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Biomedical subjects

M W Hengeveld

Publications and source records attributed to M W Hengeveld.

At least 55 records · Page 3Linked to original sources
PubMed1991

Management of patient-staff and intrastaff problems in psychiatric consultations.

Four possible types of management of patient-staff and/or intrastaff (PS/IS) problems in psychiatric consultations are distinguished and operationalized. The occurrence and correlates of these types of interventions were studied in a multisite investigation of 1112 consecutive consultations in five general hospitals. PS/IS problems (possibly, probably, or certainly) played a role in 28.1% of the consultations studied. The psychiatric consultants utilized a primarily patient-oriented approach in 56.7% of these 310 consultations, whereas in 42.3% they performed (covert or overt) staff-oriented case consultations. A staff-oriented approach may be contraindicated when the PS/IS problems are not very serious or too complex. In the literature staff resistance and hospital culture are frequently mentioned as obstacles to staff-oriented interventions. The present study showed, however, that it was often the consultants' own degree of security about the PS/IS problems that determined the way they handled these problems. Staff-oriented consultations took significantly more of the psychiatric consultants' time. The clinical and economic benefits of such interventions have still to be established. But the psychiatric consultant with a true biopsychosocial approach should always be cognizant of the possible occurrence of PS/IS problems and consider applying a staff-oriented intervention.

Humans↗
PubMed1991

Suicide risk in female suicide attempters not responding to a follow-up study.

The 95 patients not responding to a follow-up study of 227 female suicide attempters differed from the responders in that fewer of them were undergoing psychiatric treatment at the time of the suicide attempt and fewer were referred for psychiatric outpatient aftercare following the suicide attempt. Yet, the subsequent occurrence of suicide was no higher in the group of nonresponders than in the group of responders. This study again underlines the difficulty of predicting recurrent suicidal behavior, even in a high-risk group of suicide attempters.

Adult↗
PubMed1990

Staff attitudes toward violence in the general hospital. A comparison between Amsterdam and Tel Aviv.

This study reports the results of a cross-cultural comparative investigation of violent behavior of patients, relatives, and visitors toward the medical staff in two general hospitals. The situation in an Israeli community general hospital in Tel Aviv was compared to that of a Dutch university hospital. General impressions existed that violence appeared to be a serious problem in the hospital in Tel Aviv, whereas there are scarcely any reports of violence in general hospitals in the Netherlands. Semistructured interviews with members of the medical and nursing staff confirmed these impressions. In Israel, the "aggressor" would be described as a young male without any specific traits, whereas in the Netherlands, he would be associated with alcohol abuse, drug addiction, and would possibly belong to street gangs or be a member of a minority group. Circumstances that may lead to violence are mentioned and situational, and social and cultural influences are discussed.

Aggression↗
PubMed1989

Development of consultation-liaison psychiatry in The Netherlands. Its social psychiatric heritage.

Dutch consultation-liaison psychiatry (C-L psychiatry) has followed a developmental line separate from the American system. First, C-L psychiatry in the Netherlands has been less influenced by psychosomatic medicine than by social psychiatry. Second, the presence of psychiatric units in general hospitals that appear to be correlated with the growth of C-L psychiatry in the United States occurred later in the Netherlands. Third, little government support for clinical care, research, and especially for training has been available to Dutch psychiatry. Consequently, there has been little recent financial pressure on C-L psychiatry from reduced government support, as occurred in the United States. Finally, the relationship between primary and secondary health care in the Netherlands allows C-L psychiatry to have a direct impact on several inpatient and ambulatory levels in the health care chain. A nationally accepted database form for the computerized registration of the Psychiatric Consultations at the eight university hospitals and ten other general hospitals is currently in use. To facilitate standardization and recording the psychiatric consultation process, the Netherlands Consortium for C-L psychiatry (NCCP) was formed.

Humans↗
PubMed1989

Length of hospital stay of medical and surgical inpatients referred for psychiatric consultation: a retrospective study.

Retrospective analysis of 406 consecutive psychiatric consultations with general hospital inpatients revealed that their mean length of stay (LOS) was 26.1 days, while the mean LOS of the other hospital patients was only 11.1 days. In 36.5 percent of the consultation patients the LOS in hospital was longer than that exceeded by 10 percent of the hospital patients. The factor most strongly related to a very long LOS of psychiatric consultation patients appeared to be the referring ward. Particularly on cancer wards very long LOS patients were referred to the psychiatrist. The psychiatric consultant often supported the ward staff by making recommendations for the management of such patients. Patients with a long LOS might be a suitable group for carrying out a controlled cost-effectiveness study of psychiatric consultations in a natural setting.

Adolescent↗
PubMed1988

A proposal for standardization of psychiatric consultation-liaison data.

There is still a striking lack of homogeneity in the terminology and classifications used in the registration of psychiatric consultation-liaison (C-L) data. Nowadays, the need for standardization of C-L data is greater than ever. Each registration consists of two components: the items and their categories. The present authors distinguish three levels of C-L data: fundamental, epidemiologic, and clinical-educational. A comprehensive proposal for standardization of such items and categories is presented, both on the fundamental and on the epidemiologic level. Data on 2657 consultations carried out by the Netherlands Consortium for C-L Psychiatry (NCCP) and from a literature review of 48 C-L reports serve to illustrate and as a supply for a large database. Various characteristics of the general hospital and of the C-L service are considered to be fundamental, that is, should be presented in each C-L publication. The epidemiologic data are divided into eight groups: sociodemographics, referral characteristics, history, diagnoses, diagnostic recommendations, ward management, discharge and aftercare management, and termination data. Finally, definitions and decision rules are given.

Adolescent↗
PubMed1988

Interventions in consultation-liaison psychiatry: the development of a schema and a checklist for operationalized interventions.

A literature review and pilot investigations reveal that (ward-) management consultation-liaison (C/L) psychiatry recommendations are infrequent and unsystematically used. Furthermore, the communication with the operational group as defined by Meyer and Mendelson is not sufficiently activated. The major focus of the consultation is the first contact, but follow-up is infrequent. With the exception of biologic recommendations and disposition, chart notes by psychiatric consultants do not sufficiently specify the actions to be taken by the ward staff in a general hospital. A schema for the systematic organization of the intervention was developed. A checklist of operationalized C/L interventions is reported. This combination provides a tool for the systematic use of strategic ward management and discharge recommendations. Its basic structure is currently integrated in MICRO CARES [Hammer et al, SCAMC]. The impact on clinical care, education, and research is described.

Adjustment Disorders↗
PubMed1988

Evaluation of psychiatric consultations with suicide attempters.

Diagnosis, management and disposition were evaluated in 120 psychiatric consultations with patients referred to a university hospital following an attempted suicide. Data were registered by hospital nurses and psychiatric consultants, and the patients were extensively interviewed after discharge. Many patients (43%) had been admitted to a psychiatric hospital on previous occasions or at the time of the suicide attempt. In almost one third of the cases, the consultants did not take sufficient interest in the patients' accounts of the last and previous suicide attempts. Their estimation of the reoccurrence of suicidal behaviour had a low predictive value (54%). One fourth to one half of the patients were negative about or not satisfied with the consultation. The compliance with the psychiatric consultants' referrals, however, was very high (79%). Although a large group of patients received effective care, the consultants did not pay enough attention to the group of (former) in-patients with recurrent suicidal behaviour. Possible causes and consequences of these findings are discussed.

Adolescent↗
PubMed1988

Psychiatric consultations with depressed medical inpatients: a randomized controlled cost-effectiveness study.

Nonspecific, supportive psychiatric consultations were performed with a random sample of thirty-three general medical inpatients scoring thirteen or more on the Beck Depression Inventory. The control group consisted of thirty-five patients, matched for sex, marital status, somatic history, and seriousness of illness. The number of patients receiving no analgesic and/or psychotropic medication in the consult group (39%) was significantly greater than that in the control group (17%). When compared with their mean BDI score on admission, the BDI score just before discharge had decreased significantly in the consult group (from 20 to 13), but not in the control group (from 19 to 16). Probably because the patient sample was too heterogeneous, with too low a prevalence of mental disorders (45%), a significant reduction in other medical care expenditures and in length of hospital stay could not be demonstrated.

Cost-Benefit Analysis↗
PubMed1988

Psychological aspects of bone marrow transplantation: a retrospective study of 17 long-term survivors.

In a retrospective study 17 patients were interviewed 1-5 years after bone marrow transplantation (BMT) about their emotional experiences and about the information and support given to them. In all patients the illness, the BMT and its consequences created severe emotional strain; their psychological state was closely linked to their physical condition. Yet, most patients showed a surprising emotional elasticity and affective adjustment. Although the patients were overwhelmingly positive about the information and support they had received, an important number of them felt inadequately prepared for the emotional and sexual problems they had to face in the first period after discharge. The results of this study have led to structural changes in the psychiatric and psychosocial approach to the BMT patients.

Activities of Daily Living↗