Hospital admission rates and the primary health team

The use of hospital beds was studied for a period of one year in a practice under the care of a closely co-ordinated team composed of the family physician, the family nurse, and a medical social worker. Admission rates and mean duration of stay in hospital are analysed and discussed in relation to selected socio-demographic variables.The results showed that the study population used only half as many hospital beds when compared with national rates in Israel. We consider that this was achieved by the provision of planned co-ordinated comprehensive medical nursing and social services for patients suffering from long-term illness. Such a team is able to provide a high quality medical care and can significanlty reduce the use of in-patient hospital services.     

Psychiatric hospital admission rates: Facts and artifacts.

Examined types of patient admissions in the 1st yr of a new psychiatric hospital opening to address issues raised by I. Silverman and D. Saunders (see record 1982-01855-001). It was found that, for all patients residing in the county where the new facility was located, 39%, 48%, and 13% were transfer admissions, readmissions, and 1st admissions, respectively. By using a more valid definition of the same criterion variable (admission rates), these results question Silverman and Saunders's interpretation of the same data. (French abstract) (3 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Elevated serum creatine kinase activity in adolescent psychiatric inpatients on admission

A 59-year-old male developed a severe adult respiratory distress syndrome following a right pneumonectomy for pulmonary cancer. Extracorporeal membrane oxygenation for 11 days was life-saving. The operation was considered curative, but the patient died nine months later with multiple metastases. The pathogenesis and treatment for postpneumonectomy pulmonary oedema and an explanation for rapid dissemination of the cancer are stated.     

Iowa record-linkage study: death rates in psychiatric patients

The Iowa record-linkage study was developed to investigate death rates in psychiatric patients, and involved computer matching of death certificates with a roster of patients. A list of all patients admitted to our hospital from 1972 through 1981 was obtained and after removing duplicate entries the list was pared to 5412 names. The record included multiple identifiers (e.g., name, gender, date-of-birth, hospital number). This information was then linked by computer with all Iowa death certificates for the same period; a total of 331 deaths were identified. Patients were assigned to a single psychiatric diagnostic category based on a computer program that reviewed each patient's clinical diagnoses and picked the one with the highest priority in a hierarchy we had created. Age and sex adjusted mortality tables were constructed, allowing us to compute expected numbers of deaths. Relative risk for premature death was greatest among women, and those under 20 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either gender with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psychophysiological disorders; and men with neuroses. Death from natural causes, especially from heart disease, was significantly excessive among women, while death from accidents and suicides was excessive for both men and women. The overall SMR was 1.65 (P < 0.001). Most importantly, we found that the greatest excess of mortality occurred within the first 2 years following hospital discharge. Thus, we were able to demonstrate that risk of mortality in general, and of suicide specifically, differed according to age, gender, diagnosis, and portion of the follow-up. We have subsequently used this method to investigate specific risk factors associated with mortality in mood disorders, schizophrenia, and antisocial personality disorder. Findings from these studies are reported.     

A retest of MMPI prediction of admission to a psychiatric hospital

In a previous study, Jones, Kahn, and Langsley (1965) investigated the hypothesis that the MMPI would prove clinically useful in the prediction of admission to a psychiatric hospital. They found that the MMPI had negligible predictive validity for such an application. However, several methodological flaws left the conclusion of that study in doubt. This paper retested the hypothesis that the MMPI can be predictive of the admission decision when a sophisticated multivariate classification technique and adequate sample size are used. Given our results, the hypothesis again must be rejected. Possible problems associated with testing an hypothesis such as this are discussed.     

Psychiatric morbidity among adults in The Netherlands: the NEMESIS-Study. II. Prevalence of psychiatric disorders. Netherlands Mental Health Survey and Incidence Study

OBJECTIVE: To determine the prevalence of psychiatric disorders in non-institutionalised Dutch adults. DESIGN: Cross-sectional. SETTING: Trimbos Institute, Utrecht, the Netherlands. METHODS: A representative sample of 7076 adults (18-64 years) in the Netherlands' population were interviewed in 1996 to determine the prevalence of mental disorders ever, in the previous 12 months and in the previous month. Objectives and study design are described in the previous article (1997: 2448-52). The 'Composite international diagnostic interview' (CIDI) was used to assess the following mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R): affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, substance dependence and substance abuse. RESULTS: Mental disorders were common in the general population: the prevalence 'ever' of all disorders was 41.2%, the 12-month prevalence 23.5%, without sex differences. Depression, anxiety disorders and alcohol abuse and dependence showed high prevalence and comorbidity. The prevalence 'ever' of schizophrenia and other non-affective psychoses was low (0.4%).     

Situations associated with admission to an acute care inpatient psychiatric unit.

This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission. A structured interview was developed to obtain information about depressive and psychotic symptoms, stressful events, substance use, and aggressive and disruptive behaviors. Suicide risk was the most common reason for hospitalization (65%). Between 25% and 38% of patients reported interpersonal problems with family members or people outside their family, and about 50% reported financial problems immediately before hospitalization. Comparison of patients who had been readmitted within 30 days with patients who had been living in the community for at least 6 months since their last hospitalization found few differences between these groups. Results indicate that most patients were admitted to an inpatient psychiatric unit because of suicide risk, and interpersonal events seemed to precipitate hospital admission for these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in psychiatric admission MMPI profiles over a period of 15 to 20 years

An attempt was made to compare admission MMPI profiles of a matched sample of psychiatric inpatients over a 15- to 20-year period. For both males and females, significant decreases in MMPI indices of psychopathology occurred. Possible reasons for this decrease are presented.     

Dimensions of psychiatric symptom ratings determined at thirteen timepoints from hospital admission.

Principal factor-varimax factor analyses of the Symptom Rating Scale (SRS) were performed at 13 timepoints over a 4-yr period, both in and out of the hospital, on pooled samples of predominantly chronic schizophrenic patients from 12 VA hospitals (N = 329-1274). 5 symptom factors were found: Uncooperative, Depression-Anxiety, Paranoid Hostility, Deteriorated Thinking, and Unmotivated. The high degree of factor similarity found over time, place (hospital or community), and rater (psychologist or social worker) makes longitudinal comparisons meaningful and makes it possible to use the Admission SRS analysis (N = 1274) as a basis for factor scoring throughout. The findings argue for the robustness of rated psychiatric symptom dimensions over changes in time and setting of the rating and in profession of the rater. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in rates and correlates of suicidal behaviour amongst child psychiatric outpatients

A key early event of newt limb regeneration is the local dedifferentiation of cells to form dividing progenitor cells. This involves the plasticity of differentiation and the ability to re-enter the cell cycle. In culture, differentiated newt myotubes are able to re-enter S-phase in response to serum stimulation. Here, we analyzed the intracellular and extracellular requirements for this process. Cell cycle re-entry depends on the phosphorylation of the retinoblastoma protein, which is a key regulator of the G1-S transition. This is in contrast to mammalian myotubes, which are refractory to serum stimulation and cannot phosphorylate retinoblastoma protein in response to serum. The serum factor responsible for this phosphorylation appears to be distinct from common polypeptide growth factors and is enriched in crude preparations of bovine thrombin. Fractionation and analysis of this preparation indicate that the factor is regulated by thrombin and plasmin proteolysis. These results indicate that factors involved in acute responses to wounding such as clotting may be important initiators of the regenerative response.     

Predicting psychiatric admission from an emergency room. Psychiatric, psychosocial, and methodological factors

The determinants of psychiatric hospitalization, especially nonspecific issues, have been studied extensively. The methodological problem of correlational non-cross-validated findings are seen as contributing to our uncertainties about the critical issues involved in the decision to admit. A cross-validated multiple regression analysis of determinants of hospitalization in an inner-city municipal hospital revealed two determinants of hospitalization: severity of schizophrenic symptoms and active suicidal and/or homicidal ideation. They accounted for one third of the variance without shrinkage. Quasi-experimental designs may be the most efficient means of studying the remaining unexplained variance.     

Laparoscopic cholecystectomy in The Netherlands

Laparoscopic cholecystectomy was introduced into the Netherlands in the Spring of 1990. The aim of this study was to evaluate the results of the procedure in Dutch hospitals over the first 2 years to obtain some insight into its safety and efficacy in general surgical practice. A written questionnaire was sent to all 138 Dutch surgical institutions enquiring about conversion rate, complications (with emphasis on mortality rate and common bile duct injuries), operating time and hospital stay. The surgeons' opinions were also sought on possible contraindications such as previous operation, bile duct stones and cholecystitis, as were their estimations of the percentage of patients in their practice eligible for laparoscopic cholecystectomy. Data were obtained for 6076 laparoscopic cholecystectomies; the response rate was 100 per cent. Conversion to open cholecystectomy was necessary in 413 patients (6.8 per cent), mostly because of adhesions, cholecystitis, haemorrhage and unclear anatomy. Postoperative complications were reported in 260 patients (4.3 per cent). There were seven deaths (0.12 per cent) and 52 (0.86 per cent) bile duct injuries, of which 20 were recognized during laparoscopy. The mean operating time for the ten most recent patients in each institute was 70 (range 30-180) min and the mean hospital stay 4.5 (range 2-8) days. Previous lower abdominal operations were not considered to be a contraindication by 96 per cent of surgeons, whereas previous upper abdominal procedures were regarded as a contraindication by 66 per cent. After successful clearance of the bile duct at endoscopic retrograde cholangiopancreatography, only 12 per cent would perform an open procedure. Moderate cholecystitis was not considered a contraindication to laparoscopic cholecystectomy by 71 per cent of surgeons, but severe cholecystitis was a reason for open cholecystectomy for 83 per cent. In most surgical practices 70-80 per cent of patients were considered to be eligible for the laparoscopic procedure. In conclusion, laparoscopic cholecystectomy has gained rapid acceptance in the Netherlands. Although the number of bile duct injuries is high, the findings of this general survey are similar to those from highly specialized centres and match the overall results of conventional cholecystectomy.     

Regional suicide rates in the Netherlands: does religion still play a role?

We investigated the influence of apolipoprotein (apo) E-containing particles on LDL receptor binding of large, buoyant LDL subfractions (LDL I) from subjects with predominantly large (phenotype A) and small (phenotype B) LDL particles. Direct binding by human fibroblast LDL receptors was tested at 4 degrees C before and after removal of apoE-containing particles by immunoaffinity chromatography. The binding affinity of total LDL I in phenotype B was greater than that in phenotype A (Kd of 1.83+/-0.3 and 3.43+/-0.9 nmol/L, respectively, P<.05). LDL I from phenotype B subjects had a higher apoE to apoB molar ratio than did that from phenotype A (0.16+/-0.04 versus 0.06+/-0.02, P<.05). Nondenaturing gradient gel electrophoresis of apoE-containing LDL I isolated by immunoaffinity chromatography revealed a substantially larger peak particle diameter than in apoE-free LDL I, and comparison of LDL I composition before and after immunoaffinity chromatography suggested an increase in triglyceride content of apoE-containing particles. After removal of these particles, there was a greater than twofold reduction in LDL receptor affinity of phenotype B LDL (Kd of 1.83+/-0.3 to 3.76+/-0.6, P<.01), whereas in phenotype A no change was observed (Kd of 3.43+/-0.9 to 3.57+/-0.4, respectively). The receptor affinity of apoE-free LDL I from phenotype A and B subjects did not differ. These findings confirm that large, buoyant LDL particles from phenotype B subjects have a higher LDL receptor affinity than does LDL I from phenotype A subjects and suggest that this difference is due to an increased content of large, triglyceride-enriched, apoE-containing lipoproteins. It is possible that the accumulation of these particles reflects abnormalities in the metabolism of remnant lipoproteins that contribute to atherosclerosis risk in phenotype B subjects.