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PubMed1991

[Staff requirements for inpatient psychiatry. "Regulation of criteria and principles for personnel requirements in inpatient psychiatry" by the Federal Government in comparison with a personnel analysis generated by the clinic].

A comprehensive analysis of the organization and personal setup was conducted at the Hans-Prinzhorn Clinic in Hemer, West Germany, from July to September 1989 after appropriate preparations that had taken about 12 months. The investigation method and the results are described. Besides the results themselves, planning and execution of this systematic study are significant in shaping the future development of this clinic. Later, and independent of our analysis, the Federal German Government promulgated a special regulation governing the setup of personal engaged in psychiatry, on 18 December 1990. The results of this regulation are compared with those obtained at our clinic. The results are practically always comparable or similar. Hence, minimum staff requirements in inpatient psychiatry were found to be near-identical as assessed by methodically different and independent analysis conducted at different times.

Germany↗
PubMed1995

Outcome of treatment of chronic low back pain in inpatients. Effect of individual physiotherapy including intensive dynamic training in inpatients with chronic low back trouble, evaluated by means of low back pain rating scale.

UNLABELLED: The purpose of the present study is to evaluate the efficacy of the treatment regime for chronic low back pain patients of the impatient clinic of Ringe Rehabilitation Hospital, Denmark, by means of a modified version of Claus Manniche's Low Back Pain Rating Scale. Ninety-three patients were included, of whom 63 (67%) participated in the one year follow-up interview. RESULTS: improvements in subjective as well as objective measures when discharge scores are compared to admission scores. The one year follow-up scores are on the same level as the admission scores. More patients are at work, but still more patients receive pension for health reasons at the one year follow-up. CONCLUSION: The improvements achieved during admission do not last. We suggest that the patients should be more carefully selected for intensive treatment during admission, and that the treatment perhaps should continue beyond the inpatient period. Perhaps the regime should include psychological treatment and vocational rehabilitation, all to be offered at the same institution.

Adult↗
PubMed1995

[Serum folic acid and vitamin B12 in depressed inpatients. A study of serum folic acid with radioimmunoassay in 121 depressed inpatients].

According to the newer literature on folate deficiencies in depressive patients serum folate and vitamin B12 levels were studied (RIA) in 121 consecutively admitted depressive inpatients (47 male, 74 female depressives; age 17-86 years, mean age 48 years, diagnostic by ICD-9 300.4, 296.1) during the first (1-3) days of admission (normal volumes folate 3-17 ng/ml, vitamin B12 200-900 pg/ml). Only in two patients serum folate below 3 ng/ml were found, low vitamin B12 levels (below 200 pg/ml) showed 14 patients. This result is in contrast to other authors who found folate deficiencies in 10-50% of psychiatric patients.

Adolescent↗
PubMed1995

Casemix for the elderly inpatient: Resource Utilization Groups (RUGs) validation project. Casemix for the Elderly Inpatient Working Group.

Current methods of contracting for patient treatment in the health service are not suitable for elderly patients with multiple pathology and functional impairment. This study examines Resource Utilization Groups (RUGs) for use in geriatric medicine in England and Wales, based on 1675 patients from 26 hospitals in eight health districts in England and Wales. Nurses completed a questionnaire on the clinical characteristics of patients required to allocate them to one of 44 RUG groups. Nurse/patient contact times were recorded over a 24-hour period. Therapist/patient contact times were recorded for a week. Data were analysed using analysis of variance with time as independent and RUG group as dependent variable. Variance explanation in excess of 45% was achieved in acute and rehabilitation wards. In long-stay wards, variance explanation (23%) was no better than ADL score alone. RUG-III could form the basis of a casemix system for geriatrics in England and Wales in acute and rehabilitation settings.

Activities of Daily Living↗
PubMed1988

Propofol for inpatient dental anaesthesia. A comparison of propofol as sole anaesthetic agent with thiopentone and halothane for inpatient dental anaesthesia.

The induction, maintenance and recovery characteristics of propofol anaesthesia were compared with thiopentone induction and halothane maintenance in 51 spontaneously breathing, intubated patients who underwent dental surgery. Induction with thiopentone produced fewer side effects than propofol, notably pain on injection. Control of the depth of anaesthesia was better in patients who breathed halothane than in those who received intermittent bolus doses of propofol. Recovery characteristics of the two groups were similar.

Adult↗
PubMed1981

Medicare and Medicaid programs;schedules of limits on home health agency costs per visit, hospital inpatient general routine operating costs, and skilled nursing facility inpatient routine service costs--Health Care Financing Administration. General notice.

This document corrects three notices in the Federal Register this year. These notices set forth schedules of limits on costs for home health agencies, hospitals, and skilled nursing facilities. In deriving these limits, we used a wage index to reflect differences in costs that are correlated with are wage differences. Tables of wage index values for urban and rural areas were published in each notice. Due to a reporting error, we used incomplete data to calculate the wage index values for three New England areas. We have since obtained corrected data, and have used this to recalculate the wage index values for these areas. This document sets forth the corrected wage index values.

Costs and Cost Analysis↗
PubMed1987

[Effect of nitrogen oxides and suspended dust in the air on the incidence of inpatient treatment of children with stenosing laryngotracheitis (pseudocroup). Results of an 8-year epidemiologic retrospective study based on inpatient case figures and area-related data of air measurements in the Bochum city district].

Results of a recently published study over a test period of 18 years showed no relationship between croup incidence of hospitalized children and SO2 levels measured in the city of Bochum. In the following study 642 hospitalized children with stenosing laryngotracheitis were examined for a possible time-dependent relationship between croup incidence and NO2, NO- and dust immission levels measured in the city of Bochum (approx. 1000 000 readings). Evaluation of a 6-year period yielded a decrease of croup patients for the lower NO2 concentration range and a statistical increase of croup cases during days with higher NO2 concentrations. However no cause-effect relationship between both variables can be established because other determinants like infections, temperature, weather change influences, in door pollution etc., could not be excluded. Evaluation of NO levels over 3 years and dust levels over a test period of 1 year showed no statistical relationship with corresponding croup incidence.

Air Pollutants↗
PubMed2004

Impact of alcohol related disease and inpatient workload of gastroenterologists in Scotland.

BACKGROUND: Concern among Scots gastroenterologists about alcohol related illness prompted this inpatient prevalence study during the winter of 2000-01. AIMS: To study gastrenterology inpatient workload due to alcohol-related illness, to determine how much was specialty specific, and if there were regional variations. METHODS: 40 Consultant gastrenterologists throughout Scotland collected data on the prevalence of alcohol related conditions among inpatients under their care on each of three specified days during the winter of 2000/2001. All inpatients under the care of participating consultants on the designated study days were included in the study. Overall return rate was 65%. Patients were categorised as follows; (a) general medical inpatients admitted for reasons other than alcohol related illness (b) general medical inpatients with no gastrointestinal or liver disease, but whose admission to hospital was primarily related to alcohol misuse, (c) gastrointestinal (including liver) inpatients admitted for reasons unrelated to alcohol intake, and with no alcohol related disease, and (d) gastrointestinal inpatients whose admission to hospital resulted from alcohol related disease. Additionally the numbers of patients with (e) decompensated liver disease of all causes, (f) decompensated alcoholic liver disease, and (g) the numbers "blocking" acute beds after initial hospitalisation with an alcohol related illness were collected. RESULTS: Overall, 829 general medical and 538 gastroenterology inpatients were entered in the study; total 1367 (705 male, 662 female). Of these, 25% (337/1367) were admitted because of alcohol related illness: 15% (201/1367) had decompensated alcoholic liver disease. Of 538 gastroenterology inpatients, 238 (44%) had problems related to alcohol and 201 of these (37% of all gastoenterology inpatients) had decompensated alcoholic liver disease. Of 246 inpatients with decompensated liver disease, 82% (201) had alcoholic liver disease. Alcohol related illness was significantly more prevalent among male inpatients in the West of Scotland. 10% of specialist gastroentelogy beds were occupied by patients whose discharge was delayed because of alcohol related problems. CONCLUSION: Most Scottish gastroenterlogists contribute to general medical receiving but their specialist inpatient workload is dominated by treatment of patients with alcohol related disease. (44% in gastroenterology v 12% in general medicine). Inpatients with decompensated alcoholic liver disease form 37% of gastroenterology workload. Alcohol related disease contributes to delayed discharge in acute medical units, especially in gastroenterology wards. There are regional differences in prevalence of alcohol related disease, which is greatest in male inpatients in the West of Scotland. Here, alcoholic liver disease accounts for nearly a decompensated liver disease. The findings point to a need to review the current patterns of acute service provision for alcohol related illnesses, so as to assess and improve both the linical effectiveness and cost effectiveness of care, and to ensure that alternatives to acute hospital admission are available when appropriate. This need should not be neglected while efforts are simultaneously being made to improve the early detection of alcohol abuse and prevent irreversible alcohol related disease.

Alcohol-Related Disorders↗
PubMed2003

Temporal trends over ten years in formal inpatient gastroenterology consultations at an inner city hospital.

GOALS: Inpatient consultation is an important, but poorly understood, component of medical subspecialty practices. In a time when all services strive for cost-effective and efficient treatments, little is known about the epidemiology of inpatient subspecialty consultation. This study is designed to describe the nature and trends of formal inpatient gastroenterology consultations during the past decade. STUDY: All inpatient gastroenterology consultations at Grady Memorial Hospital in Atlanta, GA, in 1998 and 1988 were retrospectively reviewed. Percentages of inpatient gastroenterology consultations were calculated for each year accordingly. Top ten reasons for inpatient gastroenterology consultations were compared. RESULTS: Formal inpatient gastroenterology consultations have steadily increased in the past 10 years (2.8% of all admissions in 1988 to 4.8% in 1998, < 0.0001). Inpatient gastrointestinal endoscopic procedures have significantly increased over the past decade (30.9% of the total consultations in 1988 to 36.1% in 1998, = 0.008). The leading reasons for formal inpatient gastroenterology consultations in 1998 were hematemesis, abnormal liver tests, hematochezia, anemia, and melena. Consultations for abnormal liver tests have significantly decreased in the past 10 years (27% of the total consultations in 1988 to 16% in 1998, < 0.001). CONCLUSIONS: Formal inpatient gastroenterology consultations and inpatient gastrointestinal endoscopic procedures have significantly increased over the past 10 years, despite pressures to decrease costs of inpatient care. The main reason for formal inpatient gastroenterology consultations shifted from abnormal liver tests to gastrointestinal bleeding.

Endoscopy, Gastrointestinal↗
PubMed2001

Effects of an HMO hospitalist program on inpatient utilization.

OBJECTIVE: To assess the impact of a health maintenance organization (HMO) hospitalist program on inpatient utilization. PATIENTS: The study sample consisted of patients admitted to the hospital for a routine, uncomplicated acute surgical or medical diagnosis included under Milliman and Robertson's Optimal Recovery Guidelines (ORGs). Evaluation involved comparison of 2 physician management groups: inpatients managed by staff primary care physicians (PCPs) (study group) and inpatients managed by network PCPs (comparison group). STUDY DESIGN: Data before and after introduction of the hospitalist program were available. From the same period, data were available from patients of network PCPs who managed their own inpatient stays (nonhospitalist comparison sample). Three outcomes were used to represent inpatient utilization: (1) number of inpatient stays meeting ORG goals; (2) number of inpatient stays not meeting ORG goals that had > or =1 medically necessary days; and (3) number of inpatient stays not meeting ORG goals that had > or =1 medically unnecessary days. RESULTS: Multiple logistic regression results indicated that inpatient stays were more likely to be within ORG utilization goals when managed by hospitalists vs nonhospitalists (P < .05). Introduction of the hospitalist program reduced the number of stays with unnecessary days among staff inpatients. There was an increase in stays with unnecessary days in the comparison group, ie, inpatients managed by network physicians. CONCLUSIONS: Full-time hospitalists are efficient managers of HMO inpatients. The ORGs for acute, uncomplicated diagnoses provided useful hospital utilization measures that captured inpatient management by hospitalists and PCPs.

Adolescent↗
PubMed2002

HIV patients' experiences with inpatient and outpatient care: results of a national survey.

CONTEXT: Little is known about HIV patients' care experiences. OBJECTIVE: To assess HIV patients' experiences with inpatient and outpatient care, and to assess the relationship and relative influence of patient characteristics and site of care on care experiences. DESIGN: Cohort study. SETTING: Patients with HIV receiving care outside of emergency rooms, prisons, or the military throughout the continental United States. One thousand seventy-four patients provided ratings of an inpatient stay and 2204 rated an outpatient visit; 818 patients provided evaluations of both inpatient and outpatient care. PATIENTS: A national probability sample of persons in care for HIV from the HIV Cost and Services Utilization Study. MEASUREMENTS: Outcome variables were rates of problems with, and global ratings of, inpatient and outpatient care. RESULTS: Mean problem rates were 20.9% and 8.4% (lower score means fewer problems) for inpatient and outpatient care, respectively. On 9 of 10 of the individual inpatient report items, 15% or more of respondents reported problems. Global ratings of inpatient and outpatient care were 65.3 and 75.0 (0-100 scale, higher scores indicate better ratings), respectively. In multivariable models that controlled for site effects, the only patient characteristic that was consistently associated with problem rates and global ratings of care was mental health (P <0.0001 for both inpatient and outpatient care). Models including site effects explained two to four times as much variance as models excluding site effects. CONCLUSIONS: Inpatients with HIV reported higher problem rates with inpatient than outpatient care. Better provider-patient communication during inpatient stays is needed. For both inpatient and outpatient care, quality improvement efforts may be most productively focused on providers and processes of care at sites rather than on specific patient subgroups.

Adult↗
PubMed2006

The risk of malpractice litigation in care to head-injury patients in comparison with other high-risk patient groups: an inpatient-based epidemiological study in Taiwan.

BACKGROUND: The purpose of this study was to assess the risk of being sued in district courts for care for head-injury patients from the perspective of epidemiology. METHODS: This research was designed to be a retrospective population-based cohort study. We researched the incidences of litigations arising from head-injury inpatients under neurosurgical care, all neurosurgical inpatients, and birth inpatients in Taiwan, and computed their relative risks. The study period was from 1998 to 2002. RESULTS: The average annual incidence rate of becoming a plaintiff for head-injury neurosurgical inpatients was 15 per million; for all neurosurgical inpatients 11.8 per million; and for birth patients 33.5 per million. The relative risk comparing head-injured neurosurgical inpatients against all neurosurgical inpatients was 1.27; whereas comparing head-injury neurosurgical inpatients against birth inpatients was 0.45, and comparing all neurosurgical inpatients against birth inpatients, 0.35. CONCLUSIONS: The findings of our population-based study indicate that for the inpatient populations, whether head-injury patients or not, neurosurgeons in Taiwan are facing a relatively lower rate of litigation in comparison with those treating birth patients. Nonetheless, head-injury patients still pose a major challenge in the ED, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.

Brain Injuries↗
PubMed2003

An integrated inpatient therapy for type 1 diabetic females with bulimia nervosa: a 3-year follow-up study.

OBJECTIVE: To describe an "integrated inpatient therapy" for type 1 diabetic patients with recurrent binge eating and to assess its effectiveness for females with bulimia nervosa (BN). METHODS: At the first visit to our outpatient clinic for treatment of an eating disorder and diabetes, type 1 diabetic females with BN underwent single session "outpatient counseling." All patients then returned to the referring physician for further treatment and observation. None of the BN patients had the minimum expected 1% fall in HbA1c and all were therefore encouraged to undergo our "integrated inpatient therapy." However, only patients accepting inpatient treatment on their own volition were admitted. An "INPATIENT" group (n=9) consisted of those who underwent inpatient therapy and had a 3-year follow-up period after discharge. The clinical course was assessed by the HbA1c and BMI course and by comparison of psychological/behavioral factors between baseline and follow-up. For reference, the clinical course of a "NON-INPATIENT" group (n=10), who did not have the inpatient therapy for at least 2 years after first visit, was also assessed. RESULTS: The "INPATIENTs" had significantly lower HbA1c; lower psychological test scores related to eating disorder psychopathology, depressiveness, and anxiety-proneness; a reduced frequency and amount of binge eating; and fewer patients exhibited purging behaviors at follow-up than at first visit. At follow-up, seven (78%) "INPATIENTs" no longer fulfilled any criterion for clinical or subclinical eating disorders. The "NON-INPATIENTs" had no significant improvement. CONCLUSION: The findings give interesting insights into the possibilities of "integrated inpatient therapy" as an effective treatment for type 1 diabetic females with BN.

Adolescent↗