Clinical outcome of patients with self-inflicted burns.

INTRODUCTION: Patients with self-inflicted burns (SIB) are thought to have a longer length of stay compared to patients with accidental burns. However, other predictors for a longer length of stay are often not taken into account, e.g. percentage of the body surface area burned, age or comorbidities. Therefore, we wanted to study the outcome of patients with SIB at our burn center. METHODS: A retrospective, observational study was conducted. All adult patients with acute burns admitted to the burn center of the Martini Hospital Groningen, between January 1, 2009 and December 31, 2013 were included. Data on characteristics of the patient, injury, and outcome (LOS, mortality, discharge destination) were collected. In patients with SIB, suicide attempts (SA) were distinguished from self-harm without the intention to die (non-suicidal self-injury, NSSI). To evaluate differences in outcome, each patient with SIB was matched on variables and total score of the Abbreviated Burn Severity Index (ABSI) to a patient with accidental burns (AB). RESULTS: In total 29 admissions (21 SA and 8 NSSI) were due to SIB and 528 due to accidents. Overall, when compared to AB, there were significant differences with respect to mortality and LOS for SA and/or NSSI. Mortality was higher in the SA group, while the LOS was higher in both the SA and NSSI groups compared to the AB group. However, after matching on ABSI, no statistical significant differences between the SA and SA-match or the NSSI and NSSI-match group were found. CONCLUSION: With the right and timely treatment, differences in mortality rate or length of stay in hospital could all be explained by the severity of the burn and the intention of the patient.

[The Health of Nation Outcome Scale as clinical outcome indicator in elderly psychiatry]. / De Health of the Nation Outcome Scale als effectmaat in de ouderenpsychiatrie.

The Health of the Nation Outcome Scales65+(HoNOS65+) seems to be a useful instrument for effect measuring in elderly psychiatry. The instrument is implemented as an outcome measure within a psychiatric unit for older persons. From 244 patients a repeated assessment is completed: at the start of the treatment and at discharge. Our goal is to determine the sensitivity of change of the Health of the Nation Outcome Scales65+ for patients who are in treatment for a limited period. The sensitivity of change is examined for outpatients and inpatients and for four diagnostic groups (mood disorders, organic disorders, psychotic disorders and others) according to their DSM-IV diagnoses. Comparisons between first and second assessment were done using pairwise t-tests. Inpatients as well as outpatients showed a significant change between intake and discharge. This also holds for all four diagnostic groups. The conclusion is that the HoNOS 65+ is sensitive to change and meets the criteria for a clinical outcome indicator in elderly psychiatric patients.

[Implementation of the HoNOS65+]. / Implementatie van het meetinstrument HoNOS65+. Onderzoek op een afdeling voor ouderenpsychiatrie.

BACKGROUND: In the last few years mental healthcare has had to become increasingly accountable to health insurance companies, the government and patient groups with regard to the efficacy, appropriateness and patient-friendliness of the care provided. Routine outcome assessment, based on various measuring instruments, is likely to become more and more frequent in the years to come. AIM: To assess whether the Health of the Nation Outcome Scales for elderly people (HoNOS65+) can be successfully implemented within a psychiatric unit for older persons, whether the instrument is suitable for use in clinical practice and whether it provides an adequate picture of the older population in general. METHOD: The implementation phase consisted of training 51 social workers within the various sections of the unit. The trained social workers used the HoNOS65+ with 387 patients from various units for older persons within Lentis. RESULTS: The social workers found the HoNOS65+ to be a useful instrument and for each treatment setting and diagnosis it differentiated significantly between types of behaviour problems, symptoms and social problems. CONCLUSION: The HoNOS65+ can be used profitably with individual patients and patient groups and it highlights the problems in relevant areas of psychiatry for older persons.