ranged from 668-725 patients. Over the course of our study, we examined two long term care units at the facility The study units discontinued the use of prescribing antipsychotics on an as needed (PRN) basis and began an initiative modeled after “Appropriate Use of Antipsychotics,” based on the Canadian Foundation for Healthcare Improvement and Appropriate Use of Antipsychotics collaborative. This initiative included a series of interventions to reduce antipsychotic use overall, including staff education and training in specific behavioral interventions. We collected data on the rates of prescribing medications, including antipsychotics, benzodiazepines and trazodone at four time periods: at baseline, some months prior to the start of the initiative (Jan – March 2017), after PRN antipsychotics were discontinued immediately prior to the start of the initiative (July – Sept 2017), during the initiative (January – March 2018) and later after the start of the initiative in follow-up (July – Sept 2018). Six days during each time period (the 15th and last day of the month for each of the 3 months in the period) were selected during which data were collected from the MAR examining the number of medication administrations of each medication. Further analysis was performed looking specifically at the rates of benzodiazepine and trazodone administrations, since these were found to be commonly prescribed medications. Results Administrations of antipsychotics decreased (from 22.0% of the total number of patients at the facility receiving an antipsychotic at time 1 to 19.0% in time 3; to 16.7% at time 4). Concurrently, rates of trazodone prescription rose significantly both by average number of doses per day prescribed (see figure 1; ANOVA for differences between the four time periods F(3,20)=95.43, P Conclusions As rates of antipsychotic prescribing on the units decreased, we observed a phenomenon of substitute prescribing in the form of a significant increase in the amount of trazodone prescribed. At the same time, there was a slight decrease in the amount of benzodiazepines prescribed. Our findings suggest that trazodone was felt by prescribers to be a safer alternative to antipsychotics. The absence of a similar increase in benzodiazepine prescribing suggests that prescribers remained wary of this class of medication because of its longstanding association with adverse effects such as falls. These data also suggest that an ongoing focus on behavioral interventions for agitation in dementia is still needed in order to minimize the phenomenon of substituting one medication with side effects for another with a different set of side effects. Side effects of trazodone include oversedation (which leads to risks of falls), hypotension, QT prolongation, and cognitive effects. A strength of this study is our access to accurate, detailed prescribing data. An additional strength is that the study took place at a facility with stable nursing and medical staffs, thereby decreasing the possibility that staff changes acted as confounders. Limitations of our study include that our data was observational, did not differentiate between PRN doses of a medication and standing doses, did not investigate the symptoms for which each medication was prescribed, and did not compare the effectiveness or adverse effects of these prescriptions. Future research is needed to describe the clinical impact of the phenomenon of medication substitution as antipsychotic prescribing continues to be reduced. This research was funded by: This study took place at Hebrew Rehabilitation Center/Hebrew SeniorLife and was supported by the Canadian Foundation for Healthcare Improvement, a not-for-profit organization funded by Health Canada.

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Improving Care for Patients with Dementia: What to Do Before, During, and After a Transition

Paroxysmal Sympathetic Hyperactivity Rate in Vegetative or Minimally Conscious State after Acquired Brain Injury Evaluated by Paroxysmal Sympathetic Hyperactivity Assessment Measure.

The rate of paroxysmal sympathetic hyperactivity (PSH) was retrospectively assessed using the Paroxysmal Sympathetic Hyperactivity-Assessment Measure (PSH-AM) scale in patients with disorders of consciousness attributed to traumatic and non-traumatic acquired brain injury during the rehabilitation phase. These results were compared with previous studies carried out in the same clinical scenario, in order to verify the prevalence of PSH signs from 1998 to 2014. The entire sample consisted of 140 patients in vegetative state/unresponsive wakefulness syndrome or minimally conscious state admitted to a neurorehabilitation subacute unit from June 2010 to December 2014. PSH-AM revealed the presence of PSH in 16% of traumatic and 12% of non-traumatic younger patients. In the non-traumatic group, the rate was higher in patients with anoxia-hypoxia (37.5%) etiology than those with vascular brain injury (6.7%). A comparison with previous studies revealed a reduction in the number of PSH cases in traumatic patients. This study provides evidence that PSH-AM can be used prospectively to detect the rate of PSH and stratify severity of signs. Further longitudinal analysis is warranted to confirm the prevalence of PSH signs in non-traumatic brain injured patients.

Enhanced Patient-Centered Educational Program for HF Self-care management in Sub-acute settings

Heart Failure (HF) is a complex condition that leads to inadequate blood circulation causing shortness of breath, fatigue, and weakness. It is one of the leading causes of death in the United States. Heart failure is associated with adverse outcomes such as high rates of hospitalization, readmission, mortality, and poor quality of life. However, despite the establishment of interventions to assist with the control of HF, numerous patients are still being readmitted to the hospital. The main purpose of this evidence-based practice (EBP) project was to implement and evaluate the effectiveness of patient centered educational program on self-care management among HF patients in sub-acute settings. The EBP was implemented in two sub-acute units at Alaris Health located at Cedar Grove. A total of 20 participants completed the pretest and 14 participants completed the post test. The Expanded Chronic Care Model of 2003 (ECCM) was utilized as the theoretical framework to coordinate the health determinants which is the “self-care management.” This EBP project used a pretest and post-test using the tool Self-care of Heart Failure Index V6.2(SCHFI). The data was analyzed using the descriptive statistics using the mean and the difference between the pre- and post-test scores. Educational intervention was provided based on the survey scores. The intervention involved provision of educational program related to effective self-care management among HF patients, their families, and care providers. The results of the study demonstrated a statically significant increase in the mean score between the pre-and post-survey related to self-care maintenance, self-care management, and self-confidence. The results of the project suggested that patient-centered educational program can enhance self-care maintenance, management, and confidence among heart failure patients.

Changes in Statin Prescription Patterns in Patients Admitted to an Australian Geriatric Subacute Unit

Assessment of demographic and clinical factors influencing the decision of statin discontinuation in the elderly population admitted to subacute geriatric unit. The aim of this study is to assess the clinical factors impacting the decision-making process of statin discontinuation in the elderly. We retrospectively assessed changes in statin discontinuation and prescription among patients (≥60 years old) discharged from a geriatric evaluation and management unit by reviewing hospital digital medical records at Western Health - The Williamstown Hospital over a 12-month period from 4 February 2012 until 4 February 2013 inclusive. The main outcome of the study was to determine the independent predictors of statin discontinuation using logistic regression analysis. Of the studied population, 46% were already prescribed statins prior to their admission. Statins were discontinued in 17.5% of patients at discharge. Predictors of statin de-prescription included octogenarian status, primary prevention indication, poor functional recovery, residential care facility discharge destination and lower cognitive function. The presence of previous cardiovascular disease history and the burden of comorbidities were not predictors of statin discontinuation. We observed that factors that conveyed poor prognosis such as advanced age, poor functional recovery, worse cognitive function, being discharged to a residential care facility as well as primary prevention indication for statin prescription are predictors of statin discontinuation in the geriatric unit.

Prevalence of healthcare-associated infections in long-term care facilities in Catalonia. VINCat Program

IntroductionLong-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs). ObjectiveTo determine the prevalence of HAIs in LTCFs. MethodDuring the period 2011–2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology. ResultsA total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%). ConclusionThese results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control.

Perfil y evolución de pacientes crónicos complejos en una unidad de subagudos

ObjectiveTo improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated. DesignDescriptive-comparative, cross-sectional, and quantitative study. LocationSG located in intermediate care hospital. ParticipantsConsecutive patients admitted in the SG during 6months. Main measurementsWe compared baseline characteristics (demographic, clinical and geriatric assessment data), results at discharge and 30days post-discharge between PCC/MACA patients versus other patients. ResultsOf 244 patients (mean age±SD=85,6±7,5; 65.6%women), 91 (37,3%) were PCC/MACA (PCC=79,1%, MACA=20,9%). These, compared with unidentified patients, had greater comorbidity (Charlson index=3,2±1,8 vs 2,0; p=0,001) and polypharmacy (9,5±3,7 drugs vs 8,1±3,8; p=0,009). At discharge, the return to usual residence and mortality were comparable. PCC/MACA had higher mortality adding the mortality at 30day post-discharge (15,4% vs 8%; p=0,010). In a multi-variable analysis, PCC/MACA identification (p=0,006), as well as a history of dementia (p=0,004), was associated with mortality. Although PCC/MACA patients had higher readmission rate at 30day (18,7% vs 10,5%; p=0,014), in the multivariable analyses, only male, polypharmacy, and heart failure were independently associated to readmission. ConclusionsDespite having more comorbidity and polypharmacy, the outcomes of patients identified as PCC/MACA at discharge of SG, were comparable with other patients, although they experienced more readmissions within 30days, possibly due to comorbidity and polypharmacy.

In search of a new identity: An institutional consultation at a sub-acute inpatient unit in a general hospital.

Hospitals are constantly morphing under the pressure of ever-evolving health care technologies, procedures, and reimbursement practices. In turn, healthy institutional identities and personnel allegiance contribute to counterbalance the potentially destabilizing effects of those changes. An institutional consultation was requested at a general hospital recently created sub-acute unit (SAU) due to malaise and dissatisfaction in the nursing staff. The consultation included a total of 3 group meetings with the SAU nursing staff as well as observation of procedures and milieu in this and adjacent units. In the course of this process, a structure of demeaning narratives about the unit and the nursing personnel's own role in the context of changes within the hospital was detected, destabilized, and transformed, and the kernel of a new identity for the unit was developed, using a shift in a routine evaluation procedure for patient's progress as a fulcrum for generating change. Follow-up evaluation indicated a qualitative improvement in the unit milieu and nurses' job satisfaction, resonating with an enhancement in the staff's identification with the unit's reformulated mission as part of a constructive continuum of care. This improvement was also acknowledged and rewarded by hospital administration. While maintaining a stance of positive connotation, assumptions of good intent, and a systemic view of the organization, demeaning collective narratives can be transformed through timely interventions that restitute pride and meaningfulness to the personnel and improve the unit's quality of care. (PsycINFO Database Record

Acute and Subacute Care Units. From the high-tech to the high-touch technologies

Introduction: Decompensation of chronic diseases in patients of advanced age are common. They generate a large consumption of resources, hospital readmissions and require hospitalization for care. Despite various initiatives, it can not be prevented and often require acute hospital care. These patients in most cases have already been studied. Therefore, they do not need further high-tech testing but conventional hospital care. In the Consorci Sanitari Integral, an organization that serves the population of Baix Llobregat we set to implement an Acute and Subacute Geriatric Units to provide health resources to the area's population. In order to achieve this we wanted to make the most of high-tech resources of Hospital General de L’Hospitalet (Ultrasound scan, tomography, MRI -magnetic resonance, and laboratory testing) and Geriatric structure of Hospital Sociosanitari de L’Hospitalet . Objective: To describe the results of the implementation of a Acute and Subacute Geriatric Units as well as the impact on the set of hospital discharges of patients in our area of influence. Patients and Methods: Retrospective analysis of clinical activity during the period 2014-2015, quantifying the number of patients treated, the profile of users and sociodemographic variables, length of stay, mortality, number of readmissions and institutionalization. Results: Subacute Unit (2014-11 beds): Discharges 348; home-discharges 79.5%, lenght of stay 9.59 days, readmissions 10.34% Mortality 10.63% Subacute Unit (2015-11 beds-6 months) Discharges 169; home-discharges 78.5%, lenght of stay 9.94 days, readmissions 7.10% Mortality 10.6%. Acute Care Unit 2015 (16 beds - 6months): Discharges 211; home-discharges 61.5%, lenght of stay 11.06 days, readmissions 13.45% Mortality 15.17% Conclusion: 1. The use of General Hospital technology resources to care for geriatric patients has allowed quality care at a lower consumption of resources and close to home. 2. The most fragile patients benefit from care close to home with similar standards to those of quality literature. (Selection bias to the geriatric dept) 3. This model of care can be very useful in the context of metropolitan areas with large demands and need for acute care hospitalization.

Patient participation: causing moral stress in psychiatric nursing?

The aim of this study was to explore psychiatric nurses' experiences and perspectives regarding patient participation. Patient participation is an ambiguous, complex and poorly defined concept with practical/clinical, organisational, legal and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance when moral caring acts are thwarted by constraints. An explorative quantitative pilot study was conducted at a psychiatric subacute unit through three focus group interviews with a total of nine participants. A thematic analytic approach was chosen. Preliminary empirical findings were discussed with participants before the final data analysis. Ethical research guidelines were followed. Patient participation is a difficult ideal to realise because of vagueness of aim and content. What was regarded as patient participation differed. Some interviewees held that patients may have a say within the framework of restraints while others saw patient participation as superficial. The interviewees describe themselves as patient's spokespersons and contributing to patients participating in their treatment as a great responsibility. They felt squeezed between their ethical values and the 'system'. They found themselves in a negotiator role trying to collaborate with both the doctors and the patients. Privatisation of a political ideal makes nurses vulnerable to burn out and moral distress. Nurses have a particular ethical responsibility towards vulnerable patients, and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Unclear concepts make for unclear division of responsibility. Patient participation is often a neglected value in current psychiatric treatment philosophy. When healthcare workers' ethical sensibilities are compromised, this may result in moral stress.

Voluntary and involuntary admission to a subacute psychiatric hospitalization unit

IntroductionInvoluntary admissions continue to be a controversial topic in psychiatry. However, it is well known that psychosocial rehabilitation treatment is more successful when the patient is involved in it improving awareness and adherence to treatment.ObjectivesThis study examined admissions patterns, including voluntary, involuntary, and partly voluntary admissions to a subacute psychiatric hospital.MethodsThis is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Patients's basic sociodemographic and clinical data were collected and compiled in a database. Descriptive statistics were performed using SPSS Software.ResultsA total of 88 patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Among 88 patients, 44 (50%) had voluntary admissions, 16 (18.2%) had involuntary admissions, 27 (30.7%) had partly voluntary admissions and just one patient (1.1%) had partly involuntary admissions. Seventy-one (80.1%) patients had voluntary admissions at discharge, and only one of them escape from hospital and did not finish the treatment.ConclusionsIn the short term involuntary hospitalization has benefits, however also can have adverse long-term consequences for the patient-therapist allegiance, breaking the psychotherapeutic relationship and making the patient abandon treatment. It's important to reassess the condition of admission and work with the patient the need to engage in treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prevalencia de infección relacionada con la asistencia sanitaria en centros sanitarios de cuidados prolongados de Cataluña. Programa de Vigilancia de la Infección Nosocomial en Cataluña (VINCat)

IntroductionLong-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs). ObjectiveTo determine the prevalence of HAIs in LTCFs. MethodDuring the period 2011-2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology. ResultsA total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%). ConclusionThese results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control.

Enhancing Recovery from Trauma: Facilitating a Mindfulness Skills Group on a Department of Veterans Affairs Inpatient PTSD Unit

Mindfulness and acceptance based treatments are being increasingly implemented for a variety of emotional and psychological related problems, including the impact of military and combat related trauma exposure. This article describes a mindfulness skills group as it was implemented on a sub-acute inpatient PTSD Unit at a Department of Veterans Affairs medical center, to demonstrate and explore the role of the mindfulness skills development in a group setting, for Post-Traumatic Stress Disorder and other trauma related problems.