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1.
Bratisl Lek Listy ; 120(10): 717-722, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31663344

RESUMO

INTRODUCTION: Sarcopenia is associated with a higher risk of adverse outcomes among hospitalized patients with chronic diseases. Currently, an unmet need lies in its low diagnostic yield. We conducted a pilot study with the aim to screen hospitalized patients for sarcopenia using the EWGSOP2 criteria. PATIENTS AND METHODS: A cross-sectional study among hospitalized patients in internal medicine was carried out, inclusion criteria: age>55, ability to stand-up from a chair. EXCLUSION CRITERIA: bed-bound, terminal stages of the disease, ICU stay. We measured hand-grip strength, fat-free mass by bioimpedance and short physical performance battery test (SPPB). Sarcopenia was diagnosed in low hand-grip strength and low muscle mass (EWGSOP2), severe sarcopenia in sarcopenic patients with low physical performance (SPPBT≤8). RESULTS: 40 patients were enrolled, sarcopenia was diagnosed in 8/20 (40%) men and 3/20 (15%) women (p=0.15), severe sarcopenia in 6/20 men (30%) and 2/20 (10%) women (p=0.24). 65% of men and 40% of women had SPPBT≤8, and 60% of men and 55% of women had gait speed≤0.8m/s. CONCLUSION: Among hospitalized internal medicine patients sarcopenia and severe sarcopenia are common, particularly in males. New diagnostic criteria provide a relatively simple and applicable tool for screening among internal medicine inpatients (Tab. 3, Ref. 25).


Assuntos
Pacientes Internados , Sarcopenia/diagnóstico , Estudos Transversais , Impedância Elétrica , Feminino , Análise da Marcha , Força da Mão , Humanos , Medicina Interna , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Projetos Piloto , Prevalência
3.
J Appl Lab Med ; 4(2): 137-139, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31639657
4.
Praxis (Bern 1994) ; 108(14): 923-930, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31662109

RESUMO

Integrated Complex Treatment for Extreme Anorexia Nervosa; An Interdisciplinary Treatment Concept of the University Hospital Zurich Abstract. The serious physical mental and psychosocial morbidity due to anorexia nervosa is often perceived by sufferers as less serious than from their environment. Doctors and other healthcare professionals are therefore confronted with the difficulty that urgent medical treatment is considered as unnecessary or even threatening by those affected. Although patients with anorexia nervosa usually wish to improve their condition, they are usually only able to tolerate treatment aimed at normalizing eating behavior and gaining weight in response to high external pressure. In view of this situation, an interdisciplinary team with experience in these treatments is required to treat these patients. Close cooperation is necessary to ensure a supporting treatment framework.


Assuntos
Anorexia Nervosa , Anorexia Nervosa/terapia , Terapia Combinada , Hospitais Universitários , Humanos , Pacientes Internados , Ganho de Peso
5.
Z Gerontol Geriatr ; 52(Suppl 4): 273-281, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31664583

RESUMO

BACKGROUND AND OBJECTIVE: Mobility decline and worsening of the cognitive status are all too often the result of acute hospital treatment in older patients. This is particularly pronounced in patients with pre-existing cognitive impairment. This study strived to analyze the routines of geriatric acute care and identify reasons and triggers for sedentary behavior during acute hospitalization of cognitively impaired inpatients. METHODS AND PATIENTS: A sample of 20 moderately cognitively impaired geriatric inpatients (average age 84 years) were recruited on an acute care ward. Information on persons attending the patient, daytime, location, context, patient's activity behavior and difficulty of action were collected by behavioral mapping over a period of 35 1­min timeslots and extrapolated to a period of 525 min. Routines were further analyzed via semi-structured interviews with five healthcare professionals (HCP). RESULTS: Relevant relations between various categorical and ordinal variables, such as patients' activity behavior, persons attending the patient, daytime, location, difficulty of action and contextual factors were found. Extrapolated data showed that patients spent 396.9 min (75%) in their room, 342.0 min (65%) were spent alone and 236.2 min (45%) lying in bed. The time patients spent alone was grossly underestimated by HCP. CONCLUSION: Time spent without company, lacking meaningful activities and continuous bedridden periods due to missing demands to leave the room might have led to time spent inactive and alone. These seem to be strong predictors for sedentariness. Routines of acute care should be reorganized to increase physical activity and thereby reduce sedentary behavior of this patient group.


Assuntos
Atividades Cotidianas , Disfunção Cognitiva/psicologia , Pacientes Internados/psicologia , Comportamento Sedentário , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Hospitalização , Humanos , Projetos Piloto
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 895-899, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484250

RESUMO

Objective: To conduct a viral pathogen surveillance program on pediatric inpatients less than five years old with acute gastroenteritis in Shanghai and to better understand the pathogenic spectrum and molecular features in the target population, for setting up programs on control, prevention, medication and vaccine applications of the diseases. Methods: Fecal samples were collected from inpatients less than 5 years old who were admitted to a pediatric hospital for having acute gastroenteritis. Information related to demographic, clinical and epidemiological features of the patients was also collected. Laboratory assays including ELISA, real-time PCR and nested PCR, were performed to detect the presence of pathogens as rotavirus, calicivirus, astrovirus and adenovirus. Results: A total of 1 018 samples were collected (male 671 and 347 female), with the positive detection rate as 40.57% which peaked from autumn till winter, annually. Calicivirus and rotavirus A presented with the highest detection rates (24.75% and 13.95% respectively). The lowest detection rate was found in the 0-6 month-olds (32.20%). 65% of the patients with positive virus had received antibiotic treatment prior to the hospitalization. However, no statistically significant difference was seen, regarding the rates of antibiotic medication in the virus positive or negative populations (P>0.05). Data from the Rotavirus genotype analysis revealed that G9P[8] genotype was the predominant strain, and causing majority of rotavirus infections in all the age groups. Conclusions: Among the inpatients under 5 years of age in Shanghai, the positive detection rate for Calicivirus was higher than that for rotavirus group A, suggesting the necessity to carefully monitor the changes regarding the pathogenic spectrum and subtypes of the virus. Antibiotics should also be attentively administered, together with the development of suitable vaccine.


Assuntos
Caliciviridae/isolamento & purificação , Fezes/virologia , Gastroenterite/virologia , Pacientes Internados/estatística & dados numéricos , Infecções por Rotavirus/diagnóstico , Rotavirus/isolamento & purificação , Doença Aguda , Pré-Escolar , China/epidemiologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Humanos , Lactente , Masculino , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia
7.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 911-916, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484253

RESUMO

Objective: To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China. Methods: From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria. Results: A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups. Conclusions: Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/diagnóstico , Influenza Humana/diagnóstico , Pacientes Internados/estatística & dados numéricos , Mycoplasma pneumoniae/isolamento & purificação , Infecções Respiratórias , Viroses/diagnóstico , Vírus/isolamento & purificação , Doença Aguda , Adolescente , Bactérias/genética , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , China/epidemiologia , Coinfecção/epidemiologia , Hospitalização , Humanos , Lactente , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Viroses/epidemiologia , Viroses/virologia , Vírus/genética
8.
Braz J Med Biol Res ; 52(9): e8204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482974

RESUMO

Sarcopenia remains poorly managed in clinical practice due to the lack of simple and accurate screening tools. This study aimed to identify the cutoff values of the SARC-F questionnaire and Ishii's score using the variables age, grip strength, and calf circumference in older inpatients in China to compare the accuracy of the two methods and to explore their predictive ability for adverse outcomes (rehospitalization, falls, fracture, and death). Hospitalized patients (n=138) aged ≥60 years were included. The accuracy of the two tools was evaluated using the reference diagnosis recommended by the Asian Working Group on Sarcopenia (assessing patients with measurements of muscle mass, handgrip strength, and usual gait speed). Follow-up data were obtained by telephone and clinical visits combined with the inpatient medical record system after discharge for at least one year. The results showed that the SARC-F score reached the highest Youden's index when a score of 3 was set as the cutoff value. Ishii's score presented a higher accuracy than SARC-F (area under the receiver operating curve: 0.78 vs 0.64, P=0.01). The Kaplan-Meier survival analysis demonstrated a higher cumulative incidence of rehospitalization in sarcopenic individuals compared to non-sarcopenic individuals according to SARC-F (log-rank test, P<0.001). Cox analysis revealed that SARC-F was an independent risk factor for rehospitalization (adjusted hazard ratio: 4.23, 95%CI: 2.12-9.79, P<0.001). The SARC-F and Ishii's scores might facilitate the early detection of sarcopenia and help identify older adults at risk for adverse outcomes in clinical practice.


Assuntos
Índice de Massa Corporal , Avaliação Geriátrica/métodos , Força da Mão/fisiologia , Sarcopenia/diagnóstico , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pacientes Internados , Estimativa de Kaplan-Meier , Masculino , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Sarcopenia/fisiopatologia
9.
Psychiatr Danub ; 31(Suppl 3): 354-356, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488752

RESUMO

BACKGROUND: Gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone (GBL) are popular drugs of abuse used for their euphoric, (potential) anabolic, sedative, and amnestic properties. Daily use of GHB/GBL can lead to addiction and the possibility of withdrawal syndrome on cessation which results in tremor, tachycardia, insomnia, anxiety, hypertension, delirium, coma. AIM: To describe the baseline characteristics, treatment and retention in patients admitted for GHB/GBL withdrawal management. METHODS: A retrospective review of 4 consecutive cases of patients reporting GHB/GBL addiction who were admitted for inpatient management of withdrawal syndrome. RESULTS: All patients were using GHB/GBL daily, 1-1.5 ml per hour. One of them was using cannabis additionally, others were using alcohol, cocaine and amphetamine type stimulants. Psychiatric comorbidities as personality disorders, depression, anxiety and bigorexia were recognized. Patients were treated with benzodiazepines and/or clomethiazole, atypical and typical antipsychotics and beta-blockers. Delirium was developed in two patients. One patient completed detoxification and finished the treatment program. One patient completed detoxification but stopped his treatment earlier, two patients did not completed detoxification and left the program. CONCLUSION: GHB/GBL withdrawal can be severe and retention in program is poor. Polysubstance use, psychiatric co-morbidities and heavier GHB/GBL use as possible predictors of poor treatment outcome need consideration in treatment planning.


Assuntos
4-Butirolactona/efeitos adversos , Oxibato de Sódio/efeitos adversos , Síndrome de Abstinência a Substâncias/terapia , 4-Butirolactona/metabolismo , Humanos , Pacientes Internados , Estudos Retrospectivos , Oxibato de Sódio/metabolismo
10.
Psychiatr Danub ; 31(Suppl 3): 462-466, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488773

RESUMO

Individuals with multiple disabilities can have a wide range of characteristics depending on the combination and severity of the disabilities, such as intellectual disability, mobility issues, sensorial impairment, language issues and brain injury. New technologies can help therapists find an alternative way to engage and interact with clients by opening a communication window and starting to build the therapeutic relationship. The need to use more customized technological tools led us to develop the Painteraction system, an intuitive tool based on Augmented Reality that allows clients to be immersed in their own images. Just by moving their bodies individuals are able to make drawings and receive visual feedback, both from themselves and their therapists, as it appears on the screen. The pilot testing of Painteraction was performed on 21 inpatients at Istituto Serafico (Assisi, Italy) with severe/multiple disabilities in order to explore and assess reaction and responsiveness in a semi-structured art therapy setting. The sample was formed by 14 males and 7 females (N=21) between the ages of 7 and 35. All participants attended three twenty-minute individual art therapy sessions which were approximately one week apart. Through direct and indirect (video recordings) observation of the sessions, it appeared that the specific Augmented Reality tool introduced in the art therapy setting was easily accepted by most of the clients involved and generally allowed the development of an interpersonal therapist-client relationship. The present study therefore gave us the opportunity to test new digital tools in the challenging setting of severe/multiple disabilities and observe the huge potential of new media to empower clients to express themselves and their creativity, and ultimately overcome mental and physical barriers. We propose that Augmented Reality tools are particularly well-suited to art therapy and create an equally suitable therapeutic environment to address specific client needs.


Assuntos
Terapia pela Arte/métodos , Pessoas com Deficiência/reabilitação , Deficiência Intelectual/reabilitação , Adolescente , Adulto , Criança , Feminino , Humanos , Pacientes Internados , Itália , Masculino , Adulto Jovem
11.
Psychiatr Danub ; 31(Suppl 3): 486-489, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488777

RESUMO

Mixed states are often underdiagnosed, with important consequences in terms of worsening prognosis, frequent admission to the hospital, higher suicide risk and poorer quality of life. For this reason, we analyzed retrospective data from patients admitted in the Psychiatric Hospital from January 1st to April 30th 2019 to identify clinical features of the mixed states by administering the G.T. MSRS scale. Within the 90 subjects of the sample, the large majority (75%) met criteria for mixed state. Of those only 16 were discharged with a diagnosis of Affective Disorder, however 26 (30.9%) were prescribed a mood stabilizer. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The scale can be a useful instrument to detect early in the course if the hospitalization the presence of mixed state, in order to guide a tailored psychopharmacological treatment, and improve prognosis.


Assuntos
Pacientes Internados/psicologia , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Unidade Hospitalar de Psiquiatria , Humanos , Transtornos do Humor/tratamento farmacológico , Prognóstico , Qualidade de Vida , Estudos Retrospectivos
12.
Psychiatr Danub ; 31(Suppl 3): 490-496, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488778

RESUMO

BACKGROUND: Differentiating Borderline Personality Disorder (BPD) from Bipolar Disorder (BD) represents a very difficult challenge for clinicians. Dysphoria could be a possible key to differentiate these disorders. We currently define dysphoria as a complex and disorganized emotional state with proteiform phenomenology, characterized by a multitude of symptoms. Among them irritability, discontent, interpersonal resentment and surrender prevail. These dimensions can be detected using the Neapen Dysphoria Scale - Italian version (NDS-I). Dysphoria role in BPD has been highlighted by the recent theorization of the Interpersonal Dysphoria Model, according to which dysphoria could represent the "psychopathological organizer" of the BPD. On the other side, dysphoria role in BD has not yet been established. This is simply considered as an aspect, and not fundamental, of the symptomatology characterizing BD, especially in mixed states patients. The phenomenological analysis of the dimensional spectrum of dysphoria within BPD and DB could provide a valuable aid in the differential diagnosis between BPD and BD. AIMS: The aim of this paper is to verify if the dimensional spectrum of dysphoria differs between Borderline Personality Disorder (BPD) and Bipolar Disorder Spectrum (BD) through an observational comparative study SUBJECTS AND METHODS: In this study, 65 adult patients, males and females between the ages of 18 and 65, were enrolled from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), Italy, from January 1st 2018 to April 30th 2019. We have formed 2 groups. A BPD group composed of 33 patients (19 female patients, representing approximately 57.6% of the sample) and a BD group composed of 32 patients (18 Female patients, representing approximately 56.2% of the sample). Patient's comorbid with BD and BPD have been excluded from the study. After a preliminary assessment to exclude organic and psychiatric comorbidity, and after at least 72 hours from hospitalization, we administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and their NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender); For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05. CONCLUSIONS: This study allowed us to explore and analyze dysphoria dimensions expressions in BPD and BD. Despite the small sample analyzed, the results show a significant different dimensional spectrum expression of the dysphoria between the two disorders. In particular, Irritability and Interpersonal Resentment dimensions show greater interest in BPD than BD spectrum. Further studies with a larger and stratified sample are needed to confirm these results.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Pacientes Internados/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Am J Occup Ther ; 73(5): 7305205050p1-7305205050p9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484029

RESUMO

IMPORTANCE: Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services. OBJECTIVE: To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status. DESIGN: Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period. MEASURES: Admission measures included the Inpatient Rehabilitation Facility-Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care-Revised was administered after discharge. RESULTS: Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge. CONCLUSION: and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research. WHAT THIS ARTICLE ADDS: This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.


Assuntos
Terapia Ocupacional , Adulto , Análise por Conglomerados , Hospitalização , Humanos , Pacientes Internados/estatística & dados numéricos , Avaliação de Resultados (Cuidados de Saúde) , Centros de Reabilitação , Resultado do Tratamento
14.
Tijdschr Psychiatr ; 61(8): 527-535, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31512736

RESUMO

BACKGROUND: In an era of patient centered care, the question rises whether practitioners of these patients are sufficiently aware of their treatment preferences.
AIM: To study the opinion and knowledge of older, long-term psychiatric patients about their medication and health priorities.
METHOD: Patients were interviewed with the Patient's Attitudes Towards Deprescribing questionnaire. Furthermore patients were asked to name their medication by heart, their health priorities and preferences in medication changes. These preferences were compared with those of their practitioners.
RESULTS: 47 patients (median age 67 years, median 11 drugs) were interviewed. The mean percentage of spontaneously recalled drugs was 37%. Though 64% believed all used drugs were necessary, 77% would like to deprescribe if the doctor said it was possible. Preferences in deprescribing of patients and doctors didn't correspond in about 80%.
CONCLUSION: Most of old psychiatric patients are willing to deprescribe, but await initiative of their doctor. They can recall little of their currently used drugs. Preferences in deprescribing of the patient and doctor do often not match. We recommend to include a patient interview about the need for education and treatment preferences in the annual medication reviews in order to deprescribe and deliver more patient centered care.


Assuntos
Antipsicóticos/uso terapêutico , Desprescrições , Transtornos Mentais/tratamento farmacológico , Preferência do Paciente , Assistência Centrada no Paciente , Idoso , Feminino , Humanos , Pacientes Internados , Masculino
15.
Tijdschr Psychiatr ; 61(8): 536-543, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31512737

RESUMO

BACKGROUND: Various measures aim to stimulate prosecution of violence and aggression against mental-health workers. Considering a possible increase of inpatient incidents through article 2.3 of the Bill Forensic Care, this is a desirable development. Mental health care and the judiciary seem to have opposing opinions whether the emphasis should lie on care or punishment in handling intramural offense.
AIM: To investigate which arguments judges apply in their trial of intramural incidents, to gain insight into the obstacles which impede awarding punishment during treatment, and to give recommendations for balancing the need for care and the need for punishment.
METHOD: A qualitatively thematic analysis based on semi-structured interviews with eight judges. Themes were based on relevant literature and case reports.
RESULTS: The majority of the judges considered judging intramural incidents complicated because of: 1. insufficient information on possible exclusion of guilt, 2. the fear that punishment will lead to recidivism, and 3. ambiguity on the impact of the crime on the victim. They emphasized that they needed more up-to-date information from the institution. Judges wanted to avert punishment as this may lead to discontinuity of care or worsening of the mental health of the suspect.
CONCLUSION: A verdict can also support a (clinical) mental health treatment. With the arrival of the 'bopz-brigades' (Law bopz: Law on Compulsory Admission to Psychiatric Hospitals) at the Public Prosecution Service, all relevant information from mental health care, police and Public Prosecution can be combined into a claim, leading to a verdict in which care and punishment serve each other optimally.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Crime , Psiquiatria Legal , Transtornos Mentais/terapia , Humanos , Pacientes Internados , Saúde Mental , Prisioneiros/psicologia
16.
Am J Psychother ; 72(3): 75-83, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31533453

RESUMO

In this article, a clinical protocol for delivering a flexible, spiritually integrated cognitive-behavioral therapy, called spiritual psychotherapy for inpatient, residential, and intensive treatment (SPIRIT), is presented, and its implementation is described.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Pacientes Internados/psicologia , Espiritualidade , Humanos
17.
Medicine (Baltimore) ; 98(37): e16814, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517812

RESUMO

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.Patients included in the National Inpatient Sample (NIS) database (2005-2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51-2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17-3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43-75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79-0.93).Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.


Assuntos
Fixação Interna de Fraturas , Côndilo Mandibular/lesões , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/cirurgia , Redução Aberta , Adulto , Comorbidade , Estudos Transversais , Feminino , Fixação Interna de Fraturas/economia , Custos de Cuidados de Saúde , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Pacientes Internados , Tempo de Internação/economia , Masculino , Fraturas Mandibulares/economia , Fraturas Mandibulares/epidemiologia , Redução Aberta/economia , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(37): e17131, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517851

RESUMO

Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000-2001 were recruited; their 2000-2001 and 2004-2005 data were considered baseline and postintervention data, respectively.Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ±â€Š0.35 days and 5.29 ±â€Š0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ±â€ŠNT$97.43, NT$3249.90 ±â€ŠNT$1108.27, NT$421.03 ±â€ŠNT$100.03, and NT$13,866.77 ±â€ŠNT$2,114.95 before GB system implementation to NT$2224.34 ±â€ŠNT$238.36, NT$4272.31 ±â€ŠNT$1466.90, NT$2217.03 ±â€ŠNT$672.20, and NT$22,856.41 ±â€ŠNT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ±â€Š2.7% and 8.3% ±â€Š2.4% before implementation to 6.3% ±â€Š2.2% and 4.0% ±â€Š1.7% after implementation.GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.


Assuntos
Orçamentos , Febre/economia , Febre/terapia , Hospitalização/economia , Medicina Estatal/economia , Adolescente , Feminino , Febre/epidemiologia , Febre/etiologia , Custos de Cuidados de Saúde , Humanos , Pacientes Internados , Masculino , Qualidade da Assistência à Saúde/economia , Fatores de Risco , Taiwan , Adulto Jovem
19.
Stud Health Technol Inform ; 264: 1627-1628, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438263

RESUMO

This study aims to review the literature evaluating the design, acceptance, use and usability of inpatient portals for family caregivers. Fourteen articles were included. Information about patient medication, lab results and healthcare team was most important. Most caregivers were satisified and perceived the ease of use and usefulnesss of portals. Further research is needed to collect sufficient evidence with regard to the impact of inpatient portals on patient engagement and quality of care.


Assuntos
Cuidadores , Portais do Paciente , Cuidados Críticos , Humanos , Pacientes Internados , Participação do Paciente
20.
Stud Health Technol Inform ; 264: 1650-1651, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438275

RESUMO

Wide spread of electronic medical records provide an opportunity to use time-variant longuitudinal data near real time. Hospital nurses would benefit greatly from the ability to use such data to predict adverse event risks of individual patient. We have developed an clinical decision support service to predict inpatient falling using machine learning and clinical big data approach. This study reports the initial responses of nurses to the service in an acute care setting.


Assuntos
Acidentes por Quedas , Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Humanos , Pacientes Internados , Aprendizado de Máquina
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