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Terui T, Kunii Y, Hoshino H, Kakamu T, Hidaka T, Fukushima T, Anzai N, Gotoh D, Miura I, Yabe H. Post-Disaster Community Transition of Psychiatric Inpatients: Lessons from the Fukushima Nuclear Accident. Community Ment Health J 2024; 60:764-771. [PMID: 38308774 DOI: 10.1007/s10597-024-01232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/08/2024] [Indexed: 02/05/2024]
Abstract
This study sought to explore factors related to community transition after the mandatory evacuation of psychiatric inpatients to other hospitals owing to the Fukushima Daiichi Nuclear Power Plant accident. A retrospective cohort design was adopted and 391 psychiatric patients were examined. Univariate and multivariate analyses were conducted to confirm the association between the achievement or non-achievement of discharge to community living and their backgrounds (age, gender, evacuation destination, psychiatric diagnoses, and physical complications). Multivariate analysis indicated that patients with psychiatric diagnoses of schizophrenia, schizotypal, and delusional disorders (International Statistical Classification of Diseases and Related Health Problems 10th revision, F20-29), and those with physical diagnoses of the circulatory (I00-95) and digestive (K00-93) systems showed a significant association with the non-attainment of community transition. From these results, we hypothesized that difficulties in the management of medication during and immediately after the extremely chaotic settings of evacuation could have negative effects on the community transitions. Furthermore, another possible concern was that individuals' persistent psychotic status before the accident had been carried over to the destination hospitals. Therefore, pre-disaster daily cooperation across hospitals and challenges for vulnerable psychiatric patients' future community lives are also essential.
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Affiliation(s)
- Toshihiro Terui
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan.
| | - Yasuto Kunii
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8573, Japan
| | - Hiroshi Hoshino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Nobuo Anzai
- Graduate School of Clinical Psychology, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshima-Ku, Tokyo, 170-8445, Japan
| | - Daisuke Gotoh
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
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Vranda MN, Ranjith PJ, Aadi S, Gunasekaran DM, Thirthalli J, Naveen Kumar C, Thirumoorthy A, Vasanthra CR, Amaresha AC. Predictors of long-stay in a tertiary care psychiatry hospital in India. Int J Soc Psychiatry 2023; 69:1979-1985. [PMID: 37403413 DOI: 10.1177/00207640231183916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Many psychiatric patients continue to stay for longer duration in psychiatric institutions. Community reintegration and rehabilitation of such patients needs to be explored to ensure appropriate bed occupancy rates and access to in-patient care for newer patients in need of the same. OBJECTIVES The aim is to identify the risk and protective factors leading to long-term admission of mentally ill patients in tertiary care hospital. METHODOLOGY A cross-sectional study was conducted with all patients in the long-stay ward between May 2018 and February 2023. A retrospective chart review followed by cross sectional assessment of risks and disability was carried out with all the patients living in a long-stay psychiatric ward (N = 101) at a tertiary hospital in Bangalore, India, between May 2018 and February 2023. RESULTS The hospital's average length of stay (LOS) was 5.70 ± 8.30 years. The risk and protective factors for LOS in psychiatric hospitals were analyzed using the Poisson Regression model. The results revealed that the male gender, diagnosis of schizophrenia or psychosis, clinicians' knowledge of family information, good clinical improvement, and higher participation in ward activities are the protective factors for a shorter hospital stay. While higher age, family history of mental illness, being married and employed, absence of children, and/or having family members rarely visiting the patient at the hospital were some factors that increased the risk of LOS. CONCLUSION This study highlighted the importance of possible LOS predictors in the tertiary care psychiatric hospital. The multi-disciplinary team may utilize risk and protective factors for delayed LOS to introduce comprehensive psychosocial interventions and policies that reduce the risk of delays or length of stay in mental health hospitals.
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Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabhu James Ranjith
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shivaleela Aadi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Ammapattian Thirumoorthy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Cicil Radhakrishnan Vasanthra
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kaggwa MM, Najjuka MS, Kesande C, Nyemara N, Kule M, Mamum MA, Bongomin F, Ashaba S. Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver's presence. DISCOVER MENTAL HEALTH 2022; 2:15. [PMID: 37861871 PMCID: PMC10501016 DOI: 10.1007/s44192-022-00018-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Whether the presence of caregivers during the hospital stay of patients with mental illness affects the length of hospital stay (LoS) remains inconclusive. AIMS (1) To determine the average LoS and the associated factors, and (2) to determine the role of caregivers' presences during inpatient stay on LoS. METHODS We conducted a cross-sectional study in two hospitals in Uganda; one with caregivers and the other without caregivers between July to November 2020. Mann-Whitney U test was used to compare LoS in the two selected hospitals and linear regression was used to determine factors associated with LoS. RESULTS A total of 222 participants were enrolled, the majority were males (62.4%). Mean age was 36.3 (standard deviation (SD) = 13.1) years. The average LoS was 18.3 (SD = 22.3) days, with patients in a hospital without caregivers having a longer median LoS (i.e., (30 (interquartile range (IQR) = 30) vs. 7 (7) days; χ2 = 68.95, p < 0.001). The factors significantly associated a longer LoS among our study participants included; being admitted in a hospital without caregivers (adjusted coefficient [aCoef]: 14.88, 95% CI 7.98-21.79, p < 0.001), a diagnosis of schizophrenia (aCoef: 10.68, 95 %CI 5.53-15.83, p < 0.001), being separated or divorced (aCoef: 7.68, 95% CI 1.09-14.27, p = 0.023), and increase in money spent during the admission (aCoef: 0.14, 95% CI 0.09-0.18, p < 0.001). CONCLUSION Patients with mental illness in southwestern Uganda have a short LoS (below 28 days), and the stay was much shorter for patients with fulltime caregivers. We recommend caregivers presence during patient's hospital stay to reduce the LoS and minimize healthcare expenditure.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- African Centre for Suicide Prevention and Research, Mbarara, Uganda.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
| | | | - Claire Kesande
- Butabika National Referral and Teaching Mental Hospital, kampala, Uganda
| | - Novatus Nyemara
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Moses Kule
- Department of Psychiatry, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Mohammed A Mamum
- CHINTA Research Bangladesh, Dhaka, Savar, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Savar, Bangladesh
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Xu Z, Xue C, Zhao F, Hu C, Wu Y, Zhang L. Hospitalization Costs and Length of Stay in Chinese Naval Hospitals Between 2008 and 2016 Based on Influencing Factors: A Longitudinal Comparison. Mil Med 2021; 185:e282-e289. [PMID: 31287875 DOI: 10.1093/milmed/usz170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION A retrospective review conducted in three hospitals of Guangdong and Hainan, China. To analyze the variation tendency of mean hospitalization costs and length of stay (LOS) in naval hospitals over nine years, paying special attention to the factors affecting hospitalization costs and LOS to provide a reference base for health resource allocation in naval hospitals. MATERIALS AND METHODS A total of 21,375 cases of military patients who were hospitalized and treated in three naval hospitals between January 2008 to December 2016 were extracted from the military health system. There were 16,278 complete and effective cases during those nine years. The situation, trends, and factors influencing hospitalization costs and LOS were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and multiple linear regressions. RESULTS The following factors showed statistically significant differences in hospitalization costs: special care, primary care, year, military rank, critical illness, allergies, and condition (p < 0.0001); and number of hospitalizations, gender, and age (p < 0.01). The following factors showed statistically significant differences in hospital LOS: year, number of hospitalizations, outcomes, military rank, special care, severity of illness, and condition (p < 0.0001); allergy (p < 0.01); and service and gender (p < 0.05). LOS between 2008-2016 showed a decreasing tendency, while hospitalization costs showed an increasing trend. There were 6 factors that affected Abstract (or Structured Summary) both the cost of hospitalization and LOS: special care, year, military rank, condition, allergy, and gender. CONCLUSIONS The results suggest that improving efficiency of military hospital require strengthening hierarchical referrals and controlling hospital LOS. Shortening LOS, optimizing clinical pathways, and reasonably controlling the costs associated with medicines and surgery can help reduce hospitalization costs for military patients. Controlling the growth of hospitalization costs can help avoid the physical and psychological burden of medical over-treatment on patients and may also optimize the allocation of military health resources.
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Affiliation(s)
- Zhenqing Xu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China.,952nd Hospital of PLA, Glomud, Qinghai, China
| | - Chen Xue
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Fangjie Zhao
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Chaoqun Hu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Yaomin Wu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Lulu Zhang
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
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Barroilhet SA, Pellegrini AM, McCoy TH, Perlis RH. Characterizing DSM-5 and ICD-11 personality disorder features in psychiatric inpatients at scale using electronic health records. Psychol Med 2020; 50:2221-2229. [PMID: 31544723 PMCID: PMC9980721 DOI: 10.1017/s0033291719002320] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Investigation of personality traits and pathology in large, generalizable clinical cohorts has been hindered by inconsistent assessment and failure to consider a range of personality disorders (PDs) simultaneously. METHODS We applied natural language processing (NLP) of electronic health record notes to characterize a psychiatric inpatient cohort. A set of terms reflecting personality trait domains were derived, expanded, and then refined based on expert consensus. Latent Dirichlet allocation was used to score notes to estimate the extent to which any given note reflected PD topics. Regression models were used to examine the relationship of these estimates with sociodemographic features and length of stay. RESULTS Among 3623 patients with 4702 admissions, being male, non-white, having a low burden of medical comorbidity, being admitted through the emergency department, and having public insurance were independently associated with greater levels of disinhibition, detachment, and psychoticism. Being female, white, and having private insurance were independently associated with greater levels of negative affectivity. The presence of disinhibition, psychoticism, and negative affectivity were each significantly associated with a longer stay, while detachment was associated with a shorter stay. CONCLUSIONS Personality features can be systematically and scalably measured using NLP in the inpatient setting, and some of these features associate with length of stay. Developing treatment strategies for patients scoring high in certain personality dimensions may facilitate more efficient, targeted interventions, and may help reduce the impact of personality features on mental health service utilization.
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Affiliation(s)
- Sergio A. Barroilhet
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
- University Psychiatric Clinic, University of Chile Clinical Hospital, Santiago, Chile
| | - Amelia M. Pellegrini
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas H. McCoy
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roy H. Perlis
- Center for Quantitative Health, Division of Clinical Research and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
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Noohi S, Kalantari S, Hasanvandi S, Elikaei M. Determinants of Length of Stay in a Psychiatric Ward: a Retrospective Chart Review. Psychiatr Q 2020; 91:273-287. [PMID: 31865511 DOI: 10.1007/s11126-019-09699-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Considering the limited resources for providing inpatient services, identification of the factors influencing length of stay (LOS) is of great importance. The current study is a retrospective chart review which was planned to investigate the determinants of LOS in two gender-specific psychiatric wards within Baqiatallah Hospital (BQH) located in Tehran. The observation period was between March 21, 2011 and March 19, 2016. 3203 patients were recruited in terms of inclusion and exclusion criteria. Next, required data on 25 explanatory variables were extracted from their case-files. Descriptive measures were used for analysis and Independent Samples T-test, one-way ANOVA, Pearson's correlation coefficient and Bonferroni's post-hoc test for inferential analysis. Lastly, a multiple linear regression model was run to determine significant predictors of psychiatric LOS. Variables significantly correlated with patients' LOS included gender, age, employment status, marital status, number of divorces, disability rate, discharge diagnosis, physical comorbidity, number of previous hospitalizations, suicide ideation, number of suicide attempts, history of assault, tobacco consumption, a history of narcotic drug abuse and number of ECT sessions. Through the analysis of multiple linear regression, it came to light that significant predictors of LOS in the final model could account for 37.9% of the variance in LOS. From the findings of current study, it can be inferred that clinical aspects as well as treatment procedures have major effects on LOS. Although the factors examined here could not explain an acceptable variance in LOS, the results are useful for the treatment team when they want to devise a care plan or give discharge to a patient.
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Affiliation(s)
- Sima Noohi
- Associate Professor of Psychiatry, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Saba Hasanvandi
- Assistant Professor, Department of Psychology, Faculty of Humanistic Sciences, Khorramabad Branch, Islamic Azad University, Khorramabad, Iran
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Ignatyev Y, Mundt AP, von Peter S, Heinze M. Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany. Int J Geriatr Psychiatry 2019; 34:1557-1564. [PMID: 31276239 DOI: 10.1002/gps.5165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/29/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects. METHODS A secondary data analysis was conducted using administrative data from eight German mental health centres providing FIT64b. The effects of gender, age, type of centre, and main diagnosis on AHLS were calculated for all older patients with age 65 years or older (n = 3495) treated in FIT64b in the year 2016. Data were analysed with descriptive statistics and robust multiway procedures. RESULTS The AHLS of older people with mental illness was 4.8 (SD = 11.5) days. The AHLS was shorter in centres exclusively providing FIT64b than in centres providing FIT64b alongside with standard health care: 3.2 (SD = 6.4) vs 8.4 (SD = 17.8) days, P = .001. This difference was particularly marked among patients with schizophrenia spectrum disorders, mood disorders, and neurotic, stress-related, and somatoform disorders. CONCLUSIONS FIT64b relates to very short AHLS even among older people. Centres using FIT64b alongside with standard health care usually provide standard care to most patients, which could lead to lower fidelity in the implementation of FIT64b.
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Affiliation(s)
- Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Medical School, Universidad San Sebastián, Puerto Montt, Chile
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
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Comas M, Valentino K, Bridgett DJ, Hayden LC. The direct and interactive effects of physical abuse severity and negative affectivity on length of psychiatric hospitalization: evidence of differential reactivity to adverse environments in psychiatrically high-risk youth. Child Psychiatry Hum Dev 2015; 45:220-8. [PMID: 23824554 DOI: 10.1007/s10578-013-0394-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current study examined the interactive influence of multiple factors (i.e., physical abuse severity and negative affectivity) in predicting youth's inpatient psychiatric length of stay (LOS), extending previous research focused on identification of only single LOS predictors. Elevated physical abuse severity was hypothesized to predict longer youth LOS, and negative affectivity was anticipated to exacerbate this relationship. This study included 42 youth. Clinicians rated youth temperament, whereas physical abuse severity and LOS were coded from youth medical records. Controlling for other previously determined predictors of LOS (i.e., age, gender, and GAF), moderation analyses confirmed hypotheses, revealing a temperament by environment interaction. Specifically, physical abuse severity was positively associated with LOS only in the context of high negative affectivity. Findings highlighted the importance of disentangling the interactive effects of multiple factors in predicting LOS. Moreover, critical clinical implications involving prioritized trauma assessment and treatment for inpatient youth are discussed.
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Affiliation(s)
- Michelle Comas
- Center for Children and Families, Department of Psychology, University of Notre Dame, Notre Dame, IN, 46556, USA,
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Afilalo M, Soucy N, Xue X, Colacone A, Jourdenais E, Boivin JF. Characteristics and Needs of Psychiatric Patients With Prolonged Hospital Stay. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:181-8. [PMID: 26174218 PMCID: PMC4459245 DOI: 10.1177/070674371506000405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds. METHODS This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed. RESULTS A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). CONCLUSIONS Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients.
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Affiliation(s)
- Marc Afilalo
- Associate Professor, Department of Medicine, McGill University, Montreal, Quebec; Director, Emergency Department, Jewish General Hospital, Montreal, Quebec
| | - Nathalie Soucy
- Clinical Research Associate, Emergency Department—Research Division, Jewish General Hospital, Montreal, Quebec
| | - Xiaoqing Xue
- Statistician, Emergency Department—Research Division, Jewish General Hospital, Montreal, Quebec
| | - Antoinette Colacone
- Research Coordinator, Emergency Department—Research Division, Jewish General Hospital, Montreal, Quebec
| | - Emmanuelle Jourdenais
- Director, Emergency Department, Centre Hospitalier de L’Université de Montréal, Notre-Dame Hospital, Montreal, Quebec
| | - Jean-François Boivin
- Professor, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
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Chung W, Chang HS, Oh SM, Yoon CW. Factors associated with long-stay status in patients with schizophrenia: an analysis of national databases covering the entire Korean population. Int J Soc Psychiatry 2013; 59:207-16. [PMID: 22222848 DOI: 10.1177/0020764011431794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Admissions lasting over six months (long-stay) occur frequently among patients with schizophrenia in South Korea. AIMS To identify some patient-level and institution-level factors associated with long-stay status of patients with schizophrenia. METHODS This is a retrospective cross-sectional study. We analysed a nationwide population-based reimbursement claims data set consisting of 496,338 claims for 58,287 patients with schizophrenia between 1 January 2005 and 30 June 2006. A two-level random effects logistic regression model was used to identify those factors. RESULTS Age (<20 years (ref), 60-69 (OR 2.000, 95% CI: 1.640-2.438), ≥ 70 (2.068, 1.682-2.543)), male gender (1.192, 1.144-1.242), type of national health insurance plan (national health insurance (ref), Medical Care Aid Type 1 (4.299, 4.024-4.593)), secondary diagnosis (none (ref), psychiatric diagnosis (0.719, 0.666-0.777), non-psychiatric diagnosis (0.918, 0.850-0.991)) and type of institution (clinic (ref), psychiatric hospital (2.769, 1.507-5.087)) were associated with likelihood of long-stay status. Institutional variable associated with long-stay status included a higher number of beds (1.073, 1.013-1.137). The number of professionals (0.752, 0.646-0.876) showed negative association with long-stay status. CONCLUSIONS Researchers could improve their assessment of long-stay status of patients with schizophrenia by using a two-level analysis including patient-level and institution-level factors. This study suggests that mental health interventions to reduce the long stay of patients with schizophrenia focus on older male patients, those enrolled in a national medical care aid programme and those admitted to psychiatric hospitals.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, South Korea
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Tulloch AD, Fearon P, David AS. Length of Stay of General Psychiatric Inpatients in the United States: Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 38:155-68. [DOI: 10.1007/s10488-010-0310-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Adenovirus serotype 5 (Ad5) continues to be regarded as a gene delivery vehicle of high utility for a variety of clinical applications. However, targeting of the virus to alternate, non-native receptors has become a mandate for many gene therapy approaches, as inefficient viral transduction of target tissues has proven detrimental to the utility of Ad5. Thus, various targeting strategies have been endeavored to the end of highly specific cellular transduction, including that of genetic manipulation of the viral capsid. Modification of the tropism-determining fiber protein and other capsid locales has allowed vectorologists to develop vectors that are highly superior to the first-generation adenoviruses employed for gene therapy. Herein, the various genetic targeting strategies for Ad5 are reviewed, and the various schemas in which targeted transduction has been achieved with tropism-modified vectors are outlined.
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Affiliation(s)
- Sam C Noureddini
- VectorLogics, Inc., 550 11th Street South, Birmingham, Alabama 35294, USA
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