Biomedical subjects
Jonathan F Borus
Publications and source records attributed to Jonathan F Borus.
The chair's work: fun, but never done.
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Nonspecific medication side effects and the nocebo phenomenon.
Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors. Physicians and other health care personnel can attempt to ameliorate nonspecific side effects to active medications by identifying in advance those patients most at risk for developing them and by using a collaborative relationship with the patient to explain and help the patient to understand and tolerate these bothersome but nonharmful symptoms.
Predictors and outcomes of delirium.
OBJECTIVES: To determine factors associated with the occurrence of delirium among patients undergoing surgical repair of abdominal aortic aneurysm (AAA). METHODS: The sample included all consenting patients who underwent AAA repair during a 12-month period. Before surgery, daily while in hospital, and at 1 and 6 months after surgery, we assessed patients' mood, mental status and functional status. We compared delirious and nondelirious patients for severity of preoperative depressive symptoms, length of hospital stay and mortality. The effects of delirium on postoperative functional status were assessed in conjunction with postoperative depressive symptoms using regression models. RESULTS: The sample of 35 patients was primarily male and elderly; one-quarter had three or more medical conditions; and eight (23%) developed delirium after surgery. Postoperative delirium was significantly associated with preoperative depressive symptoms, alcohol use and cognitive impairment as well as with longer lengths of stay and poorer functional status at 1 and 6 months after surgery. CONCLUSION: Identification and treatment of patients with depressive symptoms, alcohol use and cognitive impairment prior to AAA surgery could reduce the incidence of postoperative delirium and the prolonged hospital stays and impaired functional status associated with it. Surgeons should consider using simple screening instruments before surgery to identify patients at risk and referring them for psychiatric evaluation and treatment. They should also consider including psychiatrists early in the care of high-risk patients to improve detection of and early intervention for delirium.
Getting our own house in order: improving psychiatry education to medical students as a prelude to medical school education reform.
OBJECTIVE: The authors summarize efforts to revitalize psychiatry teaching to medical students at Harvard Medical School (HMS) in advance of a major overhaul of the medical school curriculum. METHODS: This preliminary report chronicles key challenges and the organization of the reform effort within the departments of psychiatry affiliated with the medical school. RESULTS: Based upon a comprehensive internal review of psychiatric education at the medical school, the HMS Psychiatry Executive Committee and psychiatry faculty concluded that psychiatry teaching was underresourced and lacked cohesion and consistent standards and expectations across clinical sites involved in psychiatry teaching. Through a willingness to identify and vigorously address deficiencies in medical student education within a large decentralized program, psychiatry has earned a reputation as an effective reform agent at the medical school. CONCLUSIONS: Psychiatry education improvements have strengthened our partnership with the medical school as it is undertaking major educational reform of its entire curriculum.
Through the golden chalkboard: twelve teaching pearls on the teaching-learning process in psychiatry.
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