The purpose of the study was to explore the relationship between schizophrenic patients' length of stay in a state psychiatric hospital and readily available intrapersonal, interpersonal, and sociodemographic factors. The factors selected for study were:1. Admission Legal Basis2. Relationship of Responsible Person3. Previous Episodes of Hospitalization 4. Sex5. Admission Age. 6. Marital Status7. Race8. Education9. DiagnosisThe subjects were 461 patients admitted to the Richmond, Indiana State Hospital from July 1, 1974 to June 30, 1979. All patients who met the criteria for selection were included.The design for the study was the ex post facto approach. It was essentially a Design 3 situation using only one group and holding to the assumption of random distribution of nonmanipulated variables. Two null hypotheses were tested using stepwise hierarchical multiple regression. The .05 level of significance was required.FindingsThe multiple regression analysis yielded a significant multiple correlation (R = .26, R2 = .07, P <.05) between length of stay as the dependent variable and the composite predictor variable. However, an inspection of the results showed that Admission Legal Basis was the only variable found to be individually significant. In view of the low amount (7%) of variance explained by the composite predictor variable, the analysis was terminated at that point and the results were not interpreted or considered to have a practical use.ConclusionThe only conclusion made was that the results of this study were inconclusive due to the small percentage of variance explained. Thus it was hypothesized that there were factors which remained unidentified that were in operation and greatly influenced length of stay.

Thesis (M.H.A.)--University of Michigan, 1959.

Thesis (M.H.A.)--University of Michigan, 1959.

In recent years, concern about the rising costs of health care has prompted the development of programs aimed at reducing utilization of hospital services and facilities while maintaining an acceptable standard of care. One of the major strategies that has emerged in the effort to accomplish these dual objectives, is utilization management. Although there are a number of different approaches, the primary aim of all utilization management programs is to identify and eliminate unnecessary and inappropriate hospital use. To date, most of the utilization research and program development has taken place in the United States. To a great extent, this effort has focussed on the development and use of norms for utilization based on a breakdown of length of stay data by diagnostic-related groups (DRG's). Canadian interest in this type of approach is reflected in the recent development of data bases defined by case-mix groups (CMG's). However, while continued efforts are being made to refine these schemes, they have been vulnerable to the criticism that they do not provide adequately objective criteria for establishing what constitutes appropriate patterns of hospital use. In addition, because they are based on statistically derived norms, they have been criticized as lacking sufficient clinical relevance to encourage physician support. Since hospital utilization is largely determined by the medical staff, utilization management programs that fail to obtain physician support are unlikely to succeed. An alternative approach, which appears to be gaining in popularity, involves the formulation of criteria which can be used to determine what constitutes appropriate and necessary hospital use. Essentially, it is argued that by directly identifying the source and nature of misutilization, it should be possible to develop more effective strategies for the resolution of identified problems. The American Appropriateness Evaluation Protocol designed by Gertman & Restuccia (1981) is one of the earliest and most highly tested examples of a criterion-based system. In Canada, interest in this type of approach is more recent and, consequently, little attention has as yet been focussed on the development and use of clinical criteria in utilization review and management. One exception, however, is the SWITCH Index System. This system, which was developed and implemented in 1984 by the Peace Arch District Hospital (White Rock, B.C.), makes a direct attempt to identify and eliminate days of hospital stay during which no appropriate acute care services are being provided. The criteria used in this system are classified under the headings Signs, Wind, Intramuscular Therapy, Tubes, Consultant, and Hospice. Patients are considered to be appropriately placed in the hospital if, on any given day, at least one of the specified criteria are met. Otherwise they are classified as Off-Index and action is taken to identify the source of the problem and to initiate corrective action. Since a major objective of the SWITCH system is to identify and eliminate inappropriate use, an observable outcome, if the program is successful, should be a reduction in length of stay. The present study investigated this hypothesis by comparing pre- and post- intervention length of stay trends at the Peace Arch District Hospital. In addition, to take into account any general secular trends in length of stay over time, the Peace Arch length of stay was compared to the length of stay observed for a control group of three peer-group member hospitals. Although data covering the four year period 1982 to 1985, indicated that the length of stay at the Peace Arch District Hospital had been decreasing over time, no component of this general decline could be attributed to the SWITCH Index System. Time series regression analyses failed to detect changes in either the slope or the height of the estimated response curve. However, limitations in the study design do not permit any conclusions regarding the potential effectiveness of this system. Characteristics specific to the Peace Arch District Hospital may have prevented the detection of an effect. In addition, because it is likely that there would be a lag between when the program was implemented and when it might be expected to effect a reduction in length of stay, the follow-up period of eleven months may have been too short for the determination of the program's effectiveness. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Background: Hospitalizations including the diagnosis of an eating disorder (ED) have increased significantly in the pediatric population over the past few decades. Patients who are male, who areage, who receive an nasogastric (NG) tube, or who require admission to a residential treatment program often remain in the hospital for longer periods of time. Few studies examining LOS exist for children and adolescents with an ED. Longer lengths of stay have previously been associated with factors such as having Medicaid, a reduced body mass index (BMI) upon admission, and a diagnosis of anorexia nervosa (AN). Objective: The purpose of this study is to examine risk factors related to a longer LOS in children and adolescents admitted to a large urban pediatric hospital with AN or bulimia nervosa (BN). Participants/setting: A retrospective cohort study was conducted in 65 patients 9-20 years of age who were admitted to Children’s Healthcare of Atlanta (CHOA) between January 1, 2014 and December 31, 2015. Statistical Analysis: Frequency statistics were used to describe the demographic, anthropometric, and clinical characteristics of the population. A Mann Whitney U test or Kruskal-Walllis test was used to examine differences in LOS by demographic characteristics, mode of nutrition therapy, discharge treatment program location, and admission BMI category. The association between LOS category by demographic and clinical characteristics was determined using a Chi-square statistic. Results: A total of 65 patients (94% female, 89% Caucasian) with a mean age of 14.6 ± 2.4 years were admitted during the study period. The median LOS was 9 days (IQR; 6, 13) and was significantly longer in those who had an NG tube placed vs. oral diet (11 days (IQR; 7, 21) vs. 8 days (IQR; 5, 9.3), respectively; p Conclusion: The characteristics of hospitalized pediatric patients with an ED were consistent with those of other studies. Longer lengths of stay in those who had an NG tube placed may have been due to the patient’s lack of compliance, failure to gain weight, and severity of malnutrition since more time is needed for medical recovery. More treatment centers for children and adolescents with an ED are needed in the state of Georgia to potentially reduce LOS. Future studies should include a greater percentage of males and larger population of children and adolescents.

This study was undertaken to assess factors contributing to difference in nutritional status of patients at high risk for malnutrition. Twenty-five patients hospitalized for treatment of cancer and other disorders and for surgery were assessed using anthropometric, biochemical and dietary measures.Significant malnutrition was found. Males, as compared with females, had lower percent triceps skinfold, percent weight-for-height, percent hemoglobin, decreased appetites and total iron binding capacity. Mean total iron binding capacity for males was 62 percent of normal suggesting acute malnutrition similar to kwashiorkor. Cancer patients had lower total lymphocyte counts than those with other diagnosis. Patients hospitalized more than 23 days showed evidence of marasmus, with lower percent mid-arm muscle circumference, percent hematocrit, percent hemoglobin and a tendency for decreased weight/height than those hospitalized for a short time. Compared with patients with good appetites, those experiencing poor appetites had increased caloric and protein needs but lower protein intake compared to needs and lower creatinine-height-index.Five subjects with decreased weight/height had lower total iron binding capacity. The mean was 61 percent of normal indication severe depletion. The mid-arm muscle circumference was 82 percent of normal suggesting acute malnutrition imposed upon compromised somatic protein stores. Nine subjects showed evidence of frank kwashiorkor, three other subjects experienced marasmic-kwashiokor indication acute malnutrition imposed upon chronic malnutrition.In conclusion, this study suggests several characteristic features of hospitalized patients at risk for malnutrition: hospitalization for over three weeks, inadequate caloric and protein intake relation to need and anorexia. These patients are candidates for nutritional assessment and support.

International Study Exchange Programmes as a Form of Student Mobility Abstract Czech students have been only little surveyed as a mobile population so far, despite the increasing importance of student mobility in the contemporary globalised world. This thesis examines student mobility on the example of Czech students from geographical departments of Charles University in Prague, Faculty of Science, who joined the Erasmus exchange programme as a part of their studies in the past five years (2005-2010). This study aims to analyze the directions and intensity of Erasmus student flows and motivation of students to take part in the student exchange programme. One of the main goals is also to measure the influence of the Erasmus study exchange on the potential international mobility of students. A multi-method approach is used in this case study, including questionnaire surveys among mobile students, interviews with Erasmus coordinators and a statistical analysis of existing data sources (especially the statistics of the geographical departments and the database of Czech National Agency for European Educational Programmes). The results show that the motivation to student mobility is influenced by many factors. The questionnaire data reveal a major importance of language and life experience as motivational...

MPH, Faculty of Health Sciences, University of the Witwatersrand, 2011 / Background: General public hospitals in South Africa are currently overloaded with psychiatric patients who cannot be transferred to specialised psychiatric hospitals because of lack of beds. Identification of factors influencing bed occupancy could be used to model ideal referral systems for psychiatric patients. There has been no known study conducted in the specialised psychiatric hospitals in South Africa to assess patient profiles since the implementation of the Mental Health Care Act of 2002. This study was planned to determine the length of stay in a psychiatric hospital in Gauteng Province and to identify factors that could influence the length of stay in that hospital. Aims: To determine the length of stay in specialty units and the influence of specific factors on length of stay at the Tara - the H Moross Centre, during a one-year period. Methodology: This was a cross sectional study which involved the analysis of retrospective data for a one-year period. This data is routinely collected by the Hospital. Variables included age, gender, ethnicity, marital status, employment status, medical aid utilisation, education level, hospital classification, unit of admission, access to hospital, source of referral, season, frequency of admissions, medico-legal status, and length of stay. Descriptive statistics was used to analyse the data. Permission was obtained from the Gauteng Department of Health and Social Development, and the University of the Witwatersrand Ethics and Postgraduate Committees. Results: The findings indicate that most patients stay in Tara for 49 (29-78) days, which is in keeping with the expectation of this hospital, which is an acute to medium term psychiatric hospital. Significant differences in gender, ethnicity, marital status, employment status, medical AID status and hospital classification among different wards was established. The clinical profile was predominantly biochemical related disorders from public tertiary and public secondary hospitals reflecting the under privileged groups in the population. Social demographic factors and clinical profiles were found to significantly influence the LOS. Gender, ethnicity, employment status, and source of referral were more influential. Conclusion: A follow up study could look at the readmission rates of these patients who stay in the hospital for this short period to determine if the rehabilitation programmes are indeed effective or the patients are being discharged prematurely only to be readmitted.

Thesis advisor: Shawn McGuffey / This paper provides a look into the lives of 13 stay-at-home fathers. This qualitative, exploratory study conducted in-depth interviews with 13 men who defined themselves as stay-at-home fathers. Respondents were obtained through convenience sampling. Fathers were from several major metropolitan U.S. cities, from New York, Los Angeles, Boston, to Washington, D.C. All respondents were white, middle- to upper-middle class males. This study aims to analyze gender through the theories of “doing gender” (West and Zimmerman, 1987) and structuralism (Risman, 1998). This paper argues that what dictates an individual to become a successful parent is not sex or a biological desire, but structural and situational demands. Due to financial reasons and time availability, these men were able to commit the time and energy needed to become a full-time parent. This paper also analyzes the different ways in which men construct masculinity when taking on an untraditional role. Stay-at-home fathers emphasize physical activity, sports, and a lack of emotional connection as a way of maintaining and constructing masculinity. This paper concludes that gender is not only socially constructed, but also that gender is constructed within the structural demands of the situation. Although stay-at-home fathers still find ways to construct masculinity, their stories demonstrate that they are just as capable as women to rise up to the challenges of full-time parenting. In conclusion, this study argues that good parenting knows no gender, and that government policies and programs should advocate for all different family structures. / Thesis (BA) — Boston College, 2010. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Sociology Honors Program. / Discipline: Sociology.

A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated the discharge plan with the patients on admission. Discharge planning on admission and daily briefings involving care coordination and bedside staff reduced the length of stay, improved HCAPHS scores, and reduced 30-day readmissions by fostering better communication and collaboration. A 1-group pretest and posttest were utilized to compare data before care coordination and after care coordination. These findings yielded a length of stay reduction of 2.04 days, a 50% reduction in 30-day readmissions, and HCAPHS communication composite scores above the 50th percentile. The care coordination team exposed various programs and community resources that assisted with medications and durable medical equipment and suggested that companionship alleviated potential anxiety post discharge for those financially and socially burdened. The implications of a patient-centered team-based approach to discharge planning on admission eliminated barriers to discharge, improved patient knowledge of disease management, and provided a positive hospital experience.