Inpatient Treatment Research Articles

Existential concerns among young adults with psychotic vulnerability in mental health care: a qualitative study in the Netherlands

BackgroundYoung adults with psychotic vulnerability are dealing with disrupting experiences early in life, often with far-reaching or even lifelong impacts. These experiences can lead to existential questions during young adulthood. Identity realization and finding meaning and purpose in life are central to this development stage.AimThe current study investigated to what extent profound experiences such as psychosis in young adulthood lead to existential concerns as formulated by Yalom and to other existential themes during inpatient and outpatient mental health treatment and care.MethodsA qualitative study was carried out among patients (N = 11) with psychotic vulnerability aged between 17 and 31 years, participating in interviews about their existential life questions and experiences in mental health care. In the thematic analysis, the primary deductive codes were based on theory, while the subcodes were inductively derived from the interviews.ResultsThe respondents clearly affirmed existential concerns about freedom (e.g., loss of or changed future), meaninglessness (e.g., questioning purpose and meaning), isolation (e.g., disconnection, importance of personal bonds), identity (e.g., loss of self, changed identity) and death (e.g., questioning life and death). The five existential themes appeared to be related to each other. Furthermore, the importance of addressing existential themes in treatment emerged as a latent care need.DiscussionThe results of this study provide insight into experiences with meaning-making in mental health care and existential themes. The respondents generally expressed positive feelings about addressing and the possibility to talk about existential life questions, which fits within recovery oriented mental health care.

(No) Treatment for people without health insurance coverage : When access to inpatient surgical care is denied

For people without health insurance coverage access to healthcare is severely restricted. In large cities such as Frankfurt am Main, parallel structures have emerged to ensure free basic medical care for those affected; however, when inpatient treatment is required the medical infrastructure for people without health insurance is inadequate. This article outlines the importance of access to surgical treatment for people without health insurance and the serious consequences when this access is denied. The Clearing Center1.0 at the Public Health Authority of Frankfurt am Main and the Elisabeth Street Outpatient Department of the Caritas Association Frankfurt represent two low-threshold outpatient clinics that exist in the city of Frankfurt. The basic structure and function of each clinic are described along with acharacterization of the patient populations, including adescription of the sociodemographic characteristics. From the total patient collective, three case scenarios are selected as examples and are outlined with respect to (1)social history, (2)access barriers, (3)findings, (4)surgical indications and (5)treatment course. Patients face complex barriers due to legal restrictions, financial hardships and precarious living conditions. The lack of afunding provider results in necessary surgery not being performed. The consequences are pain, functional limitations and worsening of life-threatening diseases. Timely surgical care for people without health insurance is essential to maintain health and avoid high follow-up costs. Atreatment fund provides asolution. The combination of case management, secure accommodation and raising awareness among professionals helps close care gaps and develop solutions.

Brief Report: Association Between Inpatient Medication Treatment for Opioid Use Disorder and Reduced One-Year All-Cause Mortality in Patients with Invasive Bacterial Infections

Abstract Invasive bacterial infections are frequent causes of hospitalization among people who use opioids. We evaluated the association between inpatient administration of medication for opioid use disorder with one-year all-cause mortality in patients hospitalized with invasive bacterial infections.

The societal costs of avoidant personality disorder.

The study aims to estimate the societal costs of avoidant personality disorder (AvPD). Cross-sectional data on AvPD patients during 2017-2020 were retrieved from the quality register of the Norwegian Network for Personality Disorders. Cost estimations were based on a bottom-up approach, using a structured interview covering the 6-month period prior to initial assessment. Unit costs were retrieved from public records. The human capital approach was used to calculate productivity losses. Diagnoses were determined according to DSM-5 by semi-structured diagnostic interviews (SCID-5-PD). Mean societal costs were €19,378 for the total group (N = 410). The subgroup with a single diagnosis (n = 270) incurred €18,818, whereas the subgroup with at least one comorbid PD (n = 140) incurred €20,458. The difference between the two subgroups was not statistically significant. The largest cost component was productivity loss (69%), whereas health service costs constituted 31%. The main contributors to societal costs from the health service cost components were inpatient treatment (18%) and individual outpatient treatment (11%). In conclusion, societal costs for AvPD patients were high, on the same level as borderline PD, schizotypal PD, and schizophrenia, and higher than anxiety disorders, depression, and rheumatoid arthritis. In the future, development of effective AvPD treatment programs enhancing personality functioning and workforce participation is important in order reduce the cost of illness.

A mindfulness- and relaxation-based nature intervention improves mood in depressed patients in psychosomatic rehabilitation: Results from the GREENCARE non-randomized controlled clinical trial.

IntroductionGuided contact with nature has positive effects on well-being. Little is known about the effectiveness of adding nature-based interventions to inpatient treatment for depression. Therefore, we evaluated a mindfulness- and relaxation-based nature intervention for depressed patients in psychosomatic rehabilitation treatment. MethodPsychosomatic rehabilitation inpatients with depression were allocated to either a Greencare mindfulness- and relaxation-based nature intervention (n = 116) or to treatment as usual plus waitlist control group (TAU+WL) (n = 111) in two centres. All patients received questionnaires on admission (T1) and discharge (T2). Greencare patients received follow-up questionnaires three months after the intervention (T3). Main outcome was mood, assessed by the Positive and Negative Affect Schedule (PANAS). Secondary outcomes were depression, mindfulness, state self-compassion, and contact with nature. Data were analysed as intent-to-treat using mixed models for repeated measures, adjusted for propensity score and centre. Patients’ ratings of the effectiveness of the sessions and their well-being, and situational aspects of each session, were recorded. ResultsWe found significant interactions of time*group for PANAS, showing greater positive affect (Cohen’s d at T2 = 0.48) and lower negative affect (Cohen’s d at T2 = 0.52) in the Greencare group compared to the TAU+WL group at T2. At follow-up (T3), the effects in the Greencare group decreased, but remained significant compared to T1. Significant results for self-compassion and non-significant effects for depression and mindfulness were found. The groups did not differ in the amount of contact with nature. Sensitivity analyses revealed more favourable follow-up effects for patients with higher levels of depression. Patients reported high ratings of effectiveness and well-being for each session, and these ratings were not related to the weather conditions. No adverse events were reported. DiscussionDepressed inpatients benefitted from a Greencare mindfulness- and relaxation-based nature intervention by improving positive and negative affect. The effects were slightly reduced after three months, but less in patients with higher levels of depression on admission. Results show that the intervention is feasible and effective even for patients with higher symptom burden. Trial RegistrationGerman Clinical Trials Register (trial registration number: DRKS00023369, universal trial registration number: U1111-1260-7305)

Youth Inpatient and Residential Treatment Psychiatric Beds: National Trends and Potential Causal Factors, 2010-2022.

Youth inpatient and residential treatment psychiatric services are essential components of the continuum of care. Concern has grown about the diminished availability of these services and the increasing need for them. This study aimed to examine the number of youths treated at inpatient and residential psychiatric facilities over a 12-year period and to assess the perceptions of state mental health authorities (SMHAs) about the reasons for changes in availability. In this multimodal study, the authors conducted a secondary analysis of a national survey (including all 50 states, Washington, D.C., and Puerto Rico) of mental health facilities that was administered seven times between 2010 and 2022. In addition, the study relied on 2023 data from a survey of SMHAs (N=34 respondents). Most states experienced a decline in the number of youths in inpatient (79%) and residential treatment psychiatric facilities (94%). Although some people posit that increased use of outpatient services may explain such declines, 81% of states had a reduction in community outpatient psychiatric care for youths during the study period. SMHAs reported that the impact of the COVID-19 pandemic and preexisting workforce shortages contributed to the reduction of youths treated. These findings show a nationwide decline in the number of youths treated in inpatient and residential treatment psychiatric facilities over time. Determining causal factors in these declines is challenging, and it is critical to develop a monitoring and reporting system for the number of youths requiring services and the capacity within each state for addressing youth needs.

Prospective Follow-up of Patients with Schizophrenia – Results for Outcome Predictors

Schizophrenia is a heterogeneous disease with wide variation in the therapeutic response of patients – from good to treatment refraction and severe disability. This study has naturalistic, non-interventional design, and includes one-year prospective follow-up. Schizophrenia patients are evaluated in three time points: at admission (T1), at discharge (T2), and one year after the hospitalization (T3). Psychopathology is assessed by the Positive and Negative Syndrome Scale (PANSS), negative symptoms – by the Scale for Assessment of Negative Symptoms (SANS), aggression – by the Modified Overt Aggression Scale (MOAS), and functioning – by the Global Assessment of Functioning (GAF) scale. Statistical analyses are performed using descriptive methods, Student's t-test, Wilcoxon Signed Ranks Test, and multiple regression. Ethical approval for the study has been obtained. The sample consists of 108 patients with mean age of 39 (SD ± 12.7), and 89.8% (N = 97) of them were prospectively assessed after one year. All symptom dimensions in the 5-factor model – positive, negative, disorganized, manic, and depressive, measured by PANSS, as well as the negative symptoms (objectified by SANS) and aggression (objectified by MOAS) rates, are significantly lower after inpatient treatment. There is an improvement in functioning one year after admission (z = –8.01, p < .001), although both negative symptoms (z = –2.45, p = 0.015) and aggressive behaviour (z = –4.260, p < .001) are significantly higher as compared to discharge. From the multiple regression, at T1, involuntary admission is a significant predictor for higher aggression and lower functioning (p < .001$). The duration of hospitalization is longer with lower compliance (p = .022$), and the treatment with atypical antipsychotics decreases the hospital stay (p = .021$). One year after admission, employment serves as a positive predictive factor as it is significantly associated with drop of psychopathology (p = .001) and negative symptoms (p < .001), and with improvement of functioning (p < .001). Good compliance is a predictor for lower psychopathology (p = .015), less aggression and higher functioning (p < .001). The inpatient treatment is efficacious in terms of psychopathology and aggression, and is linked to better functioning. The naturalistic design shows depletion of the positive effects of treatment in terms of negative symptoms and aggression probably due to incomplete medication compliance, which is a poor prognostic factor for functioning. This demonstrates the imperative need of continuity in mental health care and better psychoeducation after discharge.

Investigation of neurogenic dysphagia in commonly seen neurological diseases

Neurological disorders lead to varying degrees of impairment in the functions of vital swallowing structures, such as the cortex, cerebellum, brainstem, cranial nerves, and muscles. Neurogenic dysphagia is observed in approximately 50% of common neurological disorders such as stroke, multiple sclerosis, and Parkinson’s disease. Although the pathophysiology and course of the disease vary, dysphagia may occur at any stage of swallowing, including oral preparation, oral, pharyngeal, and esophageal phases. Neurogenic dysphagia ranks among the top symptoms that restrict patients’ independence in daily life activities, reduce their quality of life and increase morbidity and mortality rates. Despite being a prevalent and highly impactful symptom among patients, neurogenic dysphagia can go unnoticed among the multiple symptoms experienced by neurological disorders due to their nature. It is important to be aware of disease-specific risk factors for the early detection of neurogenic dysphagia. Overlooked dysphagia can lead to complications such as aspiration pneumonia, dehydration, malnutrition, and weight loss. Among these complications, aspiration pneumonia is the most common, requiring attention due to its recurrent hospitalizations, inpatient treatment, and high healthcare costs. Many patients exhibit common neurogenic dysphagia symptoms such as drinking liquids in small sips, cutting solid foods into small pieces, decreased appetite, and prolonged meal times. The aim of this study is to examine various aspects of neurogenic dysphagia in different neurological disorders, including its etiology, risk factors, symptoms, and prevalence.

P-1661. Characteristics and Outcomes Associated with Treatment of Asymptomatic Bacteriuria Among Patients with Neurogenic Bladder in a Statewide Hospital Database

Abstract Background Inappropriate treatment of asymptomatic bacteriuria (ASB) among hospitalized patients leads to longer length of stay (LOS) without improving outcomes. ASB is common in individuals with neurogenic bladder (NB); however, little is known about the epidemiology, treatment, and outcomes of inpatients with NB and ASB. Methods Between 1/1/2017-12/31/2023, abstractors collected deidentified data—including signs/symptoms of urinary tract infections (UTI) and 30-day outcomes—from inpatients with a positive urine culture (UC) at 46 hospitals. Due to poor documentation of NB, we defined NB using surrogates (Table 1). Patients without signs or symptoms of UTI were classified as ASB. Characteristics of patients a) with vs. without NB and b) with NB and ASB who were treated vs. untreated were compared using t or chi-squared tests. Finally, we compared 30-day outcomes of patients with NB and ASB treated vs. untreated using general estimating equation models adjusting for variables known to be associated with the outcomes via inverse probability of treatment weighting. Results Of 45,800 inpatients with a positive UC, 6% (2,769) had NB (Table 2). Compared to patients without NB, patients with NB were more often male (59% vs. 29% p< 0.001), younger (median age 69 vs. 76 p< 0.001), less likely to be white (64.6% vs. 77% p< 0.001) and more likely to use a catheter (76% vs. 17% p< 0.001). While ASB rates (25.7% vs. 25.2%, p=0.62) were similar, bacteremia from a presumed urinary source (4.6% vs. 7.2%, p< 0.001) was less common in patients with NB. 85.1% (605/711) of patients with NB with ASB received antibiotic therapy. Similar to patients without NB, altered mental status (AMS) was the main predictor of ASB treatment (23.8% vs. 13.3% p=0.017; Table 3). LOS after UC was longer among those with NB and ASB who were treated vs. untreated (4 vs. 3 days, aIRR: 1.538, 95% CI: 1.33-1.77 p< 0.001; Table 4). Conclusion Among inpatients with NB in a statewide dataset, ASB was common, more frequently treated with antibiotics, and treatment was associated with longer LOS. AMS was the main predictor of ASB treatment. Bacteremia was lower among patients with NB, suggesting UC overuse. Disclosures Barbara Trautner, MD, PhD, Abbott Laboratories: Stocks/Bonds (Public Company)|AbbVie: Stocks/Bonds (Public Company)|Bristol Myers Squibb: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company)|Phiogen Pharma: Advisor/Consultant Elizabeth McLaughlin, MS, RN, Blue Cross Blue Shield of Michigan: Salary Support

P-1704. Impact of an Empiric Antibiotic Pocket Guide on Rates of Guideline-concordant Empiric Regimens for Inpatient Community-acquired Pneumonia at a Community Hospital

Abstract Background Community-acquired pneumonia (CAP) is a common cause of hospital admissions and studies have shown concordance with guideline recommendations improves outcomes. Antibiotic pocket guides (PG) have been shown to increase use of preferred agents in urinary tract and intra-abdominal infections, but their impact on inpatient CAP treatment has not yet been evaluated. This study sought to evaluate the impact of a newly introduced empiric antibiotic PG (introduced May 2023) on rates of guideline-concordant empiric CAP regimens within 24 hours of admission. Methods This retrospective, pre-post, quasi-experimental study conducted at a 300-bed community hospital included adult inpatients initiated on antibiotics with order indication of pneumonia (+/- sepsis) within 24 hours. Patients were excluded if other indications were selected, if they had severe β-lactam allergies precluding use of all recommended agents, or if initiated on azithromycin or doxycycline alone. Included patients were randomly stratified 1:1 from pre-PG (Jul–Sep 2022) and post-PG (Jul–Sep 2023). The primary outcome was the rate of guideline-concordant empiric antibiotic selection for CAP between the two time periods. Secondary outcomes included total duration of therapy and C. difficile rate within 60 days of admission. Length of stay and all-cause mortality within 30 days of discharge were exploratory safety outcomes. Results 300 patients were included,150 per group. Baseline demographics and risk factors were similar between groups except for higher rates of ICU-admission and recent hospitalization with IV antibiotics in the pre-PG group (Table 1). Patients received a guideline-concordant regimen more frequently post-PG than pre-PG, but this did not reach statistical significance (44.7% vs 35.3%, p = 0.099). No difference in appropriate duration was observed. 30-day all-cause mortality was significantly higher in the pre-PG group (p = 0.015). Other details on management and outcomes can be seen in Table 2 and Figures 1-2. Conclusion Introduction of an antibiotic pocket-guide did not result in a significant change in guideline-concordant empiric CAP treatment in this study. Though no evidence of harm was observed, other interventions may be needed to improve guideline-concordant inpatient CAP treatment.Figure 2.Hospital Length of Stay Disclosures Martin Brenneman, PharmD, BCIDP, Cardinal Health, Inc.: Stocks/Bonds (Public Company)|Dexcom, Inc: Stocks/Bonds (Public Company)|Insulet Corp.: Stocks/Bonds (Public Company)|Johnson & Johnson: Stocks/Bonds (Public Company)|Medtronic Plc: Stocks/Bonds (Public Company)

203. Screening and Targeted Prophylaxis for Clostridioides Difficile Infection: STOP-CDI

Abstract Background Patients receiving immunosuppression for oncology treatment and transplantation are at highest risk for developing hospital-onset C.difficile infection (HO-CDI). We studied a prophylactic enteral vancomycin intervention implemented to reduce HO-CDI during high-risk inpatient admissions among immunocompromised patients. Methods The STOP-CDI intervention was implemented on 11/2021 at the Hospital of the University of Pennsylvania. Patients admitted for solid-organ transplant, autologous stem cell transplant, CART, or treatment for leukemia were screened for colonization with C.difficile. Colonized patients were placed in contact isolation and were recommended oral vancomycin prophylaxis for a duration of 10 days or until discharge. Patients were compared to concurrent controls and historical controls in the two years prior to implementation of the STOP-CDI intervention. Concurrent controls were eligible for screening, but research staff were not available to perform screening. The primary study outcome was the development of HO-CDI, defined as a positive clinical diagnostic test after hospital day 3 but prior to discharge. Secondary outcomes included 90 day CDI, stool output, length of stay, VRE infection, and mortality. The impact of the STOP-CDI intervention was assessed using logistic and Poisson regression, with propensity-score weighting calculated using inpatient treatment category. Results Between 11/2021 and 12/2023, 692 patients were screened for C.difficile, 11% were colonized. Characteristics of those enrolled and matched controls are displayed in Table 1. Compared to matched controls, the odds of HO-CDI was significantly lower in the intervention group (OR 0.21, P< 0.001) with a number needed to screen of 31 (Figure 1). We also identified significant reductions in 90-day HO-CDI, stool output, and length of stay (Table 2). There was no detected difference in VRE infection or mortality. Conclusion The STOP-CDI intervention was effective at reducing HO-CDI, LOS, and symptoms of C.difficile in this high-risk cohort. Future work will assess the ability of a targeted screening and prophylaxis approach to reduce transmission of C.difficile on units and its utility in other patient populations.Figure 1.Number Needed to Screen to Prevent One Hospital-Onset C.difficile Infection. Disclosures All Authors: No reported disclosures

P-666. Impact of Ceftriaxone Duration in Community-Acquired Pneumonia: A Retrospective Comparative Analysis

Abstract Background In accordance with the American Thoracic Society (ATS) guidelines for community-acquired pneumonia (CAP), ceftriaxone plus a macrolide is commonly used as first-line for inpatient treatment of non-severe CAP(Metlay, 2019). In a community hospital, a CAP protocol was implemented to grant pharmacists the capability to discontinue antibiotics, including ceftriaxone, after 5 days of treatment in hospitalized patients that have reached clinical stability. On the other hand, extended treatment duration of ceftriaxone can lead to increased resistance, Clostridium difficile infections, adverse effects and cost (Guo 2017, Thomas 2002). The objective of this study is to compare patient outcomes between patients using ≤5 days (recommended duration) and >5 days (extended duration) of ceftriaxone. Methods This study is a retrospective chart review in a community hospital, from Nov 1, 2022 to April 30, 2023. Adult patients treated with ceftriaxone for ≥ 3 days for CAP were included. Patients treated for non-pulmonary infections and/or co-infections were excluded. The primary outcome of this study is 30-day mortality; secondary outcomes include length of stay, and Clostridium difficile infection within 90 days. Outcomes were analyzed with Chi-square/Fischer’s exact test, normality test, student t-test, and Mann-Whitney U test using Prism Version 10. IRB Number: 2024-167 AHGL Results The 30-day all-cause mortality was 7.1% for the ≤5 days group (N = 379) and 7.8% for the >5 days group (N = 166) was not statistically significant (p = 0.77). Length of stay median with interquartile range (IQR) was 6 (IQR 4-9) for the ≤5 days group and 8 (IQR 6-11) for the >5 days group (p < 0.01). The Clostridium difficile infection prevalence of 0.5% in the ≤5 days group and 0% in the >5 days group was too low to make any relevant analysis. Conclusion This study comparing patient outcomes between ≤5 days and >5 days durations of ceftriaxone for community-acquired pneumonia (CAP) revealed no significant difference in 30-day all-cause mortality rates but a significantly shorter hospital stays in ≤5 days group, which suggests that shorter ceftriaxone durations as per protocol can potentially optimize patient care by reducing hospital stays without compromising mortality outcome. Disclosures All Authors: No reported disclosures

P-1734. Pharmacist-Led Antibiotic Deprescribing for Negative Urine Cultures in the Emergency Department

Abstract Background Inappropriate antibiotic use in EDs, often due to empiric prescribing before urine culture results are available, poses significant challenges. This study evaluates the impact of a pharmacist-led intervention to deprescribe antibiotics for patients with negative urine culture results. Intervention Methods Conducted from May 1, 2023, to March 31, 2024, this study employed a two-phase approach involving a retrospective review and a prospective intervention. Inclusion criteria were patients prescribed antibiotics for a UTI with subsequent negative urine culture results during an ED visit. Exclusion criteria included patients admitted for inpatient treatment or transferred to other healthcare facilities. In Phase I (May to July 2023), a clinical pharmacist in the ED adjusted antibiotic therapy based on culture susceptibility results on weekdays. Phase II (January to March 2024) expanded to include antibiotic deprescribing in patients with negative results. The primary outcome was the number of ED readmissions within 30 days after antibiotic discontinuation for UTI symptoms or serious infection. Secondary outcomes included total antibiotic days saved, antibiotic days prescribed per patient at ED discharge, and post-intervention antibiotic days per patient. Statistical analyses utilized the Fisher Exact Test and Mann-Whitney U Test. Patient Characteristics Results The study included 78 patients: 27 in the retrospective phase and 51 in the prospective phase. Among the initial 51 patients, follow-ups with 17 revealed no continued UTI symptoms. There were no readmissions in our prospective intervention group compared to two in the retrospective group (P=0.117). Antibiotic days were significantly reduced from a pre-intervention average of 7.2 to 5.2 days per patient post-intervention (P=0.000468), saving a total of 82 antibiotic days. Results Conclusion Pharmacist-led deprescribing of antibiotics in patients with negative urine cultures significantly reduced total antibiotic days per patient without increasing ED readmissions for urinary tract infection symptoms. These findings demonstrate the feasibility and safety of deprescribing in a clinical ED setting and suggest potential changes in clinical practice, advocating for the expansion of pharmacist roles in antibiotic stewardship programs. Results Continued Disclosures All Authors: No reported disclosures

Correlates of length of stay in a short-term inpatient residential addiction treatment facility.

There is a gap in the extant literature regarding length of stay (LOS) in short-term inpatient addiction treatment facilities. Furthermore, there is a lack in focus on treatment factors which may be better indicators for positive patient outcomes than demographic profiles. The current study sought to examine modifiable correlates of LOS within a short-term inpatient residential facility to extend LOS and improve patient outcomes. N = 792 participants who completed a baseline assessment and either completed treatment or left against clinical advice were included in the sample. Outcomes of interest were self-efficacy (domains included negative affect, pro-social or positive use, physical discomfort, withdrawal, or urges), well-being (domains included symptom distress, interpersonal relations, and social role), and social network size. Baseline dysfunctional social role, larger social network size, and higher alcohol use disorder (AUD) severity all led to increases in LOS. No aspects of self-efficacy, symptom distress, interpersonal relatedness, substance use disorder (SUD) severity, nor other demographic variables were associated with LOS. This study highlights the importance of taking steps to improve self-perceived social role and social network size. Given that the purpose of this study was to determine modifiable correlates of LOS, we suggest that clinicians at inpatient, short-term addiction treatment centers adopt thorough measures of well-being and social network to support patient treatment and recovery.

Hereditary hypomagnesemia with secondary hypocalcemia in a child: a clinical case

Relevance. Magnesium is a vital cation that serves as a cofactor in numerous biochemical reactions within the human body. It plays a crucial role in various intracellular processes, including calcium homeostasis, signal transduction, and energy metabolism regulation. Deficiency of this essential micronutrient can manifest early in life and may result in a range of pathological conditions, some of which pose a significant threat to a child's health.Description of the clinical case. The parents of an 18-month-old child presented to the clinic at Kuban State Medical University, under the Ministry of Health of the Russian Federation, with concerns regarding gingival overgrowth. The child’s medical history revealed seizure episodes of unknown origin that had first occurred at three months of age, necessitating the administration of multiple high-dose anticonvulsant medications. Upon examination, edema of the subcutaneous tissue in the face, trunk, and limbs was noted, along with pronounced gingival hypertrophy in the absence of inflammatory signs. A provisional diagnosis of drug-induced gingival fibromatosis was established. To clarify the diagnosis and optimize anticonvulsant therapy, molecular genetic testing was recommended. The results confirmed autosomal recessive hypomagnesemia with secondary hypocalcemia, attributed to previously unreported genetic mutations. Inpatient treatment included magnesium supplementation with the gradual tapering of anticonvulsant medications. Over the course of treatment, a marked reduction in gingival hypertrophy was observed, and no further seizure episodes occurred.Conclusion. The diagnosis of genetically determined diseases is unattainable without the use of modern high-tech diagnostic methods. Accurate and timely identification of such conditions is essential for effectively managing pathological manifestations, ensuring the selection of appropriate treatment strategies, and preventing potential iatrogenic complications.

Legal requirements for information and their influence on patient satisfaction

The German Patientenrechtegesetz defines, among other things, medical obligations in connection with the provision of information. To date, the extent to which these legal requirements also influence patient satisfaction with information has not been investigated in Germany.The study employed an anonymized patient survey on satisfaction with information, which was recorded using a validated 10-item questionnaire.189 consultations (n=105 female, n=84 male patients) were included in the analysis. 87.8% (n=166) of the patients were undergoing inpatient treatment, 12.2% (n=23) were treated as outpatients. The patients were on average 53.2 years old (standard deviation: 20.3 years, range: 15 to 97 years) and were distributed across the following treatment areas: Anesthesia: n=68; Surgery: n=60; Internal Medicine: n=56; Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy: n=5 patients. Overall, there was a high level of satisfaction with the information provided, which did not differ significantly between the genders. However, patients were more satisfied if they were informed by doctors with German as their mother tongue (p=0.005; d=0.214) or by specialists (p<0.001; d=0.288). The duration of the consultation was significantly positively correlated with patient satisfaction (p=0.002, r=0.211). It was also shown that the physician's level of training (specialist: yes/no) was the most important factor (adjusted odds ratio: 4.48).The requirements of the Patientenrechtegesetz with regard to the comprehensibility and thoroughness of the information conveyed, as well as the proficiency of the medical practitioner, have been demonstrated to foster patient satisfaction. It is thus imperative that sufficient professional competence is always ensured. For medical practitioners whose native language is not German, the utilization of translation programs, pictorial or video-based supplementary materials is recommended to facilitate comprehension and minimize any potential language barriers. Moreover, the duration of the consultation should be tailored to the specific needs of the individual patient in order to optimize satisfaction. In order to achieve this, it would be prudent to ascertain from patients in advance the level of detail they would prefer the consultation to encompass.

Transference-focused psychotherapy in an inpatient setting for borderline personality disorders: changes in symptomatology.

This prospective, naturalistic, longitudinal study examined changes in borderline-specific symptoms in a six-month, manualbased transference-focused psychotherapy (TFP) inpatient treatment for patients with borderline personality disorder (BPD) in comparison to a waitlist control group. Seventy-four patients with BPD received TFP in a multi-professional inpatient setting, of whom 27 patients represented the waitlist control group. 31 patients completed six months of treatment. Borderline-specific symptoms were measured by means of the Borderline Symptom List (BSL-23) prior to treatment (waitlist control group), at the beginning, after 3 months, and at the end of it. BSL-23 scores decreased significantly from the beginning to the end of the six-month inpatient therapy program with a medium effect size of d=0.54. There was no change in symptoms for the waitlist control group. Our findings suggest that inpatient TFP is effective in terms of the reduction of borderline-specific symptoms. In terms of this, the duration of the treatment seems to be a meaningful factor. Further research will investigate changes in specific psychodynamic aspects as well as in the follow-up measurement.

Dynamics of heart rate variability depending on the type of anesthesia during surgery for anterior abdominal wall hernias

Background. Heart rate variability (HRV) is a non-invasive method of analyzing the response of the entire body to surgical stress. The adequacy of the autonomic nervous system response during the perioperative period involves both the initial reserves of the body and the physiology of anesthesia method. HRV is used to predict perioperative complications, especially cardiac ones, mortality, and duration of inpatient treatment. The purpose of the study was to perform a comparative analysis of the dynamics of heart rhythm variability at the stages of elective surgery for anterior abdominal wall hernias depending on the type of anesthesia. Materials and methods. Ninety-one patients with anterior abdominal wall hernias were examined and treated. They were divided into 3 groups according to the method of anesthesia (general, neuraxial and regional blockades). Patients underwent 24-hour ECG monitoring with assessment of HRV. Changes in HRV were evaluated during the surgery: the dynamics of 30 intervals of 5 minutes, a total of 2 hours and 30 minutes were chosen. The monitoring was conditionally divided into 3 stages — the initial, the main one, and the end of the surgery. Results. Under general anesthesia, the median SDNN and pNN50 by the end of the operation were significantly lower than the baseline. Under regional and neuraxial anesthesia, they increased compared to the preoperative level or returned to the baseline. In patients with general anesthesia, LF/HF median decreased statistically significantly until the end of the surgery, and under regional and neuraxial anesthesia, it increased and exceeded the preoperative level. In all patients, along with a decrease in total HRV, there was a reduction in the influence of both sympathetic and parasympathetic parts of the autonomic nervous system on cardiac rhythm. But in general anesthesia, HRV reduction was maintained until the end of the follow-up period, in contrast to patients with epidural anesthesia and regional blockades who reported an increase in both sympathetic and parasympathetic activity until the end of the surgical intervention. Conclusions. The dynamics of HRV during neuraxial and regional analgesia reflects the most physiological response of the autonomic nervous system of a patient with comorbid cardiovascular pathology during elective surgery for anterior abdominal wall hernias.

Optimization of treatment for patients with combined unstable pelvic and thoracic injuries

Background. In patients with polytrauma, damage to the pelvis and chest organs occurs in 21.2–45.7 % of cases. Thoracic trauma, one of the most frequent localizations in multiple injuries, is found in 50–80 % of patients and is of significant importance for the prognosis of the victim’s life. Clinical studies indicate that an average of 20 % of all fatal outcomes in polytrauma are due to chest trauma. Isolated chest and pelvic injuries are serious injuries themselves, and their combination, taking into account the mutual aggravation symptom, is an urgent issue of modern orthopedics and traumatology. Its solution requires a multidisciplinary approach, and further study will allow to refine treatment strategies and improve outcomes. The purpose was to improve treatment outcomes in patients with combined injuries of the pelvis and chest by optimizing treatment algorithm. Materials and methods. The clinical study is based on the examination and treatment of 36 patients with combined chest and pelvic injuries from 2014 to 2023. The average age of the patients was 41.4 ± 16.3 years. Results. Combined injuries of the pelvis and chest lead to a severe condition of patients according to the Injury Severity Score and Trauma Score. Stable fixation in type B pelvic fractures is provided by an external fixation device, while in type C fractures, stabilization of the posterior pelvic ring is mandatory. Rib osteosynthesis performed by certain indications is a more effective approach compared to non-surgical treatment, which allows to reduce the frequency of acute respiratory distress syndrome and pneumonia, the length of stay in the intensive care unit and the period of inpatient treatment. The overall mortality in the experimental group was 11.1 %. For patients who did not survive, the average Injury Severity Score was 40.3, the average Trauma Score was 5.4 ± 1.5 points. Conclusions. 1. For type B pelvic injuries, which are characterized by anterior, rotational and partially posterior instability, stabilization of the anterior part is sufficient. Type C injuries, which are characterized by anterior and posterior instability, require stabilization of the anterior and posterior pelvic rings. 2. Rib osteosynthesis performed by indications provides a lower incidence of acute respiratory distress syndrome and pneumonia, as well as a lower need for artificial lung ventilation and a shorter stay in the intensive care unit.

Rethinking gender differences: An investigation of comorbid psychopathology and alcohol use disorder in veterans.

While men have been found to drink more alcohol and have higher rates of alcohol-related mortality, women tend to experience higher rates of alcohol-related consequences, including psychological comorbidities and worse alcohol use disorder (AUD) outcomes. However, gender differences in comorbid psychopathology and associations with AUD outcomes among veterans are less well understood. Veterans (N = 126; 32 women) receiving inpatient treatment for AUD completed baseline clinical measures including the Beck Depression Inventory-II, Beck Anxiety Inventory, Early Life Stress Questionnaire, and PTSD Checklist for DSM-5. Alcohol use was assessed with the Timeline Followback for the 90 days prior to the baseline assessment and again at 1-, 3-, and 6-month follow-ups. Gender differences in baseline alcohol and psychopathology measures were examined using Fisher's exact test and Mann-Whitney U test. Linear/logistic regression was used to examine associations between comorbid psychopathology and alcohol relapse/use severity post-study. Consistent with prior literature, statistically significant gender differences in psychopathology were observed, with women reporting higher anxiety (p < 0.001), depression (p = 0.001), early life stress (p < 0.001), and PTSD (p < 0.001) at baseline. Higher early life stress was also associated with higher anxiety, depression, and PTSD. Statistically significant gender differences were not observed for alcohol use in the 90 days prior to the study. Similarly, gender was not associated with relapse or severity of use at 1-, 3-, or 6-month follow ups (ps > 0.05). Psychopathology measures were not associated with relapse or severity of use at any time point (ps > 0.05). Our study highlights that women veterans are drinking similar quantities of alcohol to men, supporting emerging evidence of a narrowing gender gap in alcohol use. Women also have a higher psychiatric burden than men; thus, identifying ways to mitigate comorbidity among women veterans should be a health priority.