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Six-month and 12-month mental health outcome of medical and surgical patients admitted to general hospital

PSYCHOLOGICAL MEDICINE 2000年第2期30卷 359-367页

作者： Balestrieri, M Bisoffi, G De Francesco, M Eridani, B Martucci, M Tansella, M Univ Verona Dipartimento Med & Sanita Pubbl Sez Psichiat I-37100 Verona Italy Univ Udine Cattedra Psichiat Dipartimento Patol & Med Sperimentale & Clin I-33100 Udine Italy

Background, We have recently reported a two-phase study on psychiatric morbidity in a sample of general hospital patients. This paper reports the results of the 6-month and 12-month follow-up of these patients. Methods. The screening questionnaire was the GHQ-12. The main diagnostic instrument used in the second phase was the CIDI-PHC. All patients who had been interviewed with CIDI-PHC (N = 363) were followed-up and the baseline assessment was compared with the scoring on questionnaires administered in the 6-month postal enquiry and with the psychopathological status at 12-month, elicited with a telephone structured interview. Results, Sixty-two and 87% of patients completed the 6- and 12-month follow-up assessment respectively. The first follow-up indicated no significant decrease in the level of symptoms. The 12-month follow-up interview showed that 23 % of males and 40 % of females had poor/mostly poor mental health. The logistic model showed that females with a definite ICD-10 diagnosis, admitted to a medical department, who had consumed psychotropic drugs in the previous year, had the most unfavourable outcome. The risk of a poor/mostly poor outcome steadily increased with the severity of the psychopathology during hospitalization. Conclusion. In medical and surgical general hospital patients the risk factors associated with a poor mental health outcome are similar to those found in primary care patients. Greater attention should be paid in assessing routinely mental health status of general hospital patients during hospitalization.

关键词：慢性酒精中毒/诊断慢性酒精中毒/流行病学慢性酒精中毒/心理学焦虑症/诊断焦虑症/流行病学焦虑症/心理学抑郁症/诊断抑郁症/流行病学抑郁症/心理学随访研究医院综合/统计学和数值数据意大利/流行病学普查/统计学和数值数据精神障碍/诊断精神障碍/流行病学精神障碍/心理学病人入院/统计学和数值数据精神病状态评定量表/统计学和数值数据心理测定学危险因素青少年成年人老年人女(雌)性人类男(雄)性中年人

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Self-destructive acts occurring during medical general hospitalization

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GENERAL HOSPITAL PSYCHIATRY 2000年第2期22卷 115-121页

作者： Hung, CI Liu, CY Liao, MN Chang, YH Yang, YY Yeh, EK Chang Gung Mem Hosp Dept Psychiat Tao Yuan 333 Taiwan Chang Gung Mem Hosp Dept Nursing Tao Yuan 333 Taiwan Natl Taiwan Univ Hosp Dept Psychiat Taipei 100 Taiwan Taipei Med Coll Taipei Taiwan

Although several articles about suicide in general hospitals have been published, the rates of self-destructive individuals among various diseases and departments have not been reported previously. Moreover, self-destructive acts in Chinese general hospital inpatients have been neglected. We retrospectively investigated self-destructive incidents among medical general inpatients. A total of 75 self-destructive incidents, including 15 fatalities, were identified during the 10-year study period. The self-destructive rate was 8.7 per 100,000, and the fatality rate was 1.8 per 100,000 admissions. The highest self-destructive rate occurred in patients admitted to the rehabilitation weird (33.4 per 100,000) followed by the neurology ward (29.9 per 100,000). The highest fatality rate occurred among patients in the neurology ward (6.7 per 100,000). The majority of self-destructive patients suffered from a chronic or terminal illness with the most frequent types of illnesses being malignant neoplasm (31.1%), neurological disease (20.3%), and chronic obstructive pulmonary disease (COPD, 10.8%). COPD patients had the highest rate of self-destructive behavior (64.0 per 100,000) and the highest fatality rate (16.0 per 100,000) due to these incidents. The most common self-destructive incident was knife-cutting More than one-half (53.4%) of the self-destructive incidents occurred within the first 2 weeks of admission, and nearly one-half (46.7%) occurred during the night shift. Moreover, the majority of severe or fatal incidents also occurred during the night shift. The results suggest that close supervision of high-risk patients should be mandatory within the first 2 weeks following admission, especially during the night shift. (C) 2000 Elsevier Science Inc.

关键词：疾病/心理学医院科室/统计学和数值数据医院综合/统计学和数值数据住院病人/心理学住院病人/统计学和数值数据住院时间危险性评估自杀/预防和控制自杀未遂/心理学自杀未遂/统计学和数值数据台湾/流行病学时间因素成年人老年人女(雌)性人类男(雄)性中年人

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Evaluating psychiatric morbidity in a general hospital: a two-phase epidemiological survey

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PSYCHOLOGICAL MEDICINE 1999年第4期29卷 823-832页

作者： Martucci, M Balestrieri, M Bisoffi, G Bonizzato, P Covre, MG Cunico, L De Francesco, M Marinoni, MG Mosciaro, C Piccinelli, M Vaccari, L Tansella, M Univ Verona Ist Psichiat I-37100 Verona Italy Univ Udine DPMSC I-33100 Udine Italy

Background. This study aimed to assess psychiatric morbidity and to collect information on disability, life events and family support in a representative sample of patients admitted to a general hospital. Methods. On the basis of information collected in a pilot study a systematic sample of patients consecutively admitted to seven general medical and seven surgical wards of the Academic General Hospital of Verona was selected and interviewed using a two-phase screening procedure and standardized instruments (GHQ-12, HADS, BDQ and CIDI-PHC), All data were analysed using appropriately weighted logistic regression procedures. Results. A total of 1039 patients completed the GHQ-12 and 298 (28.7 %) were high-scorers: 363 patients were interviewed with CIDI-PHC. The prevalence of ICD-10 cases was 26.1%. The most common psychiatric diagnoses were current depression (12.8 %) and generalized anxiety disorder (10.8 %), followed by alcohol related disorders (5 %). A higher prevalence of ICD-10 cases was found in medical wards, among females, patients older than 24 years, unemployed and separated/divorced people. Life events were associated with psychopathology, and so was the number of disability days. Although 49.8 % of ICD-10 cases were identified by the hospital doctors as having a psychological disorder, 23.1% of ICD-10 cases were referred to the liaison psychiatric service. Conclusion, The results of the present study stress the need to collect epidemiologically-based data on psychological disorders and their recognition not only in general practice, but also in general hospital settings, in order to have a more complete picture of the pathways to specialist care.

关键词：医学科学研究中心/统计学和数值数据横断面研究残疾鉴定医院综合/统计学和数值数据发病率意大利/流行病学生活变动事件精神障碍/诊断精神障碍/流行病学精神障碍/心理学病人入院/统计学和数值数据精神病状态评定量表转诊和会诊/统计学和数值数据危险因素社会支持青少年成年人老年人女(雌)性人类男(雄)性中年人

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Regional vascular surgical units: a practical means of providing specialist services

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IRISH JOURNAL OF MEDICAL SCIENCE 2000年第2期169卷 107-109页

作者： Kalbassi, MR Tierney, S Grace, PA Burke, PE Limerick Reg Gen Hosp Dept Surg Limerick Ireland

Background A comprehensive regional emergency and elective vascular surgical service was established in Limerick Regional General Hospital between 1994 and 1996 following the appointment of three surgeons with vascular training. Aim To compare vascular surgical activity before and after the establishment of a regional vascular service. Methods This study used local and national computerised databases, clinic letters, theatre registers and radiology records to compare vascular surgical activity before (1992) and after (1997) this service was established. Results Total outpatient activity increased almost six-fold and total number of inpatient vascular procedures (including radiological) increased from 146 to 432, but the venous proportion declined from 70% to 36%. The number of major arterial procedures increased from 37 to 165 in 1997 including 10 carotid endarterectomies, 24 aortic reconstructions and 54 lower limb reconstructions representing rates of 3/100,000, 8/100,000 and 17/100,000 population respectively. Conclusion As substantial changes in disease patterns are unlikely, these data indicate that patients previously diverted elsewhere for therapy are now cared for within the health board region and that further increases in workload may be expected. We suggest that these data mandate the reallocation of resources to fund appropriately staffed and audited regional vascular units.

关键词：颈动脉内膜切除术/统计学和数值数据医院综合/统计学和数值数据爱尔兰外科医院/统计学和数值数据血管外科手术/统计学和数值数据工作负荷量人类

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Home accidents in elderly patients presenting to an emergency department.

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Accident and emergency nursing 1999年第2期7卷 96-102页

作者： Lee, V.M. Wong, T.W. Lau, C.C. Accident &amp Emergency Department Pamela Youde Nethersole Eastern Hospital Chaiwan Hong Kong

A prospective study was carried out in an Accident and Emergency department (A&E) to (1) examine the pattern of home accidents in elderly patients presenting to the A&E;(2) determine the nature and mechanisms of the accidents;and (3) investigate the associated factors in these accidents. All patients aged 65 or above with a history of injury at home within one week were included. Patients who needed immediate resuscitation and patients with mental illness or violent behaviour were excluded. A convenient sample was chosen during an 8-week period. A standardized questionnaire was used to collect data on (1) demographics;(2) nature of the accident and injury;and (3) health status. Health status assessment involved three components: physical status, drug history and past health. A total of 100 subjects were included giving an average occurrence of 3.3 cases per shift. The mean age of the group was 75 with female patients (66) outnumbering the males by about two to one. The toilet was the most common site (29%) of home accident, followed by the sitting room (18%), the kitchen (14%), the bedroom (11%) and the dining room (10%). In 79 cases the patient was alone at home during the accident. Falls were the most common (75%) type of accident. The remaining 25% of injuries were categorized as sharps injury (8%), foreign body ingestion (6%), crush injury (4%), burns/scald (3%), hit by/onto fallen objects (3%) and finally, electric shock (1%). Eighteen fractures were recorded. Thirty-two patients were admitted, 16 to the surgical ward and 16 to the orthopedic ward. In the functional assessment only 34 patients could perform the get-up-and-go test satisfactorily and only 61 patients had good hand grasp. Visual and hearing impairment were common. Over 45% of the patients had more than one disease and the majority of patients (80) were taking some medication. The roles of A&E staff in the prevention of home accidents in the elderly are discussed.

关键词：事故家庭/预防和控制事故家庭/统计学和数值数据年龄分布急救医疗服务/统计学和数值数据急救医疗服务/利用老年人身心健康评价香港医院综合/统计学和数值数据前瞻性研究创伤和损伤/病因学老年人老年人 80以上女(雌)性人类男(雄)性

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Utilization of local jails and general hospitals by state psychiatric center patients

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第4期27卷 454-459页

作者： Banks, SM Stone, JL Pandiani, JA Cox, JF Morschauser, PC Briston Observ Bristol VT 05443 USA New York State Off Mental Hlth New York NY USA NYS Off Mental Hlth Bur Forens Sci New York NY USA

The idea that the deinstitutionalization of state psychiatric centers has resulted in increased utilization of general hospitals and correctional facilities by people with severe and persistent mental illness is widely held. This hypothesis of transinstitutionalization was tested by examining hospitalization and incarceration rates of people who had been or would be institutionalized in state psychiatric centers in 16 upstate New York counties. The results do not support the hypothesis of transinstitutionalization. Assumptions underlying the hypothesis are examined, potential explanations for the observed patterns are discussed, and areas for further research are suggested.

关键词：队列研究精神病人强制住院/发展趋势医院外治疗/发展趋势医院综合/统计学和数值数据医院综合/利用医院精神病/统计学和数值数据医院州立/统计学和数值数据收容入院/发展趋势纽约结果与过程评价(卫生保健) 监狱/统计学和数值数据监狱/利用回顾性研究女(雌)性人类男(雄)性

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