Psychiatric patients at the emergency department: factors associated with length of stay and likelihood of hospitalization

Emergency department (ED) care for psychiatric patients is currently understudied despite being highly utilized. Therefore, we aimed to analyze psychiatric patients' length of stay (LOS) and LOS-related factors at the ED and to investigate and quantify the likelihood of being hospitalized after an emergency psychiatric evaluation. Charts of 408 individuals who sought help at the ED were retrospectively assessed to identify patients' sociodemographic and clinical data upon ED admission and discharge. All interventions performed at the ED (e.g., medications, hospitalization, clinical advice at discharge) were collected as well. The LOS for psychiatric patients was relatively short (6.5 h), and substance/alcohol intoxication was the main factor impacting LOS. Upon ED arrival, hospitalized patients were mostly men, most often had a yellow/severe triage code, and most often had a positive history of psychiatric illness, psychotic symptoms, euphoric mood, or suicidal ideation. Manic symptoms and suicidal ideation were the conditions most frequently leading to hospitalization. Given the paucity of real-world data on psychiatric patients’ LOS and outcomes in the ED context, our findings show that psychiatric patients are evaluated in a reasonable amount of time. Their hospitalization is mostly influenced by clinical conditions rather than predisposing (e.g., age) or system-related factors (e.g., mode of arrival)

ASSOCIATIONS BETWEEN FUNCTIONAL MILESTONES AND PSYCHIATRIC ADMISSIONS IN AN URBAN AREA: UTILITY OF A CLUSTER-ANALYTICAL APPROACH

Background: The purpose of the study was to identify homogenous subgroups, based upon achievement of two functional milestones (marriage and employment) and Global Assessment of Functioning (GAF) score in a sample of 848 acute patients admitted to the Psychiatric Emergency Service (PES) of the Città della Salute e della Scienza di Torino, during a 24-months period. Subjects and methods: A two-step cluster-analysis, using GAF total score and the achievements in the two milestones as input data was performed. In order to examine whether the identified subgroups differed in external variables that were not included in the clustering process, and consequently to validate the found functional profiles, chi-square tests for categorical variables and analyses of variance (ANOVA) for continuous variables were performed. Results: Five clusters were found. Employed patients (Clusters 4 and 5) had more years of education, less illness chronicity (shorter duration of illness and lower proportion of previous voluntary hospitalizations), lower use of mental health resources in the last year yet higher treatment adherence, larger network size, and higher ordinary discharge. Married inpatients (Clusters 3 and 5) had lower frequencies of substance abuse. Conclusions: The remarkably high rate of unemployment in this inpatients’ sample, and the evidence of associations between unemployment and poorer functioning, argue for further research and development of evidence-based supported employment programs, that put forth diligent effort in helping people obtain work quickly and sustain; they may also help to reduce health care service use among that clientele

gender and quality of life in laryngectomized patients

Background: the aim of this study was to investigate possible correlations between the perception of postoperative quality of life and gender. Methods: the questionnaires “the Brief illness Perception Questionnaire” (B-iPQ) and “Voice handicap index” (Vhi) were administered to 94 patients divided into two groups according to gender group a: 73 men, group B: 21 women. RESULTS: The results showed that gender should be considered a factor influencing perceived quality of life in laryngectomized patients. Specifically, women showed greater concern towards the disease, its evolution, and the consequences on their lives, compared to men. CONCLUSIONS: the care of the laryngectomized woman should consider the impact that loss of voice has on the perception of her femininity, and the physical, functional, and above all emotional issues that such surgeries may lead to for women

Conceptual disorganization as a mediating variable between visual learning and metacognition in schizophrenia

ObjectivesThe aim of this study was to evaluate the relative contributions of visual learning and conceptual disorganization to specific metacognitive domains in a sample of outpatients with stable schizophrenia.MethodsA total of 92 consecutive outpatients with stable schizophrenia were recruited in a cross-sectional study. We analyzed the data with five path analyses based on multiple regressions to analyze the specific effect of visual learning on metacognitive capacity and metacognitive domains and the possible mediating role of conceptual disorganization.ResultsWe found that (i) visual learning was negatively correlated to metacognitive capacity and its domains on the one hand and conceptual disorganization on the other hand; (ii) conceptual disorganization was negatively associated with metacognition and its domains; and (iii) when the mediation effect was considered, conceptual disorganization fully mediated the relationship between visual learning and mastery, whereas it served as a partial mediator of the effect of visual learning on the other metacognition domains, i.e., self-reflectivity, understanding others’ mind, and decentration.ConclusionThese results delineate an articulated panorama of relations between different dimensions of metacognition, visual learning, and conceptual disorganization. Therefore, studies unable to distinguish between different components of metacognition fail to bring out the possibly varying links between neurocognition, disorganization, and metacognition

Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive