Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program.

BACKGROUND: Impulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during partial hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment. METHOD: Participants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based partial hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment. RESULTS: Higher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p < .001, Cohen's dz = 0.61) and positive urgency (p < .001, Cohen's dz = 0.39) significantly decreased during treatment. DISCUSSION: Findings suggest that participants report decreases in urgency during brief partial hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.

Novedades en Artroplastia de Cadera. 2017 / News in Hip Arthroplasty. 2017

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Cuidados paliativos para pacientes con insuficiencia respiratoria crónica / Palliative care for patients with chronic respiratory failure

La creciente prevalencia de enfermedades respiratorias crónicas y su más larga supervivencia han motivado que aumente el número de pacientes en situación avanzada de la enfermedad y en techo terapéutico. Sin embargo, este hecho epidemiológico no se ha acompañado de un desarrollo paralelo de programas de cuidados paliativos, lo que motiva que los enfermos que se encuentran en esta situación no reciban los cuidados médicos óptimos para asegurar su confort y evitar ingresos sucesivos que poco aportan a su pronóstico y calidad de vida. La experiencia del Hospital Lucus Agusti revela que el 7% del total de ingresos de neumología corresponden a pacientes con enfermedad crónica respiratoria avanzada no neoplásica, que solo el 65% de ellos reciben tratamiento paliativo de sus síntomas y que la práctica totalidad fallece en el hospital. Es necesario poner en práctica proyectos que no solo involucren a neumólogos, sino también a personal de enfermería, médicos de atención primaria, de hospitalización a domicilio y personal del hospital de día

The increasing prevalence of chronic respiratory diseases and the longer survival of patients with these disorders have lead to a rise in the number of individuals in a terminal condition with no chances of responding to additional medication. Nevertheless, this epidemiological fact has not been accompanied by a parallel development of palliative care programmes, and this prevents the patients from receiving optimal medical care to ensure their well-being and to avoid further unnecessary admissions to hospital. Our local experience in the Lucus Augusti University Hospital reveals that 7% of the admissions to the respiratory ward correspond to patients with advanced and non-neoplastic chronic respiratory disorders. Only 65% of these patients benefit from a well-structured palliative care plan and practically all of them die in the hospital. Altogether, these data highlight the need for a strategy that involves not only pneumologists but also general practitioners, nurses and palliative care physicians

Characterizing gender differences in nonsuicidal self-injury: Evidence from a large clinical sample of adolescents and adults.

While nonsuicidal self-injury (NSSI) is common in both men and women, research exploring the intersection of NSSI and gender has been limited by the use of small samples of males drawn primarily from non-clinical populations. To address these limitations, we analyzed data from a large sample of patients enrolled in an NSSI partial hospitalization program (PHP) to compare males and females across several variables, including NSSI characteristics, correlates, and pre-post treatment outcomes. Results indicated similar NSSI characteristics and treatment outcomes for males and females, with few exceptions. Males notably reported lower severity levels for most NSSI correlates (e.g., psychopathology, suicidality), highlighting the need to screen males for NSSI even when reporting comparatively less impairment. Finally, our results also suggest that PHP treatment for NSSI can be beneficial for both males and females. These findings have implications for the assessment, diagnosis, conceptualization, and treatment of NSSI in males and females.

Variabilidad en los hospitales de día de Reumatología en España: proyecto VALORA / Variability in Rheumatology day care hospitals in Spain: VALORA study

Objetivos. Describir la variabilidad de las unidades de hospitalización de día (UHdD) de Reumatología en España, en términos de recursos estructurales y procesos de funcionamiento. Material y métodos. Estudio descriptivo, multicéntrico, con evaluación de las UHdD mediante cuestionario autocumplimentado a partir de estándares de calidad de la Sociedad Española de Reumatología. Se analizaron recursos estructurales y procesos de las UHdD estratificados por complejidad del hospital (comarcal, general, mayor y complejo), y se determinó la variabilidad mediante el coeficiente de variación (CV) de la variable con relevancia clínica que presentara diferencias estadísticamente significativas al comparar por centros. Resultados. Un total de 89 centros (16 comunidades autónomas y Melilla) se incluyeron en el análisis. El 11,2% de los hospitales son comarcales; el 22,5%, generales; el 27%, mayores, y el 39,3%, complejos. El 92% de las UHdD son polivalentes. El número de tratamientos aplicados, la coordinación entre las UHdD y farmacia hospitalaria y la presencia de formación posgrado fueron las variables de proceso que presentaron diferencias estadísticamente significativas en función del nivel de complejidad del hospital. La tasa de tratamientos más alta se halló en hospitales complejos (2,97 por 1.000 habitantes), y la más baja, en hospitales generales (2,01 por 1.000 habitantes). El CV fue de 0,88 en hospitales mayores, de 0,86 en comarcales, de 0,76 en generales y de 0,72 en los complejos. Conclusiones. Existe una mayor variabilidad en el número de tratamientos de UHdD en los hospitales mayores, seguido de los comarcales. Sin embargo, la variabilidad en estructura y funcionamiento no parece deberse a diferencias de complejidad de los centros (AU)

Objective. To describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes. Material and methods. Multicenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers. Results. A total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22,5% general, 27%, major and 39,3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1,000 population), and the lowest in general hospitals (2.01 per 1,000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex. Conclusions. there was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity (AU)

Case Report: Red Urine After Day Care Strabismus Surgery.

In the absence of surgery on the urinary tract, the emission of red urine after anesthesia should be considered as a diagnostic emergency because it can be a sign of hematuria, hemoglobinuria, blood transfusion reaction, significant myoglobinuria, or porphyria.This case describes the management of a 12-year-old boy who presented red urine at the day care unit after strabismus surgery.

[Regional Budgets in Psychiatry: An Alternative to Hospital per Diem Charges and the New Reimbursement System? - A Case Study from the District of Dithmarschen]. / Regionalbudgets in der Psychiatrie: Eine Alternative zu tagesgleichen Pflegesätzen und zum zukünftigen Finanzierungssystem?

Objective The study looked at the impact that the switch from a reimbursement system with hospital per diem charges to a regional budget had on treatment. Methods Routine data from two clinics over a period of ten years were evaluated. Results Treatment took place in day clinics and on an outpatient basis to an increased extent after the change. Conclusion The change in reimbursement system was the cause of the change in treatment. Since similar effects can also be expected when switching from the new reimbursement system for psychiatry and psychosomatic medicine to a regional budget system, regional budgets are a reasonable alternative.

[Psychiatric and psychosomatic day hospitals in Austria]. / Psychiatrische und psychosomatische Tageskliniken in Österreich.

This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.

When Partial Hospitalization Fails: Risk Factors for Inpatient Hospitalization.

Partial hospitalization is an understudied bridge between outpatient and inpatient care. One of its primary functions is to prevent the need for inpatient hospitalization. We examined potential demographic and clinical risk factors for inpatient hospitalization for current partial hospital patients. We conducted separate multiple logistic regression analyses for patients referred from inpatient care and the community. For individuals referred from inpatient care, suicidal ideation and greater psychotic symptoms upon admission to the partial program were associated with acute inpatient re-hospitalization. For individuals referred from the community, suicidal ideation and worse relationship functioning upon partial hospital admission were significant risk factors for inpatient hospitalization. Number of previous inpatient hospitalizations and greater substance abuse were not associated with inpatient hospitalization in either sample. Implications at the provider and program level are discussed.

[Structural quality in inpatient and daycare child and adolescent psychiatry- indicators for planning future staff ratios for the era following the Psychiatry Personnel Act]. / Strukturqualität in der stationären und teilstationären Kinder- und Jugendpsychiatrie.

The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.

Muchas personas imprescindibles para afrontar los retos de la atención a los niños y adolescentes / Many people are essential to cope with the challenges of attention to children and adolescents

En este monográfico sobre el Servicio de Pediatría del Hospital Universitario Cruces nos hubiera gustado incluir a todas las personas que atienden directamente a los niños y a sus familias. Ellas son las principales protagonistas de la reconocida calidad de nuestra atención sanitaria, y serán también las personas claves para conseguir los retos y cambios que se deberán establecer en los próximos años. Sin embargo, las limitaciones de espacio para publicar esta revista han impedido que se puedan incluir todas las áreas del servicio. En este capítulo sie analizarán algunos cambios relevantes observados en los 10 últimos años y se presentarán nuevos proyectos que nos ilusionan a nivel de hospitalización pediátrica, alternativas a la hospitalización (hospital de día o a domicilio), consultas externas y otras actividades integradas con los pediatras de Atención Primaria, servicios sociales y educativos (AU)

In this monograph on the Pediatrics Department of the Hospital Universitario Cruces (University Hospital Cruces), we would like tO include all persons who directly attend the children and their family. They are the main protagonists of the recognized quality of our health care and will also be the key persons to achieve the challenges and changes that should be established in the upcoming years. However, the limitations in space available to publish in this journal have made it impossible to be able to include all the areas of the service. In this chapter, some important changes observed in the last 10 years will be analyzed and new projects that we are excited about on the pediatric hospitalization level will be presented. These are alternatives to hospitalization (day hospital or home treatment), utpatient clinics and other activities integrated with primary care pediatrics, social and educational services (AU)

Day Care Centers for Seniors in Singapore: Looking Back and Looking Ahead.

The burden of care for frail elderly persons on families and the society is ever real as our population ages. Given the dual-income nature of many working families, day care centers offer a strong alternative to nursing homes for families wishing to provide custodial care and meaningful engagement for seniors while continuing to uphold their filial duties. Recognizing this, several initiatives, such as SPICE (Singapore Programme for Integrated Care for the Elderly) and Weekend Respite Care, have been launched to enhance the services of Singapore's day care centers. This article traces the evolution of this process, distills current challenges, and offers policy recommendations to improve Singapore's day care services for seniors.

[Effects of implementation of psychiatric out-patient clinics ("institutsambulanzen") on hospital admissions]. / Auswirkungen der Einrichtung von Institutsambulanzen auf die Inanspruchnahme stationärer Behandlung.

OBJECTIVE: In the German federal state Baden-Wuerttemberg psychiatric out-patient clinics ("Institutsambulanzen") have been implemented since 2002, later than elsewhere. The effects of these new out-patient services on the use of in-patient services should be examined in a defined catchment area. METHOD: Data on the use of in-patient services 2002 - 2011 was recorded from psychiatric hospitals and day hospitals in a catchment area of 862 000 inhabitants as well as data from the corresponding out-patient clinics. RESULTS: While the number of patients in the out-patient clinics increased from 1986 in 2002 to 7925 in 2011, the number of hospitalised patients increased only moderately, from 4452 in 2002 to 4930 in 2011. An increasing percentage of patients in the out-patients clinic did not use in-patient services in the respective year. This concerned particularly patients with adjustment and personality disorders, who do not find other appropriate psychotherapeutic care as out-patients. CONCLUSIONS: The implementation of out-patient clinics had no significant effect on the number of hospitalisations and occupied beds.

'I am closer to this place'--space, place and notions of home in lived experiences of hospice day care.

In the United Kingdom hospice day care services are the fastest growing yet least researched of the palliative care services. Using photo-elicitation interviews with 11 day care patients attending a specialist hospice day care setting we explored their experiences of the hospice as a place and how these changed over time. Informed by concepts from existential and humanistic geography we propose three existential modes of being--Drifting, Sheltering and Venturing--which characterize the patients' lived experiences of the hospice. Our phenomenological analysis shows that the hospice is (re)constructed purposefully to achieve a sense of 'home' and 'homelikeness', creating an important therapeutic landscape for patients.