Use of a Handheld Ultrasonographic Device to Identify Heart Failure and Pulmonary Disease in Rural Africa.

Importance: Agreement in lung ultrasonography findings between clinicians using a handheld ultrasonographic device and expert sonographers using a high-end ultrasonographic machine has not been studied in sub-Saharan Africa. Objective: To determine the agreement in ultrasonographic findings and diagnoses between primary care clinicians trained in lung ultrasonography, board-certified expert sonographers, and senior physicians. Design, Setting, and Participants: This cross-sectional single-center study was conducted from February 1, 2022, to April 30, 2023 at a referral center in rural Tanzania. Individuals 5 years or older with respiratory symptoms and at least 2 distinct respiratory signs or symptoms were eligible. A total of 459 individuals were screened. Exposures: Participants provided their medical history and underwent a clinical examination and lung ultrasonography performed by a clinician, followed by a lung ultrasonography performed by an expert sonographer, and finally chest radiography and a final evaluation performed by a senior physician. Other tests, such as echocardiography and Mycobacterium tuberculosis testing, were conducted on the decision of the physician. Clinicians received 2 hours of instruction and three 2-hour sessions of clinical training in the use of a handheld lung ultrasonographic device; expert sonographers were board-certified. Main Outcomes and Measures: Percentage agreement and Cohen κ coefficient for sonographic findings and diagnoses compared between clinicians and expert sonographers, and between clinicians and senior physicians. Results: The median (IQR) age of 438 included participants was 54 (38-66) years, and 225 (51%) were male. The median (range) percentage agreement of ultrasonographic findings between clinicians and expert sonographers was 93% (71%-99%), with κ ranging from -0.003 to 0.83. Median (range) agreement of diagnoses between clinicians and expert sonographers was 90% (50%-99%), with κ ranging from -0.002 to 0.76. Between clinicians and senior physicians, median (range) agreement of diagnoses was 89% (55%-90%), with κ ranging from -0.008 to 0.76. Between clinicians and senior physicians, diagnosis agreements were 85% (κ, 0.69) for heart failure, 78% (κ, 0.57) for definite or probable tuberculosis, 50% (κ, 0.002) for viral pneumonia, and 56% (κ, 0.06) for bacterial pneumonia. Conclusions and Relevance: In this cross-sectional study, the agreement of ultrasonographic findings between clinicians and sonographers was mostly substantial. Between clinicians and senior physicians, agreement was substantial in the diagnosis of heart failure, moderate in the diagnosis of tuberculosis, but slight in the diagnosis of pneumonia. These findings suggest that handheld ultrasonographic devices used in addition to clinical examination may support clinicians in diagnosing cardiac and pulmonary diseases in rural sub-Saharan Africa.

Self-efficacy, mindfulness, and perceived social support as resources to maintain the mental health of students in Switzerland's universities of applied sciences: a cross-sectional study.

BACKGROUND: Switzerland's student population is at a particularly high risk of developing mental health disorders, creating a major challenge for Switzerland's higher education establishments. Research to date has primarily sought to identify the risk factors affecting students' mental health; however, their exposure to these factors is often unavoidable. Thus, the present study adopted a salutogenic approach focussing on the determinants of health. We examined the mental health resources available to students reported in the literature as being susceptible to helping them maintain good mental health despite their exposure to risk factors. METHODS: In February 2020, 2,415 first- and second-year bachelor's degree students in applied sciences in French-speaking Switzerland completed an online questionnaire. The variables measured were self-evaluated mental health, perceived stress and three potential health resources: students' feelings of self-efficacy, their capacity for mindfulness and their social support. The results were analysed using hierarchical linear regression models. RESULTS: When all the variables were included in the model without interaction effect, our results revealed that students' self-evaluated mental health was negatively associated with perceived stress (ß = -0.43, p < 0.001) and positively associated with the three potential health resources (self-efficacy: ß = 0.26, p < 0.001; mindfulness: ß = 0.10, p < 0.001; social support: ß = 0.17, p < 0.001). An analysis of the interaction effects also revealed that a high level of self-efficacy was associated with perceived stress being less strongly linked to mental health (ß = 0.29, p < 0.001). CONCLUSIONS: These findings suggest that self-efficacy, mindfulness, and perceived social support are valuable resources for protecting students' mental health. Thus, implementing interventions aimed at reinforcing them, could support students in applied sciences all along their academic pathway, in their classes and during their professional work experience placements.

Factors protecting Swiss nurses' health during the COVID-19 pandemic: a longitudinal study.

BACKGROUND: The COVID-19 pandemic reached Europe in early 2020 and impacted nurses over a prolonged period, notably causing heavy work overloads. Exposure to sources of stress in such situations is inevitable, which can put nurses' health at risk. The present study took a salutogenic approach to investigating nurses' health and the principal factors protecting it found in the literature (i.e., resilience, post-traumatic growth, social support, and certain organizational factors), as well as how those elements evolved from February 2021 to September 2022. METHODS: All nurses working at eight French-speaking Swiss hospitals who accepted to disseminate the study to their employees were invited to complete an online questionnaire at four time points (February 2021, September 2021, March 2022, and September 2022: T0, T1, T2, and T3, respectively) and respond to items measuring their health, factors protecting their health, and their perceived stress levels. Data were analyzed using random-intercept linear regression models. RESULTS: A cumulated total of 1013 responses were collected over all measurement points (625 responses at T0; 153 at T1; 146 at T2; 89 at T3). Results revealed that nurses' health had not changed significantly between measurements. However, their perceived stress levels, feelings of being supported by their management hierarchies, and belief that they had the means to deliver a high quality of work all diminished. At every measurement point, nurses' health was negatively associated with perceived stress and positively associated with resilience, perceived social support, and the belief that they were provided with the means to deliver a high quality of work. CONCLUSION: Despite the difficult conditions caused by the pandemic, the factors recognized as protective of nurses' health played their role. The lack of improvements in nurses' health in periods when the pandemic's effects lessened suggests that the pressure they were experiencing did not drop during these moments. This phenomenon may have been due to the need to clear backlogs in scheduled surgery and the work overloads caused by prolonged staff absences and nurses quitting the profession. Monitoring changes in nurses' health is thus crucial, as is establishing measures that promote factors protective of their health. Organizational factors influencing nurses' working conditions are also key and should not be neglected.

Patient's learning needs and self-efficacy level after percutaneous coronary intervention: A descriptive study.

AIMS AND OBJECTIVES: Identify and compare learning needs, levels of self-efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital. BACKGROUND: After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self-efficacy must be considered when developing effective therapeutic patient education (TPE). METHODS: Learning needs and self-efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self-Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross-sectional studies was used in reporting this study. RESULTS: Ninety-three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p < .001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self-efficacy level. CONCLUSIONS: This study shows that after PCI, patients have high learning needs and moderate levels of self-efficacy that require addressing. RELEVANCE TO CLINICAL PRACTICE: Patient's individual learning needs and self-efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self-efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process. NO PATIENT OR PUBLIC CONTRIBUTION: For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research.

Workplace Wellbeing and Quality of Life Perceived by Portuguese Nurses during the COVID-19 Pandemic: The Role of Protective Factors and Stressors.

During the COVID-19 pandemic, nurses were exposed to many stressors, which may have been associated with some mental health problems. However, most of the studies carried out on nurses' quality of life and workplace wellbeing during the COVID-19 pandemic took a pathogenic approach. Given that current scientific knowledge in this field presented too many gaps to properly inform preventive and therapeutic action, the aim of this study was to explore whether protective factors (resilience, perceived social support, and professional identification) and stressors (perceived stress and psychosocial risks in the workplace) influenced the quality of life and workplace wellbeing perceived by Portuguese nurses during the COVID-19 pandemic. Data for this cross-sectional study was collected through online self-administered questionnaires. Linear regression models were used to analyze the relationships between variables. Results showed that perceived stress, resilience and job satisfaction were associated with quality of life and workplace wellbeing among Portuguese nurses. The study's findings could serve to inform health policy and should draw the attention of nursing managers to the needs and difficulties reported by nurses, to the importance of providing them with emotional support, and to the relevance of promoting a good work environment.

Protective Factors and Coping Styles Associated with Quality of Life during the COVID-19 Pandemic: A Comparison of Hospital or Care Institution and Private Practice Nurses.

In France, nurses work either in hospitals and care institutions or in private practice, following physicians' prescriptions and taking care of patients at their homes. During the COVID-19 pandemic, these populations of nurses were exposed to numerous sources of stress. The main objective of the present study was to identify the protective factors they mobilized to face the crisis and how these factors contributed to sustaining their quality of life (QoL). A cross-sectional study was conducted to answer these questions. Overall, 9898 French nurses participated in the study, providing demographic information and filling out QoL (WHOQOL-BREF), perceived stress (PSS-14), resilience (CD-RISC), social support (MSPSS), and coping style (BRIEF-COPE) questionnaires. The results revealed very few differences between the two groups of nurses, which is surprising given the drastically different contexts in which they practice. Social support and two coping strategies (positive reframing and acceptance) were associated with a high QoL, whereas perceived stress and four coping strategies (denial, blaming self, substance use, and behavioral disengagement) were associated with poor QoL. In the light of these results, we recommended promoting social support and coping strategies to help nurses cope during the pandemic.

Health and coping strategies of nursing home residents and their relatives during the COVID-19 pandemic: a mixed-methods study protocol.

INTRODUCTION: The COVID-19 pandemic hit older adults particularly hard, especially those living in nursing homes. The present study's primary aim is to quantify the states of physical and mental health of nursing home residents and their relatives following the implementation of the exceptional confinement measures. The secondary aim is to explore the lived experiences of the stressors perceived by older adults and their relatives, as well as the support strategies implemented by health professionals and their results. METHODS AND ANALYSIS: We chose a mixed-methods (quantitative/qualitative) study to best deliver a profound understanding of this phenomenon.Quantitative phase: participants are asked to complete several questionnaires. The study population includes all the nursing home residents in four French-speaking cantons of Switzerland (and their relatives) who are living through the COVID-19 pandemic. Descriptive statistics will be calculated for the scores of the General Health Questionnaire-12, Impact of Event Scale-6, Perceived Stress Scale, Brief Cope, Post-traumatic Growth Inventory, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and WHOQOL-OLD scales. Correlational analyses will be considered.Qualitative phase: data are collected from several sources (individual semi-structured interviews, focus groups, field notes). Interviews are planned with about 12 representatives of each group of participants (residents and relatives). Two focus groups made up of healthcare professionals will be constituted to explore the lived experiences of the stressors perceived by residents and relatives, the coping strategies those two groups implemented to deal with them. The interviews and focus groups will be subjected to a thematic contents analysis.Integrating the quantitative and qualitative data will take place jointly with data interpretation. ETHICS AND DISSEMINATION: This project was approved by the Human Research Ethics Committee of the Canton of Vaud on 14 December 2020 (project ID: 2020-02397). The prior written informed consent of the study subjects is collected by a member of the research team before data collection. Study results will be disseminated via professional and peer-reviewed publications. TRIAL REGISTRATION NUMBER: ISRCTN12345167.

The scope of nursing practice in a psychiatric unit: A time and motion study.

WHAT IS KNOWN ABOUT THE SUBJECT?: The evaluation of nurse care practices poses many challenges, including the identification of all the aspects of the care given. Few studies have looked at the scope of nursing practice in psychiatry. However, the evaluation of care practices in the mental health field poses many challenges, including the identification of all aspects of care. WHAT THE DOCUMENT ADDS TO EXISTING KNOWLEDGE?: Findings demonstrated that mental health nurses do not invest in all domains of their scope of practice in the same way and the time spent with patients is low. Several factors contributed to this, including the increasing complexity of care, stagnant staffing levels, and a culture of care that continues to be influenced by the medical model. Current models of care still retain the stigma of this past, prioritizing medically delegated tasks rather than promoting a holistic approach to care. Although the professional identity of nurses is evolving and asserting itself, the paradigm shift in practice is still incomplete. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is essential to describe concretely what is actually expected of nurses, to help them allocate their time effectively and to identify opportunities for improvement. The field of practice of nurses is put under stress by a demanding work environment subject to many pressures and constraints. Changing practices so that nurses can use the full scope of nursing practice requires strong nursing leadership and action on education and the organization of care, particularly on clinical assessment. ABSTRACT: Introduction The evaluation of nursing care practices poses many challenges, including identifying all the aspects of the care given. However, few studies have examined the scope of nursing practice in psychiatry. Aim The aim of this study was to describe the intensity of nursing activities on a psychiatric unit based on the adaptation of Déry and D'Amour's (2017, Perspect Infirm Rev Off Ordre Infirm Qué, 14, 51) Scope of Nursing Practice Model. Method This 56-day descriptive observational study used the time and motion method to follow eight nurses. Results 500 h of observations were carried out. The greatest lengths of time were allocated to communication and coordination of care activities and to "non-healthcare" domains. Less time was devoted to activities related to clinical evaluation and therapeutic education. Discussion Findings demonstrated that MHNs do not perform all the possible functions in the domains of their scope of practice in the same way, and time spent with patients was short. Several factors contributed to this, including the fact that nurses are working in increasingly demanding care settings that keep them under constant pressure.

Stressors, self-reported overall health, potential protective factors and the workplace well-being of nurses during the COVID-19 pandemic in Switzerland: a longitudinal mixed-methods study protocol.

INTRODUCTION: The COVID-19 pandemic was making a huge impact on Europe's healthcare systems in the spring of 2020, and most predictive models concurred that pandemic waves were in the offing. Most studies adopted a pathogenic approach to the subject; few used a salutogenic approach. These showed, however, that nurses can retain their health despite a pandemic by mobilising generalised resistance resources. Our study aims to understand how nurses working in Switzerland's hospitals protected their health and workplace well-being during the COVID-19 pandemic by investigating the moderating effects of the health resources they mobilised against the stressors inherent to the situation. The study aims to explore and describe the stressors and the resources nurses used to remain healthy during the COVID-19 pandemic. METHOD AND ANALYSIS: We will use a concurrent mixed-methods panel design with qualitative analyses ancillary to quantitative analyses. Quantitative data will be collected using electronic questionnaires at four time points over 2 years. Qualitative data will be collected using focus groups. Nurses from Switzerland's two main linguistic regions who had direct, indirect or no contact with patients with COVID-19 will be invited to participate. The a priori sample size will be at least 3631 participants at T0 and 1852 at T4. Longitudinal structural equation modelling and knowledge mapping will be used to analyse quantitative and qualitative data, respectively. The results derived from the two data types will then be compared and discussed using a side-by-side approach to determine whether they agree or disagree and how they complement each other to achieve our aims. ETHICS AND DISSEMINATION: Nurses will receive an electronic informed consent form. The data collected will be stored on a secure server at the authors' institution. This research project was approved by the Human Research Ethics Committee of the Canton of Vaud (2020-02845).

How do nurses spend their time? A time and motion analysis of nursing activities in an internal medicine unit.

AIM: To describe the nature and duration of nursing activities and how much time registered nurses allocate to the different dimensions of their scope of practice in a Swiss university hospital internal medicine ward. DESIGN: A single-centre observational descriptive study. METHOD: Using a time and motion study, two researchers shadowed healthcare workers (N = 21) during 46 complete work shifts in 2018. They recorded each activity observed in real time using a tablet computer with a pre-registered list of 42 activities classified into 13 dimensions. RESULTS: A total of 507.5 work hours were observed. Less than one third of registered nurses' work time was spent with patients. They allocated the most time to the dimensions of 'communication and care coordination' and 'care planning', whereas 'optimizing the quality and safety of care', 'integrating and supervising staff' and 'client education' were allocated the least time. CONCLUSION: This study provided a reliable description of nurses' time use at work. It highlighted suboptimal use of the full scope of nursing practice. IMPACT: Both work organization and culture should be reconsidered to promote better use of nursing skills. Practice optimization should focus on the following three main areas: (1) greater involvement of registered nurses in building relationships and directly caring for patients and their families; (2) better use of registered nurses' skills in the activities required of their proper roles, including nursing clinical assessments and patient education and (3) more systematically updating registered nurses' knowledge.

Scope of nursing practice on a surgery ward: A time-motion study.

AIM: To log the activities of registered nurses and nursing assistants on a visceral surgery ward. BACKGROUND: By prioritizing their activities, nurses fail to exercise their full scope of practice even though this is essential for health care systems to function effectively and efficiently. METHOD: A descriptive observational time-motion study was conducted over a period of 48 days. The activities of nurses (n = 24) and nursing assistants (n = 9) were logged over the course of their entire work shifts, both in the day and at night. RESULTS: In all, 499 hr of observation were logged. Tasks that fell under the dimensions of care activities and of communication and care coordination, which cover documentation, non-care activities and delegated medical tasks, were the ones that took up most of the nurse work time. Patient assessment, relational care, therapeutic teaching/coaching, and knowledge updating and utilization were categories that nurses were under-engaged in. CONCLUSION: The study shows that the scope of nursing practice was not optimal. IMPLICATION FOR NURSING MANAGEMENT: The results can serve to improve the work environment of carers, optimize the use of human resources and increase the visibility and efficiency of nursing work.

Facilitators and barriers in implementing clinical nursing assessment in mental health care for older people: A multimethod approach.

With the aging of the population and the growing prevalence of dementia, specialized and collaborative nursing care is paramount in this area. To ensure better quality care, it is necessary to use effective and context-specific processes to implement evidence-based practices and more specifically clinical nursing assessment. This study aimed to identify and describe factors that may influence the implementation of clinical nursing assessment in mental health care for older people. The Consolidated Framework for Implementation Research was employed to guide evaluation in the pre-implementation phase in the specific context of mental health care for older people. Using a multimethod approach, interviews, focus groups, and a quantitative survey were conducted with a non-probability convenience sample. A total of 39 hospital nurses (registered nurses and head nurses) were interviewed. Analysis yielded five main factors, notably three barriers and two facilitators. Barriers include a lack of general nursing culture, deficiencies in leadership, and difficulties in communication and collaboration. Facilitators comprise team cohesion and the perceived benefits of the study.

Fondamentaux des soins : un cadre et un processus pratique pour répondre aux besoins physiques, psychosociaux et relationnels des personnes soignées.

Since 2008, an international group has been helping to promote a better response to the fundamental needs of individuals receiving care. This group provides a framework on the fundamentals of care that focuses on the relationship between the nurse, the individual being cared for, and his or her relatives, as well as on the response to the patient’s physical, psychosocial, and relational needs. A practice process supports the concrete application of this framework. The purpose of this discursive article is to present the French translation of the Fundamentals of Care Framework and its Practice Process. To begin with, the translation process will be briefly explained. Next, the Fundamentals of Care Framework and the stages in its Practice Process will be presented. To help the reader better understand the proposal, a clinical illustration will be used to present the situation of Mr. Perron, who is living with Alzheimer’s disease, and his spouse, who is his family caregiver. Finally, the article discusses the usefulness of the Fundamentals of Care Framework and its Practice Process in terms of the four main areas of the discipline of nursing : practice, management, training, and research. This article paves the way for the development of knowledge on the fundamentals of care in the French-speaking world.

Development and validation of clinical profiles of patients hospitalized due to behavioral and psychological symptoms of dementia.

BACKGROUND: Patients hospitalized on acute psychogeriatric wards are a heterogeneous population. Cluster analysis is a useful statistical method for partitioning a sample of patients into well separated groups of patients who present common characteristics. Several patient profile studies exist, but they are not adapted to acutely hospitalized psychogeriatric patients with cognitive impairment. The present study aims to partition patients hospitalized due to behavioral and psychological symptoms of dementia into profiles based on a global evaluation of mental health using cluster analysis. METHODS: Using nine of the 13 items from the Health of the Nation Outcome Scales for elderly people (HoNOS65+), data were collected from a sample of 542 inpatients with dementia who were hospitalized between 2011 and 2014 in acute psychogeriatric wards of a Swiss university hospital. An optimal clustering solution was generated to represent various profiles, by using a mixed approach combining hierarchical and non-hierarchical (k-means) cluster analyses associated with a split-sample cross-validation. The quality of the clustering solution was evaluated based on a cross-validation, on a k-means method with 100 random initial seeds, on validation indexes, and on clinical interpretation. RESULTS: The final solution consisted of four clinically distinct and homogeneous profiles labeled (1) BPSD-affective, (2) BPSD-functional, (3) BPSD-somatic and (4) BPSD-psychotic according to their predominant clinical features. The four profiles differed in cognitive status, length of hospital stay, and legal admission status. CONCLUSION: In the present study, clustering methods allowed us to identify four profiles with distinctive characteristics. This clustering solution may be developed into a classification system that may allow clinicians to differentiate patient needs in order to promptly identify tailored interventions and promote better allocation of available resources.

[From daily care to expert consensus: state of evidence of nursing interventions and their prioritization according to the clinical profiles of older people hospitalized due to behavioral and psychological symptoms of dementia]. / Du soin pratiqué au quotidien au consensus d'experts : état de I'évidence sur les interventions infirmières et leur priorisation selon le profil clinique des personnes âgées hospitalisées our des symptômes comportementaux et psychologiques de la démence.

The description of the different profiles of somatic, psychiatric and socio-relational comorbidites of psychogeriatric inpatient hospitalized due to behavioral and psychological symptoms of dementia and their associated nursing interventions are poorly documented. This study aimed to describe the observations and interventions given to patients from the four LPCI clinical profiles and to reach a consensus of experts on relevant interventions per profile. A content analysis was conducted on computerized nursing notes of 40 patients. By combining individual and collective production phase, the TRIAGE method allowed reaching an expert consensus on relevant interventions. The results showed that the current practices are generally similar for all patients while appropriate interventions from the expert consensus varied depending on the profile. Also, some problems remain poorly invested, such as screening, assessment and treatment of depressive symptoms and the maintenance of functional autonomy. Since most interventions have been tested in long- term institutions, the development of studies to test interventions tailored to acute psychogeriatric environment and the implementation of evidence-based practices are needed.

Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia.

BACKGROUND: The clinical courses of psychogeriatric inpatients presenting behavioral and psychological symptoms of dementia, between their admission and discharge, have been poorly documented. Based upon our previously elaborated profiles of psychogeriatric patients, this study aimed to describe these courses and to explore whether changing clinical profiles could predict living arrangements at discharge. METHODS: Retrospective data were collected on 397 patients with dementia and hospitalized from 2011 to 2014 in French-speaking Switzerland. Patients were classified on admission and at discharge using four clinical profiles (BPSD-affective, BPSD-functional, BPSD-somatic, and BPSD-psychotic). Multinomial logistic regression analyses were used to identify predictors of living arrangements at discharge. Age, gender, marital status, living arrangements on admission, and clinical profile on admission and discharge, were used as potential predictors. RESULTS: Of the patients classified as BPSD-functional or BPSD-affective on admission, 70.18% and 73.48%, respectively, had the same classification at discharge. However, 45.74% of patients classified as BPSD-somatic on admission were discharged with a BPSD-functional profile, and 46.15% of inpatients classified as BPSD-psychotic on admission were discharged as BPSD-affective (χ(2)(9)=128.8299; p<0.000). At discharge, 64.99% of all patients were admitted to a nursing home. The significant predictors of return to home were: being male (OR=0.96; 95% CI: 0.93-0.99) and BPSD-affective profile (OR=1.95; 95% CI: 1.08-3.54. Significant predictors of transfer to acute care or death were: BPSD-somatic (OR=12.98; 95% CI: 1.96-85.91) or BPSD-psychotic profile (OR=13.53; 95% CI: 1.65-111.05). DISCUSSION: This study provides new information concerning the clinical course of older psychogeriatric inpatients using profiles derived from clinically sensitive profiles.