Validity of HoNOS in identifying frequently hospitalized patients with ICD-10 mental disorders.

OBJECTIVE: To identify frequently hospitalized patients by using the outcome and severity measure Health of the Nation Outcome Scales (HoNOS) in combination with the International Classification of Diseases (ICD)-10 in patients consecutively admitted to a psychiatric hospital. METHOD: All full-time in-patients and all day-hospital patients were considered. Frequently hospitalized patients were defined as those with 10 or more hospitalizations. RESULTS: The total HoNOS score at admission was found valid to discriminate between frequently and non-frequently hospitalized patients as well as in ranking the ICD-10 diagnosis by severity of symptoms and social problems. Frequently hospitalized patients were predominantly found within the diagnoses of schizophrenia and bipolar affective disorders. In these groups, high HoNOS scores were significantly associated with a longer stay in hospital. Improvement during hospitalization as measured by the HoNOS was significantly better for bipolar than for schizophrenic patients. CONCLUSION: HoNOS was found to be a clinically relevant supplement to ICD-10 in identifying frequently hospitalized patients.

Combined treatment with imipramine and mianserin. A controlled pilot study.

The effect of imipramine plus mianserin and imipramine plus a placebo was compared in 40 depressed patients with a median age of 60 years. The imipramine dosage was flexible to give a plasma concentration around 200 nmol/l and mianserin was given at a fixed dosage of 30 mg daily. After six weeks of treatment the results showed that the scores on the Hamilton Depression Scale as well as on the Melancholia Scale were significantly more improved in the imipramine-plus-minaserin group than in the group of patients receiving imipramine alone (P less than 0.01). In terms of percentage of improvement (a reduction of baseline rating scores of 50% or more) 77% of the imipramine-plus-mianserin group had improved, compared with 27% of the imipramine group. The combination of imipramine and mianserin was well tolerated both as regards clinical side-effects and laboratory tests.

Regional variation in the use of antibiotics in four Danish hospitals.

The increasing use of antibiotics contributes to the selection of resistant bacteria and to the cost of health care. Large regional differences in the use of antibiotics between and within countries exist. This study describes such usage in four Danish hospitals, and includes a comparison with that of the average of 450 US hospitals. Compared to the Danish hospitals, the US hospitals used approximately double the amount of antibiotics in defined daily dosages (DDD)/100 bed days. In contrast to the comparison with the American hospitals no real differences were found comparing the four Danish hospitals. The four Danish hospitals differed in degree of specialization, presence of a clinical microbiological department or a hospital pharmacy. Use of antibiotics, in DDD/100 bed days, was highest in the hospital without a department of clinical microbiology, while the highest cost of antibiotics/admission was found in the hospital with the highest degree of specialization. Restraint in antibiotic usage calls for the joint efforts of the department of clinical microbiology, the hospital pharmacy and the local drug committee - the most important tools being: continuous education, audits of antibiotic use, provision of guidelines and recommendations, facilities for rapid diagnosis of infectious diseases, and limitation of the number of antibiotics used in routine sensitivity testing.