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Patient satisfaction is a key indicator of inpatient care quality and is associated with clinical outcomes following admission. Different patient characteristics have been inconsistently linked with satisfaction. This study aims to overcome previous limitations by assessing which patient characteristics are associated with satisfaction within a large study of psychiatric inpatients conducted across five European countries.
All patients with a diagnosis of psychotic (F2), affective (F3) or anxiety/somataform (F4) disorder admitted to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and the UK were included. Data were collected from medical records and face-to-face interviews, with patients approached within 2 days of admission. Satisfaction with inpatient care was measured on the Client Assessment of Treatment Scale.
Higher satisfaction scores were associated with being older, employed, living with others, having a close friend, less severe illness and a first admission. In contrast, higher education levels, comorbid personality disorder and involuntary admission were associated with lower levels of satisfaction. Although the same patient characteristics predicted satisfaction within the five countries, there were significant differences in overall satisfaction scores across countries. Compared to other countries, patients in the UK were significantly less satisfied with their inpatient care.
Having a better understanding of patient satisfaction may enable services to improve the quality of care provided as well as clinical outcomes for all patients. Across countries, the same patient characteristics predict satisfaction, suggesting that similar analytical frameworks can and should be used when assessing satisfaction both nationally and internationally.
Dilated cardiomyopathy is a leading cause of cardiac death in children. Approximately 30% of children die or need cardiac transplantation in the first year after establishing the diagnosis. New strategies are needed to improve the outcome in this high-risk patient population.
Method and results
We present our experience in 38 patients below the age of three years, who were diagnosed with dilated cardiomyopathy and who were treated at our institution between 2006 and 2012. The treatment strategy involved institution of β-blockers and angiotensin-converting enzyme inhibitors as soon as feasible. In selected cases, pulmonary artery banding or intracoronary autologous bone marrow-derived cell therapy was performed. The median age at presentation was six months (range 1–26 months). The median follow-up age was 16 months (range 2–80 months). Kaplan–Meier analysis of survival after dilated cardiomyopathy diagnosis revealed a one-year survival of 97% and a five-year survival of 86%. The rate of freedom from death or heart transplantation was 82% at one year and 69% at five years. Surviving patients who were free of transplantation, at the follow-up at 25 months (3–80 months), showed a significant improvement in left ventricular ejection fraction (from 19±11 to 46±16%) and left ventricular end-diastolic diameter (z-score from 4.6±2.4 to 1.4±1.6). In addition, the levels of B-type natriuretic peptide improved significantly (from 3330±3840 to 171±825 pg/ml).
Our data suggest that the clinical approach described here may result in a markedly improved medium-term outcome in young children with dilated cardiomyopathy. Further studies are required to evaluate whether these approaches reduce end-points such as transplantation or death.
In spite of tremendous progress in the medical and surgical treatment of children with congenital heart disease and dilated cardiomyopathy achieved during the past few decades, for some children a heart transplant remains the only option. Clinically relevant benefits of intracoronary injection of autologous stem cells on cardiac function and remodelling have been demonstrated in adult patients with acute myocardial infarction. Experience with autologous stem cell therapy in children with severe congenital or acquired pump failure is limited to a small number of case reports.
Method and results
Between 2006 and 2010, nine severely ill children were treated with intracoronary infusion of autologous bone marrow-derived mononuclear cells as part of a compassionate therapy in our centre. No procedure-related unexpected adverse events occurred. There was one patient on extracorporeal membrane oxygenation who died of haemorrhage unrelated to the procedure; three patients proceeded to heart transplantation once a donor heart became available. The other five patients showed an improvement with respect to New York Heart Association classification (greater than or equal to 1), brain natriuretic peptide serum levels, and ejection fraction.
Similar to adults, intracoronary injection of autologous bone marrow cell is technically feasible and safe for children. On the basis of our data, we propose to perform a pilot study for children with congestive heart failure, to formally assess the efficacy of intracoronary autologous bone marrow cell therapy.
MnO nanoparticles (NPs) were surface functionalized by two different approaches, (1) using a dopamine-poly(ethylene glycol) (PEG) (DA-PEG) ligand and (2) by encapsulation within a thin silica shell applying a novel approach. Both MnO@DA-PEG and MnO@SiO2 NPs exhibited excellent long-term stability in physiological solutions. In addition, the cytotoxic potential of both materials was comparatively low. Furthermore, owing to the magnetic properties of MnO NPs, both MnO@DA-PEG and MnO@SiO2 lead to a shortening of the longitudinal relaxation time T1 in MRI. In comparison to the PEGylated MnO NPs, the presence of a thin silica shell led to a greater stability of the MnO core itself by preventing excessive Mn ion leaching into aqueous solution.
Quantitative X-ray powder Rietveld refinements for a series of alloys from the solid solution EuyFe4−xNixSb12, synthesized by argon arc-melting followed by long term annealing, established in all cases isotypism with the partially filled skutterudite-type structure, LaFe4P12. The Eucontent of the samples was determined from the combined data obtained results of Rietveld refinements and electron microprobe measurements. These investigations confirmed a systematic trend for the Eu-occupancy y in the parent lattice, revealing a gradual decrease of the maximum Eu-content from practically full occupancy, y = 0.83, in Eu0.83Fe4Sb12 to y ∼ 0.5 for Eu∼0.5Fe2Ni2Sb12. Eu0.83Fe4Sb12 orders magnetically below 84 K and the transition temperature decreases as a function of Fe/Ni substitution. As a further consequence of the Fe/Ni substitution electronic transport crosses over from a hole conductivity regime into electron dominated behaviour. Concomitantly, the transition metal exchange increases the Seebeck coefficient significantly, hence the figure of merit enhances.
Few risk factors and indicators of vulnerability for suicide in custody are known so far.
A case-control study was conducted to investigate the relevance of criminal history, psychiatric morbidity and social integration to suicide in prison.
For every suicide that occurred in an Austrian correctional institution between 1975 and 1999, two controls matched for correctional institution, gender, nationality, age, custodial status and time of admission were selected. Psychiatric characteristics, previous suicidal behaviour, criminal history and indicators of social integration were compared.
Of 250 recorded suicides, 220 personal files were available and matched to 440 controls. The most important predictors for suicide in custody were a history of suicidality (status following attempted suicide and suicide threat), psychiatric diagnosis, psychotropic medication, a highly violent index offence and single-cell accommodation.
A significant finding is the importance of suicidal behaviour as an indicator of risk of suicide in correctional institutions, which until now has been a matter of debate. This study demonstrates the need for staff to take suicidal behaviour as seriously in custodial settings as in any other circumstances.