Objectives: To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. Methods: We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality. Results: A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003–2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and $13,654 to $10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001). Conclusion: Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.

Background and Aim: Acute kidney injury (AKI) is used as a marker of severity in Clostridium difficile infection (CDI) patients. We estimated the true effect of AKI in inpatient mortality of CDI patients, as there are no large-scale, population-based, propensity-matched studies evaluating AKI's effect in this patient cohort. Methods: A retrospective observational study utilizing the National Inpatient Sample from years 2003 to 2012, including all adults with CDI, excluding cases missing data on age, inpatient mortality or gender. Trends and CDI-related complications as mortality predictors were assessed using survey-weighted multivariable regression. We estimated AKI's independent effect by propensity-matching, post-stratifying by chronic kidney disease status, allowing for multiple comorbidity adjustment. Results: A total of 2 859 599 patients with CDI were included, of which 896 122 (31.3%) had principal diagnosis of CDI. AKI prevalence was 22%. Mortality rate was 8.4%, while among AKI patients was higher (18.2%). In multivariable regression, AKI was associated with higher mortality (odds ratio [OR] = 3.16, 95% confidence interval [CI]: 3.02–3.30; P < 0.001), while after propensity matching, AKI increased mortality by 86% (OR = 1.86, 95% CI: 1.79–1.94; P < 0.001). CDI incidence increased by 1.8, together with the rate of AKI (12.6% in 2003 to 28.8% in 2012, P-trend < 0.001). Despite increasing hospitalizations, mortality over the study period decreased to 7.2% (2012) from 9.0% (2003); P-trend < 0.001. Conclusion: Hospital admissions of patients with CDI and concomitant AKI are increasing, but their inpatient mortality has improved over the study period. AKI is a significant contributor to mortality, independently of other comorbidities, complications, and hospital characteristics, emphasizing the need for early diagnosis and aggressive management in such patients.

Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the goal of early communication to the interdisciplinary team. The project aims are as follows: a) to integrate the “Preparing for Caring” screening tool into the electronic health record, b) for nursing to provide education to the caregiver and assist with identification of needs during the inpatient stay, c) for nursing and the interdisciplinary team to collaborate with the caregiver during the inpatient stay to prepare for discharge, d) to provide education of resources available within the community upon discharge, and e) to include discussion of caregiver presence during the daily interdisciplinary team meeting. Program outcome measures will include use of aggregate data reports to determine the percentage of compliance for screening conduction, case review of identified caregivers, discharge education, and provision of a resource list upon discharge. Specified outcomes are being measured weekly during the implementation phase. As a result of the above, it will be determined if identification and subsequent intervention for informal family caregivers reduces readmission rate to an inpatient facility and the caregiver’s overall sense of burden in providing care upon discharge. Expected outcomes will be reduction in 30-day readmission to the inpatient geropsychiatry unit due to caregiver distress.

Magister Pharmaceuticae - MPharm / Background: Venous thromboembolism (VTE) is reported to be the leading cause of death in hospitalised patients worldwide. Thromboprophylaxis provides a well-established and evidence-based approach to preventing VTE. This approach employs individualised patient risk stratification followed by the provision of pharmacological and/or non-pharmacological prophylaxis. Although various VTE risk assessment models (RAMs) are available, the Caprini RAM offers an objective, evidence-based and validated approach to risk assessment in hospitalised medical patients. Literature findings are indicative of a trend towards both under- and inappropriate VTE prophylaxis prescribing in this patient population. Together with the reported lack of medical practitioner appreciation for VTE risk assessment, the necessity to explore these aspects of practice is evident. Methods: This study used a retrospective, cross-sectional study design. It was conducted at one regional- and two district-level public hospitals in the Cape Town Metropole in the Western Cape province of South Africa. Medical folders of all adult hospitalised medical patients who were admitted to a general medical ward between January and July 2020 were retrospectively reviewed using a uniquely designed data collection tool. The data collection tool included the 2013 version of the Caprini RAM, which was employed to document VTE risk factors and assess overall VTE risk. Thromboprophylaxis regimens prescribed as well as contraindications to pharmacological thromboprophylaxis were also reviewed

No description available.

No description available.

Research is lacking on the efficacy of aggression management training programs based on clinical outcomes. This study examined the efficacy of an aggression management training on managing aggression and violent behavior at East Mississippi State Hospital (EMSH), an inpatient behavioral health program. This training, The Mandt System, replaced a previous training, Techniques for the Management of Aggressive Behavior (TMAB), which was considered to be non-replicable outside state facilities in Mississippi. This study should not be seen as a comparative study between The Mandt System and TMAB, but rather as an investigation into the effects of implementing The Mandt System as a new training at EMSH. The efficacy of The Mandt System was examined through 4 key variables: patient to patient incidents, patient to staff incidents, seclusion episodes and restraint episodes. Over a 6 year period, incidents of aggression and violence were identified by extracting archival data from incident reports. Archival data were examined 3 years prior to the implementation of The Mandt System and 3 years after the implementation of the training. The researcher found that the rate of patient to patient incidents decreased as well as the rate of seclusions and restraint episodes following implementation of The Mandt System training. The rate of the patient to staff incidents did not decrease. Effective training on the management of aggression is essential in decreasing aggressive and violent behavior. Nevertheless, these findings are difficult to validate due to a scarcity of research that is supported by evidence from randomized controlled studies. A review of the literature revealed that researchers do not give precedence to the study of aggression management training when dealing with aggressive behavior in inpatient behavior health settings. This is possibly due to the findings of Hage, Van Meijel, Fluttert, and Berden (2009) that research on the effectiveness of intervention strategies requires a more complicated study design and involves many methodological and logistical challenges. Although the results of this study suggest that this training can have a positive effect on aggression and violence, much more needs to be done to evaluate the effectiveness of aggression management training programs.

No description available.

No description available.

Background: Approximately twenty percent (20%) of children and adolescents have mental health disorders and between 50–75% of all adult mental illness has its onset before the age of 18. Few under 18-year-olds with mental health disorders are, however, admitted for psychiatric inpatient care. The majority of those are adolescents who present with emerging serious mental health disorders. Very little is known about inpatient admission of preadolescent children (under 13 years) with mental health disorders. A review in 2000 showed mixed results about outcomes from admissions and highlighted a number of challenges with outcome studies. Objectives: The purpose of this study was to investigate the outcomes of preadolescents (hereafter referred to as ‘children') after inpatient admission, both locally and internationally. Methods: To meet the first aim, we performed a scoping review. Two reviewers independently searched EBSCOhost and Scopus (January 2000 – February 2017), using keywords ‘inpatient'; ‘psychiatry'; ‘psychiatric unit'; ‘mental health'; ‘children'; ‘treatment outcome/s'; ‘follow-up'; ‘secondary care'; to identify studies examining child (0–12 years) psychiatric inpatient outcomes. To meet the second aim, perspectives of convenience sampled parent-child dyads, who were previously patients at an inpatient psychiatric unit for under 13-year-olds in Cape Town, South Africa, were gathered using in-depth individual interviews. Data generated from the interviews were transcribed and analysed using thematic analysis. Results: Seventeen studies were identified by the PRISMA-guided search strategy in the scoping review. Measurements used differed widely. Significant improvements were reported at discharge and was maintained in short-term follow-up (1–4 months) studies. However, medium-term (5–11 months) and long-term (1 year or more) follow-up studies showed mixed results, with marked deterioration in very long-term studies. The qualitative study showed that most families found inpatient admission helpful, and indicated positive outcomes, but with ongoing difficulties over time. Two main themes related to outcomes emerged from the 10 parent-child dyads included in the study. The first theme (“A turn in the road”) highlighted inpatient admission as the catalyst of positive outcomes. Diagnostic certainty; newly acquired cognitive and behavioural skills; improved parent-child relationships; appropriate school placements; development of peer relationships; as well as follow-up psychiatric care and medication, were seen as contributing to positive outcomes. Conversely, the second theme (“Still a rough journey”) described ongoing difficulties including lingering problems despite improvement; minimal improvement when lacking a diagnosis; regression with transition to mainstream secondary school; and negative outcomes associated with lack of peer relationships and discontinuation of psychiatric care and medication. Conclusion: Taking together findings from our work, inpatient stay for child psychiatric patients was found to result in substantial short-term improvement. Medium-term outcomes were less clear, while long-term outcomes appeared mixed, with potential deterioration in the very long-term. However, the relatively few and diverse studies found in the scoping review made interpretation of the findings difficult. One striking finding from the research, was the absence of internationally agreed outcome measures to inform such research. In this study, qualitative data from families and children who had received inpatient treatment provided several functional outcomes that may be important, both for outcomes research and for post-discharge clinical practice.