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Academic Emergency Medicine : Official... Apr 2014
Topics: Acute Disease; Chronic Disease; Emergency Service, Hospital; Female; Humans; Male; Wounds and Injuries
PubMed: 24730411
DOI: 10.1111/acem.12358 -
BMC Health Services Research Oct 2019Because there is heterogeneity in disease types, competition among hospitals could be influenced in various ways by service provision for diseases with different...
BACKGROUND
Because there is heterogeneity in disease types, competition among hospitals could be influenced in various ways by service provision for diseases with different characteristics. Limited studies have focused on this matter. This study aims to evaluate and compare the relationships between hospital competition and the expenses of prostatectomies (elective surgery, representing treatments of non-acute common diseases) and appendectomies (emergency surgery, representing treatments of acute common diseases).
METHODS
Multivariable log-linear models were constructed to determine the association between hospital competition and the expenses of prostatectomies and appendectomies. The fixed-radius Herfindahl-Hirschman Index was employed to measure hospital competition.
RESULTS
We collected data on 13,958 inpatients from the hospital discharge data of Sichuan Province in China from September to December 2016. The data included 3578 prostatectomy patients and 10,380 appendectomy patients. The results showed that greater competition was associated with a lower total hospital charge for prostatectomy (p = 0.006) but a higher charge for appendectomy (p < 0.001). The subcategory analysis showed that greater competition was consistently associated with lower out-of-pocket (OOP) and higher reimbursement for both surgeries.
CONCLUSIONS
Greater competition was significantly associated with lower total hospital charges for prostatectomies, while the opposite was true for appendectomies. Furthermore, greater competition was consistently associated with lower OOP but higher reimbursement for both surgeries. This study provides new evidence concerning the heterogeneous roles of competition in service provision for non-acute and acute common diseases. The findings of this study indicate that the pro-competition policy is a viable option for the Chinese government to relieve patients' financial burden (OOP). Our findings also provide references and insights for other countries facing similar challenges.
Topics: Acute Disease; Aged; China; Chronic Disease; Delivery of Health Care; Economic Competition; Female; Health Services Research; Hospital Charges; Hospitals; Humans; Male; Marketing of Health Services
PubMed: 31640684
DOI: 10.1186/s12913-019-4543-x -
Journal of Midwifery & Women's Health May 2019
Topics: Acute Disease; Chronic Disease; Clinical Competence; Female; Humans; Midwifery; Pregnancy; Preventive Medicine; Primary Health Care; Professional Practice; Professional Role; Women's Health
PubMed: 31034732
DOI: 10.1111/jmwh.12976 -
General Hospital Psychiatry 2004Patients who are admitted to psychiatric inpatient wards often undergo a medical screening examination in the emergency department to rule out serious or underlying... (Review)
Review
Patients who are admitted to psychiatric inpatient wards often undergo a medical screening examination in the emergency department to rule out serious or underlying medical conditions that may be better treated elsewhere. Unfortunately, prior research has been conflicting on the relative merits of various screening procedures, making it difficult to implement guidelines. A systematic review of the literature was undertaken to research the current state of knowledge in medical screening procedures. Electronic searches were conducted in PubMed, MEDLINE, and the Cochrane Library for publication years 1966-2003. No restrictions were placed on language or on quality of publications. Twelve studies were found that reported specific yields of various screening procedures. Results indicate that medical history, physical examination, review of systems, and tests for orientation have relatively high yields for detecting active medical problems in patients presenting with psychiatric complaints. Routine laboratory investigations generally have a low yield for clinically significant findings. However, these should be added selectively for four groups at higher risk of serious medical conditions, i.e., the elderly, substance users, patients with no prior psychiatric history, and patients with preexisting medical disorders and/or concurrent medical complaints.
Topics: Acute Disease; Chronic Disease; Comorbidity; Cross-Sectional Studies; Diagnostic Tests, Routine; Emergency Service, Hospital; Humans; Incidental Findings; Mental Disorders; Multiphasic Screening; Patient Admission
PubMed: 15474641
DOI: 10.1016/j.genhosppsych.2004.04.006 -
European Psychiatry : the Journal of... Sep 2015Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause... (Comparative Study)
Comparative Study
BACKGROUND
Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society.
METHOD
To study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life.
RESULTS
Patients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62).
CONCLUSION
Mental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine.
Topics: Activities of Daily Living; Acute Disease; Adult; Chronic Disease; Cost of Illness; Disability Evaluation; Female; General Practice; Germany; Humans; Male; Mental Disorders; Middle Aged; Severity of Illness Index
PubMed: 26021271
DOI: 10.1016/j.eurpsy.2015.04.004 -
BMJ (Clinical Research Ed.) Apr 2010To assess the effects of inpatient rehabilitation specifically designed for geriatric patients compared with usual care on functional status, admissions to nursing... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the effects of inpatient rehabilitation specifically designed for geriatric patients compared with usual care on functional status, admissions to nursing homes, and mortality.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, Embase, Cochrane database, and reference lists from published literature. Review methods Only randomised controlled trials were included. Trials had to report on inpatient rehabilitation and report at least one of functional improvement, admission to nursing homes, or mortality. Trials of consultation or outpatient services, trials including patients aged <55, trials of non-multidisciplinary rehabilitation, and trials without a control group receiving usual care were excluded. Data were double extracted. Odds ratios and relative risks with 95% confidence intervals were calculated.
RESULTS
17 trials with 4780 people comparing the effects of general or orthopaedic geriatric rehabilitation programmes with usual care were included. Meta-analyses of effects indicated an overall benefit in outcomes at discharge (odds ratio 1.75 (95% confidence interval 1.31 to 2.35) for function, relative risk 0.64 (0.51 to 0.81) for nursing home admission, relative risk 0.72 (0.55 to 0.95) for mortality) and at end of follow-up (1.36 (1.07 to 1.71), 0.84 (0.72 to 0.99), 0.87 (0.77 to 0.97), respectively). Limited data were available on impact on health care or cost. Compared with those in control groups, weighted mean length of hospital stay after randomisation was longer in patients allocated to general geriatric rehabilitation (24.5 v 15.1 days) and shorter in patients allocated to orthopaedic rehabilitation (24.6 v 28.9 days).
CONCLUSION
Inpatient rehabilitation specifically designed for geriatric patients has the potential to improve outcomes related to function, admission to nursing homes, and mortality. Insufficient data are available for defining characteristics and cost effectiveness of successful programmes.
Topics: Acute Disease; Aged; Hip Fractures; Homes for the Aged; Hospitalization; Humans; Nursing Homes; Prognosis; Quality of Health Care; Randomized Controlled Trials as Topic
PubMed: 20406866
DOI: 10.1136/bmj.c1718 -
International Journal of Nursing Studies Jul 2007A review of psycho-educational intervention studies to benefit children adapting to a close (parent, sibling, or grandparent) family member's serious illness was... (Review)
Review
BACKGROUND
A review of psycho-educational intervention studies to benefit children adapting to a close (parent, sibling, or grandparent) family member's serious illness was conducted.
OBJECTIVES
To review the literature on studies addressing this topic, critique research methods, describe clinical outcomes, and make recommendations for future research efforts.
DATA SOURCES
Research citations from 1990 to 2005 from Medline, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, and PsycINFO databases were identified.
REVIEW METHODS
Citations were reviewed and evaluated for sample, design, theoretical framework, intervention, threats to validity, and outcomes. Reviewed studies were limited to those that included statistical analysis to evaluate interventions and outcomes.
RESULTS
Six studies were reviewed. Positive outcomes were reported for all of the interventional strategies used in the studies. Reviewed studies generally lacked a theoretical framework and a control group, were generally composed of small convenience samples, and primarily used non-tested investigator instruments. They were diverse in terms of intervention length and intensity, and measured short-term outcomes related to participant program satisfaction, rather than participant cognitive and behavioral change.
CONCLUSIONS
The paucity of interventional studies and lack of systematic empirical precision to evaluate intervention effectiveness necessitates future studies that are methodologically rigorous.
Topics: Acute Disease; Adaptation, Psychological; Adolescent; Attitude to Health; Child; Child, Preschool; Family; Female; Humans; Male; Models, Nursing; Nursing Research; Nursing Theory; Outcome Assessment, Health Care; Patient Education as Topic; Pediatric Nursing; Psychology, Child; Research Design
PubMed: 16889781
DOI: 10.1016/j.ijnurstu.2006.05.008 -
Journal of Rehabilitation Medicine Sep 2013This pilot study investigated the effects of acute neuropsychological intervention for relatives of patients with severe brain injury.
OBJECTIVE
This pilot study investigated the effects of acute neuropsychological intervention for relatives of patients with severe brain injury.
METHODS
Participants were enrolled in an intervention group comprising 39 relatives, and a control group comprising 47 relatives. The intervention consisted of supportive and psycho-educational sessions with a neuropsychologist in the acute care setting.
RESULTS
The intervention group completed self-report scales in the acute setting and after the intervention at admission to sub-acute rehabilitation. The control group completed the self-report scales only at admission to sub-acute rehabilitation. Outcome measures included selected scales from the Symptom Checklist Revised 90 (SCL-90-R), the Short Form 36 (SF-36), and a visual analogue quality of life scale. The intervention group showed a significant decrease in anxiety scores from the acute to the sub-acute setting (t = 2.70, p = 0.010, d = 0.30), but also significantly lower Role Emotional scores (t = 2.12, p = 0.043, d = 0.40). In the sub-acute setting, an analysis of covariance model showed a borderline significant difference between the intervention and the control group on the anxiety scale (p = 0.066, d = 0.59).
CONCLUSION
Any effects of the acute neuropsychological intervention were limited. Further research is needed to explore the effects of different interventions in more homo-genous and larger groups of relatives.
Topics: Acute Disease; Adolescent; Adult; Brain Injuries; Child; Child, Preschool; Emotions; Family; Female; Health Education; Humans; Infant; Male; Middle Aged; Pilot Projects; Self-Help Groups; Young Adult
PubMed: 24002321
DOI: 10.2340/16501977-1181 -
Psychology & Health Aug 2016To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether people's beliefs about their illness, conceptualised by the common sense model (CSM), can prospectively predict adherence to self-management behaviours (including, attendance, medication, diet and exercise) in adults with acute and chronic physical illnesses.
DESIGN AND MAIN OUTCOME MEASURES
Electronic databases were searched in September 2014, for papers specifying the use of the 'CSM' in relation to 'self-management', 'rehabilitation' and 'adherence' in the context of physical illness. Six hundred abstracts emerged. Data from 52 relevant studies were extracted. Twenty-one studies were meta-analysed, using correlation coefficients in random effects models. The remainder were descriptively synthesised.
RESULTS
The effect sizes for individual illness belief domains and adherence to self-management behaviours ranged from .04 to .13, indicating very weak, predictive relationships. Further analysis revealed that predictive relationships did not differ by the: type of self-management behaviour; acute or chronic illness; or duration of follow-up.
CONCLUSION
Individual illness belief domains, outlined by the CSM, did not predict adherence to self-management behaviours in adults with physical illnesses. Prospective relationships, controlling for past behaviour, also did not emerge. Other factors, including patients' treatment beliefs and inter-relationships between individual illness beliefs domains, may have influenced potential associations with adherence to self-management behaviours.
Topics: Acute Disease; Adult; Attitude to Health; Chronic Disease; Humans; Models, Psychological; Patient Compliance; Prospective Studies; Self Care
PubMed: 26911306
DOI: 10.1080/08870446.2016.1153640 -
AACN Clinical Issues Nov 1996Critical care and acute care nurses must determine ways to deliver optimal patient care without the use of physical restraints. This article explores the application of... (Review)
Review
Critical care and acute care nurses must determine ways to deliver optimal patient care without the use of physical restraints. This article explores the application of the clinical decision analysis model to the challenge of finding nonrestraint approaches to care. Clinical decision analysis is a structured, quantified approach for choosing an optimal course of action in a situation that involves tradeoffs among risks and preferences and when outcomes are uncertain. Decision analysis provides a graphic representation of the decision situation that facilitates evaluation of factors relevant to the situation and evaluation of the potential events and outcomes following a chosen strategy. The decision analysis model can be useful for determining guidelines for clinical practices, facilitating discussions among health care providers and patients, and determining areas in need of additional research.
Topics: Acute Disease; Critical Care; Decision Trees; Humans; Models, Nursing; Nursing Assessment; Restraint, Physical
PubMed: 8970261
DOI: 10.1097/00044067-199611000-00015