Psychological medicine
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Psychological medicine · May 1982
Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients.
With a psychiatrist's standardized clinical diagnosis as the criterion, the 'Mini-Mental State' Examination (MMSE) was 87% sensitive and 82% specific in detecting dementia and delirium among hospital patients on a general medical ward. The false positive ratio was 39% and the false negative ratio was 5%. ⋯ Performance on specific MMSE items was related to education or age. These findings confirm the MMSE's value as a screen instrument for dementia and delirium when later, more intensive diagnostic enquiry is possible; they reinforce earlier suggestions that the MMSE alone cannot yield a diagnosis for these conditions.
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The teaching of 'clinical skills' is generally held to be central to postgraduate training in psychiatry, but the term itself has so far escaped exact definition. In an effort to study some of the component clinical abilities, their inter-relationships, and the factors promoting their transmission, all junior psychiatrists at the Maudsley Hospital were surveyed for their views on the clinical training they had received. Three hundred and seventy three assessement on 43 units were made. ⋯ Over a 3-year period the standard of multi-disciplinary teamwork appeared to improve, but there was a decline in the standard of academic instruction and in encouragement to do research. These overall differences were due to changes in the teaching staff, rather than alterations in teaching methods. Surveys such as this may help to define the goals of postgraduate clinical training, and also monitor the extent to which an institution is achieving these goals.
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Psychological medicine · May 1980
Relationship between pre-operative anxiety and post-operative state.
Janis (1958) has proposed a curvilinear relationship pre-operative anxiety and post-operative emotional state. While other hypotheses share the prediction of a poor outcome for patients with pre-operative high anxiety, Janis' theory is unique in predicting a poor outcome for those with low anxiety. ⋯ On the whole, pre-operative anxiety was a poor predictor of other measures of recovery but, on one measure, patients with low anxiety showed a slower recovery than those with moderate anxiety, i.e. supporting the prediction of a poor outcome for low anxiety patients. The implications of these results for pre-operative preparation of surgical patients and the development of theories of anxiety are discussed.
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The natural course of anxiety before and after surgery was examined using the State-Trait Anxiety Inventory in 4 studies involving 136 surgical patients. The results suggested that high levels of anxiety were experienced before admission to hospital, between admission and surgery and following surgery, and were not restricted to the immediate pre-operative period. Only a small percentage of patients reached their maximum level of anxiety on the morning of surgery. These results have implications for those planning interventions to alleviate anxiety associated with surgery and for those studying surgical stress as a model for other naturally occurring stresses.