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Preanesthetic Evaluation
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Location and time of day, hospital versus field anesthesia and daily working hours versus out-of-hours may limit the personnel and equipment available. Anesthesia performed out-of-hours has been associated with increased mortality rate in a retrospective study.
Disability and rehabilitation for older people
Published in David Beales, Michael Denham, Alistair Tulloch, Community Care of Older People, 2018
Community rehabilitation does not necessarily have to occur within the disabled person’s home. A well-established service for older people in this country is the day hospital. Day hospitals, developed during a period when community care was rudimentary, aimed to provide comprehensive nursing, medical and rehabilitative care for old people as an alternative to hospital admission. Many day hospitals are now altering their role to provide a more flexible range of community-based services, such as home physiotherapy, occupational therapy and speech therapy in close liaison with local social services. The therapists either treat people within their own home, or provide transport to bring the patients to the day-hospital base, perhaps just for an hour or so rather than the four to six hour day which was traditional day-hospital practice.
Schizophrenia
Published in Ben Green, Problem-based Psychiatry, 2018
The absolute mainstay of treatment is oral antipsychotic medication, with a move to maintenance treatment with IM depot antipsychotic injections as an option. Sometimes violent or particularly disturbed patients may require emergency sedation of rapid tranquillisation with intramuscular benzodiazepines (like lorazepam or intramuscular neuroleptics (like levomepromazine). Depot injections (which release medication over weeks) are particularly useful if compliance is a problem – and compliance is not to be expected if insight is poor. Inpatient and day hospital stays might be from a few weeks to a year.
Occupational status and hospitalisation for mental disorders: findings from Friuli Venezia Giulia region, Italy, 2008–2017
Published in International Journal of Psychiatry in Clinical Practice, 2019
Giulio Castelpietra, Matteo Balestrieri, Massimo Bovenzi
The database provided date of admission and date of discharge of each hospitalisation in regional GHPUs during years 2008–2017. Subjects who were hospitalised once or more during the 10-year study period were identified by the unique anonymous identifier. In the database, each hospitalisation is classified as day-hospital, ordinary, urgent and involuntary. Day-hospital is a daily hospitalisation, usually following a previous full-day hospitalisation or an ambulatory visit, which requires interventions not available at the ambulatory level. ‘Ordinary’ hospitalisations are those addressed to subjects admitted by request of General Practitioner or other public physicians. ‘Urgent’ hospitalisation are those addressed to subjects who directly access to an Emergency Room and are then admitted to GHPU, or are directly admitted to GHPU. Urgent hospitalisation usually requires a prompt intervention. Both ordinary and urgent hospitalisations are on voluntary basis. ‘Involuntary’ hospitalisations implies a Compulsory Treatment Order (CTO), and are on involuntary basis. The CTO is a health intervention ruled by Italian law (Articles 33, 34, 35 and 64 of the General Health Law no. 833/1978). The CTO is requested by two public physicians, one of them should be a psychiatrist. The CTO is ordered by the resident’s municipality mayor (as representing the main territorial health authority) and it is authorised by a judge, who is entrusted with the jurisdictional safeguard of the treatment. CTO lasts seven days, but can be extended. In this case, all the procedure should be repeated.
Starvation symptoms in patients with anorexia nervosa: a longitudinal study
Published in Eating Disorders, 2018
Simona Calugi, Elisa Chignola, Marwan El Ghoch, Riccardo Dalle Grave
The treatment comprised an adapted version of CBT-E (Dalle Grave, 2012). Patients were treated for 20 weeks (13 as inpatients and for 7 weeks in day hospital). Patients attended both individual and group CBT-E sessions, and received dietician-assisted eating in the first weeks of the program. The first 4 weeks of the ICBT-E is focused on addressing refeeding and reducing eating concerns, but does not directly address the core psychopathology of anorexia nervosa (i.e., the overvaluation of shape and weight and their control); this is addressed from 4 weeks on, in parallel with the gradual achievement of weight restoration. After discharge from day hospital (at 20 weeks), participants were monitored for a 6-month follow-up period, which, inevitably, was not closed. A detailed manual describing CBT-E has previously been published.
Understanding dropout and non-participation in follow-up evaluation for the benefit of patients and research: evidence from a longitudinal observational study on patients with eating disorders
Published in Eating Disorders, 2023
Patrizia Todisco, Paolo Meneguzzo, Alice Garolla, Eva Diomidous, Athos Antoniades, Paris Vogazianos, Federica Tozzi
The treatment protocol was based on cognitive-behavioral therapy, and a multidisciplinary approach characterized it. A specialized staff of professionals delivered treatment, which included weekly individual psychotherapy sessions, daily group psychotherapy sessions, nutritional counseling, nursing care, meal planning, support by dietitians, family treatment, psycho-educational group therapy, and psychopharmacologic treatment as needed. The nutritional program is based on the needs of each patient. The program uses refeeding protocol for patients with AN, in which the food is non-forced via a tube, but always voluntarily taken. For patients with BN and BED the protocol includes regular meals with the goal of weight stability. The psycho-therapeutic program was delivered as a personalized intervention—as required according to the individual characteristics, symptoms, and history—using third wave approaches as add-ons to standard treatment. Following the national healthcare system, we provide different types of inpatient treatments that do not require patients to have additional insurance. Residential inpatient protocol provides ward stay for up to 60 or 90 days, according to patients’ residency. The day hospital protocol provides the same treatments in an intensive day hospital setting for up to 90 weekdays. For all participants, group therapy meetings for family members were proposed on a voluntary basis. The two protocols were provided separately or consecutively, according to the patient’s clinical needs, and the decision was based on the clinical evaluation before admission to the facility. The staff determined the transition between the day hospital and the ED ward according to each patient’s clinical and psychological state.