Browsing by keyword "*Patient Admission"

Now showing items 1-6 of 6

    • A 55-year-old man admitted to the medical ICU with the diagnosis of status asthmaticus responds poorly to intensive asthma therapy
      Irwin, Richard S. (2000-03-14)

    • A prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma
      Wilson, Mark M.; Irwin, Richard S.; Connolly, Ann E.; Linden, Christopher; Manno, Mariann M. (2003-09-24)
      Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. Participants included 50 patients seeking care for acute asthma. Patients received standard therapy and were randomized to receive albuterol by nebulizer or metered-dose inhaler with spacer every 20 minutes up to 2 hours. Symptoms, physical examination, spirometry, pulsus paradoxus, medication use, and outcome were evaluated. Based on clinical judgment, the attending physician decided to admit or discharge after 1 hour of therapy. Outcome was compared to the EPR-2 guidelines. Post hoc statistical analyses examined predictors of the need for admission from which a prediction model was developed. Maximal accuracy of the admit versus discharge decision occurred at 1 hour of therapy. Using FEV(1) alone as an outcome predictor yielded suboptimal performance. FEV(1) at 1 hour plus ability to lie flat without dyspnea were the best indicators of response and outcome. A model predictive of the need for admission was developed. It performed better (P =.0054) than the admission algorithm of the EPR-2 guidelines. The decision to admit or discharge acute asthmatics from the ED can be made at 1 hour of therapy. No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction.

    • Factual sources of psychiatric patients' perceptions of coercion in the hospital admission process
      Lidz, Charles W.; Mulvey, Edward P.; Hoge, Steven K.; Kirsch, Brenda L.; Monahan, John; Eisenberg, Marlene; Gardner, William; Roth, Loren H. (1998-09-12)
      OBJECTIVE: The purpose of this study was to determine what predicts patients' perceptions of coercion surrounding admission to a psychiatric hospital. METHOD: For 171 cases, the authors integrated data from interviews with patients, admitting clinicians, and other individuals involved in the patients' psychiatric admissions with data from the medical records. Using a structured set of procedures, coders determined whether or not nine coercion-related behaviors occurred around the time of admission. Correlation and regression analyses were used to describe the predictors of patients' scores on the MacArthur Perceived Coercion Scale. RESULTS: The use of legal force, being given orders, threats, and "a show of force" were all strongly correlated with perceived coercion. A least squares regression accounted for 43.3% of the variance in perceived coercion. The evidence also suggested that force is typically only used in conjunction with less coercive pressures. CONCLUSIONS: Force and negative symbolic pressures, such as threats and giving orders about admission decisions, induce perceptions of coercion in persons with mental illness. Positive symbolic pressures, such as persuasion, do not induce perceptions of coercion. Such positive pressures should be tried in order to encourage admission before force or negative pressures are used.

    • Fighting a system biased toward nursing home placement
      Barrett, Erin E. (2006-03-23)
      Essay about raising awareness of community-based options for older adults so they can avoid unnecessary nursing facility placement.

    • Perceptions of coercion in the admission of voluntary and involuntary psychiatric patients
      Hoge, Steven K.; Lidz, Charles W.; Eisenberg, Marlene M.; Gardner, William; Monahan, John; Mulvey, Edward P.; Roth, Loren H.; Bennett, Nancy (1997-04-01)

    • Treatment of psychiatric hospital patients transferred to emergency departments
      Bazemore, Patricia H.; Gitlin, David F.; Soreff, Stephen (2005-03-16)
      Two hundred public psychiatric hospitals were surveyed regarding their management of inpatients with serious medical problems. Of the 102 hospitals responding, 98 had a formal arrangement with a medical facility for transfer and treatment. Fifty of the respondents felt they regularly had difficulty in receiving acceptable information from the receiving hospital, and 37 perceived that their patients regularly received less than optimal care. There was a significant direct correlation between difficulty obtaining information and the perception of suboptimal care. Seventy-nine hospitals had developed a referral form for the transfer of information to the receiving facility. The results point to an important area of discontinuity in the care of the seriously mentally ill.