Search results

This paper aims to determine the one‐year incidence of, and risk factors for, perioperative adverse events during in‐patient and out‐patient anesthesia‐assisted procedures.

A quality assurance database was the primary data source. Outcome variables were death and the occurrence of any adverse event. Risk factors were ASA physical status (PS), age, duration and type of anesthesia care, number of operating rooms running, concurrency level and medical staff. Data were stratified by in‐patient or out‐patient, surgical (e.g. thoracotomy) or non‐surgical (e.g. electroconvulsive therapy), and were analyzed using Chi square, Fisher's exact test and generalized estimating equations.

Of 27,970 procedures, 49.8 percent were out‐patient and greater than 80 percent were surgical. For surgical procedures, adverse event rates were higher for in‐patient than out‐patient procedures (2.11 percent vs. 1.45 percent; p<0.001). For non‐surgical procedures, adverse event rates were similar for in‐patients and out‐patients (0.54 percent vs. 0.36 percent). The types of adverse events differed for in‐patient and out‐patient surgical procedures (p<0.001), but not for non‐surgical procedures. ASA PS, age, duration of anesthesia care, anesthesia type and medical staff assigned to the case were each associated with adverse event rates, but the association depended on the type of procedure.

In‐patient and out‐patient surgical procedures differ in the incidence of perioperative adverse events, and in risk factors, suggesting a need to develop separate monitoring strategies.

The paper is the first to assess perioperative adverse events amongst in‐patient and out‐patient procedures.

In many UK mental health services, in-patient psychiatric care is being separated from community care by having dedicated in-patient medical team. We evaluated staff satisfaction in this functionalised in-patient care. A survey was conducted amongst multidiscipli-nary staff from various teams using a questionnaire survey. On an average 14.3% of staff returned a satisfactory response for function-alisation, 57.3% had unsatisfactory response and others were undecided or perceived no change. There was no difference in responses amongst age, gender and professional groups. Mean scores of all groups were within unsatisfactory domain; however community staff compared to in-patient staff and staff with more than 5 years of experience compared to those with 1-5 years of experience returned significantly more unsatisfactory responses regarding functionalisation. Many positive and negative aspects of functionalisation were raised. The results of this evaluation suggest the need for further studies on the effectiveness of in-patient functionalisation. Short and long term clinical outcomes and the satisfaction of the patients should also be studied.

Migration appears to be a determinant in health-care utilisation, particularly among the elderly in India. Ageing and migration are essential socio-demographic phenomena in the 21st century for developing and developed countries to establish better public health-care policies. This study aims to focus on the status and determinants of health-care utilisation among elderly migrants who have migrated after attaining the age of 45 and above.

This study used the data from the first wave of the longitudinal ageing study in India (LASI) in 2017–2018. Two outcome variables were used to examine the health-care utilisation, including in-patient and out-patient care. Binary logistic regression was used to explore the predictors of healthcare utilisation in terms of in-patient and out-patient care among the elderly migrant population.

A total of 82.9% of elderly migrants had visited out-patient care when they were sick, whereas 15.3% have used in-patient care. Enabling factors, such as wealth quintile and health insurance, and need factor, such as chronic disease and self-rated health, were more significant factors influencing the health-care utilisation.

This study contributes to our understanding of older migrants’ health-care utilisation. Focussing on this study’s outcome, policymakers and decision makers may consider improving older migrants’ access to health-care by raising their income level, offering local health insurance and health awareness programs.

There has been much debate about the most appropriate site for in‐patient psychiatric care for people with learning disabilities. The evidence base for service delivery for this group is very scant. Even less is known about the experiences of service users and their carers, as their voices have been largely absent from this debate among service providers and policy makers. This article summarises results from a study into the experiences of adults with learning disabilities who were admitted for in‐patient psychiatric care. Their carers' views were also investigated. Differences between generic and specialist provision are considered, and implications for service delivery are discussed. Generic services in particular would appear in need of considerable improvements if they are to meet the needs of people with learning disabilities in line with current policy guidelines. Recommendations for improvement include greater sensitivity of staff to the needs of this group, increased provision of accessible information about treatment options and medication, and more careful consideration of the need to involve regular carers during the admission.

Treatment satisfaction of different mental disorders is still poorly understood, but of high clinical interest. Inpatients of a general psychiatric care hospital were asked to fill out questionnaires on satisfaction and clinical variables at admission and discharge. On the basis of an exploratory approach, differences in treatment satisfaction among diagnostic groups were examined by means of one-way analysis of variance. Potential associated clinical and socio-demographic variables were studied using multi/univariate tests. Patients with personality disorders (n=18) showed a significantly lower treatment satisfaction (ZUF-8, Zurich Satisfaction Questionnaire) and a slightly lower improvement of symptoms (CGI, Clinical Global Impression) and global functioning (GAF, Global Assessment of Functioning scale) than that of other diagnostic groups (n=95). Satisfaction in patients with personality disorders correlated much stronger with the symptom improvement and slightly with the functioning level than in patients without personality disorders. Interestingly, in patients with personality disorders psychopharmacological treatment in general (present versus not present) was independent from satisfaction. This exploratory investigation suggests that a lower satisfaction of patients with personality disorders in a general psychiatric hospital is mainly based on a reduced improvement of the symptoms and of the global functioning level.

The purpose of this study is to integrate evidence on contributing factors, consequences, in addition to coping mechanisms of depression and anxiety in patients with heart failure.

An integrative review was conducted by searching three main electronic databases: Web of Sciences, MEDLINE and Science Direct. Twenty-four studies met the inclusion criteria and were included in the final review process.

The review identified the most common contributing factors, consequences and coping mechanisms of depression and anxiety in patients with heart failure. Patients with heart failure have high anxiety and depression prevalence rates.

It is recommended to include routine assessment and management of anxiety and depression in heart failure protocols to improve clinical outcomes.

The purpose of this paper is to present a qualitative analysis of the facilitators of recovery in in-patient psychiatric rehabilitation from the service users’ perspective.

Interviews with 31 in-patients were coded and analysed thematically at an interpretive level using an inductive approach.

The dominant themes identified were hope, agency, relationships and opportunity. Totally, 20 subthemes were identified. Agency was more important to men than women and agency, hope and relationships were all more important to detained patients.

Interview data were collected in writing rather than taped. The results may not be transferrable to patient populations with significantly different demographic or service factors.

Services need to target interventions at the areas identified by service users as important in their recovery. The findings suggest both environmental and relational aspects of care that may optimise recovery. Services also need to be able to measure the quality of the care they provide. A brief, culturally valid and psychometrically assessed instrument for measuring the recovery orientation of services is required.

As far as the authors are aware no qualitative work to date has examined the recovery experiences of psychiatric rehabilitation in-patient service users in order to understand what services require to do to enable recovery from their perspective. The conceptual framework identified in this paper can be used to develop a service user self-report measure of the recovery orientation of services.

Two censuses, from 2010 and 2013, respectively, shed light on the trend in use of in-patient psychiatric care for people with learning disability or autism following the BBC documentary exposing abuse of patients at Winterbourne View. The purpose of this paper is to consider the implications of the detailed trends for future care for this group.

Published data from a recent (September 2013) census are compared with the re-analysis of a census undertaken by the Care Quality Commission in March 2010.

An overall 35 per cent reduction in numbers of in-patients is made up of larger falls in groups generally easier to discharge (older, female, in general as opposed to secure units). There is also substantial variation around the country.

There are some uncertainties about the comparability of the two censuses and the question of how complete enumeration was of people with learning disabilities in general mental illness beds.

The paper raise the question of whether the beds that are reducing fastest may be those most likely to be of value to a high quality and sustainable service in the long term.