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Kistler EA, Gopalan PR, Gannon JM, Brar JS, Then J, Shenai N, Chengappa KNR. Long-acting injectable antipsychotic care coordination in the medical hospital. Gen Hosp Psychiatry 2024:S0163-8343(24)00087-2. [PMID: 38744539 DOI: 10.1016/j.genhosppsych.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Elizabeth A Kistler
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Priya R Gopalan
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jessica M Gannon
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jaspreet S Brar
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Janine Then
- Presbyterian Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Neeta Shenai
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - K N Roy Chengappa
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Triplett PT, Prince E, Bienvenu OJ, Gerstenblith A, Carroll CP. An Observational Study of Proactive and On-Request Psychiatry Consultation Services: Evidence for Differing Roles and Outcomes. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00038-7. [PMID: 38508493 DOI: 10.1016/j.jaclp.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Proactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce the length of stay and improve staff satisfaction. However, in some settings, it is impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future. Prior research has focused on changes in outcomes with the implementation of proactive services. OBJECTIVE AND METHODS This report describes differences between contemporary proactive and on-request services within the same academic medical center, comparing demographic and clinical data collected retrospectively from a 4-year period from the electronic medical record. RESULTS The proactive service saw patients over four times as many initial admissions (7592 vs. 1762), but transitions and handoffs between services were common, with 434 admissions involving both services, comprising nearly 20% of the on-request service's total contacts. The proactive service admissions had a shorter length of stay and a faster time to first psychiatric contact, and the patients seen were more likely to be female, of Black race, and to be publicly insured. There were over three times as many admissions to psychiatry from the proactive service. The on-request service's admissions had a longer length of stay, were much more likely to involve intensive care unit services, surgical services, and transfers among units, and the patients seen were more likely to die in the hospital or to be discharged to subacute rehabilitation. CONCLUSIONS Overall, the results suggest that the two services fulfill complementary roles, with the proactive service's rapid screening and contact providing care to a high volume of patients who might otherwise be unidentified and underserved. Simultaneously, the on-request service's ability to manage patients in response to consult requests over a much larger area of the hospital provided important support and continuity for patients with complex health needs. Institutions revising their consultation services will likely need to consider the best balance of these differing functions to address perceived demand for services.
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Affiliation(s)
- Patrick T Triplett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Elizabeth Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Avi Gerstenblith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Jaén-Moreno MJ, Rico-Villademoros F, Ruiz-Rull C, Laguna-Muñoz D, Del Pozo GI, Sarramea F. A Systematic Review on the Association between Schizophrenia and Bipolar Disorder with Chronic Obstructive Pulmonary Disease. COPD 2023; 20:31-43. [PMID: 36655855 DOI: 10.1080/15412555.2022.2154646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A systematic review aimed to investigate the association between schizophrenia and bipolar disorder and chronic obstructive pulmonary disease (COPD), its prevalence and incidence, potential factors associated with its occurrence and its impact on mortality among these patients. We performed the literature search in PubMed, Scopus and PsycInfo from inception to February 2022 and identified 19 studies: ten cross-sectional, 5 that included cross-sectional and longitudinal analyses, and 4 retrospective cohort studies. The reported prevalence of COPD ranged from 2.6% to 52.7% in patients with schizophrenia and between 3.0% and 12.9% in patients with bipolar disorder. Two studies reported an annual incidence of COPD of 2.21 cases/100 person-years in patients with schizophrenia and 2.03 cases/100 person-years in patients with bipolar disorder. Among the risk factors evaluated in three studies, only advanced age was consistently associated with the presence/occurrence of COPD in patients with schizophrenia and bipolar disorder; the role of tobacco consumption was not investigated in those three studies. According to two studies, the likelihood of mortality from COPD showed an over 3-fold increase in patients with schizophrenia and a 2-fold increase in those with bipolar disorder compared to the overall population; COPD was also associated with increased inpatient mortality. Available data indicate that COPD in patients with schizophrenia and bipolar disorder is a major public health problem. National and international health organizations should strive to specifically address this issue by creating awareness about this health problem and developing specific programs for screening and early intervention aimed to reduce the burden of COPD in these populations.
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Affiliation(s)
- María José Jaén-Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
| | | | - Cristina Ruiz-Rull
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Medicina Familiar y Comunitaria, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - David Laguna-Muñoz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Gloria Isabel Del Pozo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fernando Sarramea
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Morfológicas y Sociosanitarias, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain.,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain
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Suetani S, Honarparvar F, Siskind D, Hindley G, Veronese N, Vancampfort D, Allen L, Solmi M, Lally J, Gaughran F, Stubbs B, Pillinger T. Increased rates of respiratory disease in schizophrenia: A systematic review and meta-analysis including 619,214 individuals with schizophrenia and 52,159,551 controls. Schizophr Res 2021; 237:131-140. [PMID: 34521040 DOI: 10.1016/j.schres.2021.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Despite respiratory disease being a major cause of excess mortality in people with schizophrenia, the prevalence of respiratory conditions in this population is poorly defined. A systematic review and meta-analysis were conducted to establish the prevalence and association of respiratory diseases in people with schizophrenia. MATERIAL AND METHODS Major electronic databases were searched from inception to 27 April 2020 for articles reporting respiratory disease (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, and tuberculosis) in people with schizophrenia and, where possible, a control group. A random-effects meta-analysis was conducted. The study was registered with PROSPERO (CRD42018115137). RESULTS Of 1569 citations, 21 studies consisting of 619,214 individuals with schizophrenia and 52,159,551 controls were included in the meta-analysis. Compared to the general population, people with schizophrenia had significantly higher rates of COPD (odds ratio [OR]: 1.82, 95% CI: 1.28-2.57), asthma (OR: 1.70, 95% CI: 1.02-2.83), and pneumonia (OR: 2.62, 95% CI: 1.10-6.23). In people with schizophrenia, the prevalence of COPD was 7.7% (95% CI: 4.0-14.4), asthma 7.5% (95% CI: 4.9-11.3), pneumonia 10.3% (95% CI 5.4-18.6), and tuberculosis 0.3% (95% CI 0.1 -0.8). After adjusting for publication bias, the prevalence of COPD increased to 19.9% (95% CI: 9.6-36.7). DISCUSSION All respiratory diseases examined were significantly more prevalent in people with schizophrenia compared with the general population. Future studies should focus on improving the prevention and management of respiratory disease in this group to reduce associated excess mortality.
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Affiliation(s)
- Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD 4076, Australia; Queensland Brain Institute, The University of Queensland, St Lucia, QLD 4072, Australia; Metro South Addiction and Mental Health Services, Woolloongabba, QLD 4102, Australia; School of Medicine, Griffith University, Nathan, QLD 4111, Australia; Institute for Urban Indigenous Health, Windsor, QLD 4030, Australia
| | - Faraz Honarparvar
- School of Medicine, The University of Queensland, Herston, QLD 4102, Australia
| | - Dan Siskind
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD 4076, Australia; Metro South Addiction and Mental Health Services, Woolloongabba, QLD 4102, Australia; School of Medicine, The University of Queensland, Herston, QLD 4102, Australia
| | - Guy Hindley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90100 Palermo, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Lauren Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Marco Solmi
- Department of Neuroscience, University of Padova, Padova, Italy; Padua Neuroscience Center, University of Padova, Padova, Italy
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Brendon Stubbs
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom.
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
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Weissinger GM, Brooks Carthon JM, Ahmed C, Brawner BM. Experiences of Hospitalization of Patients With Psychotic Disorders on Medical-Surgical Units: A Thematic Analysis. J Am Psychiatr Nurses Assoc 2021; 27:306-321. [PMID: 31795792 PMCID: PMC9254133 DOI: 10.1177/1078390319892313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND:Individuals with psychotic disorders are more likely to have nonpsychiatric hospitalizations than the general population. Moreover, they experience worse outcomes in terms of rehospitalization, adverse events, in-hospital mortality, and longer length of stay. AIM: A patient-centered understanding of inpatient medical-surgical hospitalization experiences could shed light on disparities in hospital outcomes among individuals with psychotic disorders. METHOD: This article reports findings from Phase 1 (Qualitative) of a mixed methods, exploratory sequential study of nonpsychiatric hospitalizations of patients with psychotic disorders. Patients on medical-surgical units with diagnosed psychotic disorders (n = 20) were interviewed about their experiences of hospitalization, and a thematic analysis was conducted of transcripts, case notes, and setting notes. RESULTS: Five themes emerged from analysis: (1) managing through hard times (subthemes: intense emotions, medically complex with many symptoms, strategies for self-management), (2) ignored and treated unfairly, (3) actively involved in health (subthemes: seeking health education, suggesting changes), (4) appreciation of caring providers, and (5) violence: expected and enacted. Participants connected the difficult nature of their hospitalization experiences with a variety of sources and outcomes, including strong emotions, variable relationships with providers and a struggle to receive health education. CONCLUSIONS: Nurses who care for patients with psychotic disorders in medical-surgical settings can better meet patients' needs by concentrating on relationship building, especially during initial interactions, and helping patients better manage their medical and psychiatric symptoms through both pharmaceutical and nursing interventions.
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Affiliation(s)
- Guy M Weissinger
- Guy M. Weissinger II, MPhil, PhD, RN, Drexel University, Philadelphia, PA, USA
| | - J Margo Brooks Carthon
- J. Margo Brooks Carthon, PhD, RN, FAAN, University of Pennsylvania, Philadelphia, PA, USA
| | - Charisse Ahmed
- Charisse Ahmed, BSN, University of Pennsylvania, Philadelphia, PA, USA
| | - Bridgette M Brawner
- Bridgette M. Brawner, MDiv, PhD, APRN, University of Pennsylvania, Philadelphia, PA, USA
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6
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Weissinger GM, Carthon JMB, Brawner BM. Non-psychiatric hospitalization length-of-stay for patients with psychotic disorders: A mixed methods study. Gen Hosp Psychiatry 2020; 67:1-9. [PMID: 32866772 PMCID: PMC7722147 DOI: 10.1016/j.genhosppsych.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with psychotic disorders experience higher rates of chronic and acute non-psychotic diseases and have frequent non-psychiatric hospitalizations which result in both longer and more varied length-of-stay (LoS) than other patients. This study seeks to use a patient-centered perspective to examine LoS. METHODS This article reports Phase Two of a mixed methods, exploratory sequential study on non-psychiatric hospitalizations for individuals with psychotic disorders. Patients' experiences were used to guide a quantitative analysis of LoS using a general linear model. RESULTS Medical comorbidities were the patient characteristics which had the largest effect on LoS. Certain processes of care highlighted by patients from Phase One were also associated with longer LoS, including: physical restraints (105%), psychiatric consults (20%) and continuous observation (133%). Only recent in-system outpatient appointments were associated with shorter LoS. Data integration highlighted that factors which were important to patients such as partner support, were not always quantitatively significant, while others like medical comorbidities and use of physical restraints were points of congruence. CONCLUSIONS Medical comorbidities were highly associated with LoS but processes relating to longer LoS are those that are used to manage symptoms of acute psychosis. Clinicians should develop policies and procedures that address psychosis symptoms effectively during non-psychiatric hospitalizations. Further research is needed to understand which patients with psychotic disorders are at highest risk of extended length-of-stay.
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Affiliation(s)
- Guy M Weissinger
- Drexel University, College of Nursing and Health Professions, 3020 Market Street, Suite 510, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America.
| | - J Margo Brooks Carthon
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
| | - Bridgette M Brawner
- University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, United States of America
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Cheraghi-Sohi S, Panagioti M, Daker-White G, Giles S, Riste L, Kirk S, Ong BN, Poppleton A, Campbell S, Sanders C. Patient safety in marginalised groups: a narrative scoping review. Int J Equity Health 2020; 19:26. [PMID: 32050976 PMCID: PMC7014732 DOI: 10.1186/s12939-019-1103-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/27/2019] [Indexed: 12/05/2022] Open
Abstract
Background Marginalised groups (‘populations outside of mainstream society’) experience severe health inequities, as well as increased risk of experiencing patient safety incidents. To date however no review exists to identify, map and analyse the literature in this area in order to understand 1) which marginalised groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for such groups and 3) what contributes to or is associated with these safety issues arising. Methods Scoping review. Systematic searches were performed across six electronic databases in September 2019. The time frame for searches of the respective databases was from the year 2000 until present day. Results The searches yielded 3346 articles, and 67 articles were included. Patient safety issues were identified for fourteen different marginalised patient groups across all studies, with 69% (n = 46) of the studies focused on four patient groups: ethnic minority groups, frail elderly populations, care home residents and low socio-economic status. Twelve separate patient safety issues were classified. Just over half of the studies focused on three issues represented in the patient safety literature, and in order of frequency were: medication safety, adverse outcomes and near misses. In total, 157 individual contributing or associated factors were identified and mapped to one of seven different factor types from the Framework of Contributory Factors Influencing Clinical Practice within the London Protocol. Patient safety issues were mostly multifactorial in origin including patient factors, health provider factors and health care system factors. Conclusions This review highlights that marginalised patient groups are vulnerable to experiencing a variety patient safety issues and points to a number of gaps. The findings indicate the need for further research to understand the intersectional nature of marginalisation and the multi-dimensional nature of patient safety issues, for groups that have been under-researched, including those with mental health problems, communication and cognitive impairments. Such understanding provides a basis for working collaboratively to co-design training, services and/or interventions designed to remove or at the very least minimise these increased risks. Trial registration Not applicable for a scoping review.
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Affiliation(s)
- Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England. .,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Gavin Daker-White
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Lisa Riste
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Sue Kirk
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Bie Nio Ong
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Keele University, Citylabs, Nelson St, Manchester, M13 9NQ, England
| | - Aaron Poppleton
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL,, England.,Centre for Primary Care, The University of Manchester, Williamson Building, Oxford Rd, Manchester, M13 9PL, England.,NIHR School for Primary Care Research, Citylabs, Nelson St, Manchester, M13 9NQ, England.,Health Innvoation Manchester, Citylabs, Nelson St, Manchester, M13 9NQ, England
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8
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Patient-related factors associated with an increased risk of being a reported case of preventable harm in first-line health care: a case-control study. BMC FAMILY PRACTICE 2020; 21:20. [PMID: 31996137 PMCID: PMC6990540 DOI: 10.1186/s12875-020-1087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022]
Abstract
Background Patient safety issues in primary health care and in emergency departments have not been as thoroughly explored as patient safety issues in the hospital setting. Knowledge is particularly sparse regarding which patients have a higher risk of harm in these settings. The objective was to evaluate which patient-related factors were associated with risk of harm in patients with reports of safety incidents. Methods A case–control study performed in primary health care and emergency departments in Sweden. In total, 4536 patients (cases) and 44,949 controls were included in this study. Cases included patients with reported preventable harm in primary health care and emergency departments from January 1st, 2011 until December 31st, 2016. Results Psychiatric disease, including all psychiatric diagnoses regardless of severity, nearly doubled the risk of being a reported case of preventable harm (odds ratio, 1.96; p < 0.001). Adjusted for income and education there was still an increased risk (odds ratio, 1.69; p < 0.001). The preventable harm in this group was to 46% diagnostic errors of somatic disease. Conclusion Patients with psychiatric illness are at higher risk of preventable harm in primary care and the emergency department. Therefore, this group needs extra attention to prevent harm.
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Kowal C, Peyre H, Amad A, Pelissolo A, Leboyer M, Schürhoff F, Pignon B. Psychotic, Mood, and Anxiety Disorders and Venous Thromboembolism: A Systematic Review and Meta-Analysis. Psychosom Med 2020; 82:838-849. [PMID: 32947580 DOI: 10.1097/psy.0000000000000863] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies have shown that psychiatric disorders can be associated with venous thromboembolism (VTE) risk, that is, pulmonary embolism (PE) and/or deep vein thrombosis (DVT). In this study, we provide a systematic review and meta-analyses of the studies addressing this issue. METHODS All studies addressing the risk of VTE phenomena (whole VTE, PE, DVT, fatal VTE) in individuals with psychotic, mood, and anxiety disorders published between 1998 and 2019 were reviewed and included in the meta-analyses. Main characteristics of the studies and data concerning VTE risk were extracted. The methodological qualities of the studies were also analyzed. A random-effects meta-analysis model was used. A meta-analysis was conducted separately for each disorder, as well as separately for unadjusted and adjusted studies. Meta-analyses were repeated considering only good-quality studies. Heterogeneity was assessed. RESULTS Sixteen studies were reviewed and 15 included in the meta-analyses. Psychotic and bipolar disorders were significantly associated with VTE risk (VTE, DVT, PE, and fatal VTE for psychotic disorder: odds ratios [ORs] between 1.29 and 2.20; VTE, DVT, and PE for bipolar disorder: ORs between 1.22 and 2.14). Depression and anxiety disorders were associated with VTE risk only in adjusted analyses (DVT and PE for depression: ORs = 1.29; VTE and PE for anxiety disorders: ORs between 1.14 and 1.49). CONCLUSIONS The risk of VTE among individuals with psychiatric disorders may be explained by hypercoagulability and stasis, with both being related to, and independent of, treatment adverse effects. VTE risk should be taken into consideration in the treatment for people with psychiatric disorders.
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Affiliation(s)
- Célia Kowal
- From the AP-HP, GH Henri Mondor (Kowal), Service de pharmacie, Créteil; AP-HP, Hôpital universitaire Robert Debré (Peyre), Service de pédopsychiatrie, Paris; AP-HP, DMU IMPACT, GH Henri Mondor (Pelissolo, Leboyer, Schürhoff, Pignon), Service de Psychiatrie; Inserm, U955, team 15 (Pelissolo, Leboyer, Schürhoff, Pignon); Fondation FondaMental (Pelissolo, Leboyer, Schürhoff, Pignon); UPEC, Université Paris-Est Créteil Faculté de médecine (Pelissolo, Leboyer, Schürhoff, Pignon), Créteil; Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, and CHU Lille (Amad), Pôle de Psychiatrie, Unité CURE; Fédération régionale de recherche en santé mentale (F2RSM) Hauts-de-France (Amad), Lille, France; and Institute of Psychiatry, Psychology and Neuroscience (Amad), College London, London, United Kingdom
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10
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Triplett P, Carroll CP, Gerstenblith TA, Bienvenu OJ. An evaluation of proactive psychiatric consults on general medical units. Gen Hosp Psychiatry 2019; 60:57-64. [PMID: 31330383 DOI: 10.1016/j.genhosppsych.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Recent studies have shown an association between proactive psychiatric consultation on medical units and shorter length of stay. The aim of this study was to assess the impact of implementing a proactive psychiatric consult service on general medical units in an urban teaching hospital on length of stay and qualitative measurement of satisfaction of adequacy of psychiatric services. METHODS Bivariate and multivariate analyses of demographic, clinical and outcome data were performed comparing patients seen by the proactive psychiatric consult team, patients seen contemporaneously on other general medical units by a traditional, reactive consult team and patients seen the prior year on the proactive intervention units by the reactive consult team. Length of stay was the primary outcome examined. Regression modeling was performed to assess further the relationship of length of stay with the three groups. Nursing and physician staff were queried before and after intervention regarding satisfaction with psychiatric resources on the intervention units. RESULTS Patients seen by the proactive team had shorter length of stay than those seen by contemporaneous reactive consult team (p = 0.005) or the prior year by the reactive team on the intervention units (p = 0.005). There was no significant difference between the latter two groups. Time to consult was also shorter for patients seen through the proactive model than the reactive model on other units at the same time (0.01) or the preceding year (<0.001). Nursing and physician satisfaction with psychiatric help increased significantly in three of four measures. CONCLUSIONS Proactive psychiatric consultation in our study correlated with shorter time to consult, shorter length of stay, and improved staff satisfaction compared to a reactive consult model.
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Affiliation(s)
- Patrick Triplett
- Johns Hopkins University School of Medicine, United States of America.
| | - C Patrick Carroll
- Johns Hopkins University School of Medicine, United States of America
| | | | - O Joseph Bienvenu
- Johns Hopkins University School of Medicine, United States of America
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Gribben JL, Ilonzo N, Neifert S, Hubert M, Leitman IM. Characteristics and Outcomes of Abdominal and Pelvic Trauma Patients With Psychiatric Illness. J Surg Res 2019; 243:440-446. [PMID: 31279984 DOI: 10.1016/j.jss.2019.05.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/15/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The association between psychiatric illness and outcomes in trauma patients in general has only recently been investigated. The aim of this study was to describe the unique characteristics, risk factors, and outcomes of patients with comorbid psychiatric illness and penetrating abdominal and pelvic injuries. MATERIALS AND METHODS This was a retrospective review of trauma patients with open injuries to the abdomen and pelvis identified in the 2010-2015 the American College of Surgeons Trauma Quality Improvement Program database. Baseline variables extracted included demographics, comorbidities, including a discrete "psychiatric illness" variable that preexisted in the database, and injury information. Outcome variables collected included in-hospital mortality, length of stay and intensive care unit stay, and complications. Categorical variables were analyzed using chi-square and Fisher's exact test. Logistic regression was used to assess independent predictors for mortality with odds ratios (ORs) and 95% confidence intervals (CIs) constructed about group differences. RESULTS There were 22,053 patients identified, 6.1% of whom were diagnosed with a psychiatric comorbidity. Patients with psychiatric illnesses were more likely to be aged ≥65 y (5.4% versus 3.2%, P < 0.0001), female (25.4% versus 12.4%, P < 0.0001), and have other comorbidities. Their injuries were more likely to be self-inflicted (34.9% versus 4.9%) and of a cut or piercing mechanism (33.7% versus 24.1%). Psychiatric comorbidity was an independent predictor of intensive care unit admission (OR 1.32, 95% CI 1.14-1.53) and was independently associated with decreased odds of mortality (OR 0.42, 95% CI 0.32-0.55) despite increased complication rates. CONCLUSIONS The presence of a psychiatric comorbidity may be independently associated with trauma patients' complications and outcomes. Patients with psychiatric comorbidities have a unique set of risk factors and health needs that must be recognized and addressed by multidisciplinary care teams.
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Affiliation(s)
- Jeanie L Gribben
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Ilonzo
- Department of Surgery, Mount Sinai St. Luke's, New York, New York
| | - Sean Neifert
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maya Hubert
- Department of Psychiatry, Mount Sinai St. Luke's, New York, New York
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
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Brunero S, Ramjan LM, Salamonson Y, Nicholls D. Generalist health professional's interactions with consumers who have a mental illness in nonmental health settings: A systematic review of the qualitative research. Int J Ment Health Nurs 2018; 27:1634-1649. [PMID: 29749009 DOI: 10.1111/inm.12472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Abstract
Generalist health professionals (GHPs) or those healthcare professionals working in nonmental health facilities are increasingly being required to provide care to consumers with a mental illness. The review aimed to synthesize the qualitative research evidence on the meanings and interpretations made by GHPs (nonmental health professional) who interact with consumers with mental illness in nonmental health settings. A systematic review of the qualitative literature was undertaken for the years 1994-2016. The following electronic databases were searched: CINAHL, MEDLINE, PsycINFO, and Sociological Abstracts. Using narrative synthesis methods, the following themes were identified: mental health knowledge (the GHPs' knowledge level about mental illness and how this impacts their experiences and perceptions); GHPs perceive mental illness as a safety risk (GHPs concern over harm to the consumer and themselves); organizational support (the system response from the environmental design, and expert support and care); and emotional consequences of care (the feelings expressed by GHPs based on their experiences and perceptions of consumers). The results suggest that GHPs provide care in a setting which consists of multiple understandings of what care means. Efforts beyond educational initiatives such as organizational and system-level changes will need to be implemented if we are to progress care for this consumer group.
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Affiliation(s)
- Scott Brunero
- Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Daniel Nicholls
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
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Abstract
RATIONALE Sciatic neuropathy has various causes; however, cases in which a pressure ulcer led to sciatic neuropathy have not been reported to date. PATIENT CONCERNS A 33-year-old woman with no pre-existing mobility problems visited our department with the chief complaint of an extensive pressure ulcer and necrosis in her right buttock. She had a medical history of being bedridden for 2 days while in a coma due to a drug overdose 2 months previously. Physical examination revealed loss of sensation and foot drop in the right foot. DIAGNOSIS Physical examination, magnetic resonance imaging, and nerve conduction studies were conducted; the patient was diagnosed with a common peroneal branch injury of the right sciatic nerve. INTERVENTIONS The necrotic tissue was debrided and sciatic nerve decompression was performed, followed by frequent dressing changes. In addition, psychiatric treatment and physical therapy were performed simultaneously. OUTCOMES The pressure ulcer decreased in size and healed to some extent with granulation tissue. However, gait disorders, accompanied by symptoms of sciatic neuropathy, continued. The patient was transferred to the department of gastroenterology for the treatment of toxic hepatitis, which occurred during her inpatient treatment. LESSONS Physicians should be aware that sciatic neuropathy may occur during the treatment of patients with a pressure ulcer who exhibit no symptoms of paraplegia or quadriplegia. To prevent neuropathy, aggressive treatment of the pressure ulcer is necessary.
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Reeves E, Henshall C, Hutchinson M, Jackson D. Safety of service users with severe mental illness receiving inpatient care on medical and surgical wards: A systematic review. Int J Ment Health Nurs 2018; 27:46-60. [PMID: 29318771 DOI: 10.1111/inm.12426] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 11/28/2022]
Abstract
This review aimed to synthesize the evidence on the likelihood of harm and mortality on medical and surgical inpatient wards for people with severe mental illness (SMI). From 937 results identified through database searching, and a further 10 papers identified through citation searching and hand searching, 11 papers met the criteria for inclusion in the final review. This review did not find strong evidence for higher in-hospital mortality in people with SMI. There was evidence that adverse events are higher in people with SMI. A higher likelihood of emergency instead of planned care, and poorer access to treatment were identified as potential contributing factors to these adverse events. In addition, service users with SMI were more likely to have a longer length of stay, associated with a higher cost of care. The severity of the mental illness increased the likelihood of harm or death, and people with schizophrenia were more likely than people with other mental illnesses to experience these adverse outcomes. There is evidence that people with SMI are provided with lower-quality health care, whereas higher-quality, better-planned care is required to overcome the inequalities in access faced by this vulnerable population.
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Affiliation(s)
- Ella Reeves
- Oxford Institute of Nursing, Midwifery and Allied Health Research - OxINMAHR, Oxford Brookes University, Oxford, UK
| | - Catherine Henshall
- Oxford Institute of Nursing, Midwifery and Allied Health Research - OxINMAHR, Oxford Brookes University, Oxford, UK
| | | | - Debra Jackson
- Oxford Institute of Nursing, Midwifery and Allied Health Research - OxINMAHR, Oxford Brookes University, Oxford, UK.,University of Technology, Sydney, New South Wales, Australia
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Quality indicators in the treatment of patients with depression, bipolar disorder or schizophrenia. Consensus study. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2018; 11:66-75. [PMID: 29317210 DOI: 10.1016/j.rpsm.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/18/2017] [Accepted: 09/18/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. MATERIAL AND METHOD Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. RESULTS Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. CONCLUSIONS This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives.
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Patient, Provider, and System Factors Contributing to Patient Safety Events During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. J Nerv Ment Dis 2017; 205:495-501. [PMID: 28557885 PMCID: PMC5559891 DOI: 10.1097/nmd.0000000000000675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to explore patient-, provider-, and system-level factors that may contribute to elevated risk of patient safety events among persons with serious mental illness (SMI). We conducted a medical record review of medical/surgical admissions in Maryland hospitals from 1994 to 2004 for a community-based sample of adults with SMI (N = 790 hospitalizations). We estimated the prevalence of multiple patient, provider, and system factors that could influence patient safety among persons with SMI. We conducted a case crossover analysis to examine the relationship between these factors and adverse patient safety events. Patients' mental status, level of consciousness, disease severity, and providers' lack of patient monitoring, delay/failure to seek consultation, lack of trainee supervision, and delays in care were positively associated with adverse patient safety events (p < 0.05). Efforts to reduce SMI-related patient safety risks will need to be multifaceted and address both patient- and provider-level factors.
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Townsend LL, Esquivel MM, Uribe-Leitz T, Weiser TG, Maggio PM, Spain DA, Tennakoon L, Staudenmayer K. The prevalence of psychiatric diagnoses and associated mortality in hospitalized US trauma patients. J Surg Res 2017; 213:171-176. [DOI: 10.1016/j.jss.2017.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 01/12/2017] [Accepted: 02/16/2017] [Indexed: 01/23/2023]
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Daumit GL, McGinty EE, Pronovost P, Dixon LB, Guallar E, Ford DE, Cahoon EK, Boonyasai RT, Thompson D. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. Psychiatr Serv 2016; 67:1068-1075. [PMID: 27181736 PMCID: PMC5048490 DOI: 10.1176/appi.ps.201500415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. METHODS Medical record review was conducted for medical-surgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. RESULTS A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3-1.7) and procedure-related events (OR=1.6, CI=1.2-2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4-10.3). CONCLUSIONS Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness.
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Affiliation(s)
- Gail L Daumit
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Emma E McGinty
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Peter Pronovost
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Lisa B Dixon
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Eliseo Guallar
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Daniel E Ford
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Elizabeth K Cahoon
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Romsai T Boonyasai
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - David Thompson
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
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Hilger H, von Beckerath O, Kröger K. Prophylaxis of venous thromboembolism in physically restrained psychiatric patients. Int J Psychiatry Clin Pract 2016; 20:187-90. [PMID: 27111058 DOI: 10.3109/13651501.2016.1174274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We analysed the rate of physical restraint in acute and chronic psychiatric patients and looked at the safety of waiving venous thromboembolic disease (VTE) prophylaxis in the case of restraining of less than 24 h. METHODS We did a retrospective analysis of all episodes of restraining in 2012 and 2013, diagnosis of restrained patients, time of restraining and use of low molecular weight heparin (LMWH) for prophylaxis of VTE associated with restraining. RESULTS Overall, 12 734 patients were hospitalised. The number of episodes of restraining was 1035 and involved 469 (7.4%) patients. Only 79 episodes of restraining lasted more than 24 h and affected only 36 (0.3%) individual patients. The most frequent psychiatric diagnoses were unstable borderline personality in 41 (52%) and schizophrenic or schizoaffective psychosis in 26 (33%) episodes. None of these prolonged restraints and none of the 956 episodes of restraining for less than 24 h were associated with clinical symptoms or signs of VTE that would have required additional diagnostic consequences. CONCLUSION The concept of waiving VTE prophylaxis within the first 24 h of restraining seems to be safe. On the other hand, LMWH sufficiently protected the small sample being restrained for more than 24 h.
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Affiliation(s)
- Hans Hilger
- a Clinic of Psychiatry and Psychotherapy of the Clinic of Landschaftverband Rheinland , Düren , Düren , Germany
| | - Olga von Beckerath
- b Department of Vascular Medicine , HELIOS-Clinic Krefeld , Krefeld , Germany
| | - Knut Kröger
- b Department of Vascular Medicine , HELIOS-Clinic Krefeld , Krefeld , Germany
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Hsu WY, Lane HY, Lin CL, Kao CH. A population-based cohort study on deep vein thrombosis and pulmonary embolism among schizophrenia patients. Schizophr Res 2015; 162:248-52. [PMID: 25623600 DOI: 10.1016/j.schres.2015.01.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/31/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Several risk factors of venous thromboembolism (VTE) and pulmonary embolism (PE) were found in patients with schizophrenia. Therefore, we hypothesize that the incidences of VTE and PE are relatively higher among schizophrenia patients in comparison with the general population. METHOD For this population-based cohort study, claims data from 1996 to 2011 were obtained from the National Health Insurance Research Database in Taiwan. We compared the incidence of DVT and PE between schizophrenia and non-schizophrenia cohorts. Cox proportional hazard regression models were used to analyze the risk of DVT and PE, according to sex, age, and comorbidities. RESULTS Compared with the non-schizophrenia cohort, the schizophrenia cohort exhibited a 2.02-fold higher adjusted hazard ratio (HR) for developing DVT, and a 1.99-fold higher adjusted HR for developing PE. Furthermore, schizophrenia patients using first-generation or second-generation antipsychotics exhibited a higher adjusted HR for both DVT and PE development. CONCLUSION Compared with the general population, the risk of DVT and PE is relatively higher among schizophrenia patients. Early diagnosis and intervention by physicians could mitigate complications and reduce mortality resulting from VTE.
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Affiliation(s)
- Wen-Yu Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Psychiatry, China Medical University and Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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Ostrow L, Manderscheid R, Mojtabai R. Stigma and difficulty accessing medical care in a sample of adults with serious mental illness. J Health Care Poor Underserved 2014; 25:1956-65. [PMID: 25418252 PMCID: PMC4353597 DOI: 10.1353/hpu.2014.0185] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Wellness of people with mental illness is increasingly a public health priority. This study examined factors associated with difficulties receiving medical care in adults with mental illness. METHODS In a sample of 1,670 adults with mental illness, we assessed difficulties in accessing medical care and stigma. RESULTS A total of 465 (28%) participants reported difficulties in accessing medical care; 211 (13%) attributed difficulties in access to stigma. Lack of comprehensive medical care coverage and mental health symptoms were associated with increased odds of perceived difficulties in accessing medical care; personal empowerment was negatively associated with perceived difficulties attributed to stigma; education was positively associated. DISCUSSION The findings highlight unmet need for medical care in this population and the need to recognize stigma as a barrier medical care. Interventions to empower patients and educate medical providers about wellness for people with serious mental illness could help to reduce barriers.
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Abstract
OBJECTIVE To validate the global features of postoperative adverse outcomes for surgical patients with schizophrenia. BACKGROUND Patients with schizophrenia were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. METHODS We present a population-based study of 8967 schizophrenic patients receiving major surgery from the Taiwan National Health Insurance Research Database within the years 2004 and 2007 compared with 35,868 surgical patients without mental disorders. Eight major postoperative complications and mortality after complications were evaluated among schizophrenic patients with different severity. RESULTS Schizophrenic patients had significantly higher risk for postoperative complications, including acute renal failure, pneumonia, bleeding, septicemia, stroke, and 30-day postoperative mortality (adjusted OR = 2.70; 95% CI: 2.08-3.49), than surgical patients without mental disorders. Among surgical patients with 1 to 2, 3 to 18, 19 to 48, and more than 49 schizophrenia-related outpatient visits within 24-month period preoperatively, the adjusted ORs of 30-day mortality ranged from 1.95 (95% CI: 1.25-3.02) to 3.97 (95% CI: 2.66-5.92) in a frequency-dependent pattern when compared with controls. When compared with surgical patients with schizophrenia-related outpatient services only, OR of 30-day postoperative mortality increased from 2.54 (95% CI: 1.93-3.34) to 3.69 (95% CI: 2.25-6.03) in surgical patients with preoperative hospitalization or emergency visit because of schizophrenia. CONCLUSIONS Surgical patients with schizophrenia showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly threefold when compared with patients without mental disorders. Our findings suggest the urgency revising the protocol of postoperative care for this specific population.
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Brunero S, Jeon YH, Foster K. Mental health education programmes for generalist health professionals: an integrative review. Int J Ment Health Nurs 2012; 21:428-44. [PMID: 22500589 DOI: 10.1111/j.1447-0349.2011.00802.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mainstreaming of mental health services has led to an increase in the presentation and care of mental health patients in generalist health settings. The lack of adequate mental health educational preparation of general health professionals (GHP) has been identified as a major barrier to meeting the health-care needs of mental health patients. This study aimed to review and synthesize research evidence on mental health education programmes (MHEP) that have been designed to develop the knowledge, skills, and attitudes of GHP. An integrative literature review was conducted following a search of key electronic databases and hand searching of references of relevant papers, and 25 papers met the study inclusion criteria. Knowledge, skill, and attitudinal improvements in GHP post MHEP were shown in most studies. MHEP that included supervised clinical experience, role play, and case scenarios were reported as being more effective. Issues such as patient participation in education, interprofessional education models, and the willingness, interest and, motivation for GHP to be involved in MHEP warrant further research.
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Affiliation(s)
- Scott Brunero
- Mental Health Liaison Nursing, Prince of Wales Hospital Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia.
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