The Cost of Mental Health Comorbid Conditions in Burn Patients: A Single-site Experience.

Many burn survivors suffer from psychiatric sequelae long after their physical injuries have healed. This may even be more pronounced in individuals who have a history of mental health disorders prior to admission. The aim of this study was to explore the clinical outcomes of patients with previously diagnosed mental health disorders who were admitted to our Burn Center. This was a single-site, retrospective review using our institutional Burn Center registry. All adult patients (18 years or older) admitted to our Burn Center between January 1, 2014 and June 30, 2021 with burn injury or inhalation injury were included in this study. Variables of interest included demographics and burn mechanism. Outcomes of interests were length of stay, cost of hospitalization, and mortality. A P-value of < .05 was considered statistically significant for all analyses. There were 4958 patients included in this study, with 35% of these patients having a previous diagnosis of mental health disorders. Patients with mental health disorders were younger, with larger burns, P < .05. They had significantly longer lengths of stay and significantly higher costs (P < .00001). Mortality for those with a mental health disorder history was 2% and 3% for those without (P = .04). Patients with pre-existing mental health disorders had decreased odds of mortality. However, they do have extended lengths of stay, which may exhaust current sparse staff and burn bed resources.

Factors Associated with Grade Appeals: A Survey of Psychiatry Clerkship Directors.

PURPOSE: In an effort to provide medical students with opportunities for accurate grading, some psychiatry clerkship directors allow for grade appeals. The authors examined the appeals process from the clerkship directors' perspective. METHODS: A 23-item survey, consisting of multiple choice and narrative questions, was sent to allopathic and osteopathic accredited schools in North America. Questions included information about the medical school, the clerkship director, and the grade appeal processes. StatPlus sorted and analyzed the data, and grade challenge rates were compared between schools. The narrative responses were independently sorted by the authors. RESULTS: Sixty-one responses were received (35% of programs). A grade challenge rate was calculated for each response, using the number of appeals/students per year, allowing for further comparison of grade challenges. Clerkships with an honors/pass/fail grading schema had a higher grade challenge rate (p = 0.002) when compared to all other reported grading schemas. Clerkships where the grade appeal could result in a lower grade had a smaller grade challenge rate (p = 0.026) as compared to programs where a grade appeal could not result in a lower grade. The authors observed three common pathways for the processing of grade appeals and four common themes among clerkship directors as contributors to grade appeals. CONCLUSION: A grade appeal is often the final step in the grading process for medical students. By identifying factors that contribute to grade appeals, areas for targeted interventions in the evaluation process are potentially identified. Future study of grade appeals, including from the medical students' perspective, is warranted.