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Biomedical subjects

A Lobo

Publications and source records attributed to A Lobo.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Referral pattern of neurological patients to psychiatric Consultation-Liaison Services in 33 European hospitals.

The referral pattern of neurological patients to 33 European psychiatric consultation-liaison (C-L) services in the general hospital was examined. Analyses were conducted on the ECLW CS data set, which consists of 14,717 psychiatric C-L referrals made in 56 European hospitals during 1991. Psychiatric referrals of patients admitted to neurological wards were compared to referrals from other wards. Information was obtained from 33 neurological wards, consisting of 34,506 neurological admissions. Of these admissions, 839 were referred to C-L psychiatry. The median consult rate among the hospitals was 1.8%. Compared to other hospital wards, patients referred from neurology were more frequently diagnosed as suffering from somatoform (P<.01) and dissociative disorders (P<.01), and less from substance abuse (P<.01) and delirium (P<.01). Referral to C-L psychiatry from neurological wards is characterized by an underestimation of psychiatric co-morbidity and a late detection, comparable to other medical specialties. An appeal is made for a standardized referral procedure including admission screening method, detecting patients at risk for nonstandard care during their hospital admission.

Delirium↗
PubMedDate not supplied

Consultation-Liaison psychiatric service delivery: results from a European study.

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.

Adult↗
PubMedDate not supplied

"INTERMED": a method to assess health service needs. I. Development and reliability.

The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational purposes. First, a feasibility study (N = 21 patients) was conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Averaged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes; as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study 1 revealed that on most items there was considerable agreement; some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was more susceptible to differences. Some improvements--mainly of the anchor points--were specified which may further enhance interrater reliability. The INTERMED proves to be a reliable method for classifying patients' care needs, especially when used by experienced raters scoring by patient interview. It can be a useful tool in assessing patients' care needs, as well as the level of needed adjustment between general and mental health service delivery. The INTERMED is easily applicable in the clinical setting at low time-costs.

Humans↗
PubMedDate not supplied

The contribution of epidemiology to psychosomatic medicine.

OBJECTIVE: To discuss the contribution of epidemiology and epidemiological methods to psychosomatic medicine. METHOD: Critical review of the literature, including both philosophical concepts and empirical data. RESULTS: The adjective "psychosomatic" has been used in two different ways: in the so called "psychosomatic" or holistic approach to medicine; and in a narrower approach, referring to particular disorders in which psychological factors were considered to have a fundamental aetiological role. While the ideal of the holistic, "humanistic" or "anthropological" approach should probably be never abandoned, the practical limitations of encompassing models, including Engel's bio-psycho-social model are also obvious: they may be heuristically sterile. On the other side, in relation to the narrow psychosomatic approach, psychogenetic views in the so called "psychosomatic illnesses" have been strongly criticized on empirical grounds. The potential of epidemiological methods to study these illnesses, but also "somatopsychic" disorders is shown in a number of papers in the empirical literature. We have grouped such contributions, including our own experience, in the five categories suggested by M. Shephered for epidemiological methods in general: 1) the completion of the spectrum of disease; 2) the establishment of outcome; 3) the actuarial assessment of morbid risk; 4) the evaluation of the efficacy of treatment; and 5) the conceptual construction of diagnosis and classification. CONCLUSIONS: The contribution of epidemiological data to areas of interest in psychosomatic medicine has been relevant in recent years. The potential of epidemiological methods in this area is very important both to increase knowledge and to improve the quality of clinical practice.

Female↗
PubMedDate not supplied

European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study.

The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse. German psychosomatic C-L services saw virtually no such patients, although in other C-L services these patients constituted one-quarter to one-third of the patients referred. The second difference lays in the remaining group of referred patients. This group is best characterized by two dimensions. One describes the severity of psychopathology -- ranging from organic mental conditions to somatization. The other describes the clarity of the physical diagnosis -- ranging from patients referred by surgical wards to those referred by general medicine and neurology wards.

Adult↗
PubMedDate not supplied

Care complexity in the general hospital: results from a European study.

There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between complexity indicators, highlighting differences between length of stay (LOS), objective complexity (such as medications or consultations), complexity ratings by the nurse, and complexity ratings by the doctor. Their findings illustrate limitations in the use of LOS as a sole indicator for care complexity. The authors show how objective and subjective complexity indicators can be used for early and valid detection of patients needing interdisciplinary care.

Diagnosis-Related Groups↗
PubMedDate not supplied

Risk factors for complex care needs in general medical inpatients: results from a European study.

The authors linked admission risk factors to a series of indicators for complex care delivery to enable detection of patients in need of care coordination at the moment of admission to the general hospital. The authors found 13 risk factors to be predictive of more than one indicator of care complexity. An admission risk screening procedure to detect patients in need of care coordination should focus on these risk factors and should include predictions made by doctors and nurses at admission and information collected from the patient and the medical chart.

Diagnosis-Related Groups↗
PubMedDate not supplied

COMPRI--an instrument to detect patients with complex care needs: results from a European study.

The authors developed a screening instrument to detect patients in need of complex care coordination at admission to a general hospital. On the basis of a series of risk factors for care complexity, the authors constructed a short, care complexity prediction instrument (COMPRI) and assessed its qualities. The COMPRI is an easily administered screening instrument that detects patients at risk for complex care needs for whom care coordination is indicated. COMPRI's predictive power exceeds all currently available case-mix instruments.

Diagnosis-Related Groups↗
PubMedDate not supplied

Spanish perspective on enlarging a small specialty: the national research network for liaison psychiatry and psychosomatics.

The Spanish Research Network in Liaison Psychiatry and Psychosomatics (REPEP) comprises 11 centers (nodes), and was one of the successful applicants in a very competitive call for a networking program for the National Institute of Health "Carlos III" project. This article describes its general objectives and strategic plans. Both qualitative and quantitative results support our statement that this "perspective" should help to enlarge what is presently a small specialty. Synergies in the network have been potentiated; an ambitious national study on depressive comorbidity in complex medical patients has been executed; and new research and training programs have been initiated.

Forecasting↗
PubMedDate not supplied

[The assessment of working memory by Mini-Mental State Examination].

INTRODUCTION: Delayed recall items of the Mini-Mental State Examination (MMSE) and the Mini Cognitive Examination are based on a simultaneous processing of the storage of the material to be remembered while other test's items are executed. This function is probably mediated by the working memory (WM) system. OBJECTIVE: A new protocol of WM assessment during the Mini Cognitive Examination application is presented. PATIENTS AND METHODS: The standard Mini Cognitive Examination is modified with two new items of registration and recall. Criteria to introduce three new words in registration 2 and 3 is a complete recall of the three previous words. The score of the three recall trials, until a 27 points maximum, represents WM. A sample of 44 patients with probable Alzheimer's disease (AD), 19 with possible AD, 39 patients with cognitive impairment without dementia and 14 control subjects were evaluated. RESULTS: Patients with probable AD and possible AD showed the minimum WM scores and the greatest percentage of words repetitions (WM 3.2 +/- 3.6 and 7 +/- 6, with 91 and 83% of repetitions, respectively); control subjects scored a WM of 22 +/- 6 with 14% of repetitions; patients with cognitive impairment without dementia scored a WM of 11 +/- 4 and 50% of repetitions. CONCLUSIONS: We propose that delayed recall items of the MMSE and the Mini Cognitive Examination are an index of WM capacity. This new method reinforces the assessment of delayed recall during Mini Cognitive Examination or MMSE application, and can facilitate an early detection of anterograde amnesia.

Aged↗
PubMedDate not supplied

[HLA antigens in bipolar affective patients].

The presence of H.L.A. antigens in bipolar affective patients attending in the University Hospital of Zaragoza was studied and contrasted with findings in the general population. A random sample of 36 patients was selected for the study. All of them fulfill, both, DSM-III and RDC diagnostic criteria . The HLA antigen was studied by means of Lymphotoxicity Test of N.I.H. standard technique. Both, A29 and B21 HLA antigens were detect in the bipolar patients more frequently that in the controls (Histocompatibility Testing data, 1980), and the differences were statistically significant. It is also suggested that the A2 HLA antigen is more frequently found in bipolar patients "non-respondent" to lithium treatment. The inclination to relate these antigens to specifics genes in the bipolar illness should be pondered, since the risk of "false positives" inherent in studies testing association hypothesis is well known.

Bipolar Disorder↗
PubMedDate not supplied

[Standardized evaluation of obsessive phenomena in patients in general medicine. Prevalence and correlations].

Clinical experience in general hospital psychiatry and literature reviews supported the conjecture that psychopathological disturbances are frequent among medical patients. Wide discrepancies of prevalence data reported by different authors, however, suggested the importance of undertaking screening studies with standardized methods of assessment. Our initial studies in oncological patients confirmed the hypothesis, but also documented obsessive phenomena, assessed with Present State Examination (PSE) criteria, in more than one third of patients diagnosed of depression Consecutive studies in different medical samples have replicated those preliminary findings in the last one, close to one quarter of first day consecutive patients seen in an internal medicine out-patient clinic, and more than three quarters of the ones diagnosed of either anxiety or depression with Research Diagnostic Criteria, had obsessive symptoms as defined by the Clinical Interview Schedule (CIS). Obsessive symptoms, however, have also been observed in individuals considered to be "non-cases" and tend to follow a "continuum" distribution, rather than a categorical one They tend to be more frequent in cases diagnosed as neurotic or reactive, rather than in the endogenous ones and to correlate with neuroticism measured by the EPQ-A. Particularly among out-patients, where the psychopathology seemed to be related to the absence of demonstrable somatic illness and probably to the presence of social distress, the hypothesis could be advanced that obsessive symptoms, among other psychopathological phenomena, are quantitative reactions to environmental situations in predisposed individuals. Nevertheless, in samples such as the endocrine in-patients, correlations have also been demonstrated between obsessive or other psychopathological symptoms and biological deviations such as hormonal levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine System Diseases↗