Background: Care transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety (Coleman, 2003; Forster et al., 2003; Picker Institute 1999; van Walraven et al., 2004; Cook et al., 2000). Patients who have complex care needs and undergo treatment from multiple care settings may be at a greater risk for poor care transitions (Coleman et al., 2004). Using quantitative performance measurement scales is one method that can assess the quality of care transitions, and identify areas for improvement. The psychometric properties of the primary performance measurement scale, the Care Transitions Measure (CTM), have not been rigorously assessed, particularly within a higher risk, medically complex population such as older adults with musculoskeletal (MSK) disorders. Furthermore, despite the negative health implications that can result from poor transitions and the commonality of care transitions among persons with complex care needs, there is a significant dearth of research on this crucial aspect of health care. Methods: This research examines the ability of the CTM to adequately assess the quality of care transitions among a complex population of older MSK rehabilitation patients and explores care transitions from the perspective of the patient and the health care provider. Information was gathered through telephone administration of the CTM to MSK patients after they transitioned from inpatient rehabilitation units to home, and through a series of qualitative key informant interviews with a range of health care professionals in care settings relevant to the care continuum of older MSK patients. Inter-rater reliability, a type of reliability that has never been tested with the CTM, and construct validity were assessed and qualitative analyses were used to examine qualitative information obtained through the CTM administration to patients and through the interviews with health care providers. Results: The CTM demonstrated excellent inter-rater reliability for the overall score (intraclass correlation coefficient = 0.77; p=0.03) despite only fair agreement between each item. Internal consistency of the CTM was high (Cronbach’s alpha = 0.94). The construct validity of the CTM was supported; however qualitative data from the patient and health care provider perspectives suggest additional items should be considered for inclusion. Qualitative information from patients also suggests the need for revisions to the wording of some items and the response options. Health care provider interviews suggest that issues surrounding transitional care are similar regardless of the care setting involved. Conclusions: Although the CTM proved to be reliable, qualitative data suggests that the addition of items should be considered to improve the content validity of the CTM, which would in turn improve its construct validity as well. Recommendations for scale improvement are made, as are recommendations for an alternative scale to assess care transition quality from a health care provider perspective. The results of this study support efforts to improve the outcomes of care transitions, care planning, and the overall quality of life for older rehabilitation patients.

Bakgrund: Patienter med psykisk sjukdom har en ökad risk att utveckla somatisk sjukdom. Antalet vårdtillfällen inom psykiatrisk slutenvård har ökat under det senaste decenniet. Sjuksköterskan ska kunna observera, åtgärda och hantera patientens såväl psykiska som fysiska omvårdnadsbehov och hon ska även ha en helhetssyn och ett etiskt förhållningssätt. Sjuksköterskan har även en skyldighet att arbeta utifrån vetenskap och beprövad erfarenhet. Syfte: Syftet med studien var att undersöka sjuksköterskors upplevelser av att vårda patienter med somatiska tillstånd inom psykiatrisk slutenvård. Metod: Denna studie är en empirisk intervjustudie som har genomförts med en deskriptiv kvalitativ ansats. Halvstrukturerade intervjuer med fyra sjuksköterskor verksamma inom psykiatrisk slutenvård utgör materialet till denna studies resultat. Materialet har analyserats med en manifest innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier vilka beskriver informanternas upplevelser. Kategorierna är: 1) Upplevelser kring somatisk omvårdnad, 2) Vikten av kunskap samt 3) Samarbetet mellan den psykiatriska och somatiska sjukvården. Slutsats: Majoriteten av studiens informanter upplever att det somatiska omvårdnadsarbetet är svårhanterligt. Deras resurser är begränsade när somatiskt sjuka patienter vårdas på avdelningen. Det finns även en upplevelse av att det är svårt att hålla sig uppdaterad gällande somatiska kunskaper och att det därför finns ett behov av fortbildning avseende dessa. Informanterna upplever även att vården är uppdelad trots att vissa patienter är i behov av kompetensen och yrkeskunnandet från både den somatiska och psykiatriska sjukvården. Klinisk betydelse: Förhoppningen med studiens resultat är att ge en ökad insikt kring vilka faktorer som påverkar sjuksköterskans upplevelser av att vårda patienter med somatiska tillstånd inom psykiatrisk slutenvård. / Background: Patients with mental illness are at increased risk for physical illness. The number of patients that are admitted to the psychiatric inpatient care has increased over the past decade. The nurse should be able to observe and manage the patient's mental need as well as their physical needs. They should also have a holistic and ethical approach and their work should be based on evidence and science. Aim: The aim of this study was to explore nurses' experiences regarding the care of patients with somatic conditions in psychiatric inpatient care. Method: This study is an empirical study with a descriptive qualitative approach based on semi-structured interviews with four nurses working in a psychiatric inpatient ward. A manifest content analysis was used to analyze the interview material. Results: The analysis emerged into three main categories which describe the experiences of the nurses. The categories are: 1) Experiences of somatic care, 2) The importance of knowledge and 3) Cooperation between the psychiatric and somatic care. Conclusion: The majority of the nurses in this study felt that the somatic care was difficult. Their resources are limited when somatically ill patients are admitted to the ward. They also experience that it is hard to keep the knowledge updated regarding somatic care and that there is a need for training. The nurses also felt that health care was divided between the somatic and the psychiatric care, although some patients are in need of the expertise and professionalism from both the somatic and psychiatric care. Clinical significance: The results of the study may contribute to provide a greater understanding of which factors that influence nurses' experiences of the care of patients with somatic conditions in psychiatric inpatient care.

Darbo tikslas: Įvertinti stacionarinio gydymo (hospitalizacijos) atvejų struktūrą, priežastis ir pagrįstumą pirminės sveikatos priežiūros centro bendruomenėje. Uždaviniai: 1. Nustatyti pirminės sveikatos priežiūros centro bendruomenės narių stacionarinio gydymo atvejų struktūrą. 2. Įvertinti stacionarinio gydymo pagrįstumą pagal pagrindinius hospitalizacijos atvejų struktūros elementus. 3. Įvertinti gulėjimo stacionare trukmę ir jos pagrįstumą. Tyrimo metodika: Atlikta išrašų iš ligos istorijų, išduotų įvairaus lygio ligoninių 2007 m., ekspertinė analizė. Ekspertų grupę sudarė 3 asmenys - dvi šeimos gydytojos ir gydytoja - kontrolės ir ekspertizės vyriausioji specialistė. Nagrinėjant išrašų iš ligos istorijų duomenis buvo analizuojami hospitalizacijų atvejai pagal sociodemografinius rodiklius, stacionarinio gydymo įstaigą, skyrių, gulėjimo trukmę, galutinę diagnozę, guldymo priežastį. Nustatant stacionarinio gydymo pagrįstumą, buvo atsižvelgiama į ligos sudėtingumą, taikomą gydymą, atliktus tyrimus, į patvirtintas medicinines normas. Analizė atlikta naudojant statistinį duomenų analizės paketą SPSS 13.0. Rezultatai: Ekspertų nuomone, 56,3% stacionarinio gydymo atvejų buvo nepagrįsti ir 43,7% pagrįsti. Pagrįsto stacionarizavimo atvejai sudarė nuo 36,2% rajono ligoninėje iki 93,2% universitetinėse ligoninėse (p=0,000). Stacionarinio gydymo atvejų pagrįstumas didėjant pacientų amžiui mažėjo nuo 63,6% 0-17 metų grupėje iki 39,2% vyresnių negu 65 metų grupėje. Daugiausia pagrįstų... [toliau žr. visą tekstą] / The aim: To evaluate the inpatient treatment (hospitalization) cases structure and validity reasons and validity in the primary Health Care Center community. Objectives: 1. Identify the inpatient treatment (hospitalization) cases structure of primary Health Care Center community. 2. To evaluate the inpatient treatment validity according of the major structure elements of hospitalization cases. 3. To evaluate the length of stay in hospital and duration of its validity. Methods: Carried out on extracts from case histories, issued by all level hospitals in 2007, the expert analysis. The expert group consisted of three persons: two family doctors and a doctor of control and chief expertise specialist. The examination of extracts from medical records data were analyzed hospitalization cases according to sociodemographic characteristics, hospitalization clinic, department, length of stay, final diagnosis, reason for patient admission. In determining the validity of inpatient treatment was based on the complexity of the disease, treatments, research carried out in approved medical standards. The analysis was performed using the statistical package for data SPSS 13.0. Results: According to the experts, 56.3% of inpatient treatment cases were unfounded and based on 43.7%. Based hospitalization cases accounted for 36.2% of the district hospital to 93.2% in university hospitals (P = 0.000). Validity of inpatient treatment cases increasing patient age decreased from 63.6% in 0-17... [to full text]

As natural resources are decreasing and environmental pollution is increasing, the buildings that play an important role in this problem should be constructed sustainably so their affects are kept to a minimum. Hospitals operate 24 hours a day and 7 days a week, therefore they are one of the largest energy consumers. Hence designers have started to design healthcare facilities according to the Leadership in Energy and Environmental Design (LEED) criteria, believing that it will reduce waste production, energy consumption and increase patient satisfaction by creating brighter and less stressful facilities. To understand if the claims are correct or not, this thesis first studied the results of the patient survey, Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS), undertaken at most of the hospitals in the U.S., and compares the results to LEED and non-LEED certified hospitals. To find answers for the claims related to the financial benefits, this thesis compared three financial indicators; cost of operation of plant, profitability, and inpatient revenue. In the cases where there is a large enough sample size, a t-test is used to compare two groups, however when the sample size was not large enough, two groups are compared based on their means. For the cost of operation of plant and profitability, non-LEED certified hospitals are performing better. However, the patient satisfaction and inpatient revenues are significantly higher at the LEED-certified hospitals.

Atualmente os psicofármacos têm apresentado altas prevalências de consumo pela população. Visando fornecer subsídios para formulação de estratégias de gerenciamento de segurança no uso destes fármacos, o presente estudo teve como objetivos: identificar, entre pacientes internados em clínicas médica e cirúrgica de um hospital geral, a prevalência do uso de psicofármacos e, analisar a relação do uso destes fármacos com as variáveis demográficas, socioeconômicas e farmacoterapêuticas, com o histórico de saúde e com o resultado da aplicação do instrumento SRQ-20. Foi realizado estudo de corte transversal, com desenho correlacional descritivo e abordagem quantitativa, com 93 pacientes das clínicas em estudo. Para coleta dos dados utilizou-se a entrevista norteada por um questionário envolvendo as variáveis em estudo e pelo instrumento SRQ-20 (Self-Reporting Questionnaire), para a detecção de transtornos mentais comuns. Em seguida, foi verificado o prontuário destes pacientes, buscando a presença de prescrição de psicofármacos. Para avaliar a influência das variáveis independentes sobre o consumo de psicofármacos, foram investigadas associações estatísticas usando o teste Qui-quadrado. Para estimar a Razão de prevalência foi utilizado o modelo de regressão log-binomial simples e múltiplo. O ajuste do modelo foi feito através do procedimento PROC GENMOD do software SAS versão 9.0. Observou-se a prevalência de 38,71% de usuários de psicofármacos, evidenciando a associação do uso de psicofármacos com as variáveis sexo, custeio da internação, religião e resultado positivo no SRQ-20. Os benzodiazepínicos foram os psicofármacos mais consumidos pela amostra (64%), seguidos pelos antidepressivos (32%). As indicações dos benzodiazepínicos relatadas pelos pacientes foram: \"para dormir\" (54%), para \"depressão\" (14%), e para \"ansiedade\" (7%). A principal indicação dos antidepressivos foi a \"depressão\" (50%). Identificou-se que 25% e 22% dos pacientes estavam consumindo, respectivamente, benzodiazepínicos e antidepressivos, sem ter o conhecimento deste fato. Verificou-se que 70% das prescrições de psicofármacos foram realizadas por médicos não-psiquiatras, sendo os benzodiazepínicos a classe mais prescrita pelos não-psiquiatras e os antidepressivos os mais prescritos pelos psiquiatras. Dentre os pacientes em uso de psicofármacos, 59% realizavam apenas tratamento farmacológico, 27,8% possuíam diagnóstico de transtorno mental, 36,1% obtiveram resultado positivo e 36,1% obtiveram resultado negativo no SRQ-20. Foi identificada a automedicação em 5% dos pacientes. Espera-se que a presente pesquisa contribua para despertar a preocupação necessária relacionada ao tema, para a melhoria das informações que devem ser consideradas pelos profissionais de saúde quanto ao tratamento com psicofármacos bem como para implementação de estratégias direcionadas ao uso racional destes medicamentos. / Currently, psychotropic drugs have shown high prevalence rates of consumption by the population. Aiming to provide subsidies for formulation of strategies of security management in the use of these drugs, this study aimed to identify, among patients hospitalized in medical and surgical clinics of a general hospital, the prevalence of psychotropic use and analyze the relationship between the use of these drugs and the demographic, socioeconomic and pharmacotherapeutics variables, with the health history and the result of applying the SRQ-20. A cross sectional study with descriptive correlational design and quantitative approach was performed with 93 patients in the clinics. For data collection, an interview guided by a questionnaire involving the study variables and by the SRQ-20 (Self-Reporting Questionnaire) was used for the detection of common mental disorders. Then, the records of these patients were checked, looking for the presence of psychotropic prescription. To evaluate the influence of independent variables on the consumption of psychotropic drugs, statistical associations were investigated using Chi-square test. To estimate the prevalence ratio was used the simple and multiple log-binomial regression models. The model fit was achieved using the PROC GENMOD procedure of SAS software version 9.0. It was observed the prevalence of 38.71% of psychotropic drug users, showing the association between the use of psychiatric drugs and sex, cost of hospitalization, religion and positive result on the SRQ-20. Benzodiazepines were the most consumed psychotropic drugs by the individuals of the sample (64%), followed by antidepressants (32%). The indications of benzodiazepines reported by patients were: \"to sleep\" (54%), for \"depression\" (14%), and \"anxiety\" (7%). The main indication of antidepressants was \"depression\" (50%). It was found that 25% and 22% of the patients were taking, respectively, benzodiazepines and antidepressants, without having knowledge of this fact. It was found that 70% of prescriptions of psychotropic drugs were performed by physicians non-psychiatrists, and the most prescribed by non-psychiatrists were benzodiazepines and the most prescribed by psychiatrists were antidepressants. Among the patients using psychotropic drugs, 59% performed only pharmacological treatment, 27.8% had a diagnosis of mental disorder, 36.1% had positive outcome, and 36.1% had negative outcome in the SRQ- 20. Self-medication was identified in 5% of patients. It is expected that this research contributes to arouse the concern related to this theme required for the improvement of information that should be considered by health professionals regarding treatment with psychotropic drugs and to implement strategies aimed at the rational use of medicines.

Magister Psychologiae - MPsych / Substance abuse is a public health concern in South Africa, and Western Cape Province in particular has been identified as having alarming rates of substance abuse. Substance abuse is the cause of some of the most pervasive and costly problems in society. Substance abuse is associated with various social problems such as crime, violence, unemployment, poverty, risky sexual behaviours, the escalation of chronic diseases such as AIDS and TB, and dysfunctional family life – and these problems are often interlinked. Furthermore, substance disorders place a huge strain on the health and welfare system of South Africa. In- and outpatient treatment facilities exist in communities to assist with alleviating the problem of substance abuse. Aftercare facilities are a form of outpatient service for substance abusers who have completed inpatient treatment. The primary aim of aftercare is to assist recovered substance abusers to maintain treatment gains by abstaining from substance use and to facilitate their reintegration with their families and communities. The purpose of the present study was to explore and obtain an in-depth understanding of the experiences of rehabilitated substance abusers in aftercare, following their completion of inpatient treatment. The sampling method for the study was purposive, and the sample consisted of two female and six male participants. Participants' attendance at the aftercare programme was verified with the aftercare coordinator. Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Results of the study found that, overall, participants had a positive experience of aftercare. Furthermore, results indicated that aftercare played a vital role in assisting participants to maintain treatment gains.

Class of 2014 Abstract / Specific Aims: To compare two groups of automated dispensing technology and their impact on medication safety and costs at an inpatient pharmacy. Methods: A total of 784 medications were audited for Pyxis refill errors, 352 prior to and 432 post implementation of Boxpicker and the ATP High Speed Tablet Packager. Data were collected by obtaining refill reports for automated dispensing. Every other medication on the refill report was audited for errors in the corresponding location of the automated dispensing cabinet. The rate of reported errors was obtained from a self-reported error program, Patient Safety Net (PSN). Analysis related to costs included automated dispensing cabinet related inventory and costs associated with bulk repackaging. All data associated with costs were obtained from pharmacy financial records. Main Results: There was no significant difference in the Pyxis refill error rate between Pyxis PARx and Boxpicker (0.00284% versus 0.00231%, respectively, p =0.88). The total number of automated dispensing cabinet problems reported through Patient Safety Net transiently increased during and after implementation of new automated technology. Value of pharmacy inventory costs associated with automation was $674,460 prior to and $594,789 post implementation of technology. Bulk repackaging with the ATP High Speed Automatic Tablet Packager resulted in an estimated cost savings of $203,400 annually. Conclusion: Implementation of Boxpicker and ATP High Speed Tablet Packager resulted in no significant change in Pyxis refill error rates, a transient increase in reported automated dispensing cabinet problems, a decrease in inventory costs, and savings associated with bulk repackaging.

Class of 2016 Abstract and Report / Objectives: An estimated 5.7 million Americans had heart failure (HF) in 2012 with an economic cost of $30.7 billion. By 2030 the prevalence of the disease is expected to increase by 46%. Centers for Medicare and Medicaid Services penalizes hospitals for 30-day readmissions. This study evaluated the effect of our multidisciplinary HF intervention on readmissions. Methods: This is a retrospective cohort study. Patients were identified from electronic inpatient admission records from January 1 to December 31, 2014. Patients who received any component of intervention were compared to patients who did not receive any intervention. Intervention included student pharmacist medication counselling, HF education, and post-discharge phone calls with Modified Morisky questionnaire. Age, sex, admission/discharge dates, readmission diagnosis, smoking status, ejection fraction, medications, and Charlson Comorbidity Index (CCI) conditions were collected. Results: A total of 221 patients with 249 discrete admissions were identified. No difference in age (p=0.42), sex (p=0.48), smoking status (p=0.10) existed between the groups. No difference in readmissions was found between patients receiving complete intervention and control (p=0.41) or patients receiving 1 or 2 intervention components and control (p=0.41). Patients with CCI score≥ 8 had greater risk of readmission compared to CCI scores 0-2 (OR 7.7, 95% CI 1.6-36.3, p=0.01). Conclusions: This analysis did not identify an intervention impact on 30-day readmissions in patients with HF; high CCI scores were associated with increased readmission risk. The intervention may be best targeted towards patients with high CCI scores as they have the highest readmission rate.

Suicide is a prevalent and international problem which has substantive economic and psychological consequences. This has led to governments placing prevention of suicide as a priority on healthcare agendas. Recognition has been given to vulnerable groups in society that have been identified as being at particularly high risk of self-harm and suicide. This includes those in contact with mental health and forensic services. There is a great deal of literature that has considered the risk factors, processes and mechanisms associated with suicide. Comparatively only a small amount of literature has looked at the concept of suicidality within restricted samples such as psychiatric inpatients and prisoners. This may be as a consequence of extensive ethical and procedural processes that are involved in conducting research in such settings. This results in it being necessary to continually make generalisations from community based literature, meaning that factors relating specifically to such settings may be overlooked or underestimated. In the first paper, the initial sections consider existing risk assessments and models of suicidality. Predominantly being structured around static risk factors, means they are often criticised for lacking predictive utility and specificity. Literature examining dynamic psychosocial factors of suicidality in restricted samples was reviewed and 20 articles were identified. A wide range of dynamic correlates are presented. These form a theoretical model of suicidality specific to restricted samples. The clinical and theoretical implications are discussed in terms of risk assessment procedures and adapting and shaping interventions in accordance with the findings. Developing risk assessments around more dynamic factors will allow for greater sensitivity and prediction of those at greatest risk of imminent harm. The second, empirical paper supports the promotion of recovery focused practice and explores the relationship between suicidality and perceived personal agency in patients in secure mental health settings; Personal agency having previously been suggested as conferring resilience to suicidality. Psychometric measures and experience sampling methodology were utilised to examine the relationship. Perceptions of personal agency were found to confer resilience against suicidality. Change in perceptions of personal agency was not associated with suicidality but the overall level of personal agency was. Implications for service delivery are discussed with emphasis given to fostering perceptions of agency, control and self-efficacy and promoting inclusion, empowerment and person centred care. The final paper provides a personal and a critical reflection on the research process. It highlights and discusses clinical and theoretical strengths and limitations of the two papers and considers the methodological processes of both papers in more detail. Further reflections on how practice could be adapted in line with the findings are given. Future directions for research within secure settings are considered, in the hope of maintaining the drive for research with this vulnerable and often overlooked population.

Goals: The purpose of our study was to evaluate trends of hospitalization, acute kidney injury (AKI) and mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Background: SBP is a frequent bacterial infection in cirrhotic patients leading to increased morbidity and mortality. Materials and Methods: A total of 4,840,643 patients hospitalized with cirrhosis from 2005 to 2014 were identified using the Nationwide Inpatient Sample database, of which 115,359 (2.4%) had SBP. We examined annual trends and used multivariable mixed-effects logistic regression analyses to obtain adjusted odds ratios by accounting for hospital level and patient level variables. Results: We identified a striking increase in hospitalizations for SBP in cirrhotic patients (0.45% to 3.12%) and AKI in SBP patients (25.6% to 46.7%) from 2005 to 2014. Inpatient mortality decreased over the study period in patients with SBP (19.1% to 16.1%) and in patients with SBP plus AKI (40.9% to 27.6%). Patients with SBP had a higher inpatient mortality rate than those without SBP [15.5% vs. 6%, adjusted odd ratio (aOR): 2.02, P<0.001]. AKI was 2-fold more prevalent in cirrhotics with SBP than those without SBP (42.8% vs. 17.2%, aOR: 1.91, P<0.001) and concomitant AKI was associated with a 6-fold mortality increase (aOR: 5.84, P<0.001). Cirrhotic patients with SBP had higher hospitalization costs and longer length of stays than patients without SBP. Conclusions: Despite a higher hospitalization rate and prevalence of concomitant AKI, mortality in patients with SBP decreased during the study period. SBP is associated with high likelihood of development of AKI, which in turn, increases mortality.