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PubMed1996

Trends of the characteristics and appropriateness of admissions to acute geriatric and medical wards in Italy from 1988 through 1993. Gruppo Italiano di Farmacovigilanza nell'Anziano--GIFA.

Recent modifications in the health care system in Italy reduced the number of inpatient care beds and limited the access to outpatient services while the proportion of older persons increased. To assess the burden of these changes on hospital care the characteristics of admissions to 35 acute geriatric wards and 31 internal medicine wards in Italy were studied between 1988 and 1993. All patients admitted during 4 months in 1988, 1 month in 1991 and 4 months in 1993 were enrolled in the study. The appropriateness of admission was assessed by means of the Appropriateness Evaluation Protocol criteria. The Charlson comorbidity index score was used to quantify comorbidity. Between 1988 and 1993, 18,790 patients were studied. The mean age increased from 67.9 +/- 0.2 to 71.7 +/- 0.2 years (p < 0.0001), the mean number of drugs taken during hospital stay increased from 5.2 +/- 0.0 to 5.5 +/- 0.0 drugs (p < 0.0001), the mean Charlson comorbidity index score increased from 1.33 +/- 0.02 to 1.50 +/- 0.03 (p < 0.0001) and the mean length of stay decreased from 17.6 +/- 0.2 to 16.1 +/- 0.2 days (p < 0.0001). The rate of appropriate admissions increased from 68.6% to 85.5% (p < 0.0001). Consistent results were found when the data were stratified according to gender and type of ward. It was concluded that in Italy, concurrently to an increased load of hospital care, inappropriate admissions diminished over time. These data show that the need for geriatric care is increasing.

Acute Disease↗

PubMed1991

Suicidal behavior among psychiatric outpatient children: an estimate of prevalence.

The prevalence of suicidal behaviors displayed by pre-adolescent psychiatric outpatients has been estimated to range between 25 percent and 33 percent of the outpatient population. The current study assessed suicidal behaviors displayed by 40 children aged 12 and younger who were evaluated in a psychiatric outpatient service. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 15 percent of the sample had recently engaged in some form of suicidal behavior and almost 3 percent had made a suicide attempt that was viewed as realistically endangering life.

Age Factors↗

PubMed1984

Correlates of success and lack of success in deinstitutionalization.

This is a case study of ninety-two patients served by an outpatient service of a state psychiatric hospital in a rural area in west central New York State. The purpose was to identify variables associated with success (tenure in the community) and lack of success (number of readmissions within last year and five years and one subsequent year). Using a stepwise multiple regression analysis, age and living with others were positively correlated with success and negatively correlated with rehospitalizations within one year. Over a five-year period, affective disorders, inconsistency in taking medication, and having a hobby were correlated with multiple hospitalizations. In the year following data collection, readmissions were related only to inconsistency in taking medication. Mental health practitioners are advised to carefully follow up persons at highest risk of returning to the hospital.

Adult↗

PubMed1988

Comparison of outpatient care of discharged state hospital and non-hospitalized psychiatric emergency room patients.

The present article compares a cohort discharged from two state hospitals in a large urban area with a cohort referred for outpatient services from a psychiatric emergency room. Both cohorts were referred into the same community mental health system of services. The two cohorts are examined in terms of clinical and social demographic characteristics, in part to consider how distinct the two populations appear to be. In addition, patterns of initial contact and the nature and amounts of community services received by each group are compared. Based on these comparisons, some conclusions are drawn regarding the way in which these two groups are served by the community system.

Adolescent↗

PubMed1986

Hôpital Albert Schweitzer and the Republic of Haiti.

The Hôpital Albert Schweitzer was established near the village of Deschapelles in Haiti in 1956 by Dr. and Mrs. William Larimer Mellon of Arizona. The hospital currently has 162 acute care beds and provides inpatient and outpatient services to a district of about 160,000 people. In 1983, visits to the hospital and its dispensaries totaled 39,163. Since its founding the hospital has evolved into a tertiary care facility but has also established primary care programs through seven satellite dispensaries. Health agents and midwives play an important role in the hospital's field programs. Outreach programs concentrate on health and nutrition education, immunizations, supplementary food programs, tuberculosis screening, oral rehydration for infants with diarrheal diseases and cord cutting clinics for the prevention of neonatal tetanus. This paper describes the principal causes of morbidity and mortality in this area of Haiti, the functioning of the hospital and both its medical and non-medical programs. The latter include agricultural irrigation and well digging projects, and wood working, weaving and ceramic facilities to encourage local artisans.

Community Health Services↗

PubMed1989

A cross-cultural comparison of mental health care delivery in Athens and Groningen.

Until recently mental health care in Greece was mainly delivered by old traditional mental hospitals and few outpatient services. In order to induce the process of change the University of Athens started to experiment with a community mental health service. In order to study what has been achieved in a relatively short time, data relating to the delivery of care cohorts of patients from a pilot area in Athens and from an area in the north of the Netherlands were compared. The overall new contact rate was much higher in the Groningen area, except for the category of psychoneuroses and personality disorders. Patients with a psychosis received more intensive treatment and left the services at a later stage in Athens. Differences of patterns of care in other diagnostic and age groups are discussed.

Adult↗

PubMed1994

Rehabilitative day treatment vs. supported employment: I. Vocational outcomes.

Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States. Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs. Empirical research directly comparing these two systems of organizing outpatient services is needed. In this study the authors compared a rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model. Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change (71 in the program that changed and 112 in the other) were evaluated during both intervals. In the program that changed, competitive employment improved from 25.4% to 39.4% for all clients, and from 33.3% to 55.6% for those clients who had been regular attenders of day treatment during the baseline. Hours worked and wages earned similarly improved after the program change. For all work variables, clients who had not worked during the baseline year accounted for the improvements in outcome. Meanwhile, employment remained stable in the day treatment program. No negative outcomes were detected. These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community.

Adolescent↗

PubMed1988

Diagnosis of diabetic polyneuropathy. Correlation between clinical and instrumental findings and assessment of simple diagnostic criteria.

In the present study minimal clinical and electrophysiological criteria for the diagnosis of diabetic polyneuropathy (DP) have been tested in 48 unselected subjects attending an outpatient service for diabetics at the University Hospital of Chieti. A standard electrophysiological examination was performed in all patients on the median nerve (sensory and motor), peroneal nerve and sural nerve. Depending on the importance of the laboratory values for each nerve, nerve conduction velocity, distal latency and potential amplitude were given separate scores ranging from 0.5 to 2. A diagnosis of probable DP was made when abnormal findings were present in more than one nerve with a total score of 2.5 or more. As a whole, 28 cases (58%) had abnormal laboratory findings supporting the diagnosis of probable DP. There was a relatively high correlation between probable DP and a positive clinical examination although the validity coefficients of the neurological exam were not high enough to allow its use as a screening test for DP.

Adolescent↗

PubMed1990

[Meniscus replacement using Hoffa's infrapatellar fat bodies--initial clinical results].

Between December 1986 and July 1988 a replacement of the absent medial meniscus was taken by means of the infrapatellar adipose body in seven patients. A replacement of the anterior cruciate ligament by means of the middle one third of the patellofemoral ligament was taken too. This operation was done for reconstruction of the synergism between the anterior cruciate ligament and the posterior horn of the medial meniscus. All patients are controlled in our special knee outpatient service. There were no complication postoperatively and on all seven patients a control arthroscopy was performed twelve months postoperatively. The subjective results are very satisfying because of the restoration of knee stability. The arthroscopic controls of the meniscal replacements, however, showed a reduction in size of the transplants after one year, the tissue was weak and not identical to that of a normal meniscus. Autologous strong tissue, e.g. quadriceps tendon, may have better presuppositions for meniscal replacement.

Adipose Tissue↗

PubMed1993

Survivors of motor vehicle trauma: an analysis of seat belt use and health care utilization.

OBJECTIVE: To determine whether the protective effects of seat belt use on acute injury are followed by corresponding reductions in outpatient health care utilization. DESIGN: Retrospective cohort analysis. SETTING: Northern California Region Kaiser Health Plan hospitals and medical offices. PATIENTS: All Kaiser Foundation Health Plan members injured in motor vehicle crashes in Santa Clara County during one year (total number of patients = 246). MEASUREMENTS AND MAIN RESULTS: 54% of the study participants had been wearing seat belts at the time of injury, and 46% had not been. The belted patients had fewer head injuries (30% vs 50%, p < 0.05), better mean Injury Severity Scale scores (4.3 vs 7.4, p < 0.05), and smaller mean hospital charges ($8,580 vs $16,209, p < 0.05). However, the effects of injury did not end upon discharge from the trauma center; the patients averaged about eight outpatient visits during the subsequent year, a rate almost double their prior use. In contrast to inpatient measures of utilization, the patients who had been wearing seat belts at the time of injury had more outpatient visits during the year after injury than had their unbelted counterparts (9.0 vs 7.1, p < 0.05). This discrepancy was not explained by differences in amounts of utilization during the year before injury, which were similar in the two groups (4.4 vs 4.8, p = NS). Overall, general internists provided the most follow-up care and accounted for the largest discrepancy in utilization between the belted and unbelted patients. CONCLUSIONS: Seat belt use does not result in lower utilization of follow-up outpatient services in the year following injury. However, the beneficial effects on acute care utilization more than offset the marginal effects on subsequent medical services utilization.

Accidents, Traffic↗

PubMed2005

Correlates of quality of life with epilepsy.

OBJECTIVE: To examine the quality of life of children with epilepsy and to identify the demographic, disease related, and behavioral and emotional functioning variables in the prediction of quality of life of children with epilepsy. METHOD: Forty three children aged 4 to 15 years (Mean=10.3 years) with epilepsy were recruited from the outpatient services of the Department of Pediatrics, of a tertiary care teaching hospital in North India. Quality of life was measured by Impact of Epilepsy Schedule, a 39 items parent reported questionnaire and child's emotional and behavioral functioning at home was assessed by the Childhood Psychopathology Measurement Schedule. RESULTS: Majority of the parents expressed major concerns regarding seizures, treatment by anticonvulsants, present and future problems for the child and problems in parenting. Nearly 40% of the children had psychopathology scores in the clinically significant maladjustment range. Step-wise multiple regression analysis revealed that the psychopathology scores and mother's education accounted for 39% of the variance in the quality of life scores. CONCLUSION: Children with epilepsy have a relatively compromised quality of life and focusing simply on control of seizures may not address the full range of child's emotional and behavioral difficulties.

Adaptation, Psychological↗

PubMed2004

Age-specific prevalence of hepatitis B surface antigen in pediatric population of Aligarh, North India.

OBJECTIVE: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age. METHODS: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. < 1, 1-4, 5-9 and 10-14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA. RESULTS: Overall 4.35% (95%CI, 2.44 - 6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1-4 year age category. In the < 1, 5-9 and 10-14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816). The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577). CONCLUSION: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44 - 6.25). The prevalence progressively increases and peaks in the 1- 4 years age group. It is least in 10-14 years age group.

Adolescent↗

PubMed2003

[Use of state-of-the-art ultrasound techniques in diagnosing sarcoidosis of the salivary glands (Heerfordt's syndrome)].

AIM: The parotid gland is a rare site of sarcoidosis (6% of all cases). The role of state-of-the-art ultrasound techniques in the diagnostic assessment of parotid sarcoidosis (Heerfordt's syndrome) is presented. PATIENTS AND METHODS: Four patients (three male, one female; aged 31-42 years) with inconclusive parotid swelling associated with fever and uveitis were referred for diagnostic assessment by the ENT outpatient service over a 1 year period. High-resolution ultrasound (US) was performed using the SONOLINE Elegra system with a 7.5-MHz wide-band transducer and various, special US techniques (tissue harmonic imaging, photopic imaging, color-coded duplex US, and power Doppler). Diagnoses were confirmed in all cases by puncture and histology. RESULTS: Two patients with typical lung findings (stage I and II sarcoidosis) and two patients without known sarcoidosis showed an inhomogeneous nodular appearance of the clinically enlarged salivary glands at US. Duplex US demonstrated hypervascularization in three cases and moderate, inhomogeneous vascularization in one. In comparison to plain B-mode scanning, optimal visualization of the hypodense, nodular, structural changes was achieved using contrast-enhancing techniques. All patients underwent US-guided puncture for determining the etiology of parotitis. Histology demonstrated granulomatous epitheloid cell inflammation. CONCLUSION: An inhomogeneous nodular appearance of the parenchyma of enlarged parotid glands with areas of hypervascularization, which is optimally depicted by state-of-the-art US techniques, should suggest Heerfordt's syndrome as a possible differential diagnosis.

Adult↗

PubMed2004

[Psychological stress and impaired quality of life in patients with tinnitus].

OBJECTIVES: The majority of patients with chronic decompensated forms of tinnitus have comorbid psychological disorders, possibly accompanied by restricted quality of life and participation in everyday activities. There is no standardized tool to measure these clinically relevant dimensions. SAMPLE AND METHOD: Both the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 (SF-36) were administered to a consecutive sample of patients ( n=110) who were recruited from the tinnitus outpatient service in the department of psychiatry and psychotherapy. Using the Tinnitus Questionnaire (TF), associations of the HADS and SF-36 scales with tinnitus grading were determined and the classification of patients (mild-medium-severe-very severe) was evaluated. RESULTS: A severe tinnitus grading is correlated to a high extent of anxiety and depression and a low quality of life. With the exception of the SF-36 subscale on physical functioning, all scales discriminated between the extreme groups (mild vs severe/very severe), but less between the two medium groups. CONCLUSIONS: Patients with severe decompensated tinnitus (grades III and IV) should be seen for diagnosis of psychiatric comorbidity and supportive psychotherapy/psychopharmacotherapy used when necessary.

Activities of Daily Living↗

PubMed1999

Determinants of psychiatric inpatient admission to general hospital psychiatric wards: an epidemiological study in a region of central Italy.

OBJECTIVE: To determine which factors contribute to the decision to admit individuals to psychiatric wards in general hospitals. METHOD: Data on 1,379 individuals undergoing psychiatric evaluation in eight emergency rooms in a region of central Italy were collected. A logistic regression analysis was used to evaluate the likelihood of psychiatric admission considering the independent effects of demographic, social, and clinical factors and of the history of psychiatric treatment. RESULTS: The adjusted odds ratio for psychiatric admission significantly increased with the following variables: severity of symptoms; presence of paranoid states and schizophrenic psychoses, affective psychoses and acute psychotic conditions (with neurotic disorders used as reference); a history of outpatient treatment; the presence of a staff member of a community mental health facility upon presentation at the emergency room; and the availability of beds in the psychiatric ward. CONCLUSION: The independent effect played by the presence of a staff member of a community mental health facility is of particular interest, suggesting the existence of a collaborative relationship between inpatient and outpatient services.

Adult↗

PubMed1999

Assessment of GABA(A)benzodiazepine receptor (GBzR) sensitivity in patients on benzodiazepines.

OBJECTIVES: To measure GABA(A) benzodiazepine receptor sensitivity in patients taking benzodiazepines and compare with matched controls. METHODS: Seven patients who were on prescribed benzodiazepines for an anxiety disorder or insomnia were recruited from general practice and an adult mental health service outpatient clinic. They were matched with seven volunteers. All subjects received an intravenous injection of midazolam 50 microgram/kg in 10 ml normal saline over 10 min. Objective responses to midazolam were assessed using saccadic eye movement velocity slowing and subjective assessments using visual analogue scales. Measurements were recorded for 120 min and plasma midazolam concentrations obtained at 15-min intervals post-infusion to 120 min. Ratios of pharmacodynamic/pharmacokinetic effects were obtained for each individual to estimate GABA(A) benzodiazepine receptor sensitivity. RESULTS: Patients had an attenuated response to midazolam on both subjective and objective measures. GABA(A) benzodiazepine receptor sensitivity was significantly reduced in the patient group. CONCLUSIONS: Chronic treatment with benzodiazepines was associated with reduced effects of midazolam. Saccadic eye movement velocity was especially sensitive as a measure of attenuated response.

Adult↗

PubMed2003

The role of a child life specialist in a pediatric radiology department.

Child life programming is predominantly developed in inpatient areas throughout major pediatric hospitals. However, the trend toward outpatient services has increased the need for facilities to develop child life positions to assist in the teaching demands of patients and families coming in for routine hospital visits. Since radiology is often the first experience for families, but not the last, it is essential to involve them in a positive experience. Imaging facilities serving pediatric patients are currently developing or considering child life programs. A certified child life specialist (CCLS) is committed to developing programming that enhances the child's understanding and involvement in their medical experience. This paper provides an outline of the responsibilities and areas of expertise of the CCLS in a pediatric radiology department. The reviewed program is based on, but not limited, to fluoroscopy.

Adolescent↗

PubMed2004

[Corneal infiltrates and ulcers. A retrospective study of 239 eyes].

PURPOSE: In our outpatient service the number of corneal infiltrates and ulcers associated with contact lens wear in young patients increased during the last years. Therefore we evaluated all patients with keratitis regarding to the reason. PATIENTS AND METHODS: From January 1999 to August 2000 the medical charts of 210 consecutive patients and 239 eyes were reviewed. We evaluated the percentage of contact lens wearers. Patient age, localisation and number of infiltrates, bacteria and healing results were also evaluated. RESULTS: In 134 of 239 eyes (56%) keratitis was caused by contact lenses, 127 eyes (53%) with soft lenses. The mean age of soft contact lens wearing patients was 28,2 +/-13,0 years. Mean age in other reasons was 46,0 +/-22,5 years. 71% (170 eyes) had single central infiltrates, 19% (45 eyes) multiple peripheral infiltrates and 10% (24 eyes) corneal ulcers. Bacteria were found in 33% (78 eyes). The most frequent isolated bacteria in non contact lens induced keratitis was staphylococcus aureus (22 eyes). In those eyes with soft contact lenses we found mostly gram negative bacteria such as serratia spp. (6 eyes), pseudomonas spp. (6 eyes), stenotrophomonas maltophilia (6 eyes) and klebsiella oxytoca (5 eyes). 20% (26 of 127 eyes) of contact lens induced corneal infection healed with a scar. CONCLUSION: Our analysis shows, that the major part of keratitis was induced by soft contact lenses. One fifth of these very young patients retained a corneal scar. There is a higher risk to suffer a keratitis when using soft contact lenses. This should influence especially patients information regarding choice and use of soft contact lenses.

Adult↗