ABSTRACT
OBJECTIVE: Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need. METHODS: Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes "cardiovascular" and "feeding/fluid." MEASUREMENTS AND RESULTS: Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need "cardiovascular" decreased as length of stay increased. Multivariate analysis showed Final Hospital Need "cardiovascular" was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need "respiratory" and "other." Final Hospital Need "feeding/fluid" was negatively associated with left-sided valve procedure, but positively associated with final ICU need "respiratory," and tube feeding at discharge. CONCLUSIONS: Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.
Subject(s)
Cardiology , Patient Discharge , Humans , Child , Length of Stay , Critical Care , Hospitals , Intensive Care Units , Retrospective StudiesABSTRACT
PURPOSE: Weight loss is critical in the fight against obesity yet only about 20% of individuals maintain weight loss long term. This review examines the psychological factors influencing weight loss maintenance. DATA SOURCES: An electronic search was used to identify studies from 2003 to 2009 in the following databases: MEDLINE, CINAHL, PsycINFO, Psychology and Behavioral Sciences Collection, PsycARTICLES. CONCLUSION: Evidence indicated avoiding dichotomous thinking, eating to regulate mood, and disinhibited eating were associated with weight loss maintenance. Increased dietary restraint, perceived benefits outweighing costs, lower/stable levels of depression, and more positive body image were also associated with weight loss maintenance. Results were inconclusive on unrealistic weight loss expectations and failure to achieve weight loss goals. IMPLICATIONS FOR PRACTICE: Practitioners can play a pivotal role in screening clients for these factors and recommending treatment to increase the likelihood of successful weight loss maintenance.
