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Background: Knowledge about work-related occupational therapy in psychiatric inpatient and day hospital clients is limited. Aims: The aim of the study was to explore the desired and achieved productivity status in mental health service users participating in a pre-vocational therapy (PVT) intervention. Outcome variables were productivity status and achievement of desired productivity status at discharge, and change or persistence of productivity status between admission and discharge. Methods: This is a short-term prospective study based on observational data from health records (N = 98). Results: At admission, 53.2% of participants named a clear desired productivity status; 46.8% did not. Of the former, 76.9% expressed a desire for employment or education on the regular job market; 28.0% achieved their desired outcome at discharge, whereas 72.0% did not. Overall, 58.5% retained, established or increased productive activities, while 41.5% were not engaged in or had reduced productive activities at discharge. These two groups differed in socio-economic and social-security-related characteristics, treatment-related characteristics and psychiatric diagnosis. Conclusions and significance: Some, but not all kinds of clients in acute psychiatric inpatient and day hospital settings manage to take a first step towards productive activities during the first phase of treatment.

BackgroundPreoperative medical evaluation serves to identify risk factors and optimize patients before surgery. Providing a telehealth option in the perioperative setting has played a significant role in reducing barriers to quality perioperative health care.ObjectiveWe aimed to evaluate how telemedicine preoperative evaluations using Clinical Video Telehealth (CVT) impact hospital length of stay.MethodsWe performed a retrospective chart review between 2016 and 2017 of adult patients who underwent evaluations in our hospitalist-run preoperative medicine clinic. Patients seen in our preoperative CVT program were compared to patients seen in person to evaluate the association of visit type (preoperative CVT versus in-person evaluation) with hospital length of stay, defined as hospital stay from postoperative day 0 to discharge. There were 62 patients included in this retrospective study.ResultsThe adjusted incidence rate ratio (IRR) for hospital length of stay was significantly shorter in patients who underwent preoperative CVT compared to an in-person visit (IRR 0.52, 95% CI 0.29-0.92, P=.02).ConclusionsAfter adjusting for age and comorbidities, we show that preoperative telemedicine in the perioperative setting is associated with a shorter hospital length of stay compared to in-person visits. This suggests that telemedicine can play a viable role in this clinical setting.

BackgroundPreoperative medical evaluation serves to identify risk factors and optimize patients before surgery. Providing a telehealth option in the perioperative setting has played a significant role in reducing barriers to quality perioperative health care.ObjectiveWe aimed to evaluate how telemedicine preoperative evaluations using Clinical Video Telehealth (CVT) impact hospital length of stay.MethodsWe performed a retrospective chart review between 2016 and 2017 of adult patients who underwent evaluations in our hospitalist-run preoperative medicine clinic. Patients seen in our preoperative CVT program were compared to patients seen in person to evaluate the association of visit type (preoperative CVT versus in-person evaluation) with hospital length of stay, defined as hospital stay from postoperative day 0 to discharge. There were 62 patients included in this retrospective study.ResultsThe adjusted incidence rate ratio (IRR) for hospital length of stay was significantly shorter in patients who underwent preoperative CVT compared to an in-person visit (IRR 0.52, 95% CI 0.29-0.92, P=.02).ConclusionsAfter adjusting for age and comorbidities, we show that preoperative telemedicine in the perioperative setting is associated with a shorter hospital length of stay compared to in-person visits. This suggests that telemedicine can play a viable role in this clinical setting.

Background: Knowledge about work-related occupational therapy in psychiatric inpatient and day hospital clients is limited. Aims: The aim of the study was to explore the desired and achieved productivity status in mental health service users participating in a pre-vocational therapy (PVT) intervention. Outcome variables were productivity status and achievement of desired productivity status at discharge, and change or persistence of productivity status between admission and discharge. Methods: This is a short-term prospective study based on observational data from health records (N = 98). Results: At admission, 53.2% of participants named a clear desired productivity status; 46.8% did not. Of the former, 76.9% expressed a desire for employment or education on the regular job market; 28.0% achieved their desired outcome at discharge, whereas 72.0% did not. Overall, 58.5% retained, established or increased productive activities, while 41.5% were not engaged in or had reduced productive activities at discharge. These two groups differed in socio-economic and social-security-related characteristics, treatment-related characteristics and psychiatric diagnosis. Conclusions and significance: Some, but not all kinds of clients in acute psychiatric inpatient and day hospital settings manage to take a first step towards productive activities during the first phase of treatment.

Objectives: To examine parental participation in the care of newborn infants receiving therapeutic hypothermia, and to explore the possible impact of in-born vs out-born status, and location of hospital accommodation. Study design: Retrospective, quantitative and descriptive design. Main outcome measures: Infants medical charts were reviewed for defined aspects of parental participation (infant holding, tube feeding, and diaper change), and related to their in-born vs out-born status, and whether the parents were accommodated in the NICU or elsewhere. All infants have been cared for at the University Hospital Neonatal Intensive Care Unit, serving as a regional referral center for hypothermia treatment. This study is a part of a population-based regional cohort of asphyxiated newborn infants (n = 112) that received therapeutic hypothermia in 2007-2015. Results: Parents engaged in holding (60/112, 54%) or tube feeding (59/112, 53%) their infant. Parents of inborn infants (24/112, 21%) were more likely to check the placement of the feeding tube (11/24, 46% vs 15/88, 17%; p < 0.01) and change diapers (9/24, 38% vs 14/88, 16%; p < 0.05) than parents of out-born infants (88/112, 79%). A similar pattern of more extensive involvement was observed for both mothers and fathers who stayed at the neonatal intensive care compared to those accommodated elsewhere (p < 0.05). Conclusions: Active parental participation is feasible at the NICU even during therapeutic hypothermia. Timely postnatal transfer of parents of out-born/transported infants, and the provision of on-site accommodation may influence the quality of parental involvement.

Introduction: Left ventricular assist device (LVAD) insertion is an increasingly common intervention for patients with advanced heart failure; however, published literature on the emergency department (ED) presentation of this population is limited. The objective of this study was to characterize ED presentations of patients with LVADs with a focus on device-specific complications to inform provider education and preparation initiatives. Methods: This was a retrospective chart review of all patients with LVADs followed at an urban academic medical center presenting to the ED over a five-year period (July 1, 2009, to June 30, 2014). Two abstractors reviewed 45 randomly selected charts to standardize the abstraction process and establish a priori categories for reason for presentation to the ED. Remaining charts were then divided evenly for review by one of the two abstractors. Primary outcomes for this study were (1) frequency of and (2) reason for presentation to the ED by patients with LVADs. Results: Of 349 patients with LVADs identified, 143 (41.0%) had ED encounters during the study period. There were 620 total ED encounters, (range 1 to 32 encounters per patient, median=3, standard deviation=5.3). Among the encounters, 431 (69.5%) resulted in admission. The most common reasons for presentation were bleeding (e.g., gastrointestinal, epistaxis) (182, 29.4%); infection (127, 20.5%); heart failure exacerbation (68, 11.0%); pain (56, 9.0%); other (45, 7.3%); and arrhythmias (40, 6.5%). Fifty-two encounters (8.4%) were device-specific; these patients frequently presented with abnormal device readings (37, 6.0%). Interventions for device-specific presentations included anticoagulation regimen adjustment (16/52, 30.8%), pump exchange (9, 17.3%), and hardware repair (6, 11.5%). Pump thrombosis occurred in 23 cases (3.7% of all encounters). No patients required cardiopulmonary resuscitation or died in the ED. Conclusion: This is the largest study known to the investigato

Introduction: Left ventricular assist device (LVAD) insertion is an increasingly common intervention for patients with advanced heart failure; however, published literature on the emergency department (ED) presentation of this population is limited. The objective of this study was to characterize ED presentations of patients with LVADs with a focus on device-specific complications to inform provider education and preparation initiatives. Methods: This was a retrospective chart review of all patients with LVADs followed at an urban academic medical center presenting to the ED over a five-year period (July 1, 2009, to June 30, 2014). Two abstractors reviewed 45 randomly selected charts to standardize the abstraction process and establish a priori categories for reason for presentation to the ED. Remaining charts were then divided evenly for review by one of the two abstractors. Primary outcomes for this study were (1) frequency of and (2) reason for presentation to the ED by patients with LVADs. Results: Of 349 patients with LVADs identified, 143 (41.0%) had ED encounters during the study period. There were 620 total ED encounters, (range 1 to 32 encounters per patient, median=3, standard deviation=5.3). Among the encounters, 431 (69.5%) resulted in admission. The most common reasons for presentation were bleeding (e.g., gastrointestinal, epistaxis) (182, 29.4%); infection (127, 20.5%); heart failure exacerbation (68, 11.0%); pain (56, 9.0%); other (45, 7.3%); and arrhythmias (40, 6.5%). Fifty-two encounters (8.4%) were device-specific; these patients frequently presented with abnormal device readings (37, 6.0%). Interventions for device-specific presentations included anticoagulation regimen adjustment (16/52, 30.8%), pump exchange (9, 17.3%), and hardware repair (6, 11.5%). Pump thrombosis occurred in 23 cases (3.7% of all encounters). No patients required cardiopulmonary resuscitation or died in the ED. Conclusion: This is the largest study known to the investigato

Objective: Oral cenesthopathy is characterized by foreign body sensations without medical and dental evidence for them. It is thought to be a rare disease in psychiatry, but many patients are visiting dental clinics seeking treatment to remove a foreign body. Even though the features of oral cenesthopathy might be different between a psychiatric clinic and a dental clinic, there has been no clinico-statistical study from dentists. In this study, we report a clinico-statistical study of patients with oral cenesthopathy in dentistry. Methods: This is a retrospective chart review of 606 outpatients with oral cenesthopathy in Tokyo Medical and Dental University from April 2010 through to March 2015. Results: A total of 159 male and 447 female patients were included in this study. The mean age was 62.08 years, and female patients were older than male patients. The trigger of the dental treatment and the acute phase of depression at the onset were significantly related (p=0.037). Only 128 patients (36%) had clinically significant improvement after 6 months of pharmacotherapy. No history of psychiatric disorders (odds ratio [OR] 0.479 [95% confidence interval {CI}: 0.262–0.875], p=0.017) and longer duration of illness (>18 months) (OR 2.626 [95% CI: 1.437–4.799], p=0.002) were significant factors for clinical outcomes. Conclusion: Patients with oral cenesthopathy in our clinic were predominantly elderly female patients. Dental treatment in the acute phase of depression might be a risk factor for oral cenesthopathy. Therefore, comprehending the situation of psychiatric disorder and obtaining adequate informed consent might be required to prevent the trouble concerning oral cenesthopathy.

Statement of the problem: Hospital to community transitions for older adults are associated with poor outcomes. Integrated care is a health care approach with the potential to reduce and/or ease these transitions, but there is little empirical evidence on the topic. The objectives of this thesis were to: 1) systematically examine existing literature on this topic; 2) characterize older adults who would most benefit from integrated care to support care transitions; and, 3) explore the feasibility of indicators to measure clinical integrated care delivery for care transitions. Methods: Objective 1 was achieved with a scoping review. Objectives 2 and 3 were addressed with a retrospective chart review; data were extracted from 214 hospital medical records. For objective 2, personal characteristics were examined in relation to three outcomes representing potentially avoidable health care using multivariate logistic regression. For objective 3, literature on the elements of integrated care was used to develop clinical indicators. Reliable indicators were further explored at an individual and ward level using descriptive and inferential statistics. Results: The scoping review indicated that there has been little systematic measurement of integrated care. The findings from objective 2 highlighted the population most at risk of institutional use that could be targeted by integrated care initiatives: those with both mental and physical health impairments. Work from objective 3 resulted in 28 clinical integrated care indicators grouped in 4 domains. In the study context, application of integrated care was variable between indicators, as well as at the individual and ward level. Discussion: This thesis unites three linked bodies of work that contribute to the advancement of knowledge on integrated care for care transitions. It provides: directions for future research through identification of gaps in the literature; identification of populations to target with integrated care

Statement of the problem: Hospital to community transitions for older adults are associated with poor outcomes. Integrated care is a health care approach with the potential to reduce and/or ease these transitions, but there is little empirical evidence on the topic. The objectives of this thesis were to: 1) systematically examine existing literature on this topic; 2) characterize older adults who would most benefit from integrated care to support care transitions; and, 3) explore the feasibility of indicators to measure clinical integrated care delivery for care transitions. Methods: Objective 1 was achieved with a scoping review. Objectives 2 and 3 were addressed with a retrospective chart review; data were extracted from 214 hospital medical records. For objective 2, personal characteristics were examined in relation to three outcomes representing potentially avoidable health care using multivariate logistic regression. For objective 3, literature on the elements of integrated care was used to develop clinical indicators. Reliable indicators were further explored at an individual and ward level using descriptive and inferential statistics. Results: The scoping review indicated that there has been little systematic measurement of integrated care. The findings from objective 2 highlighted the population most at risk of institutional use that could be targeted by integrated care initiatives: those with both mental and physical health impairments. Work from objective 3 resulted in 28 clinical integrated care indicators grouped in 4 domains. In the study context, application of integrated care was variable between indicators, as well as at the individual and ward level. Discussion: This thesis unites three linked bodies of work that contribute to the advancement of knowledge on integrated care for care transitions. It provides: directions for future research through identification of gaps in the literature; identification of populations to target with integrated care

Statement of the problem: Hospital to community transitions for older adults are associated with poor outcomes. Integrated care is a health care approach with the potential to reduce and/or ease these transitions, but there is little empirical evidence on the topic. The objectives of this thesis were to: 1) systematically examine existing literature on this topic; 2) characterize older adults who would most benefit from integrated care to support care transitions; and, 3) explore the feasibility of indicators to measure clinical integrated care delivery for care transitions. Methods: Objective 1 was achieved with a scoping review. Objectives 2 and 3 were addressed with a retrospective chart review; data were extracted from 214 hospital medical records. For objective 2, personal characteristics were examined in relation to three outcomes representing potentially avoidable health care using multivariate logistic regression. For objective 3, literature on the elements of integrated care was used to develop clinical indicators. Reliable indicators were further explored at an individual and ward level using descriptive and inferential statistics. Results: The scoping review indicated that there has been little systematic measurement of integrated care. The findings from objective 2 highlighted the population most at risk of institutional use that could be targeted by integrated care initiatives: those with both mental and physical health impairments. Work from objective 3 resulted in 28 clinical integrated care indicators grouped in 4 domains. In the study context, application of integrated care was variable between indicators, as well as at the individual and ward level. Discussion: This thesis unites three linked bodies of work that contribute to the advancement of knowledge on integrated care for care transitions. It provides: directions for future research through identification of gaps in the literature; identification of populations to target with integrated care

Statement of the problem: Hospital to community transitions for older adults are associated with poor outcomes. Integrated care is a health care approach with the potential to reduce and/or ease these transitions, but there is little empirical evidence on the topic. The objectives of this thesis were to: 1) systematically examine existing literature on this topic; 2) characterize older adults who would most benefit from integrated care to support care transitions; and, 3) explore the feasibility of indicators to measure clinical integrated care delivery for care transitions. Methods: Objective 1 was achieved with a scoping review. Objectives 2 and 3 were addressed with a retrospective chart review; data were extracted from 214 hospital medical records. For objective 2, personal characteristics were examined in relation to three outcomes representing potentially avoidable health care using multivariate logistic regression. For objective 3, literature on the elements of integrated care was used to develop clinical indicators. Reliable indicators were further explored at an individual and ward level using descriptive and inferential statistics. Results: The scoping review indicated that there has been little systematic measurement of integrated care. The findings from objective 2 highlighted the population most at risk of institutional use that could be targeted by integrated care initiatives: those with both mental and physical health impairments. Work from objective 3 resulted in 28 clinical integrated care indicators grouped in 4 domains. In the study context, application of integrated care was variable between indicators, as well as at the individual and ward level. Discussion: This thesis unites three linked bodies of work that contribute to the advancement of knowledge on integrated care for care transitions. It provides: directions for future research through identification of gaps in the literature; identification of populations to target with integrated care

Aims: Dexmedetomidine (dexdor®) is approved in the European Union (EU) for sedation of adults in the intensive care unit (ICU). The present observational, retrospective study was requested by the European Medicines Agency to investigate dexmedetomidine use in clinical practice, with a particular focus on off-label use, including the paediatric population. Methods: Study countries and sites were chosen from those with highest dexmedetomidine use, based on sales. Site selection (blind) was conducted by a multispecialist, independent group. Anonymized data on demographics, treatment indication, dexmedetomidine dosing, concomitant medications and treatment effectiveness were collected retrospectively from records of all dexmedetomidine-treated patients at the site during the enrolment period. Informed consent was waived, to avoid influencing the prescribing of dexmedetomidine. Recruitment was completed within 18 months of first site initiation. Results: Data from 2000 patients were collected from 16 hospitals in four EU countries (Finland 750, Poland 505, Germany 470, Austria 275). The median age was 62 years, with more males (70.2%) than females. Dexmedetomidine was primarily used in the adult ICU (86.0%) for ICU sedation (78.6%) and mostly dosed according the product label. The intended sedative effect was obtained in 84.9% of administrations. Paediatric use (5.9% of patients, mostly in Austria and Finland) occurred mainly in the adult or paediatric ICU (75.6%) for sedation (67.2%). Conclusions: Overall, most patients were treated with dexmedetomidine according to the product labelling. Use in children was limited but significant and similar in scope to that in adults. Administrations not fully according to the product labelling usually occurred in an ICU environment and reflected extensively investigated clinical uses of dexmedetomidine.

Many of the orthopaedic studies completed within the military come from records-based research. This methodological article will assist researchers in completing such studies by highlighting the experiences and lessons learned from a recent retrospective study on amputees. Specifically, this article provides details on the various data sources available within the military, and how to access those systems, and offers general advice for the completion of retrospective studies using Department of Defense data systems. Although there are many obstacles that need to be overcome in order to successfully complete records-based research within the military, the authors hope this article will aid investigators in the completion of future projects., Published in the Journal of Surgical Orthopaedic Advanced, v22 n1 p82-94, Spring 2013.

In a chart review at a psychiatric out-patient department, latitude 59.3 degrees N, a sample of patients with tests of serum 25-hydroxy-vitamin D (25-OHD) and plasma intact parathyroid hormone (iPTH) was collected, together with demographic data and psychiatric diagnoses. During 19 months, 117 patients were included. Their median 25-0HD was 45 nmol/l; considerably lower than published reports on Swedish healthy populations. Only 14.5% had recommended levels (over 75). In 56.4%, 25-OHD was under 50 nmol/l, which is related to several unfavourable health outcomes. Seasonal variation of 25-OHD was blunted. Patients with ADHD had unexpectedly low iPTH levels. Middle East, South-East Asian or African ethnic origin, being a young male and having a diagnosis of autism spectrum disorder or schizophrenia predicted low 25-OHD levels. Hence, the diagnoses that have been hypothetically linked to developmental (prenatal) vitamin D deficiency, schizophrenia and autism, had the lowest 25-OHD levels in this adult sample, supporting the notion that vitamin D deficiency may not only be a predisposing developmental factor but also relate to the adult patients' psychiatric state. This is further supported by the considerable psychiatric improvement that coincided with vitamin D treatment in some of the patients whose deficiency was treated.

In a chart review at a psychiatric out-patient department, latitude 59.3 degrees N, a sample of patients with tests of serum 25-hydroxy-vitamin D (25-OHD) and plasma intact parathyroid hormone (iPTH) was collected, together with demographic data and psychiatric diagnoses. During 19 months, 117 patients were included. Their median 25-OHD was 45 nmol/l; considerably lower than published reports on Swedish healthy populations. Only 14.5% had recommended levels (over 75). In 56.4%, 25-OHD was under 50 nmol/l, which is related to several unfavourable health outcomes. Seasonal variation of 25-OHD was blunted. Patients with ADHD had unexpectedly low iPTH levels. Middle East, South-East Asian or African ethnic origin, being a young male and having a diagnosis of autism spectrum disorder or schizophrenia predicted low 25-OHD levels. Hence, the diagnoses that have been hypothetically linked to developmental (prenatal) vitamin D deficiency, schizophrenia and autism, had the lowest 25-OHD levels in this adult sample, supporting the notion that vitamin D deficiency may not only be a predisposing developmental factor but also relate to the adult patients' psychiatric state. This is further supported by the considerable psychiatric improvement that coincided with vitamin D treatment in some of the patients whose deficiency was treated.