General hospital psychiatry
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To determine the occurrence of delirium in oncology inpatients and to identify and evaluate admission characteristics associated with the development of delirium during inpatient admission, a prospective observational study was conducted of 113 patients with a total of 145 admissions with histological diagnosis of cancer admitted to the oncology unit over a period of ten weeks. At the point of inpatient admission, all patients were assessed for the presence of potential risk factors for development of delirium. During the index admission patients were assessed daily for the presence of delirium using the Confusion Assessment Method. ⋯ Hospital inpatient admission was significantly longer in delirium group (mean: 8.8 days vs 4.5 days in nondelirium group, P<.01). Delirium among hospitalized oncology patients is a common condition. Identification of risk factors to delirium at the time of inpatient admission can be used to recognize those patients at the greatest risk and may aid prevention, early detection and treatment.
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Gen Hosp Psychiatry · Jul 2003
Clinical TrialTreatment for delirium with risperidone: results of a prospective open trial with 10 patients.
Delirium is a common psychiatric illness among medically compromised patients. There is an increasing opportunity to use atypical antipsychotics to treat delirium. The effects of these drugs on delirium, however, the most appropriate way to use them, and the associated adverse effects remain unclear. ⋯ However, sleepiness (30%) and mild drug-induced parkinsonism (10%) were observed; the symptom of sleepiness was a reason for not increasing the dose. One patient responded to a dose as low as 0.5 mg/d, so it is recommended that treatment start at a low dose, which may then be increased gradually. This trial is a preliminary open study with a small sample size, and further controlled studies will be necessary.
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Gen Hosp Psychiatry · Jul 2003
Incidence and correlates of near-death experiences in a cardiac care unit.
Near-death experiences, unusual experiences during a close brush with death, may precipitate pervasive attitudinal and behavior changes. The incidence and psychological correlates of such experiences, and their association with proximity to death, are unclear. We conducted a 30-month survey to identify near-death experiences in a tertiary care center cardiac inpatient service. ⋯ Near-death experiences were reported by 10% of patients with cardiac arrest and 1% of other cardiac patients (P<.001). Near-death experiencers were younger than other patients (P=.001), were more likely to have lost consciousness (P<.001) and to report prior purportedly paranormal experiences (P=.009), and had greater approach-oriented death acceptance (P=.01). Near-death experiencers and comparison patients did not differ in sociodemographic variables, social support, quality of life, acceptance of their illness, cognitive function, capacity for physical activities, degree of cardiac dysfunction, objective proximity to death, or coronary prognosis.
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Gen Hosp Psychiatry · Jul 2003
The Institute of Medicine "Chasm" report: implications for depression collaborative care models.
The Institute of Medicine report "Crossing the Quality Chasm: A New Health Care System for the 21st Century" describes the barriers in the American health care system to improving quality of care and outcomes of chronic illness. This article describes how depression collaborative care models as well as newer research aimed at organizational and economic issues have addressed these barriers in order to improve outcomes for patients with depression in primary care systems.
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Gen Hosp Psychiatry · Mar 2003
Long-term quality of life in patients surviving at least 55 months after lung transplantation.
The aim of this study was to examine the long-term effect of lung transplantation on Health Related Quality of Life by studying 28 patients who survived at least 55 months after lung transplantation. Measures included the Nottingham Health Profile, questions concerning lung-specific problems, the State-Trait Anxiety Inventory, the Self-rating Depression Scale, the Index of Well-Being, the Karnofsky performance index, and questions concerning activities of daily life. Furthermore, comorbid conditions were measured. ⋯ The number of patients suffering from a decrease of kidney function, drug treated hyperlipidemia, insulin dependent diabetes mellitus and bronchiolitis obliterans syndrome increased. It may be concluded that patients experience a stable and better overall quality of life after transplantation. Long-term after lung transplantation patients experience a decline on several dimensions of quality of life, which may be explained by an increase of comorbid conditions and Bronchiolitis Obliterans Syndrome.