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Biomedical subjects

Peter de Jonge

Publications and source records attributed to Peter de Jonge.

27 records · Page 2Linked to original sources
PubMedDate not supplied

INTERMED: a measure of biopsychosocial case complexity: one year stability in Multiple Sclerosis patients.

The 1-year temporal stability of the INTERMED in a sample of patients with relatively stable care needs, patients with established Multiple Sclerosis (MS) was analyzed. Seventy MS patients underwent an interview to assess the INTERMED by a trained nurse, and two examinations of disability, EDSS and GNDS by medical doctors. At the following appointment with the nurse, approximately 1 year later, a second INTERMED assessment was done. Spearman correlations and change scores between the INTERMED assessments were calculated. Correlations between the two assessments were considerable: 0.75 for the total score and 0.55-0.74 for the domain scores (all P <.05). Median change of all four INTERMED domain scores and total score were 0. Changes in INTERMED total scores tended to be associated with changes in EDSS scores over time (P = 0.09), but not with changes in GNDS scores (P = 0.67). Patients with INTERMED scores above 20 on at least one of the two assessments had longer disease duration (P < 0.01), were more frequently suffering from a chronic form of MS (P < 0.01), and had more disability on EDSS (P < 0.01) and GNDS (P < 0.01) assessments. In a sample of patients with an established diagnosis of MS, INTERMED scores remained fairly stable over the period of a year. Implementing the INTERMED in routine care of patients with chronic conditions may help the clinician to structure interdisciplinary care.

Persons with Disabilities↗
PubMedDate not supplied

Depression following myocardial infarction: first-ever versus ongoing and recurrent episodes.

BACKGROUND: Depression following myocardial infarction (MI) can be a first-ever episode for some, whereas for others, it may represent a recurrent episode or one that was present at the onset of the infarction. We investigated if there are differences in pre- and post-MI characteristics between these subtypes. METHODS: Four hundred sixty-eight patients admitted for an MI were assessed for the presence of an ICD-10 depressive disorder following MI. A comparison was made between first-ever and ongoing or recurrent depression on demographic and cardiac data, personality, and depression characteristics. RESULTS: Depressive disorder during the first post-MI year was present in 25.4% of the MI patients (n = 119), and almost half were ongoing or recurrent (n = 53, 44.5%). Recurrent and ongoing depression was related to high neuroticism (Z = 2.77, P < .01), whereas first-ever depression was associated with MI severity (poor left ventricular ejection fraction: Z = 1.64, P = .05; PTCA or CABG during hospitalization: Z = 1.88, P = .03; arrhythmic events: Z = 1.49, P = .06). CONCLUSIONS: Our results suggest that in the first-ever post-MI depression cases, depression may be triggered by the severity of the MI, whereas ongoing and recurrent depression is more related to personality. Future research should address the question whether these subtypes of depression differ in cardiovascular prognosis and response to psychiatric treatment.

Aged↗
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Medical inpatients at risk of extended hospital stay and poor discharge health status: detection with COMPRI and INTERMED.

OBJECTIVE: To detect the patients in medical wards at risk of extended LOS and poor discharge health status with the use of complexity prediction instrument (COMPRI) and interdisciplinary medicine (INTERMED) instruments. METHODS: STUDY 1: In a sample of 275 consecutively admitted medical inpatients, a hierarchical cluster analysis on INTERMED variables was performed. The clusters were compared on length of hospital stay (LOS) and Short Form 36 (SF-36) at discharge. STUDY 2: Receiver operating characteristic (ROC) analysis was used to optimal cut-off points for the COMPRI and INTERMED. Patients detected with COMPRI and INTERMED were then compared with undetected patients on LOS and SF-36. RESULTS: STUDY 1: In concordance with previous findings, a cluster of patients with high biopsychosocial vulnerability was identified with significantly higher scores on LOS (p <.05) and lower scores on SF-36 (p <.001) than patients in other clusters. STUDY 2: A cut-off point for the COMPRI of 5/6 was found to detect patients at risk of long LOS. A cut off score for the INTERMED of 20/21 was found to detect patients at risk of poor discharge health status. Patients detected with COMPRI and INTERMED had a significantly longer LOS (p <.001) and a poorer discharge health status (SF-36 MCS: p <.001; SF-36 PCS: p =.05) than nondetected patients. Of the detected patients, 37% had an extended hospital stay and poor discharge health status; of the nondetected patients, this was only 7%. CONCLUSIONS: The COMPRI-INTERMED can help to detect complex patients admitted to medical wards within the first days of admission, and rule out those with a small chance of poor outcomes.

Case Management↗
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Implementing psychiatric interventions on a medical ward: effects on patients' quality of life and length of hospital stay.

OBJECTIVE: The authors investigated the effects of implementing psychiatric interventions on a general medical ward by means of a stepped detection and treatment strategy conducted by a consultation-liaison (CL) nurse in terms of reducing length of hospital stay (LOS) and improving quality of life (QOL) at discharge. MATERIALS AND METHODS: One hundred ninety-three patients participated in a controlled trial, in which patients were screened with COMPRI and INTERMED. A nurse under supervision of a CL psychiatrist conducted interventions, consisting of simple psychiatric interventions by herself, referral to auxiliary services, or initiation of postdischarge care. Intervention patients were compared with historic controls on LOS and QOL (SF36) at discharge. RESULTS: In multivariate analysis of variance, a significant effect of the intervention on QOL (p = 0.037) was found, which diminished after controlling for confounders (p = 0.28). No significant effect on LOS was found for the whole sample (p = 0.72), but in patients age 65 years or older, a reduction in LOS (p = 0.05) was found. This effect remained after controlling for confounders (p = 0.06). CONCLUSIONS: These data suggest that screening for risk of increased health care might improve outcomes in general medical inpatients. Because of the design of the study, however, these findings should be considered preliminary and confirmed in a larger, multicenter, randomized controlled trial.

Adult↗
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Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis.

OBJECTIVE: To assess the association of depression following myocardial infarction (MI) and cardiovascular prognosis. METHODS: The authors performed a meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO (1975-2003) combined with crossreferencing without language restrictions. The authors selected prospective studies that determined the association of depression with the cardiovascular outcome of MI patients, defined as mortality and cardiovascular events within 2 years from index MI. Depression had to be assessed within 3 months after MI using established psychiatric instruments. A quality assessment was performed. RESULTS: Twenty-two papers met the selection criteria. These studies described follow up (on average, 13.7 months) of 6367 MI patients (16 cohorts). Post-MI depression was significantly associated with all-cause mortality (odds ratio [OR], fixed 2.38; 95% confidence interval [CI], 1.76-3.22; p <.00001) and cardiac mortality (OR fixed, 2.59; 95% CI, 1.77-3.77; p <.00001). Depressive MI patients were also at risk for new cardiovascular events (OR random, 1.95; 95% CI, 1.33-2.85; p = .0006). Secondary analyses showed no significant effects of follow-up duration (0-6 months or longer) or assessment of depression (self-report questionnaire vs. interview). However, the year of data collection (before or after 1992) tended to influence the effect of depression on mortality (p = .08), with stronger associations found in the earlier studies (OR, 3.22; 95% CI, 2.14-4.86) compared with the later studies (OR, 2.01; 95% CI, 1.45-2.78). CONCLUSIONS: Post-MI depression is associated with a 2- to 2.5-fold increased risk of impaired cardiovascular outcome. The association of depression with cardiac mortality or all-cause mortality was more pronounced in the older studies (OR, 3.22 before 1992) than in the more recent studies (OR, 2.01 after 1992).

Cardiovascular Diseases↗
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Depressive symptoms in elderly patients after a somatic illness event: prevalence, persistence, and risk factors.

Elderly patients with somatic illness are at increased risk of depression. The authors studied the prevalence and persistence of depressive symptoms during the first year after the events of myocardial infarction, congestive heart failure, fall-related injury, and the diagnosis of cancer and their putative pre-event risk factors. The GLAS study contains data from 614 patients who experienced post-baseline myocardial infarction, cancer, heart failure, or fall-related injury of the extremities within 5 years after the baseline assessment. Follow-up was conducted 8 weeks, 6 months, and 1 year after the somatic event. The authors studied the relative importance of 21 baseline risk factors for experiencing significant depressive symptoms during follow-up and the persistence of depression. Depressive symptoms were prevalent in 38.3% of the subjects during the post-event year; in about 19.1%, symptoms were mild. For a majority of patients (67.5%), symptoms persisted until the next assessment. Significant pre-event risk factors were depressive symptoms at baseline, age, smoking, poor general health, poor well-being, and neuroticism. Within the depressed group, only neuroticism was related to the persistence of symptoms. Neuroticism increases the risk of experiencing post-event depressive symptoms and is related to their persistence, which suggests the existence of a depression-prone personality.

Accidental Falls↗
PubMedDate not supplied

Effectiveness of post-discharge case management in general-medical outpatients: a randomized, controlled trial.

This study was initiated to determine the impact of post-discharge, nurse-led, home-based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N=147) were randomly assigned to usual care or nurse-led, home-based, case management intervention. During the 24 weeks of follow-up, no difference between the two groups was found for readmission, care utilization, quality of life, or psychological functioning. Patients in the control group tended to move sooner to non-independent living accommodation than patients in the nurse-led, home-based, case management intervention group.

Aftercare↗
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Depressive symptoms in elderly patients predict poor adjustment after somatic events.

OBJECTIVE: The authors tested the hypothesis that elderly subjects with premorbid depressive symptoms are at increased risk of poor adjustment after a somatic event. METHODS: The GLAS study contains a baseline assessment and a follow-up of subjects who experienced post-baseline acute myocardial infarction, cancer, congestive heart failure, or fall-related injury of the extremities within 5 years after baseline assessment. Follow-up was conducted at 8 weeks, 6 months, and 1 year after the somatic event. Of a baseline sample of 5,279 elderly subjects (57 and older), 1,124 subjects who experienced one of the specified events were contacted, and sufficient follow-up data were obtained from 558 subjects. Authors analyzed the course of self-reported physical, role, and social functioning, and general health and well-being in subjects without baseline limitations. Patients with poor adjustment after the event were compared with patients with good adjustment on baseline depressive symptoms. They used logistic-regression analysis, controlling for several confounders. RESULTS: In multivariate analyses, pre-event depressive symptoms were associated with an increased risk of poor adjustment in terms of social and role functioning, well-being, and general health, but not physical functioning. CONCLUSIONS: Elderly persons living in the community reporting depressive symptoms are at increased risk of poor psychosocial adjustment after a somatic event. Each reported baseline depressive symptom was associated with an increased risk of chronic decline; this finding stresses the importance of detecting and treating depression in community-living elderly persons.

Adjustment Disorders↗