Given the increase in the number of abortions being performed in hospitals throughout the United States and Canada, there is an obvious need for counseling programs for these patients. The authors describe one such program, and emphasize the importance of close working relationships between the counselors and their supervising staff.
The authors describe an external crisis intervention service in a general hospital. This service is intended for a clientele presenting acute mental health problems, referred, in the majority of cases, from the emergency department. They present demographic data, diagnostic data, data on the factors precipitating the crises and data which can be used to qualify and quantify the clientele. In addition, they describe the therapeutic approach and the treatment philosophy, the number of follow-up sessions, and the guidance provided to the clientele after follow-up. Finally, the authors suggest prerequisites considered essential to the effective operation of a crisis intervention module in an external psychiatric clinic.
Analysis of the work of the ++somato-psychiatric departments entering a multiple-discipline hospital has shown that admission to these departments of patients with concomitant mental and somatic pathologies may be viewed as an episode for such patients. The latter ones cannot be regarded as a permanent group to be treated at the above departments. The duration of the stay at hospital is largely determined by the character of somatic pathology and, in a considerable number of cases, represents a stage in the psychiatric inpatient treatment. The data indicate that the present-day bed capacities in such departments (0.65 per 10 thousand adult and adolescent population) are insufficient. It is highly advisable that the number of such departments be increased.
Health care professionals in several countries are searching for alternatives to acute hospitalization. In Hallingdal, Norway, selected acute patients are admitted to a community hospital. The aim of this study was to analyse whether acute admission to a community hospital as an alternative to a general hospital had any positive or negative health consequences for the patients.
Patients intended for acute admission to the local community hospital were asked to join a randomized controlled trial. One group of the enrolled patients was admitted as planned (group 1, n = 33), while another group was admitted to the general hospital (group 2, n = 27). Health outcomes were measured by the Nottingham Extended Activity of Daily Living Questionnaire and by collection of data concerning specialist and community health care services in a follow-up year.
After one year, no statistical significant differences in the level of daily function was found between group 1 (admissions to the community hospital) and group 2 (admissions to the general hospital). Group 1 had recorded fewer in-patient days at hospitals and nursing homes, as well as lower use of home nursing, than group 2. For outpatient referrals, the trend was the opposite. However, the differences between the two groups were not at a 5% level of statistical significance.
No statistical significant differences at a 5% level were found related to health consequences between the two randomized groups. The study however, indicates a consistent trend of health benefits rather than risk from acute admissions to a community hospital, as compared to the general hospital. Emergency admission and treatment at a lower-level facility than the hospital thus appears to be a feasible solution for a selected group of patients.
ClinicalTrials.gov NCT01069107 . Registered 2 April 2010.
In 39 of 100 cancer patients admitted to the palliative care unit at Edmonton General Hospital, the presence of delirium during their last week of life required psychotropic drug treatment. In 10 of the 39 delirious patients, symptoms were only controllable by sedation; this was achieved in 9 patients by a continuous subcutaneous infusion of midazolam. Although haloperidol is considered to be the treatment of choice in agitated, delirious cancer patients, our data suggest that palliative care treatment strategies for these patients may be different.
This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD.
A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD.
The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admission reason (46%), and mood disorder was the most common discharge diagnosis (29%). The median length of stay for patients with DD was 8 days, which did not differ meaningfully from the comparison sample. Variables that were significantly associated with length of stay among individuals with DD included sex, referral source, and diagnosis.
When individuals with DD are psychiatric inpatients, their length of stay is affected by some factors that have been identified in previous studies not specific to DD (for example, referral source and diagnosis). Our finding that male patients with DD have longer lengths of stay than do female patients in the same sample has not been reported in previous research.
The care and treatment of adolescents on an adult acute psychiatric unit in a general hospital can pose serious problems for unit staff. Adolescents with behavior or character problems who prove violent or manipulative can disrupt treatment of both the adolescent and adult patients on the unit. Yet the demand for immediate treatment for many adolescents and the accessibility of general hospital psychiatric units often mean that adolescents may placed there inappropriately. This paper describes how an adult acute unit in a general hospital solved the problems caused by acting-out, manipulative adolescents on the unit. A committee found problems in inappropriate admissions, unworkable treatment plans, management of acting-out behaviors, case disposition, and staff attitudes. Remedies came in the form of more specific admission and discharge guidelines, strict enforcement of those guidelines, staff discussion of treatment plans, an inservice education program, and improved liaison with community facilities for adolescents.