PubMed Health⌕ Search

Biomedical subjects

D B Larson

Publications and source records attributed to D B Larson.

At least 73 records · Page 4Linked to original sources
PubMed1989

A proposed value matrix for the evaluation of psychiatric consultations in the general hospital.

A strategy of determining the value of psychiatric consultation services in the general hospital is presented. Value analysis, a theoretically driven model for establishing the worth of mental health services from multiple perspectives, is used to propose a value matrix for consultation psychiatry. Based on an integration of decision theory and evaluation science, the goal of value analysis is to establish a range of outcomes that might be viewed as important from various perspectives. This hypothesized matrix of economic and clinical values for patients, families, medical staff, providers, payors, and society provides a framework for evaluating outcomes of psychiatric consultation services.

Cost-Benefit Analysis↗
PubMed1989

Health services research in nursing homes: a systematic review of three clinical geriatric journals.

This article presents the results of a systematic review of five years of health services research found in nursing home studies published in three major geriatric journals. This review indicates that very little services research has been undertaken in nursing home settings. The small amount of quantitative, empirical research that has been published has suffered from research design, method, and analytic shortcomings. Nursing home research in at least one federal agency has experienced worse than average funding and disapproval rates. The implications of this review are discussed, and recommendations are made for advancing this important area of study.

Aged↗
PubMed1989

Religious affiliations in mental health research samples as compared with national samples.

Religious affiliations of patients in research samples in four major psychiatric journals for the years 1978-1982 were compared with those reported in national samples. Protestants and the unaffiliated were underrepresented, whereas Jewish persons were overrepresented. Catholics used mental health services in proportions similar to their presence in the population at large. These findings suggest that religious affiliation may influence the use of mental health services.

Catholicism↗
PubMed1989

Prescribing of psychotropics in elderly nursing home patients.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Aged↗
PubMed1989

Effect of a psychiatric liaison program on consultation rates and on detection of minor psychiatric disorders in cancer patients.

Because only 2% of the 47% of cancer patients with psychiatric disorders receive psychiatric consultations, the authors investigated the impact of a psychiatric liaison program on improving consultation rates on a gynecologic oncology unit. Consultation rates for gynecologic cancer patients before and after introduction of the program were compared to rates from other cancer patients in the same hospital during the same 7-year period. Rates for the gynecologic patients were higher after the program (9%) than before (4%), as were rates for follow-up consultations, and the detection of minor DSM-III disorders improved. The authors conclude that liaison improves access to psychiatric treatments that often enhance the quality of life for seriously ill patients.

Female↗
PubMed1989

The construct validity of the ischemic score of Hachinski for the detection of dementias.

Two hundred forty-one nursing home patients from the National Nursing Home Survey Pretest were assessed using the Ischemic Score of Hachinski. Medical chart diagnoses were used to classify those with and without dementia. The Mini-Mental State Examination was used to assess the accuracy of the medical-chart diagnoses of dementia. The Ischemic Score failed to differentiate multi-infarct dementia from other types of dementias. Instead, the difference between the two dementia groups was in the direction opposite that predicted by Hachinski.

Aged↗
PubMed1989

Psychosocial services for AIDS patients in the general hospital.

Ninety consecutive non-repeating hospital admissions of patients with AIDS were studied. The rates of psychosocial service utilization were quite high for consultation psychiatry (24.4%), social work (42.2%), and home care (discharge planning) nursing (24.4%). The presence of psychiatric co-morbidities and social needs were associated with increased length of stay. In addition, psychiatric co-morbidities were associated with increased charges for pharmacy and laboratory.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Site-specific analysis of total serum cholesterol and incident cancer in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.

We studied the relation of total serum cholesterol to all cancer and site-specific cancer incidence in a cohort based on a probability sample of the United States population. A total of 5125 men (yielding 459 cancers) and 7363 women (398 cancers) were initially examined in 1971-75 and followed a median of 10 yr. An examination of age-adjusted incidence rates by cholesterol level showed an inverse association between cholesterol and all cancer; lung, colorectal, pancreatic, and bladder cancers; and leukemia. In women a weak inverse relation (reflecting an elevated rate among those only in the lowest cholesterol quintile) was apparent for all cancer; more prominent inverse associations were seen for cancers of the lung, pancreas, bladder, cervix, and for leukemia. A more detailed analysis of cholesterol and colorectal cancer revealed little association in both men and women. For an aggregate group of smoking-related cancers, the inverse relation was especially prominent: the multivariate relative risk estimates for subjects in the lowest cholesterol quintile, compared to those in the highest quintile, were 2.1 (1.1-3.8) and 3.3 (1.4-7.8) for men and women, respectively. The inverse association was present for smoking-related cancers diagnosed 6 or more yr after cholesterol determination in both men and women, suggesting that this association cannot be simply dismissed as a preclinical cancer effect. Further investigation of the cholesterol-cancer question, particularly the relation between cholesterol and smoking-related cancers, may provide useful etiological leads.

Adult↗
PubMed1988

Prescribing of psychotropic medication by primary care physicians and psychiatrists.

This study investigates the prescribing of psychotropic medications by primary care physicians and psychiatrists using the National Ambulatory Medical Care Survey database. Results indicate that primary care practitioners provide a larger percentage of psychotropic drug visits than psychiatrists in every psychotropic class except for those patients prescribed lithium. In addition, the two provider groups differed in the relative proportions of the classes of psychotropic drugs prescribed. Primary care physicians prescribed anxiolytics most frequently, while psychiatrists prescribed antidepressants most often. Finally, in all therapeutic classes, when a psychotropic medication was prescribed, psychiatrists typically provided a mental health diagnosis, while primary care physicians did not.

Ambulatory Care↗
PubMed1988

Psychiatric co-morbidities and patients with head and spinal cord trauma. Effects on acute hospital care.

Three hundred twenty-one patients with traumatic head and spinal cord injuries were studied. Forty-two of these patients (13.1%) received psychiatric consultation services. Two types of consultation patients were identified--one receiving psychiatric consultation services in the acute-care hospital and one receiving psychiatric services in the post-acute care, long-term rehabilitation center. In order to assess the impact of psychiatric co-morbidities on hospital length of stay and charges, 40 consultation patients (23 acute and 17 rehabilitation) were matched to 87 control patients who received no psychiatric services. Matching was done on severity of injury, age, and sex. Psychiatric consultation cases had significantly longer stays than did matched controls. There were no differences on total charges.

Adjustment Disorders↗
PubMed1988

Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study.

The relation between self-reported physical activity and depressive symptoms was analyzed for 1,900 healthy subjects aged 25-77 years in the Epidemiologic Follow-up Study (1982-1984) to the first National Health and Nutrition Examination Survey (NHANES I). Depressive symptomatology as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) was examined by sex and race in relation to recreational physical activity and physical activity apart from recreation, controlling for age, education, income, employment status, and chronic conditions. Little or no recreational physical activity and little or no physical activity apart from recreation were cross-sectionally associated with depressive symptoms in whites and in blacks. After exclusion of those with depressive symptoms at baseline, recreational physical activity was an independent predictor of depressive symptoms an average of eight years later in white women. The adjusted odds of depressive symptoms at follow-up were approximately 2 for women with little or no recreational physical activity compared with women with much or moderate recreational physical activity (95% confidence interval 1.1-3.2). These findings are the first indication from a prospective study of a large community sample that physical inactivity may be a risk factor for depressive symptoms.

Adult↗
PubMed1988

Glucocorticoids in muscular dystrophy: beneficial effects of dexamethasone on avian myopathy.

A corticosteroid with mixed glucocorticoid-mineralocorticoid actions was previously shown to improve neuromuscular function in muscular dystrophic chickens. The significance of that finding was recently underscored by reports that a mixed-action corticosteroid improved muscle function in Duchenne dystrophy patients, albeit at high doses. In the present study a pure glucocorticoid improved function and retarded muscle histopathology in the chicken, but a pure mineralocorticoid did not. These observations suggest that elucidation of mechanisms by which glucocorticoids beneficially affect dystrophic muscle could lead to development of more effective therapies.

Acetylcholinesterase↗
PubMed1988

Adult burn patients: the role of religion in recovery.

Patients who have had a severe physical injury, such as a burn, show wide variations in their abilities to cope with the stress of hospitalization and recovery. Clinical experience has consistently shown that some of these patients have remarkable emotional resilience, while others are more seriously affected. Many researchers have attempted to understand these variations in hope of finding ways to enhance the recovery process and to improve long-term outcome. Previous research shows that when burn patients are given the opportunity to talk about what helps them cope, they frequently credit their religious faith or God. We emphasize the importance of understanding the relationship between patients' religious beliefs and their ability to deal with the stress of a traumatic injury.

Adaptation, Psychological↗
PubMed1988

Treatment opportunities on a consultation/liaison service.

The amount of time consultation psychiatrists in a large metropolitan teaching hospital spent providing direct services was studied over 1,104 consecutive consultation cases. Although the majority of cases required less than 5 hours of psychiatric time apiece, more than 10% of these cases each received more than 10 hours of direct services. This finding has important implications for understanding the types of psychiatric services provided to hospitalized medical/surgical patients.

Humans↗
PubMed1988

The couch and the cloth: the need for linkage.

Data from the Epidemiologic Catchment Area study were used to compare the demographic characteristics and psychiatric symptomatology of persons classified into four groups based on source of mental health services: clergy only, mental health specialists only, both clergy and mental health specialists, and neither source. Those receiving services from both clergy and mental health specialists were more likely to have major affective and panic disorders than those who sought services from clergy or mental health specialists only or who sought services from neither. Those in the care of mental health specialists were more likely to have substance abuse disorders. Those in the care of clergy only were as likely as those seeing mental health specialists only to have serious mental disorders. The data make clear the need for formal linkages between clergy and mental health professionals.

Adolescent↗
PubMed1988

The impact of coexisting depression and timing of psychiatric consultation on medical patients' length of stay.

Patients with a psychiatric disorder are known to make greater use of medical resources than patients without a psychiatric condition, but the impact of highly prevalent psychiatric illnesses, such as depression, on use of medical resources has not been fully explored. This study assessed the lengths of stay of 92 medical and surgical patients who met DSM-III criteria for depression and the relationship of their length of stay to the timing of psychiatric consultations. The 92 patients were hospitalized significantly longer (a mean of 2.52 days more) than they would have been had their length of stay been determined by their medical diagnosis-related group (DRG). A subgroup of 38 Medicare patients were hospitalized a mean of 5.22 days more than the mean stay allowed by their DRG. Consultations occurring earlier in the hospitalizations were linked to shorter stays.

Bipolar Disorder↗
PubMed1988

A systematic analysis of religious variables in The Journal of Family Practice, 1976-1986.

One thousand eighty-six studies were reviewed to determine the prevalence, characteristics, and quality of measures of religion or religiosity in The Journal of Family Practice for the decade ending in 1986. Religious variables occurred at a relatively low rate, even among articles with some psychosocial content. The clear preponderance of religious measures pertained to patients rather than to providers, and religious variables were generally analyzed descriptively, not inferentially. In spite of an encouraging use of some measures of religious beliefs and practices, there remained a significant focus on denominational measures of religious status. These findings suggest that the consideration of religious variables in the family medicine literature has not been commensurate with the emerging picture of the role of religious commitment in health status and mental health status. It is suggested that increased emphasis on developing an original literature of record about religious variables in family medicine will promote the empirical assessment of the beneficial, neutral, and harmful effects of religion among family medicine patients and providers.

Family Practice↗