回顾性评估中国广州一家大型精神病医院再住院的相关因素(英文)

背景:中国大多数精神科住院患者是由家人强制性入院,导致住院时间相对较长和再次住院率相对较低。然而,这种模式随着新颁布的中国精神卫生法(颁布于2013年)可能发生变化,该法限定了强制性精神科入院为那些对自己或他人产生危险的小部分精神疾病患者。目标:评估中国广州精神科住院患者再次住院率的相关因素。方法:对从中国最大的精神病医院之一——广州市精神病医院收集来的数据进行回顾性分析,使用Cox回归模型评估年龄、性别、诊断、婚姻状况、就业状况之间的关系,与主要照顾者的关系、医疗保险、指标住院的时间、以往的入院次数之间的关系,进而评估出院后一年内再住院的风险。使用多因素回归分析来评估随访一年中再次住院总时间的相关因素。结果:2011年1月至2012年12月31日间3455例住院患者的平均住院时间(标准差)为65.7(66.3)天,476(13.8%)名患者出院后一年内再入院一次或多次。在将再入院所有可能的预测因素进入多因素生存分析后,指标住院前的以往住院次数是再次住院的唯一有统计学意义的预测因子。与再住院总时间显著相关的唯一因素是指标住院的长短。结论:缩短住院时间并没有增加中国南方一家大型公立精神病院的患者再住院率。这表明,根据中国的新法规,大部分病人自愿入院时不仅不会导致再次住院率的增加,可能还会出现预期的精神病患者的住院时间的缩短。前瞻性研究将需要结合更全面的结果评估(包括患者功能,服药依从性,和家庭负担)来监测精神卫生法对患者和精神卫生服务分布的影响。     

住院精神障碍患者应用镇静催眠药状况调查分析

目的 调查住院精神障碍患者镇静催眠药的应用状况.方法 随机抽取2880例精神障碍患者的用药信息,并采用自制调查表进行相应调查.结果 在2 880例患者中,合并使用镇静催眠药的患者为768例,各类精神障碍合并使用镇静催眠药的患者分别为:精神分裂症432例(56.2％),心境障碍171例(22.3％),器质性精神障碍49例(6.4％),神经症39例(5.1％),暂时性精神病26例(3.4％),癔症14例(1.8％)等.镇静催眠药使用频率依次为:阿普唑仑、氯硝西泮、地西泮、艾司唑仑、劳拉西泮等.使用镇静催眠药时间:＜60d者为479例(62.5％),＞60d者为288例(37.5％).结论 精神科住院患者服用镇静催眠药基本规范,也有不合理用药.     

情感性精神障碍患者出院后自杀危险因素探讨

目的 探讨情感性精神障碍患者自杀的危险因素及家庭安全护理要点.方法 对符合中国精神疾病分类方案与诊断标准第3版修订本中情感性精神障碍诊断标准出院的144例患者,进行为期2～6年的护理随访,对自杀危险因素的单因素和非条件Logistic回归分析.结果 36例(25%)患者发生过自杀,其中自杀未遂30例(20.83%),自杀死亡6例(4.17%).自杀危险因素:为双方相混合或快速循环型频繁发生和自杀未遂史,保护因数为多次住院.结论 有潜在自杀危险因素的情感性精神障碍患者应加强自杀的防范,家庭安全护理非常重要,住院治疗为有效的保护因素.     

农村与城市精神分裂症患者再住院因素的调查分析

为了解农村与城市精神分裂症患者再住院的因素,我们对此进行了调查与分析。现报道如下：     

某院精神障碍患者长期住院原因调查

目的了解男女精神障碍患者长期住院的原因。方法采用自编长期住院原因调查问卷对2014年1月1日在广州市民政局精神病院普通精神科住院超过1年、病情控制稳定并能够配合医护人员的370名符合《国际疾病分类(第10版)》(ICD-10)诊断标准的精神障碍患者进行调查。结果男性住院时间比女性长(P0.01);女性长期住院问卷总评分比男性高(P0.01);女性客观维度评分比男性高(P0.01);男性受家庭因素影响明显(P0.01);女性受社会因素影响明显(P0.01)。结论客观因素可能是精神障碍患者长期住院的主要因素,其中男性受家庭因素影响明显,女性受社会因素影响明显。     

长期住院精神障碍患者的临床资料研究

目的调查精神障碍患长期住院的有关因素,探讨有关干预方法。方法用自编的长期住院病人调查问卷调查了连续住院2年以上的精神障碍患149名。结果长期住院患占同期住院患的42．9％。有122例存在不同程度的淡漠、退缩、始动性缺乏等衰退症状。有64例病人无出院要求。除19例无任何家人外,其余亲属均以接回家后无法管理,怕发病为理由拒绝接出院。131例享受政府住院补贴。结论病人长期滞留医院既有病情方面的因素,也有家庭社会及政府方面的因素。因此,应从以上几个方面进行积极干预,使患病情缓解后能顺利出院,早日回归社区。     

精神障碍非自愿住院的患方主观体验

本文回顾既往文献,对精神障碍非自愿住院的患方主观体验评估和影响因素的相关研究进行整理。     

精神分裂症患者再住院率研究

目的:比较出院后精神分裂症患者以利培酮、氯氮平、低效价和高效价传统抗精神病药治疗者的再住院率。方法:对833例1999年内出院的精神分裂症患者调查,于2003年12月底前调查患者出院后至少48个月的情况。结果:601例完成调查,利培酮组81例,氯氮平组177例,低效价传统药组161例和高效价传统药组182例,4组的未再住院率,12个月(分别为59.3%、65.5%、65.2%和67.6%)、24个月(53.1%、52.0%、55.9%和51.1%)3、6个月(48.2%、36.7%、44.7%和36.8%)和48个月(42.0%、31.1%、39.1%和30.2%),差异均无显著性(P均>0.05)。利培酮的药物完全依从率高(60.5%)。结论:精神分裂症患者不同抗精神病药物治疗出院后的再住院率相当。     

系统化护理干预对长期住院老年精神障碍患者便秘的影响

目的探讨系统化护理干预对改善长期住院老年精神障碍患者便秘的效果。方法选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)和罗马Ⅲ诊断标准的,连续住院时间≥2年,年龄≥65岁的住院精神障碍便秘患者82例,采用随机数字表法分为对照组和干预组各41例。对照组接受常规治疗及护理,干预组除接受常规治疗和护理外,同时进行包括饮食管理、功能锻炼、重建排便习惯等系统化护理干预8周。观察两组排便时间及每周排便次数。结果系统化护理干预8周后,干预组每次排便时间和每周排便次数与对照组比较[(7.39±2.21)min vs.(9.73±1.78)min,(6.46±0.98)次vs.(4.54±0.84)次],差异均有统计学意义(t=5.29、9.58,P均0.01)。结论系统化的护理干预对长期住院老年精神障碍患者便秘可能有效。     

住院精神疾病患者药物治疗临床分析

目的:分析目前住院精神疾病患者所接受的药物治疗是否规范.方法:采用自行设计的问卷,调查湖南省7所精神病院住院病人658例用药情况.结果:62.6%的病人为单一用药.精神分裂症治疗最常用药物是氯氮平(41.9%),最常用的联合用药为氯氮平 舒必利;情感障碍治疗最常用药物是碳酸锂(41.8%),最常用的联合用药是碳酸锂 氯氮平.结论:多数精神病院的住院病人的用药是规范的,但也存在不合理用药的现象.     

Risk factors for readmission among a cohort of psychiatric inpatients in Lilongwe,Malawi

Abstract

Objectives: Inpatient psychiatric capacity is limited in Malawi and no published studies have assessed psychiatric readmissions there. Information about factors associated with readmission may help guide strategies to reduce readmission rates and keep patients stabilised in the community. Our goal was to determine factors associated with readmission among a cohort of psychiatric inpatients in Lilongwe, Malawi.

Methods: We conducted a retrospective chart review of all patients admitted to an inpatient psychiatric unit in Lilongwe, Malawi from January 1 to December 31, 2011. We used logistic regression to test for associations between readmissions during the study period and patient variables.

Results: 419 patients were hospitalised during the study period. Twenty-nine patients (6.9%) were readmitted at least once during the study period. Readmission was associated only with intentional medication non-adherence at home (aOR: 3.33, p?=?0.02).

Conclusions: Intentional medication non-adherence is a potentially modifiable behaviour associated with psychiatric readmission. Efforts to improve medication adherence among patients following hospital discharge may help decrease the risk of readmission.

• KEY POINTS

• The prevalence of readmission among psychiatric inpatients in Lilongwe, Malawi was 6.9% during the 1-year study period.

• Readmission was associated with intentional medication non-adherence at home.

• Future research efforts in Malawi should focus on improving medication adherence among psychiatric patients in the community to help decrease rates of readmission.

     

Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge

OBJECTIVE: To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization. METHOD: One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via the Cox proportional hazards model, were symptom and family factors assessed at admission, aspects of psychiatric treatment, and demographic variables. RESULTS: The Kaplan-Meier rehospitalization risk within 1 year of discharge, taking into account known readmissions and censored observations, was 0.37. Most readmissions (81%) occurred within 90 days of discharge. Four variables contributed simultaneously to predicting readmission risk. More severe conduct problems, harsh parental discipline, and disengaged parent-child relations conferred a higher risk for rehospitalization; these risks were attenuated when parents disclosed higher stress in their parenting roles. CONCLUSIONS: Findings showed that psychiatric rehospitalization of children is common, most likely in the trimester after discharge, and highly related to both child symptoms and family factors measurable at admission. Results suggest that efforts to improve postdischarge outcomes of children should target the initial period following inpatient care, address vigorously the complex treatment needs of those with severe conduct problems, and aim to improve parent-child relations.     

Depression and partial remission after short-term treatment

Residual symptoms of depression after psychiatric treatment are strong predictors of early relapses. The initial treatment process should therefore be effective enough to prevent such symptoms. We conducted a 3-month follow-up study to determine what factors prevented clear alleviation of depressive symptoms (Beck Depression Inventory (BDI) score of <10 at follow-up and a BDI score decrease of at least 30%) in 45 patients treated in specialized psychiatric outpatient care. All of the patients had a DSM-III-R depressive disorder. Fifty-six per cent showed signs of partial remission after 12 weeks of treatment. Those showing signs of partial remission did not differ from those having recovered in terms of sociodemographic or clinical (including BDI score) variables at base line. Certain life events occurring during treatment were associated with partial remission. Those who recovered were more satisfied with their therapy process than those experiencing partial remission, and their life satisfaction was greater, but this could have been a result of alleviation of their depression. Patients who do not respond to treatment should be carefully re-evaluated to discover possible new stressful life events.     

老年精神疾病患者院内跌倒调查

目的：了解老年精神疾病患者院内跌倒发生情况及其危险因素。方法：回顾性调查我院1998—2001年人院的381例老年精神疾病患者的跌倒发生情况，并对其危险因素进行Logistic回归分析。结果：跌倒发生率13．4％，骨折率5．0％。多因素Logistic回归分析显示轻—中度痴呆，合并慢性疾病是跌倒的主要危险因素，而有配偶则是其保护因素。女性跌倒骨折发生率达男性的4倍。跌倒者死亡率是非跌倒者的3倍。结论：跌倒在老年精神疾病患者中较常见，带来严重后果应予重视。     

Risk factors for prolonged length of stay in patients undergoing surgery for intramedullary spinal cord tumors

Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on hospital length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to potential for prolonged length of stay and postoperative complications, it is important to better understand the factors that increase the risk of these outcomes in patients with IMSCTs.MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factors influencing prolonged length of stay and post-op complications.ResultsA total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above (OR 1.89; p = 0.0005), dependent functional status (OR 2.76; p = 0.0035) and transfer from facilities other than home (OR 8.12; p <0.0001) were independent predictors of prolonged length of stay (>5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%).ConclusionOur study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.     

Measuring observed mental state in acute psychiatric inpatients

Background  Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined. Aim  Data from a multi-centre service evaluation (11 units, 5,546 admissions) were used to examine mental state patterns and associations with clinical characteristics, events and adverse incidents. Method  During the 12-month evaluation period, nursing staff completed shift-level ratings using a new rating scale, the observed mental state (OMS) scale, which assessed active psychopathology (emotional distress, disinhibition, psychosis, cognitive impairment) and withdrawal (45,885 sets of day/afternoon shift ratings). Results  The OMS scale performed satisfactorily and is worth considering elsewhere (e.g., active psychopathology: internal consistency, α = 0.72; short-term stability, r = 0.72; sensitivity to change, adjusted standardised difference, ASD = 0.71). Levels of active psychopathology were much higher on shifts in which reportable (ASD = 1.47) and less serious aggression occurred (ASD = 1.44), compared with other shifts in which pro re nata medications were also administered (ASD = 0.76), suggesting that medication usage often followed these events, and possibly that agitation and distress levels either rose rapidly or went initially unnoticed on these shifts. Although mental state improved steadily across the admission, one-fifth of the patients with schizophrenia received OMS psychosis ratings in the moderate to severe range during the days prior to discharge. Conclusions  Observed mental state ratings were strongly linked with diagnosis and reflected key events and incidents. Routine recording using the OMS scale may assist clinical decision-making and evaluation in acute psychiatric units.