Inpatient hospitalization

The introduction of protease inhibitor-based regimens seemed to be responsible for a change within the structure of provider costs. There is some evidence that the share of drugs increased, whereas the importance of hospitalization declined. For instance, Hellinger (1993) estimated that drug costs to account for about 10% of the total provider costs, whereas the inpatient hospitals costs were responsible for some... 

Flori and le Vaillant (2004) studied the temporal relationship between the uptake of the more aggressive antiretroviral therapy and the use and cost of hospital treatment for HIV-infected patients in France from 1995 to 2000 from a hospital perspective. The authors found that during this period the proportion of patients on ARV treatment increased from 69.5% to 97%, with a large rise in the use of polytherapy. This increase was most notable for patients with CD4 cell counts above 500. ART expenditures per patient increased between the study years by 220%, reaching US 1,886 in 2000. Unlike that, inpatient hospitalization fell by 60% and average length of stay declined. Thus hospital costs (excluding ART) decreased to US 2,137 in 2000. 

A serious adverse event (experience) or reaction is any untoward medical occurrence that at any dose results in death, is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, or is a congenital anomaly/birth defect. 

Requires inpatient hospitalization or prolongation of existing hospitalization. 

During the initial evaluation, providing for the safety of the patient is of paramount importance. The severity of intoxication and potential for withdrawal must be quickly and accurately determined. Extreme alcohol intoxication can be fatal either by the production of cardiac arrhythmias, aspiration (the inhalation of stomach contents that are vomited), or other causes. We have all seen reports of college students dying from alcohol poisoning. Likewise, up to 10% of patients in severe alcohol withdrawal can die without treatment. Fortunately, most patients do not experience the most severe forms of alcohol withdrawal such as the DTs. Mild withdrawal can be managed in the outpatient setting with appropriate support and patient adherence, but severe withdrawal requires an inpatient hospitalization. See Section 6.5 for further discussion of the initial evaluation. 

The only medication that blocks GABA activity is flumazenil (Mazicon). Flumaze-nil is used only in the emergency room or in an inpatient hospital setting to treat benzodiazepine overdose. It quickly and reliably reverses the toxic effects when a patient has accidentally or purposefully taken an overdose. Restricted to emergency situations, flumazenil is never used on a routine basis. 

Zimet, S., Farley, G., and Zimet, G. (1994a) Home behaviors of children in three settings an outpatient clinic, a day hospital and an inpatient hospital. J Am Acad Child Adolesc Psychiatry 33 56-59. 

Noncompliance with medication treatment can be mul-tidetermined in children and adolescents and occurs more frequently than physicians recognize. A recent study found that only 38% of adolescents were compliant with medication treatment 14 months after inpatient hospitalization (Lloyd et ah, 1998), despite a relatively low level (23%) of side effects. 

In this same study, inpatient records of children who had been referred to the community clinics indicated that polypharmacy has become more prevalent among inpatient populations as well. While 26% of the 1988 sample received polypharmaceutical treatment in an inpatient psychiatric unit, as many as 42% of the 1992-4 sample children had been treated with concurrent multiple medications during their inpatient hospital stays. 

Inpatient hospital treatment and residential rehabilitation are very different in character, and in average length of stay. It is very useful to have both available as options for selected cases, but clearly they cannot be used at all routinely, because of the sheer numbers of drug users presenting, and the strong preference which most have for being treated from home. 

These facts must be kept in mind when evaluating the efficacy data with this antidepressant. The best evidence supporting this warning is the recent approval of the sustained release version of bupropion. Three double-blind studies were done to support the submission of this formulation for approval. The FDA concluded that all three of these studies failed to show that the sustained release version of bupropion in the doses used (i.e., less than 450 mg per day) was superior to placebo in the treatment of outpatients with major depression (bupropion summary basis of approval). As a result, this formulation was approved on the basis of bioequivalence with the immediate release formulation. The FDA in its approval documents did not specify why it chose to approve this formulation without efficacy data. One possibility is that there are reasons to believe that the sustained release formulation is less likely to cause seizures than is the immediate release version at comparable doses. In contrast to these failed studies, two relatively small studies published in 1983 reported that immediate release bupropion at doses up to 600 mg per day was superior to placebo in the treatment of inpatients hospitalized for major depression (165, 166). 

BPD can be life-threatening with a stormy course, at times necessitating inpatient hospitalization, or it can be a milder disorder managed on an outpatient basis. Thus, because one sample of patients may be more severely disturbed or has more psychotic features than another, discrepancies in outcome among studies may be due to these differences. In addition, because several studies combine schizotypal and BPDs, it is important to separate these patients when analyzing the results. 

Hypouricemia in individuals admitted to an inpatient hospital-based facility. Am J Kidney Dis 2003 41 1225-32. 

Results The results of paracentesis have generally been good up to now the number of successfully treated patients was higher, inpatient hospitalization was shorter, and complications were less frequent or less severe. The response to diuretic therapy improved considerably discontinued diuretic therapy could be successfully taken up again. (158,159) Plasma values of renin, aldosterone and norepinephrine dropped. There was an improvement in lung volume (141,143) as well as in cardiac function values. (152,153,156) The pressure in the oesophageal varices fell. (150) Paracentesis of 6 litres of ascitic fluid removes 6 X 130 mmol sodium. 

Access to clinical pharmacy services is a somewhat more difficult issue because barriers to these services are both geographic and financial. Because pharmacists cannot obtain a provider number to directly bill for clinical pharmacy services, it is difficult for them to receive the financial incentives necessary to make this service widely available. Furthermore, because financial incentives exist only for dispensing services, patients may have access to clinical pharmacists only in special environments such as inpatient hospitalization or in systems such as the Veterans Healthcare Administration (VHA) or HMOs. 

Shepperd, S. Harwood, D. Jenkinson, C. Gray, A. Vessey, M. Morgan, P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I Three month follow up of health outcomes. BMJ 1998, 316, 1786-1791. 

Social Security Act. This section of the legislation covers inpatient hospitalization, critical access hospitals, skilled nursing facilities, hospice care, and limited home healthcare. Critical access hospitals are small facilities that provide limited outpatient care and inpatient services to individuals in rural areas. 

Of the estimated 12.6 billion cost of asthma in the United States in 1998, direct medical expenditure accounted for 58% of the total, with emergency care (emergency department and inpatient hospital care) reaching 2.5 billion and prescription medications ( 3.2 billion) as the single largest direct medical expenditure. A cost-of-iUness approach takes in all measurable costs both indirect costs or costs to society and direct medical costs are considered. Using this approach, the cost per patient per year in 1994 in the United States was 756, a slight decrease in inflation-adjusted expenditures over the past 10 years. Indirect costs such as lost work and death accounted for two-thirds of these expenditures. 

Still, billing-related records carry well-worked out classification codes for diseases and treatments represented in standards, such as ICD-9-CM volume 1 and 2 as the code set for diagnosis codes, ICD-9-CM volume 3 for inpatient hospital services, CDT for dental services, and NDC codes for drugs. This is enough form to obtain knowledge for the common good on analysis of patient data. Pharmaceutical companies, FDA, and medical researchers have already started to access and analyze the anonymized form of these data. 

Medicare beneficiaries accounted for 45.2 percent of inpatient hospital S in 1989 and for 33 percent of the discharges (164). 

Sales to hospitals made up about 23 percent of total U.S. pharmaceutical sales in 1991 (128), a decline from about 29 percent in 1983 (291,320). (See figure 10-1 for a breakdown of pharmaceutical sales by type of buyer at the wholesale level.) A growing proportion of these sales represent drugs sold through hospital-based outpatient pharmacies,3 so the inpatient hospital share of the pharmaceutical market today is actually below 23 percent. 

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