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Dissertations / Theses on the topic 'Inpatients'
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1
Crichton, John Hugh McDiarmid. "Controlling psychiatric inpatients : the response of staff to inpatient misdemeanour." Thesis, University of Cambridge, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311307.
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Davies, Emma Clare. "Adverse drug reactions in hospital inpatients." Thesis, Liverpool John Moores University, 2008. http://researchonline.ljmu.ac.uk/5900/.
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Adverse drug reactions (ADRs) are a significant public health problem. This thesis examined the incidence and nature of adverse drug reactions following admission to hospital. An initial pilot study was conducted to develop methodology, which was then utilised in a study of 3695 patients. Approximately 15% of patients experienced an ADR following admission, of which one-third were serious Commonly used drugs such as opioids, diuretics and anticoagulants were the most frequent causes of ADRs. Bleeding, renal impairment and Clostridium difficile were the ADRs with the greatest impact on patient length of stay and thus should be key areas for intervention strategies. Adoption of methods used in the assessment of hospital patient safety incidents such as root-cause analysis may help in identifying underlying factors leading to ADRs as well highlighting the importance of ADRs to senior hospital managers.
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Cepoiu, Monica Elena. "Recognition of depression in elderly medical inpatients." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97920.
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Background. Studies of recognition of depression in elderly (aged 65 or more) medical inpatients showed low recognition of depression by attending physicians. However, few studies have compared different measures of recognition of depression.Objectives. To evaluate the validity of four recognition indicators and a global measure of recognition against a diagnosis of depression and the effect of patient characteristics on recognition of depression.
Methods. In a cohort of 264 medical inpatients 65 years and over (115 with major or minor depression, 78 with no depression), using data from two previous studies, sensitivities, specificities, and diagnostic odds ratios (DOR) of four indicators of recognition (Diagnosis, Symptoms, Treatment and Referral) and a global measure of recognition (any of the four indicators) were calculated. Stratified analysis was conducted to assess recognition by age, gender, history of depression, antidepressant use before admission, severity of depression, comorbidity, duration of hospitalization, disability and hospital of admission. The associations of patient characteristics with recognition were described among patients with major or minor depression using multiple logistic regression.
Results. Less than half of the patients were recognized according to the global measure of recognition. The indicator with the highest sensitivity was Treatment (27.8%, 95% CI: 20.0-37.0), while the indicator with the best specificity was Diagnosis (96.6%, 95% CI:91.9-98.7). The unadjusted DOR of global recognition was 2.6 (95% CI: 1.5, 4.4). Comorbidity, severity of depression, history of depression, duration of hospitalization, antidepressant use before admission and hospital of admission were significantly associated with global recognition.
Conclusion. Recognition of depression in elderly medical inpatients is low. Identifying factors that hinder recognition may guide interventions aimed at improving diagnosis and treatment of depression in elderly medical inpatients.
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Drummond, Hava. "Demystifying psychiatric inpatients : an interpretative phenomenological analysis." Thesis, Regent's University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.646053.
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Purpose: This study explored the lived experiences of inpatients in an adult acute psychiatric ward aiming to bring the voices, individual journeys and everyday worlds of psychiatric inpatients to the research arena. It tried to understand the meaning of psychiatric illness, acute hospitalization experience and the effects of these upon people‘s lives and identity. Lastly, it investigated the psychologists‘ role in acute wards. Method: Semi-structured interviews were conducted with ten adult inpatients in one psychiatric acute ward in the south of England. Data was collected and analysed according to the interpretative phenomenological analysis (IPA) method leading to case and group analyses of interview transcripts. Results: Themes of inpatient life were found to be: (1) admission and experiences of the early days; (2) every day life on the ward; (3) maintaining connections with the outside world; (4) relationships with other patients; (5) relationships with nursing staff; (6) relationships with psychiatrists; (7) experiences of being sectioned; (8) experiences of medical treatment and (9) reactions to inpatient care. Illness journey themes were determined to be: (1) Making sense of illness; (2) experiences of illness symptoms; (3) reactions to illness; (4) way to recovery; (5) impact on self / identity; (6) impact on life and (7) anticipation of life after illness / hospital care. Conclusions: The results show, in greater detail than in previous studies, that inpatient care and treatment can be dehumanizing and that issues of psychiatric inpatients need immediate attention from service providers. The study shows vividly that social inequalities and stigma are still problematic areas in mental health. A central theme of the research is the importance of supportive relationships to clients' recovery and wellbeing. The congruence of the recovery model with counselling psychology principles is clarified and the exciting possibility that counselling psychologists could implement the recovery model is explored.
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Benjamin, Amy. "Adolescents' perspectives on their treatment as inpatients." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/13990.
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Adolescent inpatient psychiatric care is an accepted intervention for acute adolescent behavioural and emotional problems, yet little is known about patient experiences of this care. This study explores former patients’ views of the therapeutic factors involved in the treatment they received at Kenilworth Clinic’s Adolescent inpatient unit in Cape Town, South Africa. Twelve ex-patients were interviewed using a semi-structured interview schedule; the interviews were recorded, transcribed and analysed qualitatively using template analysis. In line with Yalom and Leszcz’s (2005) work on the therapeutic factors in group work, some of these therapeutic factors featured as major themes in the interviews, specifically: the imparting of information, universality, group cohesiveness, interpersonal learning and catharsis. Other factors featured minimally or not at all; an attempt is made to understand this as well as the potential value of these factors. In addition to these therapeutic factors, patients generally perceived family sessions as both helpful and difficult. Concerns raised by participants about their treatment experience included underage smoking at the unit, confidentiality in aftercare group and a desire for individual therapy by participants. The recommendations made were for the staff at the unit to maximise the therapeutic space for the factors highlighted as important to the patients, to continue to endeavour to prevent patients without consent from smoking and to use rule-breaking therapeutically as far as possible, and to discuss confidentiality rules and concerns in the aftercare group at every session. Ideas for future research were discussed, these included a questionnaire-based study where both staff and patients rank the therapeutic factors involved in treatment according to perceived value and an outcomes study.
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Alcazar, Carla Dorr Darwin A. Morgan C. Don. "Dimensions of depression and psychopathy in psychiatric inpatients." Diss., Click here for available full-text of this thesis, 2005. http://library.wichita.edu/digitallibrary/etd/2005/d003.pdf.
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Thesis (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology."July 2005." Title from PDF title page (viewed on February 13, 2007). Thesis advisers: Darwin Dorr, C. Don Morgan. Includes bibliographic references leaves 61-65).
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Dursun, Pinar. "Recognition Of Facial Expressions In Alcohol Dependent Inpatients." Master's thesis, METU, 2007. http://etd.lib.metu.edu.tr/upload/12608450/index.pdf.
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ABSTRACT
RECOGNITION OF EMOTIONAL FACIAL EXPRESSION IN ALCOHOL DEPENDENT
INPATIENTS
Dursun, Pinar
M.S., Department of Psychology
Supervisor: Assoc. Prof. Faruk Gençö
z June 2007, 130 pages The ability to recognize emotional facial expressions (EFE) is very critical for social interaction and daily functioning. Recent studies have shown that alcohol dependent individuals have deficits in the recognition of these expressions. Thereby, the objective of this study was to explore the presence of impairment in the decoding of universally recognized facial expressions -happiness, sadness, anger, disgust, fear, surprise, and neutral expressions- and to measure their manual reaction times (RT) toward these expressions in alcohol dependent inpatients. Demographic Information Form, CAGE Alcoholism Inventory, State- Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), The Symptom Checklist, and lastly a constructed computer program (Emotion Recognition Test) were administered to 50 detoxified alcohol dependent inpatients and 50 matched-control group participants. It was hypothesized that alcohol dependents would show more deficits in the accuracy of reading EFE and would react more rapidly toward negative EFE -fear, anger, disgust, sadness than control group. Series of ANOVA, ANCOVA, MANOVA and MANCOVA analyses revealed that alcohol dependent individuals were more likely to have depression and anxiety disorders than non-dependents. They recognized less but responded faster toward disgusted expressions than non-dependent individuals. On the other hand, two groups did not differ significantly in the total accuracy responses. In addition, the levels of depression and anxiety did not affect the recognition accuracy or reaction times. Stepwise multiple regression analysis indicated that obsessive-compulsive subscale of SCL, BDI, STAI-S Form, and the recognition of fearful as well as disgusted expressions were associated with alcoholism. Results were discussed in relation to the previous findings in the literature. The inaccurate identification of disgusted faces might be associated with organic deficits resulted from alcohol consumption or cultural factors that play very important role in displaying expressions.
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Dixon, Susan. "Understanding sleep problems in rehabilitation inpatients after stroke." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3646/.
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Background and Purpose: Sleep problems are commonly reported by stroke patients. Poor sleep quality can detrimentally impact upon multiple clinical variables, including mood, physical health, cognition and the rehabilitation process itself. However, the relationship between sleep and stroke is complex and not fully understood. Pre-sleep cognitions and pre-sleep arousal have been proposed as contributing factors in sleep disturbance within the general population and this novel study investigates these variables as potential factors associated with sleep post-stroke. Methods: Stroke rehabilitation inpatients (N=21) were classified as good or poor sleepers using the Pittsburgh Sleep Quality Index (PSQI) and compared using measures of pre-sleep cognitions and pre-sleep arousal; relevant factors including daytime sleepiness, fatigue, mood and environmental disturbance were also explored. Results: Poor sleepers reported a significantly higher level of pre-sleep cognitions, pre-sleep cognitive arousal, fatigue and mood disturbance than good sleepers. The level of daytime sleepiness and perceptions of environmental disturbance did not differ significantly between groups. Conclusions: This study revealed a high level of poor sleep within the current sample (48%) based on the PSQI and pre-sleep cognitions and cognitive arousal appear potentially important factors in sleep quality post-stroke. Theoretical and practical implications and future directions for research are discussed.
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Zanger, Jonathan. "Predicting surgical inpatients' discharges at Massachusetts General Hospital." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/117956.
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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, in conjunction with the Leaders for Global Operations Program at MIT, 2018.Thesis: S.M., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, in conjunction with the Leaders for Global Operations Program at MIT, 2018.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 121-124).
In the last few years, MGH has grappled with severe bed capacity management problems. As a result, delays occur in delivering the patient to the right bed at the right time, hindering patient care. One of the root causes for those delays is the mismatch between the timing of admissions and discharges. Particularly, while bed managers know about most admissions well in advance, there is a prevalent lack of central transparency regarding which patients might be ready to leave the hospital and what are the barriers that may delay their discharge. This project aims to improve MGHs bed management processes by introducing a predictive model (based on neural network) that identifies, in real time, surgical inpatients discharges that will occur in the next 24 hours. As part of this research, we present a new modeling methodology, formalizing concepts of 'Milestones to Post-Operative Recovery' and 'Barriers to Discharge', which systematically track patients progress towards discharge. For every admitted surgical patient, our solution outputs a score that is correlated with the likelihood for discharge within 24 hours, and derives a list of barriers to discharge ranked by their significance. In addition, the solution predicts with high accuracy (R-Square 0.86) the total number of daily surgical inpatient discharges, a key piece of information for bed managers. Given training population of 15,553 surgical inpatients admitted to MGH between May 2016 and August 2017, and test population (out-of-sample) of 1,151 surgical inpatients hospitalized during September 2017, the model achieved remarkable performance with ROC of 0.857. During non-holiday weekdays, among the top 10 ranked surgical inpatients identified by the algorithm to have the highest probability of being discharged, 90% were discharged within 24 hours and 97% were discharged within 48 hours, capturing 23% of the hospital's daily surgical discharges. Among the top 30 patients ranked by the algorithm, 69% were discharged within 24 hours and 89% were discharged within 48 hours, capturing 53% of the hospital's daily surgical discharges. The model was implemented as a web-based tool and is currently being piloted at MGH. Preliminary results show potential to promote proactive discharge processes to eliminate unnecessary delays. The implemented solution is using standard EMR data streams, and can be generalized across hospitals.
by Jonathan Zanger.
M.B.A.
S.M.
10
Andover, Margaret S. "Self-mutilation and suicide attempts in psychiatric inpatients." Diss., Online access via UMI:, 2006.
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Crisanti, Annette Susan. "A descriptive longitudinal cohort study of involuntary psychiatric inpatients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0023/NQ31017.pdf.
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Ptashinsky, Natalya. "Acute care nutritional intake for inpatients with diabetes mellitus." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527742.
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Physiologic insulin protocols are replacing conventional sliding-scale practices in hospitals because of their flexibility in adapting doses to the patient's nutritional intake and insulin sensitivity. Although many noncritical wards have updated their prandial therapy to insulin-to-carbohydrate ratios, most hospitals continue fixed preprandial dosing. If patients are receiving fixed dose insulin based on prescribed nutrition and they are not consuming what is provided, the obvious outcome is an increased risk for hypoglycemia. Despite this, there are no studies aimed at profiling nutritional intake for patients with diabetes in the noncritical setting. This study was conducted for that purpose. The results validated the positivistic knowledge that these patients do not generally eat all of their rations. Further, this study included an ancillary investigation for the quality of compliance to new diabetic protocols as recorded in paper-based patient records compared to computerized medical records.
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Qi, Ling S. M. Massachusetts Institute of Technology. "Predicting department of medicine inpatients' discharges at US hospitals." Thesis, Massachusetts Institute of Technology, 2018. http://hdl.handle.net/1721.1/117962.
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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, in conjunction with the Leaders for Global Operations Program at MIT, 2018.Thesis: S.M., Massachusetts Institute of Technology, Department of Mechanical Engineering, in conjunction with the Leaders for Global Operations Program at MIT, 2018.
Cataloged from PDF version of thesis.
Includes bibliographical references (page 67).
In the last few years, US hospitals have faced severe challenges with bed capacity management that leads to capacity congestion. Delivering patients to the right bed at the right time is very important to patient care quality. However, the current process employs a self-reporting system to receive bed availability from each unit. This method does not provide consistent estimates nor does it provide a standardized, proactive bed capacity management perspective. In addition, the Department of Medicine (DOM) has a very complex patient population, both clinically and non-clinically. Various team structure and uneven distributed bed resources introduce additional challenge on patient discharges. The project aims to develop a predictive analytics tool that consistently and reliably identifies potential patient discharges in the next 24 hours. The prediction tool allows hospitals to incorporate a more proactive bed capacity management process. Every day, a ranked list with each patient's likelihood to be discharged will be the output. This list guides a more focused conversation within the care team to make patient discharge decisions. In addition, the prediction tool provides a comprehensive summary of barriers to discharge. In this work, we extended the model developed by Zanger [9] for predicting surgical patients' discharges to medicine inpatients' discharge prediction. By partitioning the training and validation set by the date on 12/31/2017, the current performance for the full model on January 2018 medicine inpatients has a prediction power of - 0.74 (Area Under Curve of a Receiver Operating Characteristic curve - AUC ROC there onwards). We further evaluated the model performance for specific patient populations. With patients' Length-Of-Stay (LOS) up to 3 days, the model's performance in terms of AUC ROC can reach ~ 0.8; 0.78 for model with patients' LOS up to 5 days, 0.77 for model with patients' LOS up to 7 days, and 0.72 for model with patients' performance up to 12 days. In addition, the model can capture 57.8% discharges in the next 48 hours, and 33.1% discharges in the next 24 hours.
by Ling Qi.
M.B.A.
S.M.
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Eisenbrandt, Lydia L., and Jill D. Stinson. "Differentiating Forensic Inpatients With and Without Psychotic Spectrum Diagnoses." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7938.
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Brdaroska, Bilyana. "The Hypothalamic-Pituitary-Gonadal Axis In Male Psychiatric Inpatients." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1604.
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A large number of neuroendocrine studies indicate a possible relationship between the Hypothalamo-Pituitary-Gonadal (HPG) axis and major depressive illness in men. This observation is not surprising, considering the similarities between the symptom profiles of depression and hypogonadism. However, owing to the strong likelihood that a number of other demographic, clinical and treatment covariates may potentially obscure a possible relationship between HPG and depression, studies in this area have produced somewhat inconsistent results. The main objective of the present study was to investigate the relationship between depression and HPG hormone levels in a population of hospitalised men. Another objective was to examine the relationship of a number of demographic, behavioural, clinical and treatment variables with HPG hormone levels and depression. METHOD: Serum hormones of the HPG axis (Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Free Testosterone (free T), Total Testosterone (total T) and Sex Hormone Binding Globulin (SHBG)) were compared between fifty-two male patients with Major Depressive Disorder (mean age = 42.04; SD = 14.1) and twenty-five male patients with other psychiatric conditions (mean age = 40.72; SD = 13.8) on admission into hospital. In addition, to elucidate the possible relationship between clinical outcome of depression and gonadal function, HPG parameters were measured in patients with depression 3 to 6 months following discharge. Based on their HDRS (Hamilton Depression Rating Scale) score, patients were categorised as remitters and non-remitters. Demographic, behavioral, clinical and treatment variables were also examined as possible correlates of hormone levels. RESULTS: Comparison between patients with depression and patients with other diagnoses indicated a significantly lower free T and total T in patients with depression. There were no differences in other hormone parameters between the two diagnostic groups. Correlational analyses indicated significant negative relationships between free T and total T and severity as well as duration of depression. Age was inversely correlated to both free T and total T, whereas BMI was negatively correlated with Total T and SHBG. There was a positive relationship between Total T as well as Free T and measures of sexual dysfunction. While no difference in hormone parameters was observed as a function of psychotic features, patients with melancholic features exhibited significantly lower levels of free T and total T compared to patients with no melancholic features. In the multiple regression analyses, age, duration and severity of depression were the strongest predictors of both free and total T. In separate regression analyses somatic features, over and above other features of depression were found to account most in the variability in free T and total T. Longitudinal analysis revealed significantly higher free T and total T levels on follow-up compared to baseline in the patients who remitted. There was no significant change in any of the hormones studies in the non-remitting group. CONCLUSION: The main findings of the present study support previous results that both total and free testosterone levels are lower during depression and that concentrations of free T and total T parallel changes in severity of depressive symptomatology. Further investigations into the mechanism for this observation, and perhaps examinations of testosterone supplementation for treatment of depression are in order.
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Gong, Zhiping, and gongzhiping@gmail com. "Developing Casemix classification for acute hospital inpatients in Chengdu, China." La Trobe University. School of Public Health, 2004. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20050314.195349.
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Hospital information systems in China are improving and a casemix system for describing inpatient care is looking more feasible than previously. Implementing a casemix classification system for acute inpatient care in China could help to improve regional planning and hospital quality and efficiency. The purpose of this study was to evaluate the Australian DRG system as the basis for developing an acute inpatient casemix system appropriate for China. The applicability of the Australian AR-DRG system has been evaluated (in terms of homogeneity achieved and comparability of rank order) using inpatient data from Chengdu in Sichuan.
Homogeneity achieved was good. The R2 value (the coefficient of multiple determination) was 0.12 for LOS and 0.17 for cost using untrimmed data and using (L3H3) trimmed data, R2 was 0.45 for LOS and 0.59 for cost. This explanatory power is comparable to other DRG classification systems although there are a few MDCs in which AR-DRGs exhibit poorer explanatory power.
Rank order of groups was generally comparable. The AR-DRG system incorporates hierarchies of DRGs within groups of adjacent DRGs, within medical and surgical partitions and across all DRGs within each MDC. I have compared the ranking of DRGs based on average cost with the ranking assumed by the AR-DRG system, at the adjacent group level, within partitions and at the level of the MDC. I used the Spearman Rank Correlation coefficient to compare DRG order across partitions and whole MDCs. In general the cost relativities of the Chinese inpatient episodes grouped by the AR-DRG system correspond to the logical hierarchies assumed by the system. On this basis Chinese and Australian episodes of care within most of the MDCs appear to reflect the same broad pattern of resource consumption.
Further research will be needed to determine where and how the grouping rules used in the AR-DRG system might need to be changed to more accurately reflect Chinese circumstances. For example the cost structures of Chinese health services are different from those in Australia. The Australian Refined DRGs (AR-DRGs) would provide a sound basis from which to develop a Chinese version of DRGs.
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Gong, Zhiping. "Developing casemix classification for acute hospital inpatients in Chengdu, China /." Access full text, 2004. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050314.195349/index.html.
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Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004.Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.
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Goodwin, A. J. ""Us vs Them" : inpatients or fellow inmates? : an autoethnographic exploration." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/20386/.
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Research shows that mental health professionals hold stigmatizing and negative attitudes towards people with mental health problems. Professionals can engage in “othering” whereby they create distance between themselves and the “different” patient, diminishing discomfort. There are significant mental health difficulties amongst professionals, but there is insufficient research exploring clinicians with lived experience, including how this impacts and/or enhances clinical practice. How professionals manage occupying multiple positions, such as professional and patient, has not been sufficiently explored, perhaps owing to the stigma in the profession. I employed Autoethnography, a method and methodology (Campbell, 2016), to critique, contribute to and extend existing research and theory. I seek an increase of insight, facilitation of social consciousness, and societal change (Adams, Linn & Ellis, 2015, p. 33). This research is a direct response to the persistent gap in literature when it comes to firsthand accounts of inpatient psychiatric treatment (Short, Turner & Grant, 2013, p. 41) and a call for more writing from professionals working in mental health with lived experience. I used my insider knowledge of a cultural phenomenon (life of a wounded healer in training) and a life-altering experience (being admitted to a psychiatric institution) to critique cultural norms and practices amongst mental health professionals, including myself. The data collection and analysis was iterative and resulted in the production of an evocative narrative. I provide the reader with a theoretical chapter that discusses salient themes that arose during this process and link these themes with parts of the narrative. I demonstrate that autoethnography can be a particularly valuable method for counselling psychologists and conclude with a number of implications and suggestions for practice stemming from my research. By using myself as both the researcher and the researched, while highlighting my hybrid identity of patient and professional, I blur the boundaries that could otherwise perpetuate othering.
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Moodley, Aneshree. "Methamphetamine use and HIV risk among severely mentally ill inpatients." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/10989.
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Includes bibliographical references.Sub-Saharan Africa accounts for 69% of the global HIV burden. Due to a variety of social, economic and behavioural factors, mentally ill patients are more likely to engage in high risk sexual behaviours. In turn, co-morbid substance use which is present in up to 75% of mentally ill patients is a leading risk factor for sexual risk behaviours. Worldwide methamphetamines are the most commonly used illicit stimulant. Both injectable and noninjectable methamphetamines have evidenced associations with high risk sexual behaviours. Smoking and inhalation of crystal methamphetamine is the predominant mode of use in South Africa. The use of crystal methamphetamine amongst mentally ill persons in Cape Town has escalated over the last decade. We aimed to determine the occurrence of methamphetamine use and risky sexual practices amongst mentally ill patients. In addition we aimed to explore the associations between methamphetamine use and HIV sexual risk behaviours in a sample of mentally ill inpatients in Cape Town, South Africa.
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Thomas, Peter F. "Functions of self-injurious thoughts and behaviors within adolescent inpatients." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9731/.
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The primary interest of this investigation concerned the self-injurious thoughts and behaviors (SITBs) of inpatient adolescents. Previous researchers have provided descriptive information regarding either automatic (or intrinsic) and social components using the Self-Injurious Thoughts and Behaviors Interview (SITBI). However, the presence and trends of these components have not firmly been established, suggesting the need to explore this area further. Eighty-two adolescent inpatients were selected and interviewed using the SITBI to evaluate the predictive ability of self-reported self-injurious behavior with regard to social and automatic, negative and positive functions. Results showed that depending on the type of thought or behavior displayed one could discern the motivation behind their actions. Automatic-Negative was seen to have the strongest relationship across all SITB behaviors while Automatic-Negative was not found to be relatively low compared to other SITB behaviors. Both Social-Positive and Social-Negative were found to be present in moderate relationships compared to Automatic in general.
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Thomas, Peter F. Kaminski Patricia L. "Functions of self-injurious thoughts and behaviors within adolescent inpatients." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9731.
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Gaudiano, Brandon A. Herbert James D. "Acceptance and commitment therapy for psychiatric inpatients with psychotic symptoms /." Philadelphia, Pa. : Drexel University, 2004. http://dspace.library.drexel.edu/handle/1860/295.
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Lyon, R. "Increasing physical activity through motivational interviewing with adult forensic psychiatric inpatients." Thesis, University of the West of England, Bristol, 2014. http://eprints.uwe.ac.uk/22276/.
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The treatment and recovery of forensic psychiatric inpatients can take many months and often years, within which time health issues such as obesity and diabetes can develop. Encouraging beneficial health behaviours with this client group is notoriously difficult for a variety of reasons and anti-psychotic medication paradoxically often serves to exacerbate physical health concerns. There is a dearth of research concerning effective interventions for improved physical health for this client group, perhaps because security and staffing issues present significant challenges to conducting research in this environment. This exploratory piece of action research employed multi-staged Motivational Interviewing (MI) sessions in nine case studies, the aim of which was to explore the utility of the approach in increasing physical activity (PA) with forensic psychiatric inpatients. Changes in PA and intrinsic motivation were assessed over three months and clients were surveyed on their views of the approach. A question exists over the propriety of client-centred care in a setting that is often necessarily restrictive and controlled. Challenges to a broader implementation of MI for health promotion amongst the multi-disciplinary care team (MDT) are considered, and were explored through the use of a staff survey. Outcomes for the research suggest that MI is a useful and valued approach to facilitating changes in physical activity levels with forensic psychiatric clients. There may be others from this environment for whom the approach is inappropriate, and there is a need for further research with clients whose health concerns are significant but who do not readily present for activity sessions. Outcomes from this research further suggest some of the MDT may be philosophically aligned with some aspects of the client-centred ethos of MI, yet still maintain a belief in the propriety of directive and authoritarian methods for promoting health. This may present a challenge to the training of MI if a broader implementation of MI for physical health issues is considered, and limited survey data may not have revealed the full extent of this challenge.
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Morreale, Mark J. "Evaluation of a care map for community-acquired pneumonia hospital inpatients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22365.pdf.
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Carr, Catherine. "Modelling of intensive group music therapy for acute adult psychiatric inpatients." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/26966.
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Background: Acute inpatient stays are decreasing. Evidence for music therapy in mental healthcare exists but practice varies. Short admissions and therapy frequency (usually weekly), limit access, yet acceptability of increased frequency to patients is unknown. Research to model processes and outcomes of intensive provision may identify how best to provide for acute contexts informing clinical practice and future research. Methods: 114 patients admitted to hospital with acute mental health problems were recruited. Patients attended group music therapy 1-3 times per week during admission. Repeated measures assessing patient experiences, session appraisal, motivation and commitment were completed. Questionnaire thematic analysis identified important processes which were coded from session recordings. Multilevel modelling was used to examine associations between music therapy components, session appraisal, motivation, commitment and subsequent attendance. End of therapy interviews with 16 patients explored changes experienced and views on therapy frequency. Results: Attendance was 3 times greater for patients with 3 sessions per week. The majority found increased frequency acceptable and beneficial. Processes of engagement, emotional expression and social connection suggested active music-making, synchrony and singing to be important for group cohesion. Singing was significantly associated with appraisal and motivation. Musical initiation by group members was associated with motivation and commitment. All three outcomes were associated with each other, with session appraisal and increased frequency independently associated with subsequent attendance. Patient attributions for change included creativity, experiential learning and therapist directed reflective discussions. Conclusion: Intensive group music therapy is acceptable to the majority of patients, perceived as beneficial and increases access. Intensive provision is associated with greater engagement and positive experiences, which in turn, are associated with group commitment. Patient experiences can inform practice. Further research should examine effectiveness of intensive provision. Therapists should continue to prioritise engagement through active music-making and singing, and services consider implementation of intensive provision.
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Moghazy, Ezzat. "Development and validation of an outcome measure for orthopaedic trauma inpatients." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/2662.
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Thesis (MScPhysio (Interdisciplinary Health Sciences))--Stellenbosch University, 2008.Introduction In clinical physiotherapy, there is a growing importance for the accuracy and reliability of assessment and outcome measures. The purpose of this study is to develop a valid outcome measure for orthopaedic trauma inpatients. Item generation was done by conducting a systematic review of published functional outcome measures and patients' interview. Item reduction was conducted by using a panel of physiotherapists and patients. Objectives The overall study objectives were: 1) To determine if a functional outcome measurement scale for trauma inpatients exists and has been published; 2) To generate functional items for the construction of a new outcome measurement tool for trauma inpatients; 3) To construct a new outcome measurement tool for trauma inpatients and assess elements of validity and reliability (face and content validity, response to change, internal consistency and floor and ceiling effects) of the new developed outcome measure. Methodology Convenience sampling was applied to collect data from 35 trauma inpatients in trauma wards at Rashid Hospital in Dubai, UAE. 88% of the trauma inpatients were male (total sample n= 100), mean age =34.75, and the standard deviation = 14.46. 21 functional activity items were generated from the collated results of the patient interviews. Internal consistency reliability, responsiveness and floor and ceiling effect were assessed. Data analysis was conducted using Statistica Version 7. Results The final number of functional activity items included in the newly developed Functional Scale outcome measure was 29 activity items relevant for trauma inpatients. A Cronbach's alpha ranged between 0.76 and 0.97. The lowest alpha result was for the 'ADL' activities at follow-up (0.76). The highest alpha result was for 'out of bed' activity at admission and discharge (0.97). The response to change of the Functional Scale for trauma inpatients over time results illustrates that there was a significant difference in the mean scores over three administrations of 'Bed', 'Out of bed' and 'ADL' activity items of Functional Scale for trauma inpatients (p=O.OOOO). In general, there was no significant floor and ceiling effects at admission or discharge for 'bed', 'out of bed' and 'ADL' activities, except there was a floor effect noted at discharge for 'bed' activities and 'ADL' activities, and a ceiling effect noted at admission for 'out of bed activities' only. Discussion and Conclusion The newly developed Functional Scale outcome measurement for trauma inpatients has been shown to be internally consistent and appears to be valid with respect to response to change in this sample of trauma inpatients. The results of this study thus suggest that the Functional Scale for trauma inpatients may be an appropriate tool when the goal is the assessment of change in disability functions in trauma inpatients, although further psychometric testing may be required.
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Philpott, Rosanna Lewissa. "Trauma-related psychological processes & psychotic-like experiences in adolescent inpatients." Thesis, King's College London (University of London), 2014. http://kclpure.kcl.ac.uk/portal/en/theses/traumarelated-psychological-processes--psychoticlike-experiences-in-adolescent-inpatients(3f7e4946-3f1b-48d7-98fe-7cb9a420f3d3).html.
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This project looks at the feasibility of adapting a Webster-Stratton Incredible Years Parenting Group for parents of children with Learning Disabilities. Such groups are recommended for parents of children with Conduct Disorders, but parents of those with a Learning Disability (LD) are often excluded. Two parenting groups were facilitated in a South London CAMHS service and the second such group was further modified following feedback from the first group. Four carers completed the first group and six carers completed the second group. The carers were satisfied with the group and gave positive feedback. There was a significant improvement in the carers’ level of anxiety and some improvement on levels of depression. In the second group there was a significant improvement on a parenting measure. Recommendations were made for taking the programme forward, including assessing both the carers’ level of understanding of LD and its co-morbidities and assessing the children themselves. Recommendations were also made as to how the programme could further improve its accessibility. Finally it was recommended that, as the programme becomes established in this service, it is targeted towards younger children and those beginning to show challenging behaviours, in order to prevent these behaviours from becoming established.
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Chau, Cecilia, Córdova Hugo Morales, and Espinoza Micaela Wetzell. "Coping style and performance status in a group of oncological inpatients." Pontificia Universidad Católica del Perú, 2002. http://repositorio.pucp.edu.pe/index/handle/123456789/102502.
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The associations between coping styles, measured by COPE Test, dispositional version (Carver,Scheier and Weintraub, 1989), and Health Status inferred through a performance status, measured by Karnofsky's Index of Behavioral Performance are examined. The study focuses upon 28 oncological in patients. Positive moderate Pearson's correlations were found between these two variables in this correlational-descriptive study. These were interpreted in the following sense: the larger use of the style, the less health status among the scales suppression of competent activities, procrastination of coping, instrumental social support, focusing and releasing of emotions and behavioral disengagement. The active coping scale presented a negative correlationwith regard to Performance Status as a health measure.Se estudian las asociaciones entre estilos de afrontamiento medidos a través del Test de Estimación del Afrontamiento COPE-versión disposicional (Carver, Scheier y Weintraub. 1989) y Estado de Salud inferido a través del Estatus Performance, medido a través del Índice de EjecuciónConductual de Karnofsky, en un grupo de 28 pacientes oncológicos hospitalizados de ambos sexos. La investigación alcanza el nivel descriptivo-correlacional, y se encontraron asociaciones entre ambas variables expresadas en correlaciones Pearson positivas y moderadas interpretadas en el siguiente sentido: a mayor empleo del estilo, menor estatus de salud entre las escalas supresión de actividades competentes, postergación del afrontamiento, apoyo social instrumental, enfocar y liberar emociones y desentendimiento conductual. La escala afrontamiento activo, presentó una correlación negativa respecto al Estatus Performance como medida de salud.
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Booth, A., and Jill D. Stinson. "Effects of Adverse Childhood Experiences on High-Risk Inpatients’ Criminal Behavior." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7908.
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Booth, Alexis, Jill D. Stinson, and Carrie C. LeMay. "Effects of Adverse Childhood Experiences on High-Risk Inpatients’ Criminal Behavior." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/7960.
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Adverse childhood experiences (ACEs) play a role in the development of chronic mental and physical diseases in adulthood. These experiences include adversities such as: emotional/verbal abuse, sexual abuse, physical abuse, and household dysfunction. Building from the ACE study conducted by Kaiser Permanente from 1995-1997, this study aims to contribute to the body of knowledge gained about ACE’s and their effects on health in high risk populations, and to examine the effects of developmental diversity on criminality. In this study, we hypothesize that forensic mental health offenders will have higher ACE scores than community participants. Secondly, we hypothesize that these participants will show higher rates of and earlier incidences of offending, arrest, incarceration, and hospitalization as a result of their ACE scores. Further, we hypothesize that males and females will be affected by ACE’s differently, as seen in number of arrests, incarceration, and hospitalizations. Using archival data from a secure forensic psychiatric facility in the Midwestern US, data were collected from 211 participants, of which 80% were males and 18% females. The ages of the participants ranged from 23 to 72 with a median age of 42. Caucasians comprised 46% of the sample followed by African Americans at 34%. Using SPSS software, we were able to determine frequency of the ten categories of abuse, maltreatment, and familial dysfunction as included in the original 2015 Appalachian Student Research Forum Page 49 ACE research. Correlations were run to determine the relationship between ACE’s and criminal behavior. Statistical comparisons were also run to examine the differences between males and females. ACE score significantly correlated with age at first psychiatric admission. Males and females were significantly different with regard to ACE score. However, other variables were not significant, as predicted by prior research, and suggest that future research that need to more deeply examine differences between males and females with regard to adverse childhood experience, and additional variables that determine criminal outcomes in high-risk samples.
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Nguyen, Ngoc Tu. "Atrial fibrillation and frailty in older inpatients in Australia and Vietnam." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15480.
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Atrial fibrillation (AF) is a common health problem and a major risk factor for stroke in older people. As the world population is ageing, the increased prevalence of AF and AF-related stroke are growing public health concerns. There is marked heterogeneity amongst people aged over 65 years. Some of this may be captured by increasing chronological age. However, much of this variability is thought to be due to biological age or frailty, a state of vulnerability that can impact on the treatment and prognosis in older people with AF. The broad aim of this thesis was to investigate the impact of frailty on the pharmacological treatment and outcomes in older patients with AF. A dominant part of this thesis involved a prospective observational study in Australia about the impact of frailty on the pharmacological treatment, coagulation changes and outcomes in older inpatients with AF. In this study, a total of 302 inpatients aged ≥65 years with AF admitted to Royal North Shore Hospital, a tertiary referral teaching hospital in Sydney, Australia, was recruited. Of these, 134 patients participated in the sub-study on coagulation function. Chapters One, Two, Three are introduction, literature review and methods, respectively. Chapter Four describes the differences in clinical characteristics, pharmacological treatment and incidence of stroke and major bleeding over six months between the frail and the non-frail. Compared to the non-frail, frail participants were older, had more comorbidities and higher risk of strokes (as reflected by CHA2DS2-VASc score) but not haemorrhage (as reflected by HASBLED score). Upon discharge, 55.7% participants were prescribed anticoagulants (49.3% frail, 62.6% non-frail, p=0.02). Frail participants were less likely to be prescribed an anticoagulant and were more likely to receive digoxin upon discharge, although the impact of frailty on these prescriptions was reduced in multivariate analysis. Compared to previous studies in Australia, prescription of anticoagulants was higher in this study in older patients with AF, especially in the frail. A significant percentage of participants with AF received antiplatelets with no evidence of ischemic heart disease, suggesting that antiplatelets may be used for stroke prevention in AF although current guidelines do not recommend aspirin for stroke prevention in AF unless patients refuse the use of any oral anticoagulant. After six months, overall incidence of ischemic stroke was 2.1% and, in patients taking anticoagulants, incidence of major/severe bleeding was 6.3%, with no significant difference between frailty groups. The findings from Chapter Five established that in older inpatients with AF, frailty was associated with prolonged length of stay and increased all-cause mortality but not re-admission during six months after discharge. The coexistence of frailty and delirium during hospitalisation significantly increased the risk of mortality. Chapter Six and Chapter Seven report the two pilot studies testing the hypotheses of altered platelet function, coagulation function and responses to antithrombotic drugs in frail patients. In Chapter Six, platelet aggregation studies were performed using Whole Blood Impedance Aggregometry. While there was no significant relationship between frailty and platelet aggregation in participants not taking any antiplatelet drugs, there was a reduced responsiveness to aspirin in the frail amongst those taking aspirin. The observed reduced platelet responsiveness to aspirin in the frail supports the current guidelines that do not recommend aspirin for stroke prevention in AF, and raises a question about the risk benefit ratio of aspirin prescription in older patients with AF, which is usually commoner in the frail, in whom prescribers may be more concerned about using anticoagulants. In Chapter Seven, the Overall Haemostatic Potential and Calibrated Automated Thrombogram were used to globally assess coagulation function. Compared to non-frail participants, frail participants had significantly reduced fibrin generation, which may reflect decreased acute phase response in the frail. There was no difference on coagulation profiles between the frail and the non-frail on warfarin, suggesting that frail warfarinised patients are not at higher risk of bleeding which is consistent with the clinical follow up findings in Chapter Four. There have been few published studies about AF or frailty in developing countries; hence, this thesis also aimed to investigate the evidence about AF and frailty in developing countries with two systematic reviews and an observational study in Vietnam. Chapter Eight is a systematic review of epidemiology and management of AF in developing countries with a summary of 70 studies of AF in these countries. The prevalence of AF in the community-based studies ranged from 0.03% to 1.3%, while the prevalence of AF in hospital-based studies varied from 0.7% to 55.7%. The most common conditions associated with AF were hypertension and valvular heart disease. The prevalence of stroke in patients with AF ranged from 6.7% to 27%. The utilisation of anticoagulants was highly variable (2.7%-72.7%). There was a high prevalence of use of rate control therapies (55.3%-87.3%). Chapter Nine is a systematic review of frailty research in developing countries, with a total of 20 studies of frailty in these countries. The prevalence of frailty in community-dwelling older people ranged from 5.4% to 43.9%. The prevalence of frailty in hospitalised and institutionalised older people was from 32.3% to 49.3%. The prevalence of frailty in outpatient clinics was 27.8% to 71.3%. Fried frailty phenotype was the most commonly used definition of frailty in developing countries. Frailty was associated with increased mortality and comorbidities, decreased physical and cognitive function, and poor perceptions of health in these countries. In the reviews in Chapter Eight and Chapter Nine, there were no published studies of the pharmacological treatment of AF in older patients in Vietnam and no published studies related to frailty in Vietnam, a typical developing country with a rapidly ageing population. Chapter Ten presents a cross-sectional study of the prevalence of AF among older hospitalised patients in Vietnam and describes clinical characteristics and treatment of these patients. Of the 461 older patients recruited at the National Geriatric Hospital in Hanoi, Vietnam, during seven months, the prevalence of AF was 3.9%, which is similar to that reported in other countries. Amongst patients with AF, the most common medical conditions were hypertension (72.2%), followed by stroke (55.6%), heart failure (50.0%), type 2 diabetes (44.4%). The prevalence of frailty in patients with AF was 39%. Living alone (OR=10.2, 95% CI 1.5–70.1), having a habit of using vitamins at home as self-medication (OR=3.8, 95% CI 1.1–13.4), having heart failure (OR=31.3, 95% CI 9.6–101.8), and having type 2 diabetes (OR=3.5, 95% CI 1.2–10.7) were associated with the presence of AF on admission. All patients with AF had a high risk of stroke and 72.2% of them had a high risk of bleeding with anticoagulant medications. Only 22.2% were anticoagulated on admission and 22.2% upon discharge, with no difference between frail and non-frail patients. In conclusion, AF and frailty are growing public health concerns in developed countries as well as in the developing world. The studies in this thesis in Australia and Vietnam provide new evidence on the frequency, treatment and prognosis for patients with AF. Frailty was common in older patients with AF in both Australia and in Vietnam. In both countries there was evidence of sub-optimal use of anticoagulant medications: among frail people with AF in Australia and among all patients with AF in Vietnam. A large size, multi-centre prospective cohort study or pharmaco-epidemiological study using existing linked healthcare data looking at outcomes in frail and non-frail patients on anticoagulants is needed to derive accurate results about the impact of frailty on anticoagulation utilisation, efficacy and complications. Further clinical epidemiological research is needed on AF and frailty in developing countries such as Vietnam. Such research will become increasingly important as population ageing leads to rapidly increasing numbers of people with AF and/or frailty. The interaction between frailty and coagulation requires further laboratory investigation. More research is also needed to investigate the impact of frailty on responses to newer direct oral anticoagulants.
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Booth, Alexis L., and Jill D. PhD Stinson. "Effects of Adverse Childhood Experiences on High Risk Inpatients Criminal Behavior." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/honors/289.
Full textAbstract:
Adverse childhood experiences (ACEs) play a role in the development of chronic mental and physical diseases in adulthood. These experiences include adversities such as: emotional/verbal abuse, sexual abuse, physical abuse, and household dysfunction. In this study, we hypothesize that forensic mental health offenders will have higher ACE scores than community participants. Secondly, we hypothesize that these participants will show higher rates of and earlier incidences of offending, arrest, incarceration, and hospitalization as a result of their ACE scores. Further, we hypothesize that males and females will be affected by ACEs differently. Using archival data from a secure forensic psychiatric facility in the Midwestern US, data were collected from 211 participants, of which 80% were males and 18% females. The ages of the participants ranged from 23 to 72 with a median age of 43. Using SPSS software, we were able to determine frequency of the ten categories of abuse, maltreatment, and familial dysfunction as included in the original ACE research. Correlations were run to determine the relationship between ACEs and criminal behavior. Statistical comparisons were also run to examine the differences between males and females. ACE score significantly correlated with age at first psychiatric admission. Males and females were significantly different with regard to ACE score. However, other variables were not significant and suggest that future research need to more deeply examine these differences, and additional variables that may determine criminal outcomes in high-risk samples.
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Whittle, Peter. "Causal beliefs and psychiatric disorder." Thesis, University of Exeter, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337740.
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Alsunni, Ahmed. "Ischaemic and diabetic cardiomyopathy : pathological and immunohistochemical studies inpatients and animal models." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.506843.
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Ischaemic heart disease (lHD) and diabetes are a cause of considerable morbidity and mortality worldwide. They cause several functional and structural changes in the myocardium leading to heart failure. Although functional changes in the diabetic heart are well established, the structural basis for these changes is not well defined, especially in man. This study quantified pathology of cardiomyocytes and myocardial microvasculature in relation to the expression of angiogenic factors namely HIF-1a, VEGF and VEGFR2 in the left atrial appendage (LAA) of 100 patients with IHD and/or diabetes compared to subjects without IHD or diabetes. There was a significant reduction in cardiomyocyte diameter in diabetic patients compared to controls. Furthermore, vascular density was reduced in diabetic patients and this was significant in those with IHD. Detailed quantification of distal myocardial capillaries in diabetic patients confirmed the presence of microangiopathy characterised by luminal narrowing, endothelial hypertrophy and hyperplasia and pericyte atrophy with basement membrane thickening. This pathology was associated with a significant increase in HIF-I a expression but with a significant reduction in VEGF expression on the endothelium of diabetic patients compared to controls. In IHD patients there was no change in cardiomyocyte diameter but there was a significant increase in arteriolar walllIumen ratio and a trend for an increase in capillary density. Myocardial capillaries showed a significant reduction in the luminal area without endothelial cell hypertrophy/hyperplasia or basement membrane thickening compared to controls. This was associated with a significant increase in the intensity and percentage of HIF-1a expression but no change in VEGF or VEGFR2 expression compared to controls. Pathology of cardiomyocytes and myocardial microvasculature has also been quantified in the atrium and ventricle of two different animal models of diabetic complications: the Zucker diabetic fatty (ZDF) rat and galactosaemic dog. There was a significant reduction in vascular density in the LAA but not the ventricle of the ZDF rats compared to lean Iittermates. The cardiomyocyte diameter was increased in the LAA, reaching significance in the left ventricle (LV) of the ZDF rats. There was no alteration in arteriolar or venular wall/lumen ratio, however, myocardial capillaries showed a reduction in lumen size in the LAA and basement membrane thickening in both LAA and LV. Galactosaemic dogs showed a significant increase in arteriole wall to lumen ratio in both the atrium and ventricle compared to controls. Myocardial capillaries of the galactosaemic dogs demonstrated a reduction in luminal area with hypertrophy of endothelial cells and a reduction in pericyte area but no basement membrane thickening or change in cardiomyocyte diameter. In conclusion, this thesis provides detailed pathological quantification of both cardiomyocytes and myocardial microvasculature in patients with IHD and diabetes as well as 2 animal models of diabetes. It demonstrates significant distal capillary abnormalities in patients with IHD and an abnormality of the cardiomyocyte and distal myocardial capillaries in the LAA of diabetic patients which have been related to both clinical and molecular alterations. In the 2 experimental models structural pathology though present differs in its characteristics and severity.
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Ghaleb, Maisoon Abdullah Adel. "The incidence and nature of prescribing and administration errors in paediatric inpatients." Thesis, University College London (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.435831.
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LeMay, Carrie C., Jill D. Stinson, Lydia L. Eisenbrandt, Courtney Smith, and Megan Quinn. "Polypharmacy Among Psychiatric Inpatients With Serious Mental Illness in Secure Forensic Care." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/7951.
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Polypharmacy is broadly defined as the administration of more than one medication in a single patient, with the most commonly used definition indicating the concurrent use of five or more medications. Polypharmacy occurs in most clinical settings, particularly inpatient settings and treatment settings for persons with chronic illness and the elderly. Reasons for receiving more than one medication include ineffective treatment with monotherapy, targeting specific but varied symptoms, treating two distinct but co-morbid illnesses, addressing unremitting symptoms, and treating extrapyramidal side effects. Research indicates that each medication added to the patient’s regimen increases the likelihood of an adverse outcome, as well as the risk of adverse drug reactions, drug-to-drug interactions, cumulative toxicity, medication errors, patient non-compliance, patient morbidity, and patient mortality. The current study seeks to investigate the rates of polypharmacy and related characteristics predictive of polypharmacy within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101), African American (40.1%, n=73), and Hispanic (2.2%, n=4), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). Of those currently taking medications, 99.2% have been prescribed more than one type of medication, with 93.1% of those individuals being prescribed four or more. Polypharmacy was observed in 91% of participants. Of those diagnosed with a mood or psychotic disorder, an average of 3.6 different types of psychotropic medications were prescribed. Co-morbidity of mental illness was predictive of polypharmacy trends, F(1,181)=5.28, p<.05. Additionally, individuals with at least one chronic illness also were subjected to polypharmacy practices, with rates increasing for those with more than one chronic illness. As a measure of onset and severity of symptoms, age at first hospitalization and age of onset of aggressive behaviors were measured, and, interestingly, both measures were predictive of polypharmacy within these patients, F(1, 181)=13.45, p<.01. Results indicate that perceived severity of symptomology, aggression, and complex health problems all contribute to polypharmacy practices among prescribing physicians. The high rates of polypharmacy observed are concerning because of the potential for increased aversive health outcomes. Understanding the predictive factors, rates, and trends of polypharmacy has valuable implications for the future treatment and rehabilitation of individuals residing in a forensic psychiatric setting.
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Talatala, Mvuyiso. "Cannabis use in psychiatry inpatients." Thesis, 2008. http://hdl.handle.net/10413/661.
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Background: Cannabis among patients admitted in psychiatric units is higher than the general population and this has been shown in various countries where studies on cannabis use have been undertaken. Such an observation has been made by psychiatrists in South Africa and the association between cannabis use and psychotic presentation among these patients has also been observed. Cannabis use by patients with severe or chronic medical illnesses to ameliorate the symptoms of such illnesses has been documented in the literature. A study to explore use of cannabis among psychiatric inpatients as well as medical patients was undertaken. Purpose: The purpose of this study was to firstly determine the prevalence of cannabis use in psychiatric patients admitted to an acute admissions unit in King Edward VIII Hospital and to correlate it with the psychiatric diagnosis. Secondly, it was to compare the cannabis use in psychiatric patients admitted to an acute admissions unit to patients admitted in a medical ward at King Edward VIII Hospital. Thirdly, to assess self reporting of cannabis use by psychiatric and medical patients. Methods: A case control study was conducted at King Edward VIII Hospital, Durban, where cannabis use among 64 subjects included in the study admitted in a psychiatric ward was compared with a control group of 63 control subjects admitted in a medical ward. Both groups were tested for urinary cannabinoids and a questionnaire was filled. The questionnaire contained demographic details as well as a question on use of substances including cannabis. Results: 17 subjects (26.6%) in the study group tested positive for urinary cannabinoids and 2 subjects (3.2%) in the control group tested positive. Cannabis use was significantly higher among males when compared to females in both the study group and the control group. Only 7 subjects in the study group reported cannabis use and out of those 7 subjects, 4 subjects tested positive for urinary cannabinoids. The commonest diagnosis among the study group subjects were the psychotic disorders and schizophrenia being the most common psychotic disorder. Conclusion: Cannabis use is significantly higher among psychiatric patients as compared to medical patients and it is probably higher than in the general population. Self reporting of cannabis use among psychiatric patients is low and unreliable and psychiatrists treating these patients must continue to use objective measures such as objective testing as well as collateral information to determine such use. In this study most subjects who tested positive for urine cannabis were likely to have a psychotic disorder and tended to be of younger age groups. The low prevalence of cannabis use in the control group makes it unlikely that there was a significant number of subjects in this group who were using cannabis for medicinal purposes.Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.
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Lin, Ling-Hua, and 林玲華. "Screening for Depression in Cancer Inpatients." Thesis, 2000. http://ndltd.ncl.edu.tw/handle/94616541303048891268.
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碩士長庚大學
護理學研究所
88
Depression is the common problem for cancer patients. However, to have psychiatrists performing diagnostic assessment for every cancer patient is not feasible. A simple and valid method to screen depression is in need. The purpose of this research is to compare the screening ability of two simple instruments of depression for cancer inpatient. A secondary aim is to examine the risk factors of depression. 121 cancer inpatients aged over 18 were invited to participate in this research, and who completed two depression scales (HADS and GDS) and psychiatric interview within 72 hours. According to the structured interview (M.I.N.I.), we got psychiatric diagnosis which based on DSM-Ⅳ. Using the DSM-Ⅳ diagnosis as a golden standard, we proceeded analysis of ROC curves. The result indicates the prevalence of depression in this population is 34.7%. A cut-off point of 7 for HADS-D gives 81.0% sensitivity and 63.3% specificity. And a cut-off point of 11 for HADS contributes 81.0% sensitivity and 54.4% specificity. GDS and SF-GDS can not get an optimal cut-off point from analysis of ROC curve. With the criterion of 70% sensitivity, the better cut-off points of GDS and SF-GDS are 10 and 6 respectively. The AUC of HADS-D (.7575) is the greatest of all scales. This study also affirms poor functional status, perceived ineffective of treatment, lower educational level and lower income of family associated with higher depression prevalence rate. HADS-D appears on this study, to be a more feasible screening scale, but original cut-off point is inadequate. Optimal cut-off point of HADS-D is 7 for clinical implication. Besides, nurses should offer more physical and psychosocial support for high-risk patients of depression.
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Kapoor, Shitij McAlister Alfred Sexton Ken. "Burden of diabetes in cancer inpatients." 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1467406.
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Chiu, Chin-Kai, and 邱勁凱. "Using RFID for the inpatients' nursing care." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/29284888163648524850.
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碩士國立暨南國際大學
資訊管理學系
97
The financial crisis has severe impacts on many businesses. Many companies bankrupt during this impact. Medical facilities also suffer the pressure due to the rise of operation cost and man power shortage. It is well known that medical manpower shortage will bring great threaten to inpatients’ health. How to utilize the modern technology to save the tedious and routine medical checkup is very important. This study focuses on developing a system which utilizes the Radio-frequency identification (RFID) device to inpatient in hospital. This study also shows the automatic operations by RFID can save many tiresome works and can be used to enhance patients’ safety.
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Chu, Kuan-Yu, and 朱觀宇. "An oral epidemiological study of schizophrenic inpatients." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/63767931781396538729.
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博士國立陽明大學
公共衛生研究所
99
Background: Schizophrenia is considered as one complex psychiatric disorder. A consequential poor oral health has been reported in schizophrenic inpatients. Schizophrenic inpatients are, probably, a disadvantaged minority who receive inadequate dental care. However, there is little comparative research evidence to support the claim that there is disparity in dental care between schizophrenic inpatients and the disabled people, or the general population. Meanwhile, little research has been done on the relationship between dental caries and the personal characteristics of schizophrenic inpatients. An oral health survey of schizophrenic inpatients in the largest public psychiatric hospital was conducted in Taiwan in 2006. Based on this data, this study aims (1) to provided descriptive epidemiological information on the oral health of hospitalized schizophrenic inpatients; (2) to investigate whether the subjects received poorer dental care compared with disabled people, and compared their oral health with the general population; and (3) to evaluated the association between some potential factors and oral health indexes. Methods: All subjects were selected according to a psychiatric diagnosis of schizophrenic disorder (ICD-9 code: 295) and underwent a standardized oral health examination. A total of 1,103 subjects participated in this survey. The type of research used in the survey was the clinical method, consisting of an oral examination using dental instruments and a light source. Indexes for oral health included caries experience; decayed, missing, and filled teeth index (DMFT); care index (CI); number of remaining teeth (NT); percentage edentulous; and community periodontal index (CPI). The survey index was consistent with those recommended by the WHO. The above results were compared with the findings of oral health investigations on disabled people or the general population in Taiwan using the proportion test and the t-test. Multiple regression models were used to measure the independent effects of the subjects’ characteristics on the oral health indexes. Results: A total of 1,103 with schizophrenic inpatients participated in this survey. Among the subjects, (1) caries experience is 98.5%; average number of DMFT, 13.9; mean of the care index (CI), 14.3%; average number of teeth (NT), 17.7; 5% edentulous and 39.4% having periodontal pockets above 4mm (CPI≧3). (2) compared with the disabled people, subjects’ care index (CI) is lower but caries experience (CExp) is higher in the group aged 19 to 44 years; the mean number of decayed, missing, and filled teeth index (DMFT) is lower in the group aged 45 or more. Compared with the general population, their CExp, mean number of DMFT, percentage edentulous, and community periodontal index are higher but CI and number of tooth are lower among various gender or age groups. (3) The multiple regression results indicated that age was the only variable independently associated with DMFT>8 (OR=7.74, 95% CI=3.86–15.55, p<0.001 in comparison to residents aged 65+ years vs. 20–44 years; OR=3.06, 95% CI=2.02-4.61, p<0.001 in comparison to residents aged 55–64 years vs. 20–44 years) after making adjustments for other potential explanatory variables. In addition, those with an education of only elementary school (OR=1.67, 95% CI=1.08–2.56, p=0.021), low income (OR=1.58, 95% CI=1.02–2.44, p=0.039), and length of stay (LOS) of >10 years (OR=2.09, 95% CI=1.30–3.37, p=0.002) were associated with a care index <54.7%. Older age, lower educational level, and longer hospital stays were associated with number of remaining teeth being <24. Conclusion: The findings of this study may be summarized by pointing out that (1) the unmet dental treatment needs and supported the conclusion that there was lack of dental care among the schizophrenic inpatients; (2) the CI of schizophrenic inpatients is likewise worse compared to the disabled people; overall oral health status is considerably worse compared to the general population; (3) aging was the most important factor related to a high level of dental caries. Low educational level, low income, and LOS were also associated with the indicators of dental caries among institutionalized subjects with schizophrenia. It is necessary to address the treatment factors such as prolonged stay in institutions when decision-makers are planning for preventive strategies of oral health for schizophrenic inpatients.
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Yang, Yu-Kuang, and 楊玉冠. "Determinants of the Hospital Growth in Inpatients Services." Thesis, 1998. http://ndltd.ncl.edu.tw/handle/46550349778814331934.
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Chen, Shih Ming, and 陳世明. "A study of inpatients’ transfer task assignment problem." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/07239593099650554491.
Full textAbstract:
碩士長庚大學
資訊管理學系
99
In recent years, the advancement in medical technology and changes in public’s perceptions of healthcare service has leaded people to expect better quality of cares and treatment. This study focus on solving the tasks of transfer inpatients for the scheduled examinations in a hospital, where we instigated a scheme that can assign the transfer task efficiently and, in the process, reduce the inpatients’ waiting time. The scheme for the assignment problem of inpatients’ transfer task has two phases: The first phase deals with the schedule of inpatients’ transfer tasks. According to inpatients’ number of examinations required, we scheduled and classified inpatients’ transfer and examination time. The second phase deals with the task of assign manpower for the transfer center, where we implement a greedy algorithm for finding solutions for the assignment problem. We used a set of raw data collected from the hospital on inpatients’ transfer and sets of randomly simulated data to test and verify the algorithm. The result seems to indicate that the algorithm is able to find satisfying solutions for the assignment problem and are much more effective than the current existed solutions (solution derived manually). The greedy algorithm produces results that have dramatically improved on the inpatients’ waiting time and able to complete all assignments under the stipulated time.
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Yang, Fei-Ching, and 楊斐卿. "To simplify the fall risk screening tool for inpatients." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/km9x6n.
Full textAbstract:
碩士高雄醫學大學
護理學系碩士班
104
Falling, a major health care issue in countries across the world is also the first one accident occurring most frequently in our hospital, accounting for more one quarter of all cases reports on patient safety incidents. Almost half of the patients fall that exhibited minor, moderate or severe injuries. An original 16 items fall risk screening tool was complicated and wasted time that the outcomes of sensitivity and specificity benefit was ineffective. The purpose of this study was to simplify a risk screening tool that applicable to predict the patient fall in a medical center in southern Taiwan. We used a 16 items screening tool and conducted a retrospective case-control study based on data collected between January 2016 and February 2016 regarding 169 cases of inpatient falls reported in a medical center in 2015. A control group was selected from stratified random sampling of patients treated at various departments. By controlling age and conducting a 1:1 matched sampling, we recruited inpatients that did not fall during hospitalization, totally obtaining 338 cases of data. SPSS Version 20.0 was employed to analyze the descriptive statistics of the two groups and conduct chi-square tests and diagnostic test. The 338 inpatients including male 211, female 127, and ages mostly from 52.0 to 80.3 were gathered for analysis. The results of a chi-square analysis indicated the following seven risk factors of falling: unsteady gait, past history of falls, dizziness/vertigo, patient overestimates ability/forgets limitation, needing assistance in ambulation, sedative hypnotics medication and laxative medication. The simple version of fall risk screening tool including 7 items is appropriate, the data were analyzed by receiver operating characteristic curve (ROC), the result of the analysis showed an AUC = .725. The sensitivity, specificity, positive predictive value and negative predictive value were 83.4%, 43.8%, 59.7% , 72.5% and Youden index .40, respectively, for detecting high risk of patients falling, based on the fall risk screening score using 2 points as a cutoff value. The falls risk screening tool could be used by clinical nurses as a procedure in daily physical assessments or patient admissions to identify patients with a high risk of falling. On the basis of the results of the screening, nurses can immediately formulate nursing plans and interventions that prevent patient falling.
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Chung, Cheng-Ling, and 鍾政玲. "A study on satisfaction to hospital meals among inpatients." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/09639043504934432424.
Full textAbstract:
碩士臺北醫學大學
保健營養學研究所
96
The reception of hospital meals by patients have until now been a matter of speculation. The purposes of this study were (1) to investigate the overall satisfaction of hospital inpatients eating. (2) to investigate different individual characteristics and contextual factors of the inpatients satisfaction and (3) to find out the factors that affected inpatients eating satisfaction. A structural questionnaire was used to collect and survey the inpatients eating satisfaction and a Likert 5-point scale was used to quantify satisfaction. The study sampling for this research was collected from the hospitalized patients of Mackay Memorial Hospital (Medical Center) - Taipei District. The newborn center, pediatric ward, intensive care unit, psychiatric ward inpatients and those inpatients who were unable to eat by mouth or whose meals were part of an examination diet such as TPN nutrition support patients and NG tube feeding patients were excluded. The investigational period took place in: August/2005, August/2006 and August/2007, three times altogether. Each questionnaire needed to be collected on three consecutive working days (excluding Saturdays and public holidays). In total 548 valid questionnaires were collected. The statistical analysis was performed with the software SPSS version 10.0. The results showed that age, type of diet, appetite before hospitalization, and whether dietary consult took place were parameters that significantly affected satisfaction (p<0.05). Educational level and type of diet, were also significantly different (p<0.05). The patients employment status was found to be statistically different as well (p<0.05). The scores with regard to the hospital’s meals indicated that the satisfaction scores were higher than the dissatisfaction ones. Gender and main dish (cereal, rice, etc.,), the temperature of the side dishes were all significantly different (p<0.05). Educational level and the amount of side dishes and the temperature of the main dishes have significant differences (p<0.05). The overall satisfaction and satisfaction project (n=8) were significantly different (p<0.05). In conclusion, the main factors impacting the satisfaction with hospital catering are the contents of meal, flavor of meal, freshness of meal and hospitalized appetite.
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Ho, Hsin-Lei, and 何心磊. "A Pilot Study of Healthcare Quality in Asthma Inpatients." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/55771599574064912470.
Full textAbstract:
碩士國立臺灣大學
衛生政策與管理研究所
93
Abstract Background: Although the convenience and access to healthcare have been greatly improved since the implementation of National Health Insurance in Taiwan, the quality of healthcare is still a crucial issue. Take asthma care as an example; the national clinical guideline on the management of asthma was published by DOH (department of health) Taiwan in 2001. The rate of guideline adherence is still poor and the quality among hospitals varys significantly from patients’ perspective. In this study we try to explore the structure, process and outcome perspectives of care quality for asthma inpatients in Taiwan and analyze the relationships among these 3 dimensions of quality measure. Method: We conducted 2 surveys of asthma inpatients service to investigate patients’ satisfaction and process of care in 2002 and 2004. To measure the process of care, we established 7 indicators in accordance with asthma clinical guidelines. Furthermore, we intergrated the self-reported hospital accreditation data for descriptive and inference analyses. Results: There are significantly differences of patient satisfaction scores on hospitals with distinctive accreditation level and ownership. Among the 7 indicators of guideline adherence, the highest rate of adherece is “systemic steroid given” (83.13%), while the rate of “PEF measurement” is the lowest. The average items (score) of guideline suggested treatment received by patients are 3.42 out of 7. In addition, the rate of readmission for the same disease was associated with the degree of adherence to the guideline suggested treatment. In correlation and regression analyses, there are significant correlations between (1) guideline aherence score and patient satisfaction score (2) guideline adherence score and proportion of nurses with undergraduate or higher degree. The average of ICU lenth of stay, the proportion of nurses with undergraduate or higher degree and the ownership of hospital are significant independent variables to the guideline adherence score in the multiple regression model, while the hospital accreditation level, the guideline adherence score, and the average LOS and deathrate of ICU are significant independent variables to patient satisfaction score. Conclusion: Patient satisfaction scores of asthma inpatients vary among hospitals with different accreditation level and ownership. Moreover, the condition of asthma guideline adherence is not satisfactory. Further studies should be done to investigate the comprehensive measure of quality of asthma care. Keywords: asthma, quality of care, clinical guideline, patient satisfaction
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Chen, Ying-Yi, and 陳穎儀. "Trends in the use of Cephamycin in Taiwanese inpatients." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/82078280563862593769.
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碩士高雄醫學大學
藥學研究所碩士班
93
Objectives The major purpose of this study was to analyze cefotetan、cefoxitin and cefmetazole utilization and trends for Taiwanese inpatients, from 1997 to 2001. We analyzed the utilization and long-term trends within patient’s social demography（age, sex）and medical care institution’s characteristics（branch local, hospital level）, and the usage situation of every month. Methods Data source was derived from“inpatients expenses claims data, inpatients order claim data, and medical care institutional files in National Health Insurance Research Database from 1997 to 2001. According these data files, we selected cefotetan、cefoxitin and cefmetazole for analysis. The total number of patients were 4345, and among these patients，cefoxitin was 1938, cefmetazole was 2407. SAS for Windows 8.2 was used for data management and statistic analysis, and undered the usage trends of cefotetan、cefoxitin and cefmetazole variety by analyzing the result. Results Results of the study indicated that increasing used cefoxitin and cefmetazole from 1997 to 2001. Cefoxitin used 307 patients in 1997 to 484 patients in 2001, and Cefmetazole used 468 patients in 1997 to 551 patients in 2001. In part of age and sex, cefoxitin used the most in above 65-year-old male, but cefmetazole used the most in above 65-year-old female. In part of month, cefoxitin used the most in July, and cefmetazole used the most in February. In the aspect of medical level, cefoxitin and cefmetazole both used most in medical centers, cefoxitin and cefmetazole were decreasing trends use to decreasing level of the institutions. In the aspect of branch local, cefoxitin and cefmetazole both used in Taipei Branch more than other branchs. So for this reason cefoxitin and cefmetazole usage were some differences. Conclusions Although the usage quantity of cefotetan、cefoxitin and cefmetazole at Taiwan did not be regarded as at most, but we could find that the usage still had some difference from the results. So clinicians who should use cefoxitin and cefmetazole wit caution, and could tell patients correct the medicinal methods, thus could reduce resistance and abuse.
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Tai, Chien-Shu, and 戴千淑. "A Study on Medical Resource Utilization of Burn Inpatients." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/26769351574176798365.
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碩士國立陽明大學
醫務管理研究所
93
Abstract Background: In recent several years, the government emphasized burn prevention and first aid initial management, and got a lot of improvement in both fields. With the process of health care technology, the survival rate of burn injury improved but the cost of care and rehabilitation also increased. The cost of each burn inpatient is the highest among all trauma patients, however it varies with severity. Paying an average fee with geographic and other adjustments would promote efficiency by letting the hospitals keep any profit if their costs were less than the payment and encouraging them to drop services if their costs consistently exceeded the payment. If the gap between reimbursement and actual expense is great, it may cause case shifting and patient dumping. It not only delays the treatment but also increases the cost accordingly. Therefore, the cost of burn care and reimbursement can’t be emphasized more. Objective: 1. Understanding the burn inpatient medical resource utilization. 2. Analyzing the influence factors of burn inpatient resource. Methodology: Data were collected from the NHI research database in 2001. To analyze the extent to which burn care cost is determined by the characteristics of patient(sex, age and comorbidity), severity of burn(the type, area, depth of burn, inhalation injury and ABSI score), and the characteristics of the institution in which the patient is treated(accreditation level, ownership and locality). Then compare the different burn severity model to cost of burn . Result: Costs of care are higher in elderly, with comorbidity, multiple burns, large burn area, the third burn depth, with inhalation injury, public facilities and medical center. Compare to the model of ABSI, the common severity index model own a higher explanation. Conclusion: The characteristics of patient, severity of burn and the characteristics of the institution where the patient is treated account for portions of the variance in medical resource utilization. We suggest NHI reconsider the reimbursement for burn care.
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Chang, Yen-Chan, and 張晏甄. "Quality of Care of Inpatients with Acute Myocardial Infarction." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/94408725874015712421.
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碩士國立陽明大學
衛生福利研究所
93
Lots of clinical trials have found that some therapies, like aspirin, could prevent acute myocardial infarction’s patients from death. However, studies have also showed these therapies generally were underused. In order to improve the quality of care of acute myocardial infarction, American Heart Association (AHA)、American College of Cardiology (ACC) and Centers for Medicare & Medicaid Service(CMS) developed a clinical guideline and quality indicators to assess the quality of care of AMI. The quality indicators in our study were adopted from CMS and ACC/AHA. The process quality indicators included ：using aspirin、beta-blockers、angiotensin-Converting Enzyme inhibitors(ACEI)、cholesterol-lowing therapy、withhold calcium- channel blocker、received reperfusion therapy and angiography during the hospitalization. The outcome quality indicators included death in hospital、AMI and AMI related disease readmission in 14、30 and 180 days . The study populations were divided into eligible patients and ideal patients. The source of data was National Health Insurance (NHI) inpatients’ database from 2000 to 2003 provided by Bureau of NHI. Target populations were primary acute myocardial infarction hospitalization (with ICD-9-CM codes 410) aged over 18 years. The exclusion criteria included whose without discharge date, have been transferred from other hospitals, suicide during hospitalization, escaped from hospitals, hospitalized less then two days, and has been hospitalization in previous month. . A total of 29645 patients meet the criteria. The control variables included years, patients’ age, sex, comorbidity index, and disease severity. The independent variables included hospital ownership、levels、branches and volumes. The dependent variables included the process and outcome quality indicators. To assess the process and outcome quality of care,, we use logistic regression, multiple regression, and Generalized Estimating Equation (GEE) to evaluate the influence of the independent variables. The major results were as below: (1)62.95% AMI inpatients received aspirin during the hospitalization; 53.18% patients received beta-blockers; 66.74% patients received ACE inhibitors; 63.96% patients received cholesterol-lowing therapy;79.13% patients withheld calcium-channel blocker; 45.01% patients received reperfusion therapy and 59.48% patients received angiography. (2)Average length of stay of AMI inpatients were 10.08 days and 3.23 days for general and ICU respectively. In general 1/2 to 2/3 AMI patients received the ideal therapies in Taiwan, similar to other countries. However, reperfusion therapy rate was lower than other countries. (3)Death rate of AMI inpatients was about 5.07%, death rate including those auto discharged during the hospitalization is about 14.78%; Readmission rate of AMI was 1.34-2.82%. Readmission rate AMI related disease was1.35-2.97%. In general Inpatient outcome quality of care in Taiwan was better than other studies, but the readmission rate might be underestimated in our study. (4)After controlling other variables, low-volume hospitals tended to have worse process and outcome quality of care. We have the following recommendations： (1)To the health government：(a)The government should help doctors to make better treatment decision. (b) Quality indicators of our study could be used to evaluate the quality of care of AMI. (c) The results of our study could be used to enhance hospitals’ quality of care continuously. (2) To medical providers：(a) Should follow the well established clinical guideline to improve the quality of care of their patients. (3) To other researchers：(a) Can combine NHI claim data with clinical database to conduct further analysis. Physicians’ specialists and patient volumes could be included in the analysis to conduct international comparison. (b) Can further assess the appropriateness of care during hospitalization.
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Wang, Yi-Fen, and 王憶芬. "Influencing Factors and Radiological Medical Utilizations among Elderly Inpatients." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/91935017083595648172.
Full textAbstract:
碩士中臺科技大學
醫療暨健康產業管理系碩士班
103
Background and objective: Elderly acute and chronic disease incidence and severity are higher than that of young people, and therefore more dependent on modern medical imaging diagnostic tool. Population ageing increased demand for diagnostic imaging. This study was to explore the elderly aged over 65 of radiological medical utilizations and influence factors. Methods: We used data from 2010 National Health Insurance Research Database and cross-sectional study. All inpatients over the age of 65 with a total of 531,850 people were enrolled. In addition to descriptive analyses of radiological medical utilizations, we used negative binominal regression to analysis the influence factors of 65 years and over aged inpatients radiological medical utilizations. Results: In 2010, the radiological examination of elderly inpatients aged 65+, chest X-ray (66.9%) used the largest number, followed by CT (23.8%), abdominal X-ray (23.7%), other X-ray (14.6%), and MRI (8.5%). The age group in the most used chest X-ray and CT is 75-79 years, abdominal X-ray is 80-84 years, other X-ray and MRI is 70-74 years. Once hospitalized is 62.4%, and greater than or equal to twice hospitalized is 37.6%. In using medical imaging tool, the proportion of inpatients for once hospitalized and greater than or equal to twice hospitalized are 61.8% and 90.8%. In using medical imaging tool, the ratio of inpatients for once hospitalized and greater than or equal to twice hospitalized are 61.8% and 90.8%. Negative binomial regression analysis of radiological examination in hospitalized patients over 65 years, found that utilization of chest X-ray and abdominal X-rays increased with age (reference group 65-69 years); before age 95 years, CT utilization increased with age; after age 80 years, the utilization of other X-ray and MRI decreased with age. Males received significant more chest X-ray, abdominal X-ray and CT than females; males received less other X-ray and MRI than females. Ischemic stroke inpatients have a higher radiological medical utilization in chest X-ray, abdominal X-ray, other X-ray, CT and MRI than non-ischemic stroke inpatients. Hemorrhagic stroke inpatients have a higher radiological medical utilization in chest X-ray, abdominal X-ray, CT and MRI than non-hemorrhagic stroke inpatients except other X-ray. Conclusion: Inpatients older age and male over 65 years old have higher possibility of radiological examination in chest X-ray, abdominal X-ray and CT. Ischemic and hemorrhagic stroke inpatients have higher radiological medical utilization than non-stroke inpatients. Increasing age, elderly patients' radiological medical utilization increased, and the workload of radiological department increased. We hope the results provide references to policy decision-making. Stroke increased not only disability, but also the long-term costs of health care and radiological medical utilization. In response to Taiwan's population ageing, appropriate emphasis on stroke prevention and health care advocate, in order to reduce the future burden on society.