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Biomedical subjects

C C Colenda

Publications and source records attributed to C C Colenda.

48 records · Page 3Linked to original sources
PubMed1989

First admission young adult patients to a state hospital: relative risk for rapid readmission.

High readmission rates by young adult patients to state hospitals represents a major service utilization problem for the public mental health system. By identifying those patients who have an increase risk for rapid readmission, effective community-based services could be developed to help reduce utilization of costly hospital services. A nonconcurrent prospective study of 210 first admission young adult patients admitted to a state hospital was conducted to ascertain the incidence of readmission within 180 days of discharge from the index admission (rapid readmission), and to establish relative risk for rapid readmission based on demographic, hospital utilization, and diagnostic variables. The cohort was partitioned into two subgroups: patients with no prior hospitalization, (NPH; N = 119), and patients with prior hospitalization, (PH; N = 91). Group comparisons revealed NPH patients had a lower readmission rate, had shorter hospital lengths of stay, and had a higher proportion on patients with personality or adjustment disorders. The relative risk for rapid readmission in the NPH patient group was greatest for nonwhite female patients (3.30) and for patients who had hospital length of stays between 4-15 days (1.76). In the PH patient group, the relative risk for rapid readmission was greatest for those patients with hospital length of stay less than 15 days (2.15). In both groups, patients with major mental illness were more likely to get readmitted. An association between hospital occupancy rate, the time of discharge from the index admission and readmission to the hospital, hospital length of stay, sex, race, or diagnostic category was not found.

Adjustment Disorders↗
PubMed1986

The psychiatry chief resident as information manager.

In all medical specialties, the chief resident position is considered an honor that is the culmination of a resident's hard work and clinical acumen. However, the position requires managerial skills that residents have had little exposure to during medical school and postgraduate medical training. In the paper presented here, the author describes a model involving a medical school department of psychiatry and affiliated residency programs and discusses how various components of the structure are organized (affiliated hospitals, groups of individuals, and administrative hierarchy) and how the movement of information is influenced by organizational structure and interpersonal relationships within the model. The author also describes how information management is a major administrative function for the chief resident and how various predicaments that a chief resident faces stem from his mishandling information and from a misinterpretation of his power and influence. Training issues that could maximize the chief resident's theoretical and practical administrative experience are discussed.

Humans↗
PubMedDate not supplied

Factors determining the level of anxiety state in geriatric primary care patients in a community dwelling.

The authors examined the association between anxiety state and various sociodemographic factors, as well as measures of general health, mood, and stress in a community-dwelling, geriatric population. A survey questionnaire designed for the study was completed by 123 randomly selected subjects. Univariable linear regression analysis showed anxiety state to have an inverse association with age (beta = -0.29, P = 0.0001) and general health measures (P = 0.0001), and to have a direct relationship with depression (beta = 0.78, P = 0.0001), life stress events (beta = 0.98, P = 0.01), and medical comorbidity (beta = 1.04, P = 0.01). Gender differences in anxiety state were not found. The results provide a framework to begin understanding those factors that contribute to anxiety states in late life. This study revealed anxiety and depression to be highly correlated even in elderly subjects who reported low levels of anxiety and depressive symptoms.

Age Factors↗
PubMedDate not supplied

Substance dependence and the use of pro re nata anxiolytic/hypnotic drugs in a hospital setting.

Patients hospitalized for treatment of psychiatric illness commonly receive pro re nata (p.r.n.) anti-anxiety and hypnotic agents. The relationship between illicit drug use and p.r.n. anti-anxiety/hypnotic drug use in hospitalized psychiatric patients has not been extensively examined. The purpose of the present study was to examine this relationship. A retrospective review of 99 randomly selected hospitalized patients abstracted information regarding the utilization of p.r.n. anxiolytic and hypnotic medications. Seventy percent of the patients surveyed evidenced substance dependence. The substance users utilized p.r.n. anxiolytics (t = 2.29, df = 81, p < .05) and bedtime hypnotics (t = 4.23, df = 90, p < .0001) more frequently than the nonusers. Hospitalized substance abusers appear to continue their substance abuse in the hospital, substituting prescription preparations for illicit drugs. Nevertheless, cumulative literature now suggests that p.r.n. anxiolytic and hypnotic agents play a critical role in the management of aggressive behavior and insomnia in patients hospitalized with psychiatric illness.

Adult↗
PubMedDate not supplied

An international comparison of physicians' judgments of outcome rates of cardiac procedures and attitudes toward risk, uncertainty, justifiability, and regret.

OBJECTIVE: Compare U.K. and U.S. physicians' judgments of population probabilities of important outcomes of invasive cardiac procedures; and values held by them about risk, uncertainty, regret, and justifiability relevant to utilization of cardiac treatments. DESIGN: Cross-sectional study. SETTING: University hospital and VA medical center in the United States; two teaching hospitals in the United Kingdom. PARTICIPANTS: 171 housestaff and attendings at U.S. teaching hospitals; 51 physician trainees and consultants at U.K. hospitals. MEASURES: Judgments of probabilities of severe complications and deaths due to Swan-Ganz catheterization, cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG); judgments of malpractice risks for case vignettes; Nightingale's risk-aversion instrument; Gerrity's reaction-to-uncertainty instrument; questions about need to justify decisions; responses to case vignettes regarding regret. RESULTS: The U.S. physicians judged rates of two bad outcomes of cardiac procedures (complications due to cardiac catheterization; death due to CABG) to be significantly higher (p < or = 0.01) than did the U.K. physicians (U.S. medians, 5 and 3.5, respectively; U.K. medians 3 and 2). The median ratio of (risk of malpractice suit I error of omission)/(risk of suit I error of commission) judged by U.K. physicians, 3, was significantly (p=0.0006) higher than that judged by U.S. physicians, 1.5. The U.K. physicians were less often risk-seeking in the context of possible losses than the U.S. physicians (odds ratio for practicing in the U.K. as a predictor of risk seeking 0.3, p=0.003). The U.K. physicians had significantly more discomfort with uncertainty than did the U.S. physicians, as reflected by higher scores on the stress scale (U.K. median 48, U.S. 42, p=0.0001) and the reluctance-to-disclose-uncertainty scale (U.K. 40, U.S. 37, p < 0.0001) of the Gerrity instrument. There was no clear international difference in perceived need to justify decisions, or in regret. CONCLUSIONS: The results were not clearly consistent with the uncertainty hypothesis that international practice variation is due to differences in judged rates of outcomes of therapy or with the imperfect-agency hypothesis that practice variation is due to differences in physicians' personal values. The causes and implications of practice variations remain unclear.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Positive ego and coping functions in chronic pain and depressed patients.

Three groups of elderly subjects (chronic pain patients, patients with major depression, and healthy individuals) were administered measures of self-esteem, ego defense mechanisms, and coping style to examine how these personality components are affected by illness. Ego defense mechanisms and self-esteem for all three groups were not found to be different and were positive except for depressed patients, who used greater levels of projection and demonstrated lower levels of self-esteem. Each subject group utilized equally problem-focused and emotion-focused coping styles. These findings from a preliminary study are consistent with previous research demonstrating stability of personality throughout the life span, and suggest that the psychological functioning of older individuals with chronic pain syndromes or depression remains positive and resilient.

Adaptation, Psychological↗
PubMedDate not supplied

Hospital utilization and readmission rates for geriatric and young adult patients with major depression: results from a historical cohort study.

Late-life depression may have different clinical features, hospital utilization patterns, and natural history, depending on whether the illness begins in midlife or late life. This historical cohort study examined three patient groups, late-onset geriatric depressed patients, early-onset geriatric depressed patients, and young adult depressed patients, to determine hospital utilization patterns, readmission rates, and whether specific clinical symptoms on admission predisposed patients to readmission. The two geriatric patient groups had similar demographic, medical comorbidity, and hospital utilization profiles, except that the early-onset geriatric depressed group had longer hospital lengths of stay. Hospital utilization patterns for the young adult patients were different from the geriatric patients, but in the expected direction, ie, less medical comorbidity and shorter lengths of stay. Patients with late-onset geriatric depression had the highest 24-month readmission rate (47.4%), followed by early-onset geriatric depression patients (23.1%) and young adult patients (16.7%). Delusional symptoms and agitation were similar across the three patient groups and, as expected, somatic complaints were more frequent in the geriatric patient groups. The relative risk for readmission was greatest for geriatric patients who were somatic. Readmission risk was increased for agitated late-onset geriatric depressed patients and young adult patients, but not for early-onset geriatric depressed patients. Delusional symptoms did not predict readmission for any patient group.

Adult↗