The objective of this study was to examine associations between patient age and medication errors among pediatric inpatients.
Secondary analysis of data sets generated from 2 tertiary pediatric ...hospitals: (1) prescribing errors identified from chart reviews for patients on 9 general wards at hospital A during April 22 to July 10, 2016, June 20 to September 20, 2017, and June 20 to September 30, 2020; prescribing errors from 5 wards at hospital B in the same periods and (2) medication administration errors assessed by direct prospective observation of 5137 administrations on 9 wards at hospital A. Multilevel models examined the association between patient age and medication errors. Age was modeled using restricted cubic splines to allow for nonlinearity.
Prescribing errors increased nonlinearly with patient age (P = .01), showing little association from ages 0 to 3 years and then increasing with age until around 10 years and remaining constant through the teenage years. Administration errors increased with patient age, with no association from 0 to around 8 years and then a steady rise with increasing age (P = .03). The association differed by route: linear for oral, no association for intravenous infusions, and U-shaped for intravenous injections.
Older age is an unrecognized risk factor for medication error on general wards in pediatric hospitals. Contributors to risk may be the clinical profiles of these older children or the general level of attention paid to medication practices for this group. Further investigation may allow the design of more targeted interventions to reduce errors.
As coronavirus disease 2019 cases increase throughout the country and health care systems grapple with the need to decrease provider exposure and minimize personal protective equipment use while ...maintaining high-quality patient care, our specialty is called on to consider new methods of delivering inpatient palliative care (PC). Telepalliative medicine has been used to great effect in outpatient and home-based PC but has had fewer applications in the inpatient setting. As we plan for decreased provider availability because of quarantine and redeployment and seek to reach increasingly isolated hospitalized patients in the face of coronavirus disease 2019, the need for telepalliative medicine in the inpatient setting is now clear. We describe our rapid and ongoing implementation of telepalliative medicine consultation for our inpatient PC teams and discuss lessons learned and recommendations for programs considering similar care models.
Background:
Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and ...empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent.
Aim:
The aim of this study was to investigate advanced cancer patients’ understandings, experiences, and preferences of “sympathy,” “empathy,” and “compassion” in order to develop conceptual clarity for future research and to inform clinical practice.
Design:
Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory.
Setting/participants:
Data were collected from 53 advanced cancer inpatients in a large urban hospital.
Results:
Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful.
Conclusion:
Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients’ perspectives is important and can guide practice, policy reform, and future research.
Objective:This study explored trends in the quantity of inpatient psychiatry beds and in facility characteristics.Methods:Using the National Bureau of Economic Research’s Health Systems and Provider ...Database, the authors examined changes in the number of psychiatric facilities and beds, focusing on system ownership, profit status, facility type (general acute care versus freestanding), and affiliation with psychiatric hospital chains from 2010 to 2016.Results:The number of psychiatric beds was relatively unchanged from 2010 (N=112,182 beds) to 2016 (N=111,184). However, the number of beds operated by systems increased by 39.8% (N=15,803); for-profits, by 56.9% (N=8,572); and chains, by 16.7% (N=6,256). Net increases in beds were primarily concentrated in for-profit freestanding psychiatric hospitals. In 2016, most for-profit beds were part of chains (70.2%) and systems (61.3%).Conclusions:Inpatient psychiatry has shifted toward increased ownership by systems, for-profits, and chains. Payers and policy makers should safeguard against profiteering, and future research should investigate the implications of these trends on quality of care.
RATIONALE:Use of ACEIs (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) is a major concern for clinicians treating coronavirus disease 2019 (COVID-19) in ...patients with hypertension.
OBJECTIVE:To determine the association between in-hospital use of ACEI/ARB and all-cause mortality in patients with hypertension and hospitalized due to COVID-19.
METHODS AND RESULTS:This retrospective, multi-center study included 1128 adult patients with hypertension diagnosed with COVID-19, including 188 taking ACEI/ARB (ACEI/ARB group; median age 64 interquartile range, 55–68 years; 53.2% men) and 940 without using ACEI/ARB (non-ACEI/ARB group; median age 64 interquartile range 57–69; 53.5% men), who were admitted to 9 hospitals in Hubei Province, China from December 31, 2019 to February 20, 2020. In mixed-effect Cox model treating site as a random effect, after adjusting for age, gender, comorbidities, and in-hospital medications, the detected risk for all-cause mortality was lower in the ACEI/ARB group versus the non-ACEI/ARB group (adjusted hazard ratio, 0.42 95% CI, 0.19–0.92; P=0.03). In a propensity score-matched analysis followed by adjusting imbalanced variables in mixed-effect Cox model, the results consistently demonstrated lower risk of COVID-19 mortality in patients who received ACEI/ARB versus those who did not receive ACEI/ARB (adjusted hazard ratio, 0.37 95% CI, 0.15–0.89; P=0.03). Further subgroup propensity score-matched analysis indicated that, compared with use of other antihypertensive drugs, ACEI/ARB was also associated with decreased mortality (adjusted hazard ratio, 0.30 95% CI, 0.12–0.70; P=0.01) in patients with COVID-19 and coexisting hypertension.
CONCLUSIONS:Among hospitalized patients with COVID-19 and coexisting hypertension, inpatient use of ACEI/ARB was associated with lower risk of all-cause mortality compared with ACEI/ARB nonusers. While study interpretation needs to consider the potential for residual confounders, it is unlikely that in-hospital use of ACEI/ARB was associated with an increased mortality risk.
Adolescents with psychiatric disorders are known to be more often not in education, employment, or training (NEET) in young adulthood than their peers. However, since most of the available evidence ...is based on cross-sectional measurement of NEET, there is less evidence on the processes underlying these differences in labor market disadvantage. We assessed these processes by examining transitions between NEET and non-NEET states across young adulthood and the differences in these transitions by adolescent psychiatric inpatient treatment.
We used longitudinal register data on all individuals born in Finland in 1980–1984 (N = 315,508) to identify psychiatric inpatient episodes between ages 10 and 19 and NEET between ages 20 and 34. We modeled the transitions between NEET and non-NEET states and the impact of psychiatric disorders on these transitions with multistate models.
Individuals who had psychiatric inpatient episodes in adolescence started their labor market careers as NEET twice as often as their peers. They were also more likely to transition into NEET states and less likely to transition out of NEET. In total, individuals with a history of psychiatric episodes spent from 1.8 to 6.9 more years as NEET between the ages 20 and 34 than their peers, depending on sex, baseline NEET, and diagnostic group.
Adolescents with severe psychiatric disorders are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures are required both at the start of employment trajectories and during later career stages.
Abstract Introduction Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. The most common ...causes of THA failure include osteolysis, loosening, dislocation, and infection. However, the predominant etiology of THA failure has evolved and displays variability throughout the literature depending on study design. In order to thoroughly understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large-scale. This study aims to update the current literature on rates of revision THA in the US population. Specifically, we report on: 1) etiologies for revision THA; 2) frequencies of revision THA procedures; 3) patient demographics, payor type, and US Census Region of revision THA patients; and 4) the length of stay and total costs based on type of revision THA procedure. Methods The National Inpatient Sample (NIS) database was used to identify all revision THA procedures performed between January 1, 2009 and December 31, 2013. Demographic, clinical, and economic data were obtained for 258,461 revision THAs during this time period. Patients were stratified according to etiology of failure, age, sex, race, US census region, and primary payor class in order to determine the prevalence of revision procedure performed. Results Dislocation was the main indication for revision THA (17.3%), closely followed by mechanical loosening (16.8%). The most common revision THA procedure performed was all-component revision (41.8%). Patients were most commonly white (77.4%), aged 75 years and older (31.6%), and resided in the South US census region (37.0%). The average length of stay for all procedures was 5.29 days, with arthrotomy procedures demonstrating the longest stays (10.31 days). The mean total charge for revision THA procedures was $77,851.24, with arthrotomy procedures accounting for the greatest costs ($107,371.65). Conclusion With nearly equal prevalence, dislocation and mechanical loosening make up the predominant indications for revision total hip arthroplasty in the United States. Our findings are concerning, given that these etiologies have persisted despite advancements in surgical technique and implant design. With the frequency of revision THAs projected to double in the next decade, orthopaedists must take steps to mitigate this potentially devastating complication.
Objective: Research suggests distinct criminal risk factors, not mental illness, are more strongly associated with most criminal behaviors. This notion has been supported among inpatient persons with ...mental illness (PMI) when examining antisocial cognitions; however, other key criminogenic risk factors (the Big Four and Central Eight risk factors) have not been examined among psychiatric inpatient PMI. Hypotheses: We hypothesized that criminal justice (CJ)-involved PMI would endorse significantly greater criminogenic risk compared to non-CJ-involved PMI and that these risk factors would significantly and accurately identify whether PMI had CJ involvement. Additionally, we hypothesized that PMI with and without a history of CJ involvement would not significantly differ on their reported psychiatric symptomatology. Method: We examined all Central Eight criminal risk factors and psychiatric symptomatology among psychiatric inpatient PMI (N = 142) with (n = 74) and without (n = 68) CJ involvement histories. Results: Multivariate analysis of variance and discriminant function analysis indicated significant differences between the Big Four and Central Eight criminal risk factors when classifying CJ and non-CJ groups. The Big Four risk factors correctly classified 85.9% of participants, and the Central Eight correctly classified 99.3% of participants into CJ and non-CJ groups; however, psychiatric symptoms only correctly classified 57.7% of participants into CJ and non-CJ groups. Conclusions: Criminal risk factors appear to be more strongly associated with CJ involvement among PMI than psychiatric symptomatology; therefore, psychotherapeutic intervention on criminal risk factors, not only mental illness, may decrease criminal recidivism among CJ-involved PMI.
Public Significance Statement
People have often assumed persons with mental illness become criminal justice involved because of symptoms associated with their illness or lack of mental health treatment; however, criminal risk factors (the Big Four and Central Eight), not severity of psychiatric symptomatology, most accurately classified psychiatric inpatients with and without a history of criminal justice involvement. Thus, psychotherapeutic interventions should target criminal risk factors, such as antisocial personality, attitudes toward criminal associates, and job-seeking behavior. In other words, to be most successful, when treating criminal justice-involved persons with mental illness, practitioners should assess and treat not only symptoms associated with their mental illness but their criminal risk as well.
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