Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission

Objectives

To determine whether receipt of therapy and number and timing of therapy visits decreased hospital readmission risk in stroke survivors discharged home.

住院药房药品调剂管理系统的开发与应用

目的促进信息化住院药房的建设。方法对比新旧住院药房药品调剂管理系统(简称调剂系统)应用前后1个月的流程,护理模块的改变及药师模块的优化,护士排药时间、取药等候时间、药师调配时间、调剂差错率等与医疗质量的差异。结果新调剂系统提高了护士排药效率,缩短了取药等候时间,提高了药房工作效率和准确率,调剂差错率明显下降。结论新调剂管理系统的应用提高了工作效率和管理效能,提升了药房药学服务的质量和水平。     

Effects of Adult Romantic Attachment and Social Support on Resilience and Depression in Individuals with Spinal Cord Injuries

Background:

Spinal cord injury (SCI) can cause psychological consequences that negatively affect quality of life. It is increasingly recognized that factors such as resilience and social support may produce a buffering effect and are associated with improved health outcomes. However the influence of adult attachment style on an individual’s ability to utilize social support after SCI has not been examined.

Objective:

The purpose of this study was to examine relationships between adult romantic attachment perceived social support depression and resilience in individuals with SCI. In addition we evaluated potential mediating effects of social support and adult attachment on resilience and depression.

Methods:

Participants included 106 adults with SCI undergoing inpatient rehabilitation. Individuals completed measures of adult attachment (avoidance and anxiety) social support resilience and depression. Path analysis was performed to assess for presence of mediation effects.

Results:

When accounting for the smaller sample size support was found for the model (comparative fit index = .927 chi square = 7.86 P = .01 β = -0.25 standard error [SE] = -2.93 P < .05). The mediating effect of social support on the association between attachment avoidance and resilience was the only hypothesized mediating effect found to be significant (β = -0.25 SE = -2.93 P < .05).

Conclusion:

Results suggest that individuals with SCI with higher levels of attachment avoidance have lower perceived social support which relates to lower perceived resilience. Assessing attachment patterns during inpatient rehabilitation may allow therapists to intervene to provide greater support.     

Glucose control in non‐critically ill inpatients with diabetes: towards closed‐loop

Inpatient glycaemic control remains an important issue due to the increasing number of patients with diabetes admitted to hospital. Morbidity and mortality in hospital are associated with poor glucose control, and cost of hospitalization is higher compared to non‐diabetes patients. Guidelines for inpatient glycaemic control in the non‐critical care setting have been published. Current recommendations include basal‐bolus insulin therapy, regular glucose monitoring, as well as enhancing healthcare provider's role and knowledge. In spite of growing focus, implementation in practice is limited, mainly due to increasing workload burden on staff and fear of hypoglycaemia. Advances in healthcare technology may contribute to an improvement of inpatient diabetes care. Integration of glucose measurements with healthcare records and computerized glycaemic control protocols are currently being used in some institutions. Recent interests in continuous glucose monitoring have led to studies assessing its utilization in inpatients. Automation of glucose monitoring and insulin delivery may provide a safe and efficacious tool for hospital staff to manage inpatient hyperglycaemia, whilst reducing staff workload. This review summarizes the evidence on current approaches to managing inpatient glycaemic control; its utility and limitations. We conclude by discussing the evidence from feasibility studies to date, on the potential use of closed loop in the non‐critical care setting and its implication for future studies.     

Museum object handling groups in older adult mental health inpatient care

Emerging evidence indicates that museum object handling sessions offer short-term benefits to healthcare participants. This study aimed to further understand psychological and social aspects of object handling in mental health inpatients. Older adults (N = 42) from a psychiatric inpatient ward with diagnoses of depression or anxiety took part in a series of object handling group sessions with 5–12 participants per group. Session audio recordings were subjected to thematic analysis. Five main themes were identified: ‘responding to object focused questions’, ‘learning about objects and from each other’, ‘enjoyment, enrichment through touch and privilege’, ‘memories, personal associations and identity’ and ‘imagination and storytelling’. The first four were congruent with literature associated with positive wellbeing and engagement outcomes but the fifth was a new finding for group contexts. Limitations include the relatively small sample and variable week-to-week group attendance. Audio recordings did not provide information on non-verbal communication and how objects were handled. Future studies should control for attendance and examine effects of multiple sessions over time, ideally with video recording. This study offers preliminary support for museum object handling as a group intervention in mental health care with potential to develop therapeutic aspects of the sessions. Findings indicate that object handling is a novel yet effective intervention with potential for conferring additional advantages by conducting sessions in group settings.     

The economics of inpatient on‐demand treatment for haemophilia with high‐responding inhibitors: a US retrospective data analysis

Summary. Inpatient costs comprise >50% of annual healthcare costs for haemophilia patients with inhibitors but no reports exist on inpatient resource use and costs at a US national level. To quantify inpatient resource use and costs for on‐demand treatment of bleeds of US haemophilia patients with inhibitors and compare costs and treatment duration between Factor VIII bypassing agents (BAs). Stays with haemophilia A from 2003–2008 were identified from inpatient billing records. Presence of inhibitors was inferred through use of BA; recombinant activated Factor VII and plasma‐derived activated prothrombin complex concentrate. Duration and number of infusions of BA, length of stay, use of opioid‐containing analgesics and costs were assessed and compared. Among 1322 stays mean BA treatment duration was 4.6 days with 4.9 infusions, 6.1 nights spent in hospital, and 58% administered opioid‐containing analgesics. In unadjusted analyses there were significant differences in the above mentioned outcomes by BA use, reflecting underlying differences between the two patient populations. Average inpatient costs were $82 911. In adjusted analyses, African‐American race, greater disease severity, hospital region outside the southern US and older age (cost model only) were significant predictors of longer BA treatment duration and higher costs. The economic burden of inpatient on‐demand treatment of haemophilia with inhibitors is substantial and is associated with lengthy stays, high costs and inadequate pain relief. Availability of more effective BAs could reduce the need for re‐treatment, reducing treatment costs and other medical costs, while improving health related quality of life.     

Outcome of neuropsychiatric symptoms and daily functioning of patients with dementia treated on an acute psychogeriatric ward

Abstract

Background: Dementia is associated with progressive deterioration in multiple cognitive domains, functional impairment and neuropsychiatric symptoms (NPS).

Aims: The aim of this study was to explore the factors associated with the outcome of NPS and daily functioning in patients with dementia during acute psychogeriatric hospitalization.

Materials and method: The data (n?=?175) were collected between 2009 and 2013 in naturalistic settings on one acute psychogeriatric ward at one university hospital in Finland. Behavioural symptoms were assessed using the Neuropsychiatric Inventory (NPI) and activities of daily living using the Alzheimer’s Disease Cooperative Study–Activities of Daily Living (ADCS-ADL).

Results: During the hospital stay (45 days ±30.4) NPI total score decreased from 33.9 to 18.2 (p?<?.001). Daily functioning score decreased from 31.7 to 20.9 (p?<?.001). The number of patients taking antipsychotics (96–130, p?=?.004) and anxiolytics (54–102, p?<?.001) increased from admission to discharge. Overall mean dosage (mg/day) of antipsychotics (from 40.2 to 72.0 in chlorpromazine equivalents, p?<?.00) and anxiolytics (from 3.43 to 7.47 in diazepam equivalents, p?<?.001) also increased. Higher antipsychotic dosage at discharge was a significant predictor for large NPI score change (p?=?.002) indicating better symptom reduction. Neither higher antipsychotic dosage or anxiolytic dosage at discharge were significant predictors for ADL score change.

Conclusions: Neuropsychiatric symptoms improved while deterioration was found in daily functioning from admission to discharge. Higher antipsychotic dosage at discharge was a predictor for larger NPI score change indicating better symptom reduction. Preventing threatening ADL decline during hospital stay is especially important.