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Biomedical subjects

D Bilsker

Publications and source records attributed to D Bilsker.

8 recordsLinked to original sources
PubMed1998

Factors in delays in discharge from acute-care psychiatry.

OBJECTIVE: To determine if there are any potential opportunities for patients to be discharged earlier and to determine what factors are responsible for delays in discharge. METHOD: A survey was completed by clinical staff of all patients on the wards of 12 adult psychiatry units in the Greater Vancouver Regional Hospital District (GVRD) for a 1-day period. The survey included a modified Brief Psychiatric Rating Scale (BPRS) and the Discharge Readiness Inventory (DRI). A 1-month follow-up measured discharge and nondischarge outcomes. RESULTS: Of the 327 patients surveyed, 42% were ready for discharge at the time of the assessment, and 37% of those who were ready were not discharged within 2 weeks. Delayed patients had significantly higher scores for disorientation, hallucinations, conceptual disorganization, and manifest psychopathology and significantly lower scores for Community Adjustment Potential (CAP) (P < 0.05). The most frequent reasons given for delays were ongoing medication adjustment, behaviour stabilization, and discharge planning. Patients who were delayed were more likely to need services, to need or be waitlisted for a residential placement, to be a client of the community-based mental health team that provides ongoing support to clients living in the community, to have a diagnosis of schizophrenia, and to have had no previous psychiatric hospital admission. CONCLUSION: The removal of all barriers to delays would reduce lengths of stay by 11% for this sample of patients. This would require a shift of about 42 out of 327 beds to an alternate level of care. These "earlier discharge patients" will need ongoing medication and behaviour monitoring through a variety of community services.

Adult↗
PubMed1996

From evidence to conclusions in psychiatric research.

OBJECTIVE: To identify problems in the derivation of conclusions from evidence in psychiatry research. METHOD: The scientific model of falsificationism is described as determining the logical requirements for proving conclusions from research evidence. Common types of problematic conclusions are identified, and examples from the current research literature are given. RESULTS: Poorly formed conclusions are based on inadequate hypotheses, ambiguously phrased, blind to negative findings, fallacious in logic, or neglectful of alternative explanations. CONCLUSIONS: The risks of accepting poorly formed conclusions are premature closure of scientific investigations, poor basis for decisions in psychiatric practice, and provision of misinformation to patients. It is recommended that practitioners be attentive to this aspect of critically appraising research.

Humans↗
PubMed1995

Evidence-based psychiatry.

OBJECTIVE: To apply the evidence-based medicine paradigm to the domain of psychiatric practice and to bring out the consequences for psychiatry of this approach in order to foster the emergence of an evidence-based psychiatry. METHODS: The basic assumptions of traditional and evidence-based paradigms, as delineated by the Evidence-Based Working Group, are used to structure an exploration of the evidence-based approach to psychiatry. Theoretical and practical issues are considered and an example of evidence-based decision making is given. RESULTS: An evidence-based approach to psychiatry is described as one that emphasizes the importance of systematic observation and the use of rules of evidence in hypothesis testing. It is suggested that psychiatrists using this approach will be in a position to provide superior patient care. DISCUSSION: The application of scientific method to psychiatric problems is discussed as the essence of an evidence-based approach. The common error of "scientism" is described. The authors identify advantages and limitations of an evidence-based approach to psychiatric practice and advocate a decision-making process that balances individualized clinical acumen (phronesis) and information derived from empirical study of groups of patients (techne).

Canada↗
PubMed1992

An existentialist account of identity formation.

An account of James Marcia's identity formation model is given in the language of existentialist philosophy. Parallels between ego-identity and existentialist approaches are examined and identity is described in terms of existentialist concepts formulated by Martin Heidegger (Being and Time) and Jean-Paul Sartre (Being and Nothingness). While identity formation has previously been formulated in terms of ego-analytic theory, this paper argues and seeks to demonstrate that significant benefits accrue from an existentialist account. These benefits include clarification of difficult theoretical issues, delineation of specific research directions and enrichment of clinical understanding.

Adolescent↗
PubMed1991

Adaptive regression and ego identity.

An inventory of adaptively regressive experiences (Taft Ego Permissiveness Inventory) and the Identity Status Interview were administered to 71 college students (35 female, 36 male). As hypothesized, Moratorium status individuals (actively engaged in identity formation) showed a greater disposition to adaptive regression than did individuals in other statuses. This supports the view that adaptive regression may serve an important function in the identity formation process. Contrary to hypothesis, Achievement status individuals did not show greater disposition to adaptive regression than those in Foresclosure status. Females showed substantially greater disposition to adaptive regression than did males.

Adolescent↗
PubMed1986

Clinical utility of three measures of frontal lobe dysfunction in neuropsychiatric samples.

The utility of the Word Fluency Test, Wisconsin Card-Sorting Test, and a shorter form of the Categories Test as screening instruments for detecting frontal lobe dysfunction in a neuropsychiatric setting was examined. On the basis of clinical and neurological examination, patients were assigned to one of three groups: frontal lobe injured, brain impaired excluding the frontal areas, and psychiatric with no evidence of brain dysfunctioning. It was possible to assign correctly 66.3% of the patients to their respective groups. The Word Fluency Test made the strongest contribution to the prediction of the presence of frontal lobe pathology, even when the effects of age and postmorbid intellectual functioning were controlled. The results were consistent with the interpretation of lowered verbal fluency and deficits in the capacity to suppress habitual behaviour as a major feature of frontal lobe dysfunctioning.

Brain Damage, Chronic↗
PubMed1984

Bringing the feet in from the cold: thermal biofeedback training of foot-warming in Raynaud's syndrome.

The biofeedback-assisted treatment of a case of Raynaud's syndrome was examined in order to determine the relationship between learning of the hand-warming response and the subsequent ability to produce foot-warming responses. It was found that fluctuations in dermal hand and foot temperatures were not significantly related, either within or across treatment sessions. The obtained hand-warming response was of high magnitude and rapidly learned, while the foot-warming response was more modest and took substantially more trials to learn. These results indicate that an easy generalization of the hand-warming response cannot be assumed.

Adult↗