Socioeconomic and familial factors in the involuntary hospitalization of patients with schizophrenia

In the catchment area of Matsumoto Public Health Center in Japan, 44 schizophrenic patients admitted between April 1992 and March 1997 under the national policy Involuntary Hospitalization Ordered by Prefectural Governor (IHOPG) were compared with 61 schizophrenic patients admitted under another policy, Hospitalization for Medical Care and Protection (HMCP), during the same period. The socioeconomic and familial factors that led patients to IHOPG were evaluated in detail. The results revealed the following characteristics of IHOPG patients as opposed to HMCP patients: (i) their morbidity was of longer duration; (ii) they were more likely to live in a densely populated area; (iii) they were less likely to be financially self-sufficient; (iv) prior to admission they were more likely than HMCP patients to have avoided psychiatric examination and to have refused to take medication, and most had received no treatment before their hospitalization under IHOPG; (v) their relationships with family members were more likely to be poor; and (vi) the family was less likely to have cooperated with treatment or to have solved the patient's problematic behaviors. This investigation and the ensuing discussion revealed that a patient's schizophrenia-based danger to hurt self or others, which is an essential impetus for admission to IHOPG, does not arise suddenly but rather stems from multiple factors developing over time.     

Hospitalization of children with acute immune thrombocytopenic purpura – is it necessary?

OBJECTIVE:

To identify a target group of children with acute immune thrombocytopenic purpura (ITP) that may not require hospitalization for management.

METHODS:

A retrospective chart review was conducted of all children admitted over a two-year period to a tertiary care paediatric hospital with the diagnosis of acute ITP. Patients were classified according to typical and atypical presentations. Typical patients were defined as those aged between one and 10 years, with no hepatomegaly or significant splenomegaly and who had typical laboratory features for ITP. Patients who did not meet these criteria were categorized as atypical. Outcome measures included length of stay (LOS) in hospital; frequency of bone marrow aspiration (BMA); type of treatment; incidence of intracranial hemorrhage (ICH) or severe bleeding; and admission and discharge platelet counts.

RESULTS:

There were 74 patients hospitalized for a mean of 3.6 days. No patients suffered an ICH or bleeding requiring transfusion. Patients with typical presentations (42) were compared with patients with atypical presentations (32) and were not significantly different for clinically important outcomes such as admission and discharge platelet counts, serious complications or type of therapy. Typical patients had significantly fewer BMAs than did atypical patients – 22 of 42 (52%) versus 25 of 32 (78%) (P=0.02), and a shorter LOS – 3.1 (±0.9) days versus 4.2 (±1.8) days (P=0.01).

CONCLUSIONS:

Children presenting with ITP have a low incidence of bleeding complications and many of these patients can be managed as outpatients. A multicentre study is needed to properly delineate a low risk group suited for outpatient medical management.     

Effectiveness of influenza vaccination in the elderly in a community in Italy

Objectives: Assess the effectiveness of influenza vaccination in reducing hospitalization due to pneumonia and influenza among elderly subjects in a community in central Italy. Estimate the hospitalization fraction preventable by extending the vaccination program. Methods: Case–control study. Cases were subjects aged 65+ at hospital admission (1 December 1994–31 March 1995). For each case two population controls were randomly chosen, matched by sex, age and residence. Variables of interest were recorded through a postal questionnaire and telephone interview. A matched-set analysis was carried out adjusting for concomitant chronic diseases, education, type of home heating, and smoking habits. The preventable fraction of hospitalization was computed through the application of the attributable risk estimate. The setting was 33 municipalities in central Italy including 169,370 residents aged 65 years or more. Results: Two hundred and seventy-five cases 550 controls were analyzed. Influenza vaccination was effective in preventing 33% of hospitalization due to pneumonia/influenza. The fraction of hospital admissions preventable by extending the vaccination was 17%. When the analysis was limited to self-respondents to the questionnaire (excluding next-of-kin) and to pneumonia/influenza as primary discharge diagnosis, protection from hospitalization by vaccination almost reached 50%, a better result in comparison with most case–control studies. Conclusions: Influenza vaccination was shown to be successful in reducing hospital admissions due to pneumonia and influenza. A large number of hospitalizations could be reduced extending the vaccination campaign.     

660例急性阑尾炎患者住院费用及影响因素分析

目的 通过对急性阑尾炎住院费用的分析，进一步了解影响医疗费用的因素，为合理控制医疗费用的过快增长提供参考。方法 采用多元逐步回归法对2003-2005年660例急性阑尾炎病例的有关信息对住院费用高低的影响进行了分析。结果 住院天数、手术与否、有无其他诊断、年龄等情况对住院费用的影响有统计学意义（P=0．000）。其中，住院天数是影响住院费用的主要因素。结论 影响住院费用的最主要因素是患者的住院天数，缩短病人的住院天数已成为有效地控制医疗费用增长的一个重要手段。     

应用主成分分析法对某医院住院工作进行综合评价

目的 对某医院近6年住院工作情况进行综合评价，为医院决策提供客观、科学，反映医院工作实质的统计分析。方法 选择反映工作效率、医疗质量的10项统计指标，应用主成分分析法，分别在单层次及整体水平上进行评价，并得出综合评分。分析过程采用SPSS软件进行数据处理。结果 近6年来，医院工作质量综合评价最好的是2005年，其次是2000年，2002年排名第3，综合评价最差的是2003年。结论 医院的工作效率与医疗质量同等重要，医疗质量是医院发展的根本，只有在保证医疗质量的前提下，提高工作效率，才能使医院得到更大的发展。     

成都市8382例老年住院患者医疗费用的描述性分析

目的 探讨老年人住院医疗费用特点,为建立有效的医疗费用控制机制提供依据.方法 对成都市某三级甲等医院8,382例年龄在60岁以上的老年人住院医疗费用进行描述性分析.结果 (1)老年人例均住院费用12,237元,高出全院平均费用8,597元的42.3%.(2)老年人例均住院费用和例均药品费与成都市住院患者平均水平的比较差别显著(P＜0.05).(3)70岁～79岁年龄段老年患者平均药费和平均检查治疗费高出一般患者的65.2%和61.9%.结论 应针对医院实际情况,进一步加强对老年住院患者住院天数、例均住院医疗费用,药品比例等指标的考核,提倡合理检查,合理用药,控制医疗费用的过快增长.     

Early discharge after external anal sphincter repair

PURPOSE: The aim of this study was to describe an accelerated-stay program for repair of the external anal sphincter. METHODS: Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization and complications within 30 days after the operation. Surgery was performed during the period of March 1993 to May 1997. The accelerated-stay program included preoperative information, no premedication, a surgical procedure without colostomy, single-dose prophylactic antibiotics, paracetamol for analgesia, free oral fluid and food immediately after the operation supplemented by laxatives, and enforced mobilization. Follow-up by questionnaire was performed at a median of 14 (range, 4–52) months after the operation. RESULTS: Median hospital stay was one day. Fifteen patients were discharged the day after surgery and 5 patients stayed for 48 hours after the operation. There was no 30-day morbidity, and no patient received a colostomy in conjunction with the sphincter repair. Fourteen of 19 patients available for follow-up reported a significantly improved functional result compared with preoperative state. CONCLUSION: We have described a safe accelerated-stay program (24 to 48 hours) for overlapping repair of external anal sphincter.     

高血压患者152例住院治疗的护理研究

目的探索高血压患者住院治疗的医疗护理方式对有效控制血压的影响。方法将患者分为A组和B组,2组治疗用药相同,采用的医疗护理方式不同。A组80例,采用药物治疗护理、非药物治疗护理、其他治疗护理等3种护理方式。B组72例,采用药物治疗护理、非药物治疗护理2种护理方式。①高血压药物治疗护理:根据药物制剂给药,按时按量用药,根据病情选用药物与用药剂量。②高血压非药物治疗护理:改善食物结构,增加适当的体力活动,有氧锻炼,减轻精神压力,保持心理平衡。③高血压的其他治疗护理:降血脂指导,抗血小板干预,血糖控制,康复按摩,心理辅导。结果 A组收缩压平均降低(34±8)mm Hg(1mm Hg=0.133kPa),B组收缩压平均降低(19±5)mm Hg,比A组低(15±3)mm Hg;A组舒张压平均降低(14.0±2.0)mm Hg,B组舒张压平均降低(9.0±1.0)mm Hg,比A组低(5.0±1.0)mm Hg,治疗效果A组优于B组。高血压患者对护理依从性:年龄大者、文化程度高者、农民的依从性好。结论坚持防治相结合的原则,建立有效的护理干预措施,提高患者依从性,全面拓展护理工作,高血压能够得到有效控制与降低。     

297例住院儿童意外伤害情况分析

目的 探讨住院儿童意外伤害发生的类型及影响因素。 方法 收集某医院１９９４－１９９７年期间所有因意外伤害事故而入院的２９７例０－４岁儿童的资料。 结果 男性病例数明显高于女性，１￣４岁幼儿为意外伤害事故发生的高峰年龄段。意外伤害类型及排位在０￣４岁婴幼儿中主要为烧烫伤、跌落、车祸；５￣１４岁儿童中主要为车祸、跌落、烧烫伤。１／３住院儿童完全痊愈，约２／３住院儿童留下后遗症。 结论 意外伤害事故的发