Team Ward Rounds for Quality Improvement in Patient-Centred ...

African Journals Online (AJOL)

In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of ...

[Management of malnutrition in geriatric hospital units in Germany].

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Smoliner, C; Volkert, D; Wirth, R

2013-01-01

Elderly hospitalized patients have a high risk for developing malnutrition. The causes for an impaired nutritional status in old age are various and the impact is far-reaching. Malnutrition is a comorbidity that is well treatable and various studies show the favorable effect of nutrition therapy on nutritional status and prognosis. In the past few years, several guidelines have been developed to improve nutritional management and to ensure standardized procedures to identify patients at nutritional risk who will benefit from nutrition therapy. However, it is still not clear to what extent nutrition management has been implemented in geriatric wards in Germany. This survey is intended to give an overview on the situation of the current diagnosis and therapy of malnutrition and nutritional management in geriatric hospital units for acute and rehabilitative care. In 2011, the task force of the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie", DGG) developed a questionnaire which was sent out to 272 directors of geriatric hospital and rehabilitational units. Included were questions regarding the size and staffing of the hospital and wards, food provision, diagnosis and therapy of malnutrition, as well as communication of malnutrition and nutrition therapy in the doctor's letter. A total of 38% of the questioned units answered. The following information was compiled: 31% of the geriatric facilities employed a doctor with training in clinical nutrition, 42% employ dieticians or nutritional scientists, and 90% speech and language pathologists. In 36% of the wards, a so-called geriatric menu is offered (small portions, rich in energy and/or protein, easy to chew). In 89% of the wards, snacks are available between meals. Diagnosis of malnutrition is mainly done by evaluation of weight and BMI. Validated and established screening tools are only used in 40% of the geriatric wards. Food records are carried out in 64% of the units when needed. Diagnosed

The FIM instrument to identify patients at risk of falling in geriatric wards: a 10-year retrospective study.

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Petitpierre, Nicolas Julien; Trombetti, Andrea; Carroll, Iain; Michel, Jean-Pierre; Herrmann, François Richard

2010-05-01

the main objective was to evaluate if the admission functional independence measure (FIM) score could be used to predict the risk of falls in geriatric inpatients. a 10-year retrospective study was performed. the study was conducted in a 298-bed geriatric teaching hospital in Geneva, Switzerland. all patients discharged from the hospital from 1 January 1997 to 31 December 2006 were selected. measures used were FIM scores at admission using the FIM instrument and number of falls extracted from the institution's fall report forms. during the study period, there were 23,966 hospital stays. A total of 8,254 falls occurred. Of these, 7,995 falls were linked to 4,651 stays. Falls were recorded in 19.4% of hospital stays, with a mean incidence of 7.84 falls per 1,000 patients-days. Although there was a statistically significant relationship between total FIM score, its subscales, and the risk of falling, the sensitivity, specificity, positive predictive value and negative predictive value obtained with receiver operating characteristic curves were insufficient to permit fall prediction. This might be due in part to a non-linear relationship between FIM score and fall risk. in this study, the FIM instrument was found to be unable to predict risk of falls in general geriatric wards.

Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

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Otremba I

2016-04-01

Full Text Available Iwona Otremba, Krzysztof Wilczyński, Jan SzewieczekDepartment of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, PolandBackground: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.Objective: Evaluate specific factors for development of delirium in a geriatric ward setting.Methods: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men, admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.Results: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001, preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001, previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001, previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006, and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014.Conclusion: Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.Keywords: delirium

[Psychiatry with open doors. Part 1: Rational for an open door for acute psychiatry].

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Sollberger, D; Lang, U E

2014-03-01

Despite the reform efforts of the last decades modern acute psychiatry still stands between conflicting priorities in everyday practice. The protection of patient autonomy might conflict with a regulatory mandate of psychiatry in societal contexts and the necessity of coercive measures and involuntary treatment might become problematic with respect to presumed but contentious interests of the patient. The conflicts particularly concern questions of involuntary commitment, door closing, coercive and isolation measures. Research on the topic of therapeutic effectiveness of these practices is rare. Accordingly, the practice depends on the federal state, hospital and ward and is very heterogeneous. Epidemiological prognosis predicts an increase of psychiatric disorders; however, simultaneously in terms of medical ethics the warranty of patient autonomy, shared decision-making and informed consent in psychiatry become increasingly more important. This challenges structural and practical changes in psychiatry, particularly in situations of self and third party endangerment which are outlined and a rationale for an opening of the doors in acute psychiatric wards is provided.

Delirium in the geriatric unit: proton-pump inhibitors and other risk factors.

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Otremba, Iwona; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. Evaluate specific factors for development of delirium in a geriatric ward setting. Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54-5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44-3.65; Pfall incidents (OR =1.76; CI =1.17-2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11-2.53; P=0.014). Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.

Very Low Levels of Physical Activity in Older Patients During Hospitalization at an Acute Geriatric Ward: A Prospective Cohort Study.

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Villumsen, Morten; Jorgensen, Martin Gronbech; Andreasen, Jane; Rathleff, Michael Skovdal; Mølgaard, Carsten Møller

2015-10-01

Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to investigate (1) the time spent walking during hospitalization by geriatric patients referred to physical and/or occupational therapy and (2) the development in time spent walking during hospitalization. In this observational study, 24-hr accelerometer data (ActivPal) were collected from inclusion to discharge in 124 patients at an acute geriatric ward. The median time spent walking was 7 min per day. During the first quartile of hospitalization, the patients spent 4 (IQR:1;11) min per day walking, increasing to 10 (IQR:1;29) min during the last quartile. Improvement in time spent walking was primarily observed in the group able to perform the Timed Up & Go task at admission. When walking only 7 min per day, patients could be classified as inactive and at risk for functional decline; nonetheless, the physical activity level increased significantly during hospitalization.

[Non-pharmacological treatment of dementia in geriatric psychiatry care units : Scoping review].

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Göhner, Anne; Hüll, Michael; Voigt-Radloff, Sebastian

2018-02-01

The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research. To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care. A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed. A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.

Outcomes of glycemic control in Hispanic geriatric diabetic patients admitted to a general ward community hospital in Puerto Rico.

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Maldonado-Rodríguez, Miguel; Pérez-López, Shirley; Torres-Torres, Nancy; Torres-Semprit, Erick; Millán-Aponte, Ismenio

2012-01-01

Diabetes mellitus is one of the most prevalent medical conditions among the Hispanic population. Although studies with patients in intensive care units have shown poor outcomes among those with uncontrolled glucose, more recent data have shown increased mortality associated with a tighter inpatient glucose control. In view of the lack of information regarding geriatric Hispanic patients with diabetes this study evaluated the effect of glucose control in the outcomes of this population in a community hospital in Puerto Rico. Through analysis of data from a previous study we evaluated 502 admissions of Hispanic geriatric patients with diabetes as comorbidity, for glucose control, management of diabetes and outcome. Data was stratified by age groups (65-74 years, 75-84 years and > or = 85 years) and outcomes were compared between the groups using chi-square and odds ratio. The most common admission diagnosis was pneumonia. Hypoglycemia was the most common complication and was associated with tighter glucose control in the age group of 75-84 years. An increased risk of having an acute coronary syndrome/acute myocardial infarction among uncontrolled patients was observed in the 75-84 year old group. Finally, although we found a high prevalence of uncontrolled blood glucose, only 54% of the patients received interventions for their glucose control. Poor glucose control seems to be associated with a tendency for decreased risk of hypoglycemia and higher risk of acute coronary syndrome/acute myocardial infarction as complications among geriatric patients with diabetes admitted to a general ward.

Academic detailing to teach aging and geriatrics.

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Duckett, Ashley; Cuoco, Theresa; Pride, Pamela; Wiley, Kathy; Iverson, Patty J; Marsden, Justin; Moran, William; Caton, Cathryn

2015-01-01

Geriatric education is a required component of internal medicine training. Work hour rules and hectic schedules have challenged residency training programs to develop and utilize innovative teaching methods. In this study, the authors examined the use of academic detailing as a teaching intervention in their residents' clinic and on the general medicine inpatient wards to improve clinical knowledge and skills in geriatric care. The authors found that this teaching method enables efficient, directed education without disrupting patient care. We were able to show improvements in medical knowledge as well as self-efficacy across multiple geriatric topics.

Geriatric Fever Score: a new decision rule for geriatric care.

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Min-Hsien Chung

Full Text Available Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups.Consecutive geriatric patients (≥65 years old visiting the emergency department (ED of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done.Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3, Severe coma (GCS ≤ 8, and Thrombocytopenia (platelets <150 10(3/mm3 (LST. After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0% (95% CI: 2.3-6.9%: a general ward or treatment in the ED then discharge and high (30.3% (95% CI: 17.4-47.3%: consider the intensive care unit. The area under the curve for the rule was 0.73.We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need.

Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting.

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Desteghe, Lien; Raymaekers, Zina; Lutin, Mark; Vijgen, Johan; Dilling-Boer, Dagmara; Koopman, Pieter; Schurmans, Joris; Vanduynhoven, Philippe; Dendale, Paul; Heidbuchel, Hein

2017-01-01

To determine the usability, accuracy, and cost-effectiveness of two handheld single-lead electrocardiogram (ECG) devices for atrial fibrillation (AF) screening in a hospital population with an increased risk for AF. Hospitalized patients (n = 445) at cardiological or geriatric wards were screened for AF by two handheld ECG devices (MyDiagnostick and AliveCor). The performance of the automated algorithm of each device was evaluated against a full 12-lead or 6-lead ECG recording. All ECGs and monitor tracings were also independently reviewed in a blinded fashion by two electrophysiologists. Time investments by nurses and physicians were tracked and used to estimate cost-effectiveness of different screening strategies. Handheld recordings were not possible in 7 and 21.4% of cardiology and geriatric patients, respectively, because they were not able to hold the devices properly. Even after the exclusion of patients with an implanted device, sensitivity and specificity of the automated algorithms were suboptimal (Cardiology: 81.8 and 94.2%, respectively, for MyDiagnostick; 54.5 and 97.5%, respectively, for AliveCor; Geriatrics: 89.5 and 95.7%, respectively, for MyDiagnostick; 78.9 and 97.9%, respectively, for AliveCor). A scenario based on automated AliveCor evaluation in patients without AF history and without an implanted device proved to be the most cost-effective method, with a provider cost to identify one new AF patient of €193 and €82 at cardiology and geriatrics, respectively. The cost to detect one preventable stroke per year would be €7535 and €1916, respectively (based on average CHA 2 DS 2 -VASc of 3.9 ± 2.0 and 5.0 ± 1.5, respectively). Manual interpretation increases sensitivity, but decreases specificity, doubling the cost per detected patient, but remains cheaper than sole 12-lead ECG screening. Using AliveCor or MyDiagnostick handheld recorders requires a structured screening strategy to be effective and cost-effective in a hospital setting

Locked doors in acute inpatient psychiatry: a literature review.

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van der Merwe, M; Bowers, L; Jones, J; Simpson, A; Haglund, K

2009-04-01

Many acute inpatient psychiatric wards in the UK are permanently locked, although this is contrary to the current Mental Health Act Code of Practice. To conduct a literature review of empirical articles concerning locked doors in acute psychiatric inpatient wards, an extensive literature search was performed in SAGE Journals Online, EBM Reviews, British Nursing Index, CINAHL, EMBASE Psychiatry, International Bibliography of the Social Sciences, Ovid MEDLINE, PsycINFO and Google, using the search terms 'open$', 'close$', '$lock$', 'door', 'ward', 'hospital', 'psychiatr', 'mental health', 'inpatient' and 'asylum'. A total of 11 empirical papers were included in the review. Both staff and patients reported advantages (e.g. preventing illegal substances from entering the ward and preventing patients from absconding and harming themselves or others) and disadvantages (e.g. making patients feel depressed, confined and creating extra work for staff) regarding locked doors. Locked wards were associated with increased patient aggression, poorer satisfaction with treatment and more severe symptoms. The limited literature available showed the urgent need for research to determine the real effects of locked doors in inpatient psychiatry.

Transfers to psychiatry through the consultation-liaison psychiatry service: 11 years of experience

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Michopoulos Ioannis

2008-08-01

Full Text Available Abstract Background There are only a few reports on issues related to patient transfer from medical and surgical departments to the psychiatric ward by the consultation-liaison psychiatry service, although it is a common practice. Here, we present a study assessing the factors that influence such transfers. Method We examined the demographic and clinical backgrounds of a group of patients transferred from internal medicine and surgery to the psychiatric ward over an 11-year period. A comparison was made of this data with data obtained from a group of non-transferred patients, also seen by the same consultation-liaison psychiatry service. Results According to our findings, the typical transferred patient, either female or male, is single, divorced or widowed, lives alone, belongs to a lower socioeconomic class, presents initially with (on the whole a disturbed and disruptive behaviour, has had a recent suicide attempt with persistent suicidal ideas, suffers from a mood disorder (mainly depressive and dysthymic disorders, has a prior psychiatric history as well as a prior psychiatric inpatient treatment, and a positive diagnosis on axis II of the five axis system used for mental health diagnosis. Conclusion The transfer of a patient to the psychiatric ward is a decision depending on multiple factors. Medical diagnoses do not seem to play a major role in the transfer to the psychiatric ward. From the psychiatric diagnosis, depressive and dysthymic disorders are the most common in the transferred population, whilst the transfer is influenced by social factors regarding the patient, the patient's behaviour, the conditions in the ward she/he is treated in and any recent occurrence(s that increase the anxiety of the staff.

Feasibility of implementing a practice guideline for fall prevention on geriatric wards: a multicentre study.

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Milisen, Koen; Coussement, Joke; Arnout, Hanne; Vanlerberghe, Virginie; De Paepe, Leen; Schoevaerdts, Didier; Lambert, Margareta; Van Den Noortgate, Nele; Delbaere, Kim; Boonen, Steven; Dejaeger, Eddy

2013-04-01

About 40% of all adverse events in hospital are falls, but only about one in three Belgian hospitals have a fall prevention policy in place. The implementation of a national practice guideline is urgently needed. This multicentre study aimed to determine the feasibility of a previously developed guideline. SETTING, PARTICIPANTS AND METHOD: Seventeen geriatric wards, selected at random out of 40 Belgian hospitals who agreed to take part in the study, evaluated the fall prevention guideline. After the one-month test period, 49 healthcare workers completed a questionnaire on the feasibility of the guideline. At the end of the study, 512 geriatric patients had been assessed using the practice guideline. The average time spent per patient on case finding, multifactorial assessment and initiating a treatment plan was 5.1, 76.1 and 30.6 min, respectively. For most risk assessments and risk modifications, several disciplines considered themselves as being responsible and capable. The majority (more than 69%) of the respondents judged the practice guideline as useful, but only a small majority (62.3%) believed that the guideline could be successfully integrated into their daily practice over a longer period of time. Barriers for implementation included a large time investment (81.1%), lack of communication between the different disciplines (35.8%), lack of motivation of the patient (34.0%), lack of multidisciplinary teamwork (28.3%), and lack of interest from the hospital management (15.4%). Overall, the guideline was found useful, and for each risk factor (except for visual impairment), at least one discipline felt responsible and capable. Towards future implementation of the guideline, following steps should be considered: division of the risk-factor assessment duties and interventions among different healthcare workers; patient education; appointment of a fall prevention coordinator; development of a fall prevention policy with support from the management of the hospital

The Barthel Index and the Cumulated Ambulation Score are superior to the de Morton Mobility Index for the early assessment of outcome in patients with a hip fracture admitted to an acute geriatric ward

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Hulsbæk, Signe; Larsen, Rikke Faebo; Rosthøj, Susanne

2018-01-01

with a hip fracture admitted to a geriatric ward following surgery were assessed on day 1 and at discharge (mean of 9 [SD 5.1] post-surgery days). RESULTS: Ninety eight percent and 89% of patients were not able to perform the 30-s CST at baseline and at discharge (large floor effect), respectively...

Profile of the geriatric patients hospitilised at Universitas hospital ...

African Journals Online (AJOL)

For successful geriatric care at Universitas Hospital there will be a need for at least 11 days hospitalisation, and a unit with good training in internal medicine, psychiatry, urology, orthopaedy and oncology. The main supporting services will be physiotherapy, occupational therapy and social welfare. Laboratory analyses will ...

[Impact of education program and clinical posting in psychiatry on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders].

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Simon, N; Verdoux, H

2017-06-09

The aim of the study was to explore whether a medical student education program and clinical posting in psychiatry had an impact on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders. Medical students from the University of Bordeaux were recruited during their 4-year course at the beginning of the academic education program in psychiatry. Medical students who were concomitantly in a clinical posting in wards of psychiatry or neurology were invited to participate in the study. The medical student version of the scale Mental Illness: Clinicians' Attitudes (MICA) was used to measure their attitudes towards psychiatry and persons with psychiatric disorder. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness, a higher score indicating more stigmatizing attitudes. Items exploring history of psychiatric disorders in close persons were added at the end of the MICA scale. The questionnaire was completed twice by each student, at the beginning and the end of the 11-week clinical posting. All questionnaires were strictly anonymized. Multivariate linear regression analyses were used to identify the variables independently associated with MICA total score. At the beginning of the education program and clinical posting, 174 students completed the MICA scale: the mean MICA total score was equal to 46.4 (SD 6.9) in students in clinical posting in psychiatry (n=72) and 45.1 (SD 7.01) in those in neurology (n=102). At the end of the academic and clinical training, 138 students again completed the questionnaire, with mean MICA total scores equal to 41.4 (SD 8.1) in students in clinical posting in psychiatry (n=51) and 43.5 (SD 7.3) in those in neurology (n=87). Multivariate analyses showed that lower total MICA scores were independently associated with the time of assessment (lower scores at the end of education program and clinical posting) (b=-2.8; P=0.001), female gender (b=-1.8; P=0

Fried frailty phenotype assessment components as applied to geriatric inpatients

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Bieniek J

2016-04-01

Full Text Available Joanna Bieniek, Krzysztof Wilczynski, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in elderly patients presenting with relatively good health status. Objective: The aim of this article was to assess the usefulness and limitations of Fried frailty phenotype criteria in geriatric inpatients, characterized by comorbidity and functional impairments, and to estimate the frailty phenotype prevalence in this group. Patients and methods: Five hundred consecutive patients of the university hospital subacute geriatric ward, aged 79.0±8.4 years (67% women and 33% men, participated in this cross-sectional study. Comprehensive geriatric assessment and Fried frailty phenotype component evaluation were performed in all patients. Results: Multimorbidity (6.0±2.8 diseases characterized our study group, with a wide range of clinical conditions and functional states (Barthel Index of Activities of Daily Living 72.2±28.2 and Mini-Mental State Examination 23.6±7.1 scores. All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8–69.2 (diagnostic group. One or more components were not feasible to be assessed in 35% of the remaining patients (nondiagnostic group because of lack of past patient’s body mass control and/or cognitive or physical impairment. Patients from the nondiagnostic group, as compared to patients from the diagnostic group, presented with more advanced age, higher prevalence of dementia, lower prevalence of hypertension, lower systolic and diastolic blood pressure, body mass index, Mini

On-spot rheumatology consultations in a multilevel geriatric hospital.

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Lubart, Emily; Leibovitz, Arthur; Shapir, Vadim; Segal, Refael

2014-01-01

Musculoskeletal and joint disorders are extremely common in the elderly. They directly affect mobility, gait stability, quality of life, and independence. To assess the nature of joint problems encountered in a geriatric inpatient population and evaluate the contribution of a rheumatologist. We reviewed the rheumatology consultation records that were conducted in a geriatric medical center over a 10 year period. A total of 474 consultations were held; most of these patients (86%) were hospitalized in the acute geriatric departments, 10% in the rehabilitation ward and 4% in the long-term care wards. Some patients were seen more than once. A rheumatologic joint problem was the main reason for hospitalization in 53% of these patients. Monoarthritis was the most frequent complaint (50%), followed by pauciarticular arthritis (two to five joints) in 30% of patients. Arthrocentesis, diagnostic and therapeutic, was performed in 225 patients, most of them in knee joints (81%). The most frequent diagnosis was osteoarthritis with acute exacerbation (28%), followed by gout (18%), pseudo-gout (9%) and rheumatoid arthritis (9%). In 86 cases (18%) the diagnosis was a non-specific rheumatologic problem: arthralgia, nonspecific generalized pain, or fibromyalgia. Prompt and appropriate evaluation, as well as arthrocentesis and treatment initiation, including local injections, were made possible by the presence of an in-house rheumatologist.

The Introduction of a Full Medication Review Process in a Local Hospital: Successes and Barriers of a Pilot Project in the Geriatric Ward

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Lies De Bock

2018-02-01

Full Text Available For the majority of Belgian hospitals, a pharmacist-led full medication review process is not standard care and, therefore, challenging to introduce. With this study, we aimed to evaluate the successes and barriers of the implementation of a pharmacist-led full medication review process in the geriatric ward at a local Belgian hospital. To this end, we carried out an interventional study, performing a full medication review on older patients (≥70 years with polypharmacy (≥5 drugs who had an unplanned admission to the geriatric ward. The process consisted of 3 steps: (1 medication reconciliation upon admission; (2 medication review using an explicit reviewing tool (STOPP/START criteria or GheOP3S tool, followed by a discussion between the pharmacist and the geriatrician; and (3 medication reconciliation upon discharge. Ethical approval was obtained from the Ethical Commission of the Ghent University Hospital. Outcomes included objective data on the interventions (e.g., number of drug discrepancies; number of potentially inappropriate prescriptions (PIP; as well as subjective experiences (e.g., satisfaction with service; opinion on inter-professional communication. There was a special focus on communication aspects within the introduction of this process. In total, 52 patients were included in the study, taking a median of 10 drugs (IQR 8–12. Upon admission, 122 drug discrepancies were detected. During medication review, 254 PIPs were detected and discussed, leading to an improvement in the appropriateness of medication use. The satisfaction of community pharmacists concerning additional communication and the satisfaction of the patients after counselling at discharge were positive. However, several barriers were encountered, such as the time-consuming process to gather necessary information from different sources, the non-continuity of the service due to the lack of trained personnel or the lack of safe, electronic platforms to share

Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials.

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Shields, Lynn; Henderson, Victoria; Caslake, Robert

2017-07-01

To assess the efficacy of comprehensive geriatric assessment (CGA) in prevention of delirium after hip fracture. Systematic review and metaanalysis. Ward based models on geriatrics wards and visiting team based models on orthopaedics wards were included. Four trials (three European, one U.S.; 973 participants) were identified. Two assessed ward-based, and two assessed team-based interventions. MEDLINE, EMBASE, CINAHL and PsycINFO databases; Clinicaltrials.gov; and the Central Register of Controlled Trials were searched. Reference lists from full-text articles were reviewed. Incidence of delirium was the primary outcome. Length of stay, delirium severity, institutionalization, long-term cognition and mortality were predefined secondary outcomes. Duration of delirium was included as a post hoc outcome. There was a significant reduction in delirium overall (relative risk (RR) = 0.81, 95% confidence interval (CI) = 0.69-0.94) in the intervention group. Post hoc subgroup analysis found this effect to be preserved in the team-based intervention group (RR = 0.77, 95% CI = 0.61-0.98) but not the ward-based group. No significant effect was observed on any secondary outcome. There was a reduction in the incidence of delirium after hip fracture with CGA. This is in keeping with results of non-randomized controlled trials and trials in other populations. Team-based interventions appeared superior in contrast to the Ellis CGA paper, but it is likely that heterogeneity in interventions and population studied affected this. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Clinical preference for factors in treatment of geriatric depression

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Riepe MW

2014-12-01

Full Text Available Matthias W Riepe Mental Health and Geriatric Psychiatry, Psychiatry II, Ulm University, Ulm, Germany Abstract: Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69% returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. Keywords: depressive disorder, symptoms, analytic hierarchy process, toxicity, adverse events, symptoms

Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials.

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Ellis, Graham; Whitehead, Martin A; Robinson, David; O'Neill, Desmond; Langhorne, Peter

2011-10-27

To evaluate the effectiveness of comprehensive geriatric assessment in hospital for older adults admitted as an emergency. We searched the EPOC Register, Cochrane's Controlled Trials Register, the Database of Abstracts of Reviews of Effects (DARE), Medline, Embase, CINAHL, AARP Ageline, and handsearched high yield journals. Randomised controlled trials of comprehensive geriatric assessment (whether by mobile teams or in designated wards) compared with usual care. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process used to determine the medical, psychological, and functional capabilities of a frail elderly person to develop a coordinated and integrated plan for treatment and long term follow-up. Three independent reviewers assessed eligibility and trial quality and extracted published data. Two additional reviewers moderated. Twenty two trials evaluating 10,315 participants in six countries were identified. For the primary outcome "living at home," patients who underwent comprehensive geriatric assessment were more likely to be alive and in their own homes at the end of scheduled follow-up (odds ratio 1.16 (95% confidence interval 1.05 to 1.28; P = 0.003; number needed to treat 33) at a median follow-up of 12 months versus 1.25 (1.11 to 1.42; P P P = 0.001) and were more likely to experience improved cognition (standardised mean difference 0.08, 0.01 to 0.15; P = 0.02) in the comprehensive geriatric assessment group. Comprehensive geriatric assessment increases patients' likelihood of being alive and in their own homes after an emergency admission to hospital. This seems to be especially true for trials of wards designated for comprehensive geriatric assessment and is associated with a potential cost reduction compared with general medical care.

Ergonomics in the psychiatric ward towards workers or patients?

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Silvana, Salerno; Laura, Forcella; Ursula, Di Fabio; Irene, Figà Talamanca; Paolo, Boscolo

2012-01-01

Patient's aggressive behavior is one of the major problem in the psychiatric ward. Here we present the preliminary results of a psychiatric ward case-study, of a public hospital in the Chieti province, in order to plan ergonomic improvement. We applied the Method of Organizational Congruencies in the psychiatric ward in order to study the relationship between organized hospital work and nurses wellbeing in a 24 hour shifts. We observed 58 main phases in the three work shifts. The technical actions are mainly those of any hospital wards (shift briefing, preparing and administering drugs, recording data on clinical charts, etc.). We found important differences mainly due to the nurses overcontrol activities on the patients behavior (preventing suicides or self destructive behavior), the occurrence of restraint procedure towards patients, the pollution due to patient's cigarette smoke. The fear of patient's self destructive behavior or other aggressive behaviour are the main cognitive and social aspects of this hospital ward. Nurses working in this psychiatric ward have to accept: locked doors, poor and polluted environment, restraint procedure with high risk of aggression and no availability of mental health care programs. A new interdisciplinary concept for ergonomics in psychiatry setting may represent a challenge for both nurses and patients and the community.

Geriatric Rehabilitation ('Alters-Rehabilitation'): The New Challenge for Social Medicine and Science.

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Barolin, G. S.

1996-01-01

This discussion of geriatric rehabilitation stresses the importance of holistic and permanent rehabilitation with a fluent transition from the acute phase to the rehabilitation phase under one specialist's care and in one institution. Recommendations include mixed age groups in one ward; systematic education of relatives; follow-up rehabilitation…

[Interdisciplinary treatment in geriatric traumatology from the trauma surgeons' perspective : Results of a survey in Germany].

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Bücking, B; Walz, M; Hartwig, E; Friess, T; Liener, U; Knobe, M; Ruchholtz, S; Bliemel, C

2017-01-01

Many patients treated on trauma surgery wards are geriatric trauma patients. To improve treatment of these often multimorbid patients, various interdisciplinary treatment concepts have been established in Germany between trauma surgeons and geriatricians. The aim of this study was to evaluate the dissemination and the impact of the different orthogeriatric treatment concepts for geriatric trauma in Germany. Material and methods In March and April 2014 an electronic questionnaire for assessing the interdisciplinary treatment of geriatric trauma patients was sent to 691 medical directors of trauma surgery departments in Germany. A total of 259 (37 %) fully answered questionnaires could be analyzed. The analysis revealed that 70 % of all responding trauma surgery departments had an orthogeriatric treatment cooperation. Most of them reported having patient discharge agreements to geriatric rehabilitation facilities (59 %). Geriatric counseling services were reported by 39 % while 24 % reported having regular interdisciplinary visits and orthogeriatric wards were available in 13 %. The need for orthogeriatric services was considered to be high by 79 % of the participants and benefits especially for the patients were expected. These expectations were largely fulfilled. More than 70 % of respondents planned to intensify the orthogeriatric cooperation. In this context difficulties were seen in the lack of personnel resources, especially in a lack of geriatricians. The results of this survey underline the impact and the positive experiences in orthogeriatric services. Solutions have to be found to address the emerging problem of capacity constraints.

An Appraisal Of The Colour Of Hospital Wards On The Recovery ...

African Journals Online (AJOL)

The environment where psychiatric patients are kept has been identified as an aid to their recovery attitudes. Based on the fact that the patients were being treated by qualified hands, an attempt is made to examine the significance of colour of the psychiatry ward environment as relating to the patients' rehabilitation in this ...

Pharmaceutical interventions by collaboration between staff pharmacists and clinical pharmacists and implementation of Joint Commission International Accreditation Standards on medication use may optimize pharmacotherapy in geriatric patients

Directory of Open Access Journals (Sweden)

Chen M

2016-11-01

Full Text Available Meng Chen, Quan Zhou Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaWe read with great interest the prospective study by Cortejoso et al,1 which describes the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit of a general teaching hospital. We strongly agree with their finding that shows the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in elderly patients. Furthermore, we especially appreciate their new and interesting findings that the clinical pharmacist was more frequently requested by physicians and nurses for information about the pharmacotherapy of the patients on the geriatric day unit, compared with the orthogeriatric ward at admission and discharge (5.7% vs 1.2% and 1.7%, respectively, P<0.05, and that the pharmacist asked for more confirmation of the physician orders on the geriatric day unit rather than the orthogeriatric ward (19.8% vs 1.8% and 15.7% at admission and discharge, respectively, P<0.05. We are from a Joint Commission International (JCI-accredited academic medical center hospital with 3200 beds in China. Safe medication management and use are pivotal to patient safety and quality of care on which the state-of-the-art standards of the Joint Commission focus. We would like to share our perspectives in the following paragraphs.View original paper by Cortejoso and colleagues. 

Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial.

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Aizen, Efraim; Lutsyk, Galina; Wainer, Lea; Carmeli, Sarit

2015-10-01

There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital. This was a two-stage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay. In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage. These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls.

Psychiatry residents in a milieu participatory democracy: a resident's view.

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Gersten, D

1978-11-01

Psychiatry residents respond with a variety of coping mechanisms to the lack of traditional structure in a milieu participatory democracy. To incorporate themselves into the system they must accept such democratic ideals as equality among staff and patients, group decision making, and free self-expression and give up some of their traditional ideas about staff and patient roles, treatment modalities, and the therapeutic environment. The author was a first-year resident in psychiatry on a university hospital inpatient therapeutic community; he discusses the conflicts between residents, who often adopt a "we-they" attitude, and the permanent staff, whose protectiveness of the ward community reflects their personal commitment to its ideals.

Cumulated Ambulation Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, Morten Tange; Jakobsen, Thomas Linding; Nielsen, Jesper Westphal

2012-01-01

Regaining basic mobility independence is considered important for elderly hospitalised patients. The Cumulated Ambulation Score (CAS) is a valid tool for evaluating these patients' basic mobility (getting in and out of bed, sit-to-stand from a chair and walking) in orthopaedic wards, and its use ...... is recommended in Denmark for patients with hip fracture. The aims of the present study were to evaluate the feasibility of the CAS in a geriatric ward and to describe its use after hip fracture in Denmark....

Senile anorexia in different geriatric settings in Italy.

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Donini, L M; Dominguez, L J; Barbagallo, M; Savina, C; Castellaneta, E; Cucinotta, D; Fiorito, A; Inelmen, E M; Sergi, G; Enzi, G; Cannella, C

2011-11-01

Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status. Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto). 526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile"). Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication. The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet

Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study.

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Jacobsen, Ellisiv Lærum; Brovold, Therese; Bergland, Astrid; Bye, Asta

2016-09-06

Data on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status. A cross-sectional study. Two acute geriatric hospital wards in Norway. This study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification. On the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β -3.3, 95% CI -4.9 to -1.7), pulmonary disease (β -2.1, 95% CI -3.7 to -0.46), cancer (β -1.7, 95% CI -3.4 to -0.033) and nutritional status. Our study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer and pulmonary disease are significantly associated with declines in nutritional status, as measured by the MNA, in acute geriatric patients. Published by the BMJ Publishing Group Limited. For permission to use (where not

Assesment of Disabled Geriatric Health Council Reports

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Cem Sahin

2014-12-01

Full Text Available Aim: In this study it is aimed to evaluate geriatric patients who apply to health council. Material and Method:The study retrospectively assessed 3112 patients admitted to the disability ward, of which 601 geriatric patients were included in the study. Results: Of the 601 patients, 53.1% were men and 46.9% were women. The mean age of these patients was 60 (std ± 18.35 years. Some of the reasons for admission in the hospital were need for social services (45.6% and determination of disability rate (21.6%. Most common diseases in patients aged %u226565 years were hypertension (21.6%, diabetes (12.6%, and chronic obstructive lung disease and dilated cardiomyopathy (3.7%; p 0.05. Internal disability rate was not statistically significant (p > 0.05, but total disability was statistically significant (p < 0.05. Moreover, prevalence of additional conditions was statistically significant (p < 0.05 in patients aged %u226565 years.Discussion: Rapid increases in life expectancy and number of older people has increased the prevalence of disabilities among older people. Being diagnosed with chronic diseases should not be the end of life for geriatric populations. Their mood, social life, general health, and mental profile should progress. Sufficient attention should be paid to the special needs of older patients thereby leading to a wider use of facilities.

[Geriatrics or geriatricization of medicine : Quo vadis geriatrics?

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Kolb, G F

2017-12-01

This article examines the question whether and how geriatrics will change in the future and whether in view of the demographic changes the trend will go more in the direction of a further expansion of geriatrics or more towards a geriatricization of individual specialist medical fields. The different development of geriatrics in the individual Federal States can only be understood historically and is absolutely problematic against the background of the new hospital remuneration system. Geriatrics is a typical cross-sectional faculty and still has demarcation problems with other faculties but has also not yet clearly defined the core competence. This certainly includes the increasing acquisition of decentralized joint treatment concepts and geriatric counselling services in the future, in addition to the classical assessment instruments. Keywords in association with this are: traumatology and othopedics of the elderly, geriatric neurology and geriatric oncology. Interdisciplinary geriatric expertise is increasingly being requested. Outpatient structures have so far not been prioritized in geriatrics. An independent research is under construction and it is gratifying that academic interest in geriatrics seems to be increasing and new professorial chairs have been established. It is not possible to imagine our hospital without geriatrics; however, there is still a certain imbalance between the clearly increased number of geriatric hospital beds, the representation of geriatrics in large hospitals (e.g. specialized and maximum care hospitals and university clinics), the secure establishment in further education regulations and the lack of a uniform nationwide concept of geriatrics.

Development of Geriatric Mental Health Learning Objectives for Medical Students: A Response to the Institute of Medicine 2012 Report.

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Lehmann, Susan W; Brooks, William B; Popeo, Dennis; Wilkins, Kirsten M; Blazek, Mary C

2017-10-01

America is aging as the population of older adults increases. The shortage of geriatric mental health specialists means that most geriatric mental healthcare will be provided by physicians who do not have specialty training in geriatrics. The Institute of Medicine Report of 2012 highlighted the urgent need for development of national competencies and curricula in geriatric mental health for all clinicians. Virtually all physicians can expect to treat older patients with mental health symptoms, yet currently there are no widely accepted learning objectives in geriatric mental health specific for medical students. The authors describe the development of a set of such learning objectives that all medical students should achieve by graduation. The iterative process included initial drafting by content experts from five medical schools with input and feedback from a wider group of geriatric psychiatrists, geriatricians, internists, and medical educators. The final document builds upon previously published work and includes specific knowledge, attitudes and skills in six key domains: Normal Aging, Mental Health Assessment of the Geriatric Patient, Psychopharmacology, Delirium, Depression, and Dementia. These objectives address a pressing need, providing a framework for national standards and curriculum development. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Feasibility and validity of frailty measurement in geriatric rehabilitation.

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Arjunan, Aparna; Peel, Nancye M; Hubbard, Ruth E

2018-02-10

The measurement of frailty using a Frailty Index (FI) has been criticised as too time-consuming for use in hospital settings. We aimed to assess the feasibility and characteristics of an FI derived from routinely collected data. A total of 258 participants aged 65 and older were included in a single-centre prospective cohort study conducted in inpatient geriatric rehabilitation wards. The functional independence measure (FIM™), medication count and comorbidities were coded as deficits. An FI could be derived in all participants. It was normally distributed with a mean (SD) of 0.42 (0.13) and reached a submaximal limit of 0.69. Adjusting for age and sex, the odds ratio of a poor outcome (death/discharge to higher care) was 1.38 (confidence interval 1.11-1.70) per unit (0.1) increase in FI. Derivation of an FI from routinely collected data is feasible in geriatric rehabilitation settings and is predictive of poor outcomes. © 2018 AJA Inc.

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

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Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

2015-04-25

Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

Multidisciplinary education in geriatric medicine. Continuing experience at the Middlesex Hospital.

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Beynon, G P; Croker, J

1983-01-01

The unique feature about the course in teaching geriatric medicine to undergraduates at the Middlesex Hospital is its multidisciplinary nature. The course lasts for three weeks during the first or second clinical year and involves medical students together with student physiotherapists, nurses and occupational therapists. All take part in seminars, ward rounds and multidisciplinary case presentations. A full-time course organizer funded by the School of Nursing manages the course. Assessment includes MCQ and course evaluation questionnaire and an essay.

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.

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Mudge, Alison M; Banks, Merrilyn D; Barnett, Adrian G; Blackberry, Irene; Graves, Nicholas; Green, Theresa; Harvey, Gillian; Hubbard, Ruth E; Inouye, Sharon K; Kurrle, Sue; Lim, Kwang; McRae, Prue; Peel, Nancye M; Suna, Jessica; Young, Adrienne M

2017-01-09

Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each

Measuring dynamic social contacts in a rehabilitation hospital: effect of wards, patient and staff characteristics.

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Duval, Audrey; Obadia, Thomas; Martinet, Lucie; Boëlle, Pierre-Yves; Fleury, Eric; Guillemot, Didier; Opatowski, Lulla; Temime, Laura

2018-01-26

Understanding transmission routes of hospital-acquired infections (HAI) is key to improve their control. In this context, describing and analyzing dynamic inter-individual contact patterns in hospitals is essential. In this study, we used wearable sensors to detect Close Proximity Interactions (CPIs) among patients and hospital staff in a 200-bed long-term care facility over 4 months. First, the dynamic CPI data was described in terms of contact frequency and duration per individual status or activity and per ward. Second, we investigated the individual factors associated with high contact frequency or duration using generalized linear mixed-effect models to account for inter-ward heterogeneity. Hospital porters and physicians had the highest daily number of distinct contacts, making them more likely to disseminate HAI among individuals. Conversely, contact duration was highest between patients, with potential implications in terms of HAI acquisition risk. Contact patterns differed among hospital wards, reflecting varying care patterns depending on reason for hospitalization, with more frequent contacts in neurologic wards and fewer, longer contacts in geriatric wards. This study is the first to report proximity-sensing data informing on inter-individual contacts in long-term care settings. Our results should help better understand HAI spread, parameterize future mathematical models, and propose efficient control strategies.

Geriatric trauma.

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Adams, Sasha D; Holcomb, John B

2015-12-01

The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

Recent trends in american board of psychiatry and neurology psychiatric subspecialties.

Science.gov (United States)

Faulkner, Larry R; Juul, Dorthea; Andrade, Naleen N; Brooks, Beth Ann; Colenda, Christopher C; Guynn, Robert W; Mrazek, David A; Reus, Victor I; Schneidman, Barbara S; Shaw, Kailie R

2011-01-01

this article reviews the current status and recent trends in the American Board of Psychiatry and Neurology (ABPN) psychiatric subspecialties and discusses the implications of those trends as well as several key questions whose answers may well determine subspecialty viability. data are presented on specialty and subspecialty programs; graduates; and ABPN certification candidates and diplomates drawn from several sources, including the records of the ABPN, the websites of the Accreditation Council for Graduate Medical Education and the American Medical Association, and the annual medical education issues of JAMA. fewer than half of psychiatry graduates pursue subspecialty training. While most recent specialty graduates attempt to become certified by the ABPN, many subspecialists elect not to do so. There have been recent decreases in the number of fellowship programs and trainees in geriatric psychiatry and addiction psychiatry. The pass rates for fellowship graduates are superior to those for the "grandfathers" in all of the newer psychiatric subspecialties. Lower percentages of subspecialists than specialists participate in maintenance of certification, and maintenance of certification pass rates are high. the initial interest in training and certification in some of the ABPN subspecialties appears to have slowed, and the long-term viability of those subspecialties may well depend on the answers to a number of complicated social, economic, and political questions in the new health care era.

A prediction rule for the development of delirium among patients in medical wards: Chi-Square Automatic Interaction Detector (CHAID) decision tree analysis model.

Science.gov (United States)

Kobayashi, Daiki; Takahashi, Osamu; Arioka, Hiroko; Koga, Shinichiro; Fukui, Tsuguya

2013-10-01

To predict development of delirium among patients in medical wards by a Chi-Square Automatic Interaction Detector (CHAID) decision tree model. This was a retrospective cohort study of all adult patients admitted to medical wards at a large community hospital. The subject patients were randomly assigned to either a derivation or validation group (2:1) by computed random number generation. Baseline data and clinically relevant factors were collected from the electronic chart. Primary outcome was the development of delirium during hospitalization. All potential predictors were included in a forward stepwise logistic regression model. CHAID decision tree analysis was also performed to make another prediction model with the same group of patients. Receiver operating characteristic curves were drawn, and the area under the curves (AUCs) were calculated for both models. In the validation group, these receiver operating characteristic curves and AUCs were calculated based on the rules from derivation. A total of 3,570 patients were admitted: 2,400 patients assigned to the derivation group and 1,170 to the validation group. A total of 91 and 51 patients, respectively, developed delirium. Statistically significant predictors were delirium history, age, underlying malignancy, and activities of daily living impairment in CHAID decision tree model, resulting in six distinctive groups by the level of risk. AUC was 0.82 in derivation and 0.82 in validation with CHAID model and 0.78 in derivation and 0.79 in validation with logistic model. We propose a validated CHAID decision tree prediction model to predict the development of delirium among medical patients. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Relatives' view on collaboration with nurses in acute wards: development and testing of a new measure

DEFF Research Database (Denmark)

Lindhardt, Tove; Nyberg, Per; Hallberg, Ingalill Rahm

2008-01-01

BACKGROUND: Collaboration between relatives and nurses in acute care settings is sparsely investigated, and that mostly from nurses' point of view. Feasible and valid instruments are needed for assessing collaboration, its prerequisites and outcome. OBJECTIVES: To develop and test an instrument...... to assess, from the relatives' perspective, collaboration between relatives of frail elderly patients and nurses in acute hospital wards, as well as prerequisites for, and outcome of, collaboration. DESIGN: Instrument development and psychometric testing. SETTING: Acute medical and geriatric wards......, item-to-total correlation and item-to-item correlation. Systematic internal dropout was investigated. RESULTS: A five-factor solution labelled "influence on decisions", "quality of contact with nurses", "trust and its prerequisites", "achieved information level" and "influence on discharge" showed...

[A unit for emergency psychiatry and crisis intervention--concepts, structure and initial experiences].

Science.gov (United States)

Feuerlein, W; Bronisch, T; Fürmaier, A

1983-03-01

The article reports on a ward with 12 beds which has been set up for emergency cases in psychiatry or for immediate intervention in case of a crisis experienced by a patient. In the theoretical part of this article, it is explained that crisis situations are present in most of the psychiatric emergency patients. The article then goes briefly into the fundamentals of therapeutic strategy in such patients: A therapy which helps to uncover hidden conflicts, the pros and cons of therapy focussed on conflict and on supportive measures; as well as a therapy which supports and promotes the ego. This is followed by a comparison of the ward with corresponding facilities in Germany and abroad and a description of their structure, their patients and their function within a psychiatric care system. The concluding part of the article is devoted to a description of the authors' initial experiences and impressions gained during their work with the ward patients, quoting several examples.

A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

Directory of Open Access Journals (Sweden)

Chong Mei

2011-08-01

Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

The politics of black patients' identity: ward-rounds on the 'black side' of a South African psychiatric hospital.

Science.gov (United States)

Swartz, L

1991-06-01

There are many macrosocial studies of the political organisation of health and mental health care in South Africa, and the maldistribution of resources by race is well known. Little attention, however, has been given to the minutiae of the negotiation of power in the clinical setting. This article, which reports on part of a larger study of aspects of culture in South African psychiatry, focuses on interactions in ward-rounds on the 'Black side' of a South African psychiatric hospital. Through analysis of cases, the complexity of interpreting what transpires in such a setting and the central role that the concept of culture has in debates amongst staff members are demonstrated. Close analysis demonstrates the inadequacy of models which seek to locate the institutional racism of apartheid psychiatry in the motives of individual clinicians. Clinicians may simultaneously reproduce and subvert aspects of apartheid practice. A consideration of the social positioning of the clinician both as a South African and as a practitioner of psychiatry is central to the development of psychiatry in a post-apartheid South Africa.

Teaching Forensic Psychiatry to General Psychiatry Residents

Science.gov (United States)

Lewis, Catherine F.

2004-01-01

Objective: The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been…

Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study

DEFF Research Database (Denmark)

Rathleff, C R; Bandholm, T; Spaich, E G

2017-01-01

feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. Methods: This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises......Background: Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge...... the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate...

Comprehensive geriatric assessment for older adults admitted to hospital.

Science.gov (United States)

Ellis, Graham; Whitehead, Martin A; O'Neill, Desmond; Langhorne, Peter; Robinson, David

2011-07-06

Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals. We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care. Two review authors initially assessed eligibility and trial quality and extracted published data. Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards. Comprehensive geriatric assessment increases a patient's likelihood of being alive and in their own home at up to 12 months.

[Screening of the risk of functional decline performed by an inpatient geriatric consultation team in a general hospital].

Science.gov (United States)

Benoît, F; Bertiaux, M; Schouterden, R; Huard, E; Segers, K; Decorte, L; Robberecht, J; Simonetti, C; Surquin, M

2013-01-01

The Mobile Geriatric Team (MGT) is part of the Geriatric Care Program and aims to provide interdisciplinary geriatric expertise to other professionals for old patients hospitalized outside geriatric department. Our hospital has a MGT since 2008. Our objective is to retrospectively describe the population of patients of 75 years and older hospitalized outside the geriatric ward and screened for the risk of functional decline by the MGT between 1 October 2009 and 30 September 2011. We recorded the risk of functional decline, as indicated by the Identification of Senior At Risk score (ISAR) performed within 48 h after admission, place of living, discharge destination, Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores. In two years, 1.568 patients > or = 75 Y were screened with the ISAR score (mean age 82.5 Y, 60.7% of women). We identified 833 patients with a high-risk of functional decline (ISAR > or = 3). The majority of high-risk subjects (78%) were living at home before hospitalization and 58.7% returned home after discharge. Depression and cognitive impairment were identified among respectively 41% and 59% of high-risk subjects. Only 128 patients were admitted for fall. Most of the faller patients were living at home prior hospitalization and had an ISAR score > or = 3. The MGT allowed identifying many patients > or = 75 Y living at home and presenting with high-risk of functional decline and geriatric syndromes, confirming that good screening procedures are necessary to optimize management of hospitalized olders. Most of faller patients have an ISAR score > or = 3 and should benefit a comprehensive geriatric assessment.

Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology

DEFF Research Database (Denmark)

Rathleff, Camilla Rams; Bandholm, T.; Spaich, Erika Geraldina

2017-01-01

the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate...... feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. Methods: This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises...... of 2-min pauses and a time-under-tension of 8 s. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets would be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences...

An audit of a specialist old age psychiatry liaison service to a medium and a high secure forensic psychiatry unit.

Science.gov (United States)

Shah, Ajit

2006-04-01

The elderly prison population is increasing and there is a significant amount of unidentified psychiatric morbidity among elderly prisoners. A sizeable number of elderly subjects are referred to regional forensic units. These units are able to provide advice but are reluctant to admit frail, physically ill and vulnerable elderly into their unit because the ward environment is considered inappropriate for them. A sizeable number of inpatients in medium and high secure units are elderly. This paper is an exploratory audit of referrals from a medium and high secure forensic psychiatry unit to a specialist consultation-only liaison old age psychiatry service, which was specifically developed to service the forensic unit. The demographic and clinical characteristics of the patients seen by this specialist service were similar to elderly inpatients in medium and high secure units. All referrals were judged to be appropriate and new management advice was provided in all cases. Main reasons for referral included diagnostic advice, placement advice and treatment advice. Establishing a diagnosis of dementia was considered important because Alzheimer's disease and Lewy body dementia can be treated with cholinesterase inhibitors. Placement advice was the most difficult to provide because of paucity of residential and nursing homes able and willing to accept patients with a forensic history. There is a need for a comprehensive model of specialist forensic old age psychiatry service at a regional or supraregional level. A consensus needs to be reached on the exact configuration of such a service.

High morbidity and mortality associated with an outbreak of influenza A(H3N2) in a psycho-geriatric facility.

LENUS (Irish Health Repository)

Sayers, G

2012-04-17

SUMMARYIn spring 2008, an influenza A subtype H3N2 outbreak occurred in a long stay psycho-geriatric ward and two wards in the intellectual disability services (IDS), part of a large psychiatric hospital. The attack rate in the index ward was 90% (18\\/20) for patients and 35% (7\\/20) for staff. It was 14% (1\\/7) and 17% (2\\/12) in the affected IDS wards for patients and 0% (0\\/20) and 4% (1\\/25) for staff. Many of the laboratory-confirmed cases did not have a fever >38°C, a typical sign of influenza. Control measures included oseltamivir treatment for cases and prophylaxis for contacts, standard and droplet infection control precautions, active surveillance for early detection and isolation of potential cases. As a result, the outbreak did not spread throughout the hospital. Although the staff vaccination rate (10%) prior to the outbreak was low, we observed a much lower vaccine effectiveness rate in the patients (11%) than in the staff (100%) in the index ward. Vaccination of residents and staff of such facilities remains the key influenza prevention strategy.

Geriatric Intervention in Elderly Patients with Hip Fracture in an Orthopaedic Ward

DEFF Research Database (Denmark)

Gregersen, Merete; Damsgaard, Else Marie Skjøde; Hougaard, Kjeld

2012-01-01

varia-tion between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p......=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and for the intervention group, the risk of new......Introduction: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic col-laboration (orthogeriatrics) has been organized in different ways. The aim of this study is to eva...

[Challenges for the future of psychiatry and psychiatric medical care].

Science.gov (United States)

Higuchi, Teruhiko

2013-01-01

situation, is the fact that the "psychiatry exception" system (unbalanced ratio of staff to psychiatric patients) is still present today. (2) To reach a fundamental solution, the policy of low fees for psychiatric services has to be abolished. (3) Multi-disciplinary medical teams, as practiced in other developed countries, is not yet adequately applied in Japan. From the aspect of medical fees, it is not adequately encouraged either. The only place where team medicine is actually practiced is in the "forced hospitalization" ward, but, as stated in the supplementary resolution of the Japanese diet (national assembly), high-quality medicine should not only be practiced in the "forced hospitalization" ward, but also in general psychiatry. (4) The policy of transition from hospitalization-centered to community-centered medical care, which was initiated a long time ago by the Japanese government, is not proceeding in reality, and it is time that we put our heads together and find ways to overcome this problem. It is significant that "psychiatric disorders" have been included as one of the "five diseases," (a system adopted by the government concerning community health care), and now we have the best opportunity to improve community-centered psychiatric care.

[Care of elderly subject with iron deficiency anaemia: evaluation of geriatric practice].

Science.gov (United States)

Berrut, Gilles; Dibon, Christelle; Hanon, Olivier; Gavazzi, Gaëtan; Chassagne, Philippe; de Decker, Laure

2014-06-01

The anemia with iron deficiency is frequent in the elder subjects. Few studies have reported the practice of the geriatric medicine about anemia. A national survey asked geriatric medical practitioners of hospital geriatric ward from June till September, 2013. Questionnaires were sent, filled over the phone. On 568 sent questionnaires, 312 (55%) were filled. The frequency of the anemia is considered of 46 ± 21%. The definition of the anemia in an elderly person is on average 10.7 ± 0.8 g/dL, taking into account the situation of the patient. The wanted biological examinations are the haemoglobin and the ferritinaemia, but many people suggest measuring also folates and vitamin B12 given strong prevalence of comorbidity. Prevalence of iron deficiency anemia estimated between 20 and 80% because of high prevalence of mixed cause which modified the answer. The major causes were reported as of digestive, gynecological and post-operative origins. The treatment is proposed from 9 g/dL. The oral iron and the transfusions are the most quoted. The possibility of injectable iron is reported only by 17%, of the geriatricians. The answers of the geriatricians show strong coherences in the management of the iron deficiency anemia. Guidelines should be adapted for elderly people for exercice capacity, mainly on high frequency of mixed cases.

Undergraduate teaching in geriatric medicine using computer-aided learning improves student performance in examinations.

Science.gov (United States)

Daunt, Laura A; Umeonusulu, Patience I; Gladman, John R F; Blundell, Adrian G; Conroy, Simon P; Gordon, Adam L

2013-07-01

computer-aided learning (CAL) is increasingly used to deliver teaching, but few studies have evaluated its impact on learning within geriatric medicine. We developed and implemented CAL packages on falls and continence, and evaluated their effect on student performance in two medical schools. traditional ward based and didactic teaching was replaced by blended learning (CAL package combined with traditional teaching methods). Examination scores were compared for cohorts of medical students receiving traditional learning and those receiving blended learning. Control questions were included to provide data on cohort differences. in both medical schools, there was a trend towards improved scores following blended learning, with a smaller number of students achieving low scores (P learning was associated with improvement in student examination performance, regardless of the setting or the methods adopted, and without increasing teaching time. Our findings support the use of CAL in teaching geriatric medicine, and this method has been adopted for teaching other topics in the undergraduate curriculum.

Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines.

Science.gov (United States)

Southerland, Lauren T; Gure, Tanya R; Ruter, Daniel I; Li, Michael M; Evans, David C

2017-08-01

The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures. This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma). The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P quality indicators is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Geriatric syndromes: medical misnomer or progress in geriatrics?

NARCIS (Netherlands)

Olde Rikkert, M.G.M.; Rigaud, A.S.; Hoeyweghen, R.J. van; Graaf, J. de

2003-01-01

Both in geriatric and internal medicine journals, and in medical textbooks certain (aggregates of) symptoms are labelled as 'geriatric syndromes'. In frail elderly patients a large number of diseases present with well-known and highly prevalent atypical symptoms (e.g. immobility, instability,

Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial.

Science.gov (United States)

McVey, L J; Becker, P M; Saltz, C C; Feussner, J R; Cohen, H J

1989-01-01

To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. Randomized controlled clinical trial. University-affiliated referral Veterans Administration Medical Center. One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units. Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients' physicians. Ninety control group patients received only usual care. Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant. Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in

Development of a brief validated geriatric depression screening tool: the SLU "AM SAD".

Science.gov (United States)

Chakkamparambil, Binu; Chibnall, John T; Graypel, Ernest A; Manepalli, Jothika N; Bhutto, Asif; Grossberg, George T

2015-08-01

Combining five commonly observed symptoms of late-life depression to develop a short depression screening tool with similar sensitivity and specificity as the conventional, more time-consuming tools. We developed the St. Louis University AM SAD (Appetite, Mood, Sleep, Activity, and thoughts of Death) questionnaire. The frequency of each symptom in the prior 2 weeks is quantified as 0, 1, or 2. Patients 65 years or older from our clinics were administered the AM SAD, the Geriatric Depression Scale (GDS-15), the Montgomery-Asberg Depression Rating Scale (MADRS), and the St. Louis University Mental Status Exam (SLUMS). 100 patients were selected. AM SAD correlation with GDS was 0.72 and MADRS 0.80. AM SAD yielded a sensitivity and specificity of 79% and 62% against diagnosis of depression; of 88% and 62% with GDS-15; and 92% and 71% with MADRS. The AM SAD can be reliably used as a short depression screening tool in patients with a SLUMS score of 20 or higher. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Characteristics of patients in a ward of Academic Internal Medicine: implications for medical care, training programmes and research.

Science.gov (United States)

Becchi, Maria Angela; Pescetelli, Michele; Caiti, Omar; Carulli, Nicola

2010-06-01

To describe the characteristics of "delayed discharge patients" and the factors associated with "delayed discharges", we performed a 12-month observational study on patients classified as "delayed discharge patients" admitted to an Academic Internal Medicine ward. We assessed the demographic variables, the number and severity of diseases using the Geriatric Index of Comorbidity (GIC), the cognitive, affective and functional status using, respectively, the Mini Mental Stare Examination, the Geriatric Depression Scale and the Barthel Index. We assessed the total length of stay (T-LHS), the total inappropriate length of stay (T-ILHS), the median length of stays (M-LHS), the median inappropriate length of stay (M-ILHS) and evaluated the factors associated with delayed discharge. "Delayed discharge patients" were 11.9% of all patients. The mean age was 81.9 years, 74.0% were in the IV class of GIC and 33.5% were at the some time totally dependent and affected by severe or non-assessable cognitive impairments. The patients had 2584 T-LHS, of which 1058 (40.9%) were T-ILHS. Their M-LHS was 15 days, and the M-ILHS was 5 days. In general, the greater the LHS, the greater is the ILHS (Spearman's rho + 0.68, P < 0.001). Using a multivariate analysis, only the absence of formal aids before hospitalisation is independently associated with delayed discharge (F = 4.39, P = 0.038). The majority of the delays (69%) resulted from the difficulty in finding beds in long-term hospital wards, but the longest M-ILHS (9 days) was found in patients waiting for the Geriatric Evaluation Unit. The profile of patients and the pattern of hospital utilisation suggest a need to reorient the health care system, and to develop appropriate resources for the academic functions of education, research and patient care.

Feed-back between geriatric syndromes: general system theory in geriatrics.

Science.gov (United States)

Musso, Carlos G; Núñez, Juan F Macías

2006-01-01

Geriatrics has described three entities: confusional syndrome, incontinente and gait disorders, calling them geriatric giants. Aging process also induces changes in renal physiology such as glomerular filtration rate reduction, and alteration in water and electrolytes handling. These ageing renal changes have been named as nephrogeriatric giants. These two groups of giants, geriatric and nephrogeriatric, can predispose and potentiate each other leading old people to fatal outcomes. These phenomenon of feed-back between these geriatric syndromes has its roots in the loss of complexity that the ageing process has. Complexity means that all the body systems work harmoniously. The process of senescence weakens this coordination among systems undermining complexity and making the old person frail.

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors.

Science.gov (United States)

Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years ( P fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P falls (OR =2.55; 95% CI =1.05-6.19; P =0.039), age (OR =1.14; 95% CI =1.05-1.23; P =0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P =0.034). Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment

DEFF Research Database (Denmark)

Sletvold, O; Tilvis, R; Jonsson, A

1996-01-01

A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help f...... languages, and the translated versions should ideally have been subjected to validity and reliability testing. However, so far no scale meets these demands regarding all the five Nordic languages.......A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help...... for the clinician concerned with hospital based geriatric medicine. It may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriatricians. To some extent, the position of geriatric medicine in the Nordic countries varies between the countries. However...

Treatment resistance and psychodynamic psychiatry: concepts psychiatry needs from psychoanalysis.

Science.gov (United States)

Plakun, Eric

2012-06-01

Over the last 30 years psychiatry and psychoanalysis have moved in substantially divergent directions. Psychiatry has become rich in methodology but conceptually limited, with a drift toward biological reductionism. Psychoanalysis has remained relatively limited in methodology, but conceptually rich. The rich methodology of psychiatry has led to major contributions in discovering gene by environment interactions, the importance of early adversity, and to recognition of the serious problem posed by treatment resistance. However, psychiatry's biologically reductionistic conceptual focus interferes with the development of a nuanced clinical perspective based on emerging knowledge that might help more treatment resistant patients become treatment responders. This article argues that recognition of the problem of treatment resistance in psychiatry creates a need for it to reconnect with the conceptual richness of psychoanalysis in order to improve patient care. Psychodynamic psychiatry is defined as the relevant intersection of psychiatry and psychoanalysis where this reconnection can occur. I will suggest selected aspects of psychoanalysis that are especially relevant to psychiatry in improving outcomes in work with treatment resistant patients.

Post-stroke disposition from a geriatric-rehabilitative stroke care area: an Italian experience

Directory of Open Access Journals (Sweden)

Marco Masina

2014-02-01

Full Text Available A large number of stroke patients cannot be discharged at home. Studies on post stroke disposition have low validity outside the country in which they are carried out because healthcare systems offer different rehabilitative and long-term facilities. Moreover absolute selection criteria for admission to rehabilitation are not available yet. Few studies on post-stroke disposition from Italian stroke units are available. Authors evaluated data of a 18-month period from a geriatric managed stroke care area where comprehensive multi-professional assessment and discharge planning are routinely carried out. Only patients discharged with diagnosis related to acute stroke were considered. Baseline characteristics, clinical, neurological and functional conditions according to the structured multidimensional assessment were prospectively collected in the stroke unit registry. Univariate and multinomial logistic regression were performed to identify independent variables associated with three discharge settings: home, rehabilitation and skilled long-term ward. Out of 188 patients evaluated, 56.4% were discharged home, 18.6% to rehabilitation and 25.0% to long-term ward. Data showed an efficient disposition to intermediate settings with a shorter length of stay compared to other international studies. Factors associated with post-stroke disposition were age, dysphagia, neurological impairment on admission (NIH-SS≥6, after stroke functional status (mRankin≥3, poor pre-stroke functional level (mRankin≥3 and hemorrhagic stroke. Dysphagia, severe neurological impairment and post-stroke disability were associated with discharge to rehabilitation and long term ward. These two settings differed in age and pre-stroke functional condition. Patients discharged to long-term wards were about 10 years older than those admitted to rehabilitative ward. Only 5% of patients discharged to rehabilitation had a pre-stroke mRankin score ≥3. Disposition to a skilled

Management of malnutrition in geriatric trauma patients: results of a nationwide survey.

Science.gov (United States)

Eschbach, D; Kirchbichler, T; Oberkircher, L; Knobe, M; Juenemann, M; Ruchholtz, S; Buecking, B

2016-10-01

Prevalence of malnutrition in geriatric trauma patients ranges between 30 and 50 % in Germany. Malnutrition is associated with impaired wound healing, a prolonged in-hospital stay, reduced post-traumatic mobility, as well as a higher mortality. Thus, detection and improvement of nutritional status could be a fundamental contribution in optimizing the treatment of these patients. We sent a web-based questionnaire to 579 German hospitals with traumatological expertise, seeking information on the institutional care level, number of beds, use of nutritional assessments, and use of defined laboratory parameters for the detection of malnutrition. Furthermore, we focused on the presence and frequency of nutrition ward rounds on the intensive care unit. We received 151 answers. Nutritional status was analysed in one-third (N = 50). The half of these 50 clinics (54 %, N = 27) were using the body mass index (BMI), 20 % (N = 10) were using the nutritional risk screening (NRS), and 14 % (N = 7) used the mini nutritional assessment. 38 hospitals indicated a regular nutrition ward round; 63 % of them occurred daily, 13 % had a weekly frequency, and 24 % were on demand. Laboratory parameters were used inhomogeneously. Except for the more frequent use of the NRS (p = 0.026) in local trauma centres, we found no significant difference in the detection of malnutrition according to the care level. Although we know malnutrition is a frequent condition in geriatric patients, a minority of clinics considered it. The BMI and the NRS showed acceptance in practice; other parameters were used inhomogeneously. Although these findings may be limited in their significance, they indicate that the detection of malnutrition needs further investigation.

Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment

Directory of Open Access Journals (Sweden)

Samuel Silva

2018-04-01

Full Text Available The Comprehensive Geriatric Assessment (CGA is a multidisciplinary diagnosis approach that considers several dimensions of fragility in older adults to develop an individualized plan to improve their overall health. Despite the evidence of its positive impact, CGA is still applied by a reduced number of professionals in geriatric care in many countries, mostly using a paper-based approach. In this context, we collaborate with clinicians to bring CGA to the attention of more healthcare professionals and to enable its easier application in clinical settings by proposing a mobile application, Geriatric Helper, to act as a pocket guide that is easy to update remotely with up-to-date information, and that acts as a tool for conducting CGA. This approach reduces the time spent on retrieving the scales documentation, the overhead of calculating the results, and works as a source of information for non-specialists. Geriatric Helper is a tool for the health professionals developed considering an iterative, User-Centred Design approach, with extensive contributions from a broad set of users including domain experts, resulting in a highly usable and accepted system. Geriatric Helper is currently being tested in Portuguese healthcare units allowing for any clinician to apply the otherwise experts-limited geriatric assessment.

Preventive psychiatry: Current status in contemporary psychiatry

Directory of Open Access Journals (Sweden)

Rakesh Kumar Chadda

2017-01-01

Full Text Available Preventive psychiatry is one of the most ignored subdiscipline of psychiatry, which has got important role to play in the contemporary psychiatry. Mental disorders are very common with lifetime prevalence of about 25%, and tend to be chronic. Due to the stigma associated with mental disorders, lack of awareness, and also lack of adequate mental health resources, nearly 60%–80% of the persons suffering from mental disorders do not access mental health care services. Mental and substance use disorders have been identified as one of the major contributors to the disease-related burden and disability-adjusted life years. In this background, preventive psychiatry has an important role to play in public health sector. Since etiology of most of the mental disorders is not known, it is not possible to follow here the standard model of primary, secondary, and tertiary prevention of public health. A concept of universal, selective, and indicated prevention has been proposed in primary prevention. Preventive approaches in psychiatry focus on evidence-based risk and protective factors, promoting quality of life, reducing stressors, and improving resilience. Such interventions, when planned targeting at specific mental disorders, have a potential to prevent mental disorders. Thus, preventive psychiatry has a crucial role to play in mental health, considering the high prevalence of mental disorders, the associated disability and burden, and a great drain on human resources.

Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It?

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Paolo Orlandoni

2017-10-01

Full Text Available ObjectiveTo assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS and hospital mortality.DesignA retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST. Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models.SettingThe study was performed in an Italian geriatric research hospital (INRCA, Ancona.SubjectsTwo hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years, who gave their written consent to participate in the study, were enrolled.ResultsAccording to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential

The gap between available knowledge and its use in clinical psychiatry.

Science.gov (United States)

Munk-Jørgensen, P; Blanner Kristiansen, C; Uwawke, R; Larsen, J I; Okkels, N; Christiansen, B; Hjorth, P

2015-12-01

The time span between knowledge becoming available and its integration into daily clinical routine is lengthy. This phenomenon is explored in this study. We used the outcomes of our activities for investigating and strengthening the research-based activities to improve physical health in the routines of clinical psychiatric wards as examples for our analyses. The time span between new knowledge becoming available and its implementation into general clinical treatment is very long. However, a shortening of this time span is seen through active leadership backup and clinical research experience among psychiatrists and staff in the wards. In particular, the involvement of medical students interested in clinical research activities seems to have a positive impact. Academia needs to be re-implemented into clinical psychiatry. Staff with research experience is needed in all professions to increase evidence-based practice. Leaders must take responsibility for implementing new knowledge into the routines of the department and must support staff in these activities on a daily basis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Forensic psychiatry. Its relations to clinical psychiatry and criminology].

Science.gov (United States)

Kröber, H-L

2005-11-01

A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.

Why geriatrics? Academic geriatricians' perceptions of the positive, attractive aspects of geriatrics.

Science.gov (United States)

Cravens, D D; Campbell, J D; Mehr, D R

2000-01-01

Recruitment of geriatrics trainees has been poor, and the current shortage of academic geriatricians is expected to worsen. Although barriers to entering geriatrics practice have been identified, a review of the literature found few studies about why people choose to enter geriatrics. We used qualitative methods to investigate the positive, attractive aspects of geriatrics. Long interviews with six academic geriatricians were taped and transcribed. Transcripts were entered into a textual database computer program and reviewed independently by two investigators. Six themes emerged: 1) traditional learning experiences, 2) value on personal relationships, 3) a perception of distinctive differences, 4) a desire to feel needed personally and societally, 5) prefer democracy versus autocracy, and 6) desire intellectual challenges. Academic geriatrics, therefore, is particularly attractive to people who value enduring relationships, see challenges in complexity, practice social responsibility, prefer working within a multidisciplinary team, and derive satisfaction from making seemingly small but nonetheless important changes in peoples' lives. If further studies validate these findings, they could promote geriatrics as a career, by, for example, identifying students and family practice and internal medicine residents who share these values, beliefs, and attitudes and encouraging them to consider this important field.

Iranian Medical Students’ Perception of Psychiatry: Before and After a Psychiatry Clerkship

Science.gov (United States)

Nejatisafa, Ali-Akbar; Shoar, Saeed; Kaviani, Hosein; Samimi-Ardestani, Mehdi; Shabani, Amir; Esmaeili, Sara; Moghaddam, Yasaman

2013-01-01

Objective We aimed to compare the medical students’ attitude towards psychiatry before and after psychiatry clerkship, and to examine the association of choosing psychiatry as a future career with some personal characteristics. Method In a self-controlled, quasi-experimental study, all of the medical students entering the psychiatry clerkship in three major medical schools of Iran located in Tehran (Tehran, Shahid Beheshti, and Iran University of Medical Sciences) were asked to participate anonymously in the study on the first and the last 3-days of their psychiatry clerkship. From 346 invited 4th-5th year medical students, 225 (65%) completed anonymous self-report questionnaires before and after a 4-week psychiatry clerkship. Results Positive response to choose psychiatry as a career was seen in 13.3% and 18.3% before and after psychiatry rotation, respectively. However, the difference was not statistically significant; about one-quarter of the students were turned on to psychiatry and 25% were discouraged during the clerkship. Individual pair wise comparisons revealed significant improvements only in two out of 13 measured aspects of psychiatry. Seventeen out of 38 (47.7%) students who identified psychiatry as the career of choice or strong possibility reported that one of their family members or close friends’ mental illness had an impact on their choice. Those students who considered psychiatry as the strong possibility claimed that they are more interested in humanities (OR = 2.96; 95% CI: 1.17, 7.49), and playing a musical instrument (OR = 2.53; 95% CI: 1.15, 5.57). Conclusion It may be concluded that exposure to psychiatry clerkship could influence medical students’ opinion about psychiatry positively, or negatively. Personal characteristics and individual interests of students may play an important role in choosing psychiatry as their future career. PMID:23682250

Iranian Medical Students’ Perception of Psychiatry: Before and After a Psychiatry Clerkship

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Homayoun Amini

2013-03-01

Full Text Available Objective: We aimed to compare the medical students’ attitude towards psychiatry before and after psychiatry clerkship, and to examine the association of choosing psychiatry as a future career with some personal characteristics.Method: In a self-controlled, quasi-experimental study, all of the medical students entering the psychiatry clerkship in three major medical schools of Iran located in Tehran (Tehran, Shahid Beheshti, and Iran University of Medical Sciences were asked to participate anonymously in the study on the first and the last 3-days of their psychiatry clerkship. From 346 invited 4th-5th year medical students, 225 (65% completed anonymous self-report questionnaires before and after a 4-week psychiatry clerkship.Results: Positive response to choose psychiatry as a career was seen in 13.3 % and 18.3 % before and after psychiatry rotation, respectively. However, the difference was not statistically significant; about one-quarter of the students were turned on to psychiatry and 25% were discouraged during the clerkship. Individual pair wise comparisons revealed significant improvements only in two out of 13 measured aspects of psychiatry. Seventeen out of 38 (47.7% students who identified psychiatry as the career of choice or strong possibility reported that one of their family members or close friends’ mental illness had an impact on their choice. Those students who considered psychiatry as the strong possibility claimed that they are more interested in humanities (OR = 2.96; 95% CI: 1.17, 7.49, and playing a musical instrument (OR = 2.53; 95% CI: 1.15, 5.57.Conclusion: It may be concluded that exposure to psychiatry clerkship could influence medical students’ opinion about psychiatry positively, or negatively. Personal characteristics and individual interests of students may play an important role in choosing psychiatry as their future

Geriatric fall-related injuries.

African Journals Online (AJOL)

Conclusion: The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk fac- tors for falls including home hazards is essential for prevention of geriatric fall-related injuries. Keywords: Accidental fall, geriatrics, injury, trauma registry. DOI: http://dx.doi.org/10.4314/ahs.v16i2.24.

International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

NARCIS (Netherlands)

Wildiers, Hans; Heeren, Pieter; Puts, Martine; Topinkova, Eva; Janssen-Heijnen, Maryska L. G.; Extermann, Martine; Falandry, Claire; Artz, Andrew; Brain, Etienne; Colloca, Giuseppe; Flamaing, Johan; Karnakis, Theodora; Kenis, Cindy; Audisio, Riccardo A.; Mohile, Supriya; Repetto, Lazzaro; Van Leeuwen, Barbara; Milisen, Koen; Hurria, Arti

2014-01-01

Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the

National Database of Geriatrics

DEFF Research Database (Denmark)

Kannegaard, Pia Nimann; Vinding, Kirsten L; Hare-Bruun, Helle

2016-01-01

AIM OF DATABASE: The aim of the National Database of Geriatrics is to monitor the quality of interdisciplinary diagnostics and treatment of patients admitted to a geriatric hospital unit. STUDY POPULATION: The database population consists of patients who were admitted to a geriatric hospital unit....... Geriatric patients cannot be defined by specific diagnoses. A geriatric patient is typically a frail multimorbid elderly patient with decreasing functional ability and social challenges. The database includes 14-15,000 admissions per year, and the database completeness has been stable at 90% during the past......, percentage of discharges with a rehabilitation plan, and the part of cases where an interdisciplinary conference has taken place. Data are recorded by doctors, nurses, and therapists in a database and linked to the Danish National Patient Register. DESCRIPTIVE DATA: Descriptive patient-related data include...

Basic geriatric assessment does not predict in-hospital mortality after PEG placement

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Smoliner Christine

2012-09-01

Full Text Available Abstract Background Percutaneous endoscopic gastrostomy (PEG is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement. Methods All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality. Results A total of 1232 patients (60.4% women with a median age of 82 years (range 60 to 99 years were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664, with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%. In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR 1.030, 95% confidence interval (CI 1.003-1.056, male sex (OR 1.741, 95% CI 1.216-2.493, and pneumonia (OR 2.641, 95% CI 1.457-4.792 or the diagnosis group ‘miscellaneous disease’ (OR 1.864, 95% CI 1

Convergent validity of the Cognitive Performance Scale of the interRAI acute care and the mini-mental state examination.

Science.gov (United States)

Wellens, Nathalie I H; Flamaing, Johan; Tournoy, Jos; Hanon, Tina; Moons, Philip; Verbeke, Geert; Boonen, Steven; Milisen, Koen

2013-07-01

The Cognitive Performance Scale (CPS) is generated from five items of the interRAI/ Minimum Data Set instruments, a comprehensive geriatric assessment method. CPS was initially designed to assess cognition in residential care, where it has shown good psychometric performance. We evaluated the performance of the interRAI Acute Care in identifying cognitive impairment among patients hospitalized on acute geriatric wards. An observational study was conducted on two geriatric wards. Trained raters independently completed the interRAI Acute Care and the Mini-Mental State Examination (MMSE) in 97 inpatients (85 ± 5 years; 67% female). The level of agreement between CPS and MMSE was explored using comparisons of means, agreement coefficients, and diagnostic accuracy. Cognitive impairment was present in 61% of the participants. Average MMSE scores were significantly different between groups with low CPS scores compared with those with high CPS scores (p <0.05). CPS explained only 48.8% of the variability in MMSE. Agreement in defining cognitively impaired subjects was moderate (percentage observed agreement, 68%; κ = 0.41). With MMSE score less than 24 as a gold standard, diagnostic accuracy of CPS was moderate (area under curve = 0.73), with low sensitivity, but excellent specificity. When lowering the MMSE cutoff to less than 18 and focusing on patients with severe cognitive impairment, CPS agreement coefficients and sensitivity increased but specificity decreased. Using education-adjusted MMSE cutoffs did not substantially affect the results. CPS can be used for coarse triage between intact and severe cognitive impairment. Although promising results have been obtained in residential and community settings, our results suggest that CPS fails to differentiate across different levels of cognitive impairment in hospitalized geriatric patients. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Brain imaging in psychiatry

International Nuclear Information System (INIS)

Morihisa, J.M.

1984-01-01

This book contains the following five chapters: Positron Emission Tomography (PET) in Psychiatry; Regional Cerebral Blood Flow (CBF) in Psychiatry: Methodological Issues; Regional Cerebral Blood Flow in Psychiatry: Application to Clinical Research; Regional Cerebral Blood Flow in Psychiatry: The Resting and Activated Brains of Schizophrenic Patients; and Brain Electrical Activity Mapping (BEAM) in Psychiatry

Geriatric Cardiology: An Emerging Discipline.

Science.gov (United States)

Dodson, John A; Matlock, Daniel D; Forman, Daniel E

2016-09-01

Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists are encountering patients with a greater number of comorbid illnesses as well as "geriatric conditions," such as cognitive impairment and frailty, which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine to everyday cardiology practice. Accordingly, the tasks of a "geriatric cardiologist" may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review, we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

The role of autosuggestion in geriatric patients' quality of life: a study on psycho-neuro-endocrine-immunology pathway.

Science.gov (United States)

Sari, Nina Kemala; Setiati, Siti; Taher, Akmal; Wiwie, Martina; Djauzi, Samsuridjal; Pandelaki, Jacub; Purba, Jan Sudir; Sadikin, Mohamad

2017-10-01

There has been no study conducted about the effect of autosuggestion on quality of life for geriatric patients. Our aim was to evaluate the efficacy of autosuggestion for geriatric patients' quality of life and its impact on psycho-neuro-endocrine-immune pathway. Sixty geriatric patients aged ≥60 years in a ward were randomly assigned to either receive autosuggestion or not. Autosuggestion was recorded in a tape to be heard daily for 30 days. Both groups received the standard medical therapy. Primary outcome was quality of life by COOP chart. Secondary outcomes were serum cortisol level, interleukin-2, interleukin-6, interferon-γ, and N-acetylaspartate/creatine ratio in limbic/paralimbic system by magnetic resonance spectroscopy. The study was single blinded due to the nature of the intervention studied. Out of 60 subjects, 51 finished the study. The autosuggestion group reported better scores than the control one for quality of life, COOP chart 1.95 vs. 2.22 (95% CI, p = 0.02). There were increments of serum cortisol (p = 0.03) and interleukin-6 in the autosuggestion group (p = 0.04). Interleukin-2, interferon-γ, and N-acetylaspartate/creatine ratio in prefrontal cortex showed a tendency to increase in the autosuggestion groups. Autosuggestion is associated with improvement of geriatrics' quality of life, serum cortisol level, and adaptive immunity. There is a better trend for neuroplasticity in prefrontal cortex in the autosuggestion group.

Comparing Mental Illness Stigma among Nurses in Psychiatric and Non-Psychiatric Wards in Tabriz University of Medical Sciences

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Ebrahimi Hossein

2017-03-01

Full Text Available Stigma can complicate people’s mental health problems by affecting different sides of personal life, increasing negative attitudes, causing discriminatory behavior towards them, and reducing the chances of recovery and returning to normal life. This research aims to compare the stigma of mental illness among nurses working in psychiatric and non-psychiatric wards in Tabriz University of Medical Sciences. A total of 240 nurses participated in this descriptive and analytic study. The data were collected using a demographic questionnaire and the Community Attitudes towards the Mentally Ill (CAMI Scale, which is a 40-item self-report questionnaire. All data were analyzed using SPSS 13. The majority of nurses have a medium level of stigma toward people with mental illness, and there is no significant relation between the type of wards and mean stigma scores. After eliminating factors such as mental illness in nurses and their families, it seems that only working with people with mental illness in psychiatric wards is not enough to create a positive attitude toward them. Additionally, the less physical activity and taking advantage of legal benefits of work hardship for psychiatric nurses, low income, and stigma toward psychiatric nursing, probably may make a difference in inclining to work in psychiatry ward between the two groups in spite of relatively equal stigma scores.

What Is Psychiatry?

Medline Plus

Full Text Available ... What Is Psychiatry? Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of ... written examination for a state license to practice medicine, and then complete four years of psychiatry residency. ...

What Is Psychiatry?

Medline Plus

Full Text Available ... Back to Patients & Families All Topics What Is Psychiatry? Psychiatry is the branch of medicine focused on the ... practice medicine, and then complete four years of psychiatry residency. The first year of residency training is ...

Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical inpatients with atrial fibrillation.

Science.gov (United States)

Bo, Mario; Sciarrillo, Irene; Maggiani, Guido; Falcone, Yolanda; Iacovino, Marina; Grisoglio, Enrica; Fonte, Gianfranco; Grosjean, Simon; Gaita, Fiorenzo

2017-03-01

The aim of the present study was to investigate the prevalence of geriatric syndromes among older medical inpatients with atrial fibrillation, and their association with use of vitamin K antagonists. A retrospective study of patients aged ≥65 years discharged with a diagnosis of atrial fibrillation from the Acute Geriatric Ward was carried out. Stroke and bleeding risk were evaluated according to the CHA 2 DS 2 -VASC and HAS-BLED scores. Comorbidity, cognitive status, functional autonomy and contraindications to vitamin K antagonists were also considered. Atrial fibrillation was documented in 1078 of 3650 patients (29.5%, mean age 83.4 ± 6.6 years, 60.3% women). Contraindications to vitamin K antagonists were documented in 24.9% of patients. Prescription of vitamin K antagonists at discharge was 37.8% and 47.9%, in the overall sample and in those without contraindications, respectively. In the overall sample, prescription of vitamin K antagonists was associated with younger age, permanent/persistent atrial fibrillation, home discharge, less comorbidity, higher hemoglobin levels, better functional independence, known atrial fibrillation at admission and lower HAS-BLED score. Among patients without contraindications to vitamin K antagonists, their use at discharge was independently associated with younger age, permanent/persistent atrial fibrillation, home discharge, higher hemoglobin levels and CHA2DS2-VASC score, better functional autonomy, and greater number of drugs. We showed a high prevalence of atrial fibrillation among older medical inpatients, who have a poor health status and a high prevalence of geriatric syndromes. Vitamin K antagonists were prescribed in less than half of the patients; underuse was mainly accounted for by a high prevalence of comorbidities/contraindications, poor health status and limited functional autonomy. Geriatr Gerontol Int 2017; 17: 416-423. © 2016 Japan Geriatrics Society.

Accounts on the Behalf of Patients during Geriatric Case Conferences

DEFF Research Database (Denmark)

Nielsen, Søren Beck

2009-01-01

The analysis of actors' accounts for their actions can reveal actors' understandings of local situations and of social standards. In this paper, I discuss some of the consequences of a variant of accounting for one's own actions, namely accounting for someone else's actions. Accounts given...... on someone else's behalf explain another person's conduct. Potentially, such accounts therefore undermine interlocutors as natural tellers of personal experience and one might expect this kind of account-giving to be a delicate matter. In this paper, however, I demonstrate that a powerful, supportive aspect...... of the practice is that in explaining a previous turn, it treats the original speaker as a sense-producing individual. Accounts made on behalf of patients during case conferences in the geriatric wards of Danish hospitals are investigated. Results show that such accounts simultaneously perform two kinds...

Co-creation by the ABIM Geriatric Medicine Board and the AGS - Helping Move Geriatrics Forward.

Science.gov (United States)

Leff, Bruce; Lundjeberg, Nancy E; Brangman, Sharon A; Dubow, Joyce; Levine, Sharon; Morgan-Gouveia, Melissa; Schlaudecker, Jeffrey; Lynn, Lorna; McDonald, Furman S

2017-10-01

The American board of internal medicine (ABIM) establishes standards for physicians. The American geriatrics society (AGS) is a not-for-profit membership organization of nearly 6,000 health professionals devoted to improving the health, independence, and quality of life of all older people. Beginning in 2013, ABIM redesigned its governance structure, including the role of the specialty boards. Specialty boards are charged with responsibilities for oversight in four main areas: (1) the assessments used in initial certification and maintenance of certification (MOC); (2) medical knowledge self-assessment and practice assessment in the specialty; (3) building relationships with relevant professional societies and other organizational stakeholders; and (4) issues related to training requirements for initial certification eligibility within the specialty. The aim of this paper is to inform the geriatrics community regarding the function of geriatric medicine board (GMB) of the ABIM, and to invite the geriatrics community to fully engage with and leverage the GMB as a partner to: (1) develop better certification examinations and processes, identifying better knowledge and practice assessments, and in establishing appropriate training and MOC requirements for geriatric medicine; (2) leverage ABIM assets to conduct applied research to guide the field in the areas of training and certification and workforce development in geriatric medicine; (3) make MOC relevant for practicing geriatricians. Active engagement of the geriatrics community with ABIM and the GMB will ensure that certification in geriatric medicine provides the greatest possible value and meaning to physicians, patients, and the public. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Psychiatrists, criminals, and the law: forensic psychiatry in Switzerland 1850-1950.

Science.gov (United States)

Germann, Urs

2014-01-01

Between 1880 and 1950, Swiss psychiatrists established themselves as experts in criminal courts. In this period, the judicial authorities required psychiatric testimonies in a rising number of cases. As a result, more offenders than ever before were declared mentally deficient and, eventually, sent to psychiatric asylums. Psychiatrists also enhanced their authority as experts at the political level. From the very beginning, they got involved in the preparatory works for a nationwide criminal code. In this article, I argue that these trends toward medicalization of crime were due to incremental processes, rather than spectacular institutional changes. In fact, Swiss psychiatrists gained recognition as experts due to their daily interactions with judges, public prosecutors, and legal counsels. At the same time, the spread of medical expertise had serious repercussions on psychiatric institutions. From 1942 onwards, asylums had to deal with a growing number of "criminal psychopaths," which affected ward discipline and put psychiatry's therapeutic efficiency into question. The defensive way in which Swiss psychiatrists reacted to this predicament was crucial to the further development of forensic psychiatry. For the most part, it accounts for the subdiscipline's remarkable lack of specialization until the 1990s. © 2013.

History of psychiatry

Science.gov (United States)

Shorter, Edward

2013-01-01

Purpose of review The present review examines recent contributions to the evolving field of historical writing in psychiatry. Recent findings Interest in the history of psychiatry continues to grow, with an increasing emphasis on topics of current interest such as the history of psychopharmacology, electroconvulsive therapy, and the interplay between psychiatry and society. The scope of historical writing in psychiatry as of 2007 is as broad and varied as the discipline itself. Summary More than in other medical specialties such as cardiology or nephrology, treatment and diagnosis in psychiatry are affected by trends in the surrounding culture and society. Studying the history of the discipline provides insights into possible alternatives to the current crop of patent-protected remedies and trend-driven diagnoses. PMID:18852567

[Psychiatric care between World War II and "Psychiatrie-Enquête": early approaches of reformation in Württemberg].

Science.gov (United States)

Croissant, Daniela; Längle, Gerhard

2015-03-01

The article describes care in a psychiatric clinic between 1946 and 1975. This happens against the background of the current psychiatry-historical literature in which this phase of psychiatric care is described often summarily with the destructive words of the report of the 'Psychiatrie-Enquête' of 1975. Improvements achieved in this time were hardly examined up to now though they contributed substantially to the later effects of the 'Psychiatrie-Enquête'. The medical annual reports of the psychiatric clinic of Zwiefalten, today ZfP Südwürttemberg, refering to the mentioned period were sighted and evaluated concerning their contents. In the called period evident organizational and structural defects are deplored in the annual reports. Nevertheless, from the late 1940 s on, modern care elements appear, as for example the broadening of the range of the therapeutic offers, multiprofessional treatment, diagnosis-specific concepts for the wards, opening of stations and extensive outpatient care. It is shown that already before the appearance of the final report of the Enquête commission clear progress concerning psychiatric care was achieved. © Georg Thieme Verlag KG Stuttgart · New York.

Research on current situations of geriatric nursing education

Directory of Open Access Journals (Sweden)

Liu Yujin

2017-01-01

Full Text Available The population aging is accelerating and the aging population is growing in China. Although the geriatric nursing education has been developed for more than 20 years, geriatric nursing professionals are still insufficient and the geriatric nursing education is facing various challenges under the new situation. This paper primarily describes the developmental history and the related concepts of geriatric nursing education, and analyzes the personnel training modes and routes of geriatric nursing education, and its problems, in order to provide the basis for the reform of geriatric nursing education. The development of geriatric nursing needs a large number of outstanding nursing personnel, and the cultivation of geriatric nursing professionals depends on the development of geriatric nursing and the improvement of the teaching quality of geriatric nursing education. Front-line educators working on geriatric nursing should be committed to reforming the geriatric nursing teaching, improving the teaching quality and cultivating the high-quality nursing personnel suitable for conditions of the elderly in China.

Geriatric imaging

Energy Technology Data Exchange (ETDEWEB)

Guglielmi, Giuseppe [Scientific Institute Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Italy). Dept. of Radiology; Peh, Wilfred C.G. [Khoo Teck Puat Hospital, Singapore (Singapore). Dept. of Diagnostic Radiology; Guermazi, Ali (eds.) [Boston Univ. School of Medicine, Boston, MA (United States). Dept. of Radiology

2013-08-01

Considers all aspect of geriatric imaging. Explains clearly how to distinguish the healthy elderly from those in need of treatment. Superbly illustrated. Written by recognized experts in field. In the elderly, the coexistence of various diseases, the presence of involutional and degenerative changes, and the occurrence of both physical and cognitive problems represent ''the norm.'' It is therefore important to know how to distinguish the healthy elderly from those in need of treatment as a sound basis for avoiding overdiagnosis and overtreatment. This aspect is a central theme in Geriatric Imaging, which covers a wide range of applications of different imaging techniques and clearly explains both the potential and the limitations of diagnostic imaging in geriatric patients. Individual sections are devoted to each major region or system of the body, and a concluding section focuses specifically on interventional procedures. The book, written by recognized experts in the field, is superbly illustrated and will be an ideal resource for geriatricians, radiologists, and trainees.

Endodontic treatment in geriatric patients

Directory of Open Access Journals (Sweden)

Milly Armilya Andang

2007-11-01

Full Text Available With the increased number of geriatric population, it is predicted that the need for dental treatment also increases. The needs for esthetic factors and function of geriatric patient are maybe similar to young patient. The number of geriatric patients who refuse dental extraction is increasing if there are still other alternative. They can be more convinced when the clinician said that the dental disease experienced is a focal infection so that the loss of the tooth can be accepted as the best option. But if it is possible, they will prefer endodontic treatment, because they want to keep their teeth according to the treatment plan or based on patient's request, as a less traumatic alternative compared to extraction.Endodontic treatment consideration for geriatric patient is quite similar to younger patients. The technique is also the same, although the problem may be bigger. The problem or obstacle that may arise in endodontic treatment for geriatric patient relates to the visit duration, problems during x-ray, problems in defining root canal location, vertical root fracture, and in some cases, decreased pulp tissue recovery ability. Due to the fact that the challenge is quite big, the success of endodontic treatment in geriatric patients needs to be considered. This paper will explain the endodontic treatment prognosis for geriatric patients.

Models of Integrated Training in Psychiatry and Child and Adolescent Psychiatry

Science.gov (United States)

Sexson, Sandra B.; Thomas, Christopher R.; Pope, Kayla

2008-01-01

Objective: Previous studies indicate declining interest in child and adolescent psychiatry (CAP) as a career choice during psychiatry residency training. Programs have developed integrated training in psychiatry and CAP as a means to address the workforce shortage in CAP, but little is known about the number or nature of these training tracks.…

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

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Kocyigit, Burhan Fatih; Berk, Ejder

2018-01-01

Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

Evaluation of geriatric changes in dogs

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Pati, Soumyaranjan; Panda, S. K.; Acharya, A. P.; Senapati, S.; Behera, M.; Behera, S. S.

2015-01-01

Aim: The present study has been envisaged to ascertain the old age for critical management of geriatric dogs considering the parameters of externally visible changes, haemato-biochemical alterations and urine analysis in geriatric dogs approaching senility. Materials and Methods: The study was undertaken in the Department of Veterinary Pathology in collaboration with Teaching Veterinary Clinic complex spanning a period of 1 year. For screening of geriatric dogs, standard geriatric age chart o...

Second Order Ideal-Ward Continuity

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Bipan Hazarika

2014-01-01

Full Text Available The main aim of the paper is to introduce a concept of second order ideal-ward continuity in the sense that a function f is second order ideal-ward continuous if I-limn→∞Δ2f(xn=0 whenever I-limn→∞Δ2xn=0 and a concept of second order ideal-ward compactness in the sense that a subset E of R is second order ideal-ward compact if any sequence x=(xn of points in E has a subsequence z=(zk=(xnk of the sequence x such that I-limk→∞Δ2zk=0 where Δ2zk=zk+2-2zk+1+zk. We investigate the impact of changing the definition of convergence of sequences on the structure of ideal-ward continuity in the sense of second order ideal-ward continuity and compactness of sets in the sense of second order ideal-ward compactness and prove related theorems.

[From boxing to geriatric psychiatry : Facets from the work of East German social psychiatrist Bernhard Schwarz (1918-1991)].

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Bart, K; Steinberg, H

2017-11-29

For the first time, this study presents publications representative for the work of the neurologist and sports physician Bernhard Schwarz, whose career spans from the 1950s to the 1970s. His work is characterized by exceptional originality. Schwarz acted as the physician of the GDR national boxing team and conducted a systematic long-term study of 800 boxers. He found increased occurrences of depression, Alzheimer's and Parkinson's diseases and suggested that these were linked to recurring craniocerebral injury. He was concerned about avoiding such long-term health effects in boxers and suggested a range of preventive measures that were later reflected in the guidelines of international boxing associations. Schwarz was distinguished by his drive to directly implement social psychiatric approaches in the hospital. As head of the psychiatric clinic at Leipzig University, he initiated a club for geriatric patients to help older patients with the problematic transition from hospitalization to outpatient assistance at home. Influenced by holistic anthropological thinking, he regarded geriatric mental illness as a consequence of social isolation. In addition, Schwarz was involved in a model project that assessed the work resilience of patients in the hospital with the goal of optimizing psychiatric rehabilitation. Both projects were successes, according to his published accounts.

What Is Psychiatry?

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TOWARDS AN ANTHROPOLOGICAL PSYCHIATRY

NARCIS (Netherlands)

Mooij, A.W.M.

The situation of present day psychiatry is described as being dominated by an empiricist perspective. The limitations of this perspective are analyzed and a rough sketch of the hermeneutical approach in psychiatry is offered. It is argued that a fully developed hermeneutical psychiatry implies a

Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002).

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Christner, S; Ritt, M; Volkert, D; Wirth, R; Sieber, C C; Gaßmann, K-G

2016-12-01

The present study aimed to evaluate a short-form (MNA-SF) version of the Mini Nutritional Assessment (MNA), in which some of the items were operationalised, based on scores from tools used for a comprehensive geriatric assessment, as a method for analysing the nutritional status of hospitalised geriatric patients. We compared this MNA-SF version with the corresponding MNA long-form (MNA-LF) and Nutritional Risk Screening 2002 (NRS 2002) in terms of completion rate, prevalence and agreement regarding malnutrition and/or the risk of this. In total, 201 patients aged ≥65 years who were hospitalised in geriatric wards were included in this analysis. The MNA-SF, MNA-LF and NRS 2002 were completed in 98.0%, 95.5% and 99.5% of patients (P = 0.06), respectively. The MNA-SF, MNA-LF and NRS 2002 categorised 93.4%, 91.1% and 66.0% of patients as being malnourished or at risk of being malnourished (P evaluating the nutritional status of hospitalised geriatric patients. The NRS 2002 part 1 showed limited value as a prescreening aid in relation to the NRS 2002 part 2 in the same group of patients. © 2016 The British Dietetic Association Ltd.

[Impact of Anthropologic Psychiatry on Psychiatrie-Enquete and Psychiatric Reform in West Germany].

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Söhner, Felicitas; Becker, Thomas; Fangerau, Heiner

2017-07-01

Objectives Analysis of the perception of effects of anthropological psychiatry on the Psychiatrie-Enquete and psychiatric reform in the Federal Republic of Germany (West Germany). Methods Qualitative content analysis of expert interviews and systematic literature search. Results Literary sources and expert interviews point to the impact of the anthropologic concept on discourse on and approach to those suffering from mental illness. The attention focused on the visualisation of material-social and subjective living conditions of persons with mental illness. Reform approaches of anthropological psychiatrists were perceived as a basis for the development of social psychiatry. Academic departments of psychiatry in Frankfurt (Zutt, Kulenkampff) and Heidelberg (von Baeyer, Kisker, Häfner) were considered important centres of innovation and reform. Conclusion The thinking of phenomenological-anthropological psychiatry was understood as a facilitator of the Psychiatrie-Enquete and psychiatric reform in West Germany. © Georg Thieme Verlag KG Stuttgart · New York.

Effect of in-hospital comprehensive geriatric assessment (CGA in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

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Taraldsen Kristin

2011-04-01

Full Text Available Abstract Background Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT aims to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual in an orthopaedic unit. Methods/design The intervention of interest, a comprehensive geriatric assessment is compared with traditional care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility measured by the Short Physical Performance Battery (SPPB at 4 months after surgery. Secondary outcomes measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait, falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival. Discussion We believe that the design of the study, the randomisation procedure and outcome measurements will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility and other relevant outcomes in hip fracture patients. Trials registration ClinicalTrials.gov, NCT00667914

Predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge

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Johari N

2016-10-01

Full Text Available Nuruljannah Johari,1 Zahara Abdul Manaf,1 Norhayati Ibrahim,2 Suzana Shahar,1 Norlaila Mustafa3 1Dietetics Programme, 2Health Psychology Programme, Faculty of Health Sciences, 3Medical Department, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Purpose: Diabetes mellitus is prevalent among older adults, and affects their quality of life. Furthermore, the number is growing as the elderly population increases. Thus, this study aims to explore the predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge in Malaysia. Methods: A total of 110 hospitalized geriatric patients aged 60 years and older were selected using convenience sampling method in a cross-sectional study. Sociodemographic data and medical history were obtained from the medical records. Questionnaires were used during the in-person semistructured interviews, which were conducted in the wards. Linear regression analyses were used to determine the predictors of each domain of quality of life. Results: Multiple regression analysis showed that activities of daily living, depression, and appetite were the determinants of physical health domain of quality of life (R2=0.633, F(3, 67=38.462; P<0.001, whereas depression and instrumental activities of daily living contributed to 55.8% of the variability in psychological domain (R2=0.558, F(2, 68=42.953; P<0.001. Social support and cognitive status were the determinants of social relationship (R2=0.539, F(2, 68=39.763; P<0.001 and also for the environmental domain of the quality of life (R2=0.496, F(2, 68=33.403; P<0.001. Conclusion: The findings indicated different predictors for each domain in the quality of life among hospitalized geriatric patients with diabetes mellitus. Nutritional, functional, and psychological aspects should be incorporated into rehabilitation support programs prior to discharge in order to improve patients�

Recognition of geriatric popular song repertoire: a comparison of geriatric clients and music therapy students.

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VanWeelden, Kimberly; Cevasco, Andrea M

2010-01-01

The purposes of the current study were to determine geriatric clients' recognition of 32 popular songs and songs from musicals by asking whether they: (a) had heard the songs before; (b) could "name the tune" of each song; and (c) list the decade that each song was composed. Additionally, comparisons were made between the geriatric clients' recognition of these songs and by music therapy students' recognition of the same, songs, based on data from an earlier study (VanWeelden, Juchniewicz, & Cevasco, 2008). Results found 90% or more of the geriatric clients had heard 28 of the 32 songs, 80% or more of the graduate students had heard 20 songs, and 80% of the undergraduates had heard 18 songs. The geriatric clients correctly identified 3 songs with 80% or more accuracy, which the graduate students also correctly identified, while the undergraduates identified 2 of the 3 same songs. Geriatric clients identified the decades of 3 songs with 50% or greater accuracy. Neither the undergraduate nor graduate students identified any songs by the correct decade with over 50% accuracy. Further results are discussed.

Impact of duration of psychiatry rotation on medical interns’ attitude towards psychiatry

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Srikanth Reddy

2017-01-01

Full Text Available Background: Medical Council of India allowed the interns to take up an extra 15 days of elective posting in psychiatry along with the mandatory posting of 15 days. The study was planned to assess the effect of the additional period of psychiatry internship on the attitude of interns towards psychiatry. Material and methods: The consenting interns were given a semi structured proforma enquiring about their age and gender and were asked to fill up Attitude Towards Psychiatry (ATP scale. The assessment was done at the beginning and then after 15 days of mandatory posting. Those participants who were willing to do an additional 15 days of elective posting in psychiatry were assessed again on the 30th day of the training. Results: Mean age of the participating interns (n=47 was 25.44±1.52 and the male female ratio was 0.8. Twenty six interns did only the 15 days mandatory psychiatry internship posting (Group 1 and the remaining 21 interns took up the additional elective 15 days posting (Group 2. At the end of the 15 days posting, Mean ATP score of the group 1 increased from 88.34±6.07 to 88.46±6.19 (p=0.80 whereas the same increased from 88.04±7.06 to 88.19±7.65 (p=0.7 in the group 2 and further increased to 91.09±8.3 at the end of the additional 15 days of elective posting (p<0.05. Conclusion: A thirty days exposure of psychiatry during internship had more favourable impact on the attitude of interns towards psychiatry.

Positioning Medical Students for the Geriatric Imperative: Using Geriatrics to Effectively Teach Medicine

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Nguyen, Annie L.; Duthie, Elizabeth A.; Denson, Kathryn M.; Franco, Jose; Duthie, Edmund H.

2013-01-01

Medical schools must consider innovative ways to ensure that graduates are prepared to care for the aging population. One way is to offer a geriatrics clerkship as an option for the fulfillment of a medical school's internal medicine rotation requirement. The authors' purpose was to evaluate the geriatrics clerkship's impact on internal medicine…

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

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Jennifer C. Reneker

2016-10-01

Full Text Available This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen’s d-values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15–0.30. Two perceptions of geriatric physical therapy demonstrated a significant positive increase (P<0.05 with moderate effect sizes (d=0.47 and d=0.50. The students’ perceptions of geriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68 and enjoyment (d=1.96. Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

[Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013].

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Singler, K; Stuck, A E; Masud, T; Goeldlin, A; Roller, R E

2014-11-01

Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students' perceptions of geriatrics and geriatric education in the United States.

Science.gov (United States)

Reneker, Jennifer C; Weems, Kyra; Scaia, Vincent

2016-01-01

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21-33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen's d values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15-0.30). Two perceptions of geriatric physical therapy demonstrated a significant positive increase (Pgeriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68) and enjoyment (d=1.96). Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

What Is Psychiatry?

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Full Text Available ... PTSD) More Back to Patients & Families All Topics What Is Psychiatry? Psychiatry is the branch of medicine ... symptoms and other criteria for diagnosing mental disorders. What Treatments Do Psychiatrists Use? Psychiatrists use a variety ...

What Is Psychiatry?

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Full Text Available ... state license to practice medicine, and then complete four years of psychiatry residency. The first year of ... psychiatrists also complete additional specialized training after their four years of general psychiatry training. They may become ...

What Is Psychiatry?

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Full Text Available ... Back to Patients & Families All Topics What Is Psychiatry? Psychiatry is the branch of medicine focused on ... Light therapy is used to treat seasonal depression. Psychiatric Training To become a psychiatrist, a person must ...

[(Community) psychiatry, a parenthesis?].

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Bucheron, Bastien

2015-01-01

Beyond an a priori antagonism between these two notions, alienism and mental health cultivate analogies as to the place to which they assign mental health. Is community psychiatry not therefore simply a parenthesis in the history of psychiatry? The question is raised therefore regarding the place given to subjectivity and complexity. What must be done to ensure that this parenthesis of community psychiatry does not close? It is perhaps a case of making use of the tools which institutional psychotherapy has developed to keep the community psychiatry spirit alive. Copyright © 2015. Published by Elsevier Masson SAS.

An adolescent ward; 'in name only?'.

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Hutton, Alison

2008-12-01

The aim of the study was to explore how an adolescent ward was used by the two main users, nurses and adolescents, on a purpose-built adolescent ward. In Australia, caring for the adolescent is part of paediatric nursing and many Australian hospitals boast of 'adolescent-only facilities'. These wards are established on the premise that adolescent patients are a 'special' group deserving their own ward space. With the development of adolescent wards, set ideals around what this type of environment provides have also arisen. These ideals are increased privacy and independence for the patient, a chance for peer interaction, to be nursed by specially trained staff and to provide opportunities for adolescent patients to participate in their own care. This study used ethnography to gain a perspective of how ward space was used. Data were collected using participant observation and formal and informal interviews. Data were then analysed using the works of Lefebvre and Foucault. This study found that patient allocation, nursing observation and patient labels impact on how adolescent patients are nursed. Patients are expected to fit in, accepting all ministrations of nursing and staff. On this ward, nursing work was paramount. Nurses treated the adolescent patient like any other. In saying this, the adolescent patient still found ways to adapt to the ward space and its rules and routines; so in this sense, the ward still worked for them, even if nursing work was paramount. This study contributes to current discourse on the formation of specialized facilities in general, as it shows that no matter how a ward space is set up, if the space is not used in that way, then the purported purpose of that ward space will be lost.

What Is Psychiatry?

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Full Text Available ... Psychiatry Association of Gay and Lesbian Psychiatrists Mental Health Disorders A – Z Addiction and Substance Use Disorders ... APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Terms of Use and Privacy Policy Copyright Contact © ...

What Is Psychiatry?

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Full Text Available ... APA Foundation APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In Join General Residents and ... Learning Center APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Terms of Use Copyright Contact © 2018 ...

What Is Psychiatry?

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Full Text Available ... Psychiatry Association of Gay and Lesbian Psychiatrists Mental Health Disorders A – Z Addiction and Substance Use Disorders ... APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Terms of Use Copyright Contact © 2018 American Psychiatric ...

The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.

Science.gov (United States)

Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P

2015-02-01

The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Predicting Medical Students' Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries.

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Warnke, Ingeborg; Gamma, Alex; Buadze, Maria; Schleifer, Roman; Canela, Carlos; Strebel, Bernd; Tényi, Tamás; Rössler, Wulf; Rüsch, Nicolas; Liebrenz, Michael

2018-01-01

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students' perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students' attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N  = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The

Predicting Medical Students’ Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries

Science.gov (United States)

Warnke, Ingeborg; Gamma, Alex; Buadze, Maria; Schleifer, Roman; Canela, Carlos; Strebel, Bernd; Tényi, Tamás; Rössler, Wulf; Rüsch, Nicolas; Liebrenz, Michael

2018-01-01

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students’ perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students’ attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance

Predicting Medical Students’ Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries

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Ingeborg Warnke

2018-03-01

Full Text Available Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students’ perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students’ attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender or medical training (e.g., curriculum-related experience with psychiatry. Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small

Geriatric fall-related injuries.

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Hefny, Ashraf F; Abbas, Alaa K; Abu-Zidan, Fikri M

2016-06-01

Falls are the leading cause of geriatric injury. We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.

What Is Psychiatry?

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What Is Psychiatry?

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International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

Science.gov (United States)

Wildiers, Hans; Heeren, Pieter; Puts, Martine; Topinkova, Eva; Janssen-Heijnen, Maryska L.G.; Extermann, Martine; Falandry, Claire; Artz, Andrew; Brain, Etienne; Colloca, Giuseppe; Flamaing, Johan; Karnakis, Theodora; Kenis, Cindy; Audisio, Riccardo A.; Mohile, Supriya; Repetto, Lazzaro; Van Leeuwen, Barbara; Milisen, Koen; Hurria, Arti

2014-01-01

Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base. PMID:25071125

Anticholinergic load negatively correlates with recovery of cognitive activities of daily living for geriatric patients after stroke in the convalescent stage.

Science.gov (United States)

Kose, E; Hirai, T; Seki, T; Hidaka, S; Hamamoto, T

2018-05-16

Anticholinergic drugs are associated with risks of falls, confusion and cognitive dysfunction. However, the effect of anticholinergic drug use on rehabilitation outcomes after a stroke is poorly documented. We therefore aimed to establish whether the anticholinergic load was associated with functional recovery among geriatric patients convalescing after stroke. Consecutive geriatric stroke patients admitted and discharged from a convalescence rehabilitation ward between 2010 and 2016 were included in this retrospective cohort study. Anticholinergic load was assessed by the Anticholinergic Risk Scale (ARS), and functional recovery was assessed by the Functional Independence Measure (FIM). The primary outcome was cognitive FIM (FIM-C) gain, but we also assessed the interaction of other putative factors identified from univariate analysis. Multivariate analyses were performed, adjusting for confounding factors. We included 418 participants (171 males, 247 females) with a median age of 78 years (interquartile range, 72-84 years). Multiple regression analysis revealed that ARS change, length of stay, and epilepsy were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with anticholinergic load. A causal relationship cannot be established, but increased ARS scores during hospitalization may predict limited cognitive functional improvement in geriatric patients after stroke. Alternatively, cognitive impairment may lead to increased use of anticholinergic drugs. © 2018 John Wiley & Sons Ltd.

Psychiatry in Australia

African Journals Online (AJOL)

Enrique

ing of research on every aspect of psychiatry. A few areas where Australian research has achieved interna- tional recognition include the classification of depression, the concept of abnormal illness behaviour, treatment of anxiety disorders, schizophrenia, eating disorders and perinatal psychiatry. In the past it was common ...

Incorporating active learning in psychiatry education.

Science.gov (United States)

Kumar, Sonia; McLean, Loyola; Nash, Louise; Trigwell, Keith

2017-06-01

We aim to summarise the active learning literature in higher education and consider its relevance for postgraduate psychiatry trainees, to inform the development of a new Formal Education Course (FEC): the Master of Medicine (Psychiatry) at the University of Sydney. We undertook a literature search on 'active learning', 'flipped classroom', 'problem-based learning' and 'psychiatry education'. The effectiveness of active learning pedagogy in higher education is well supported by evidence; however, there have been few psychiatry-specific studies. A new 'flipped classroom' format was developed for the Master of Medicine (Psychiatry). Postgraduate psychiatry training is an active learning environment; the pedagogical approach to FECs requires further evaluation.

Psychiatry and Religion: Opponents or Collaborators? The Power of Spirituality in Contemporary Psychiatry.

Science.gov (United States)

Jakovljević, Miro

2017-04-01

Religion and psychiatry have had complicated, sometimes neutral or friendly and cooperative, sometimes competitive and antagonistic relations over their long histories. Relations between psychiatry and religion are influenced by complex belief systems, each diverse and changing. Psychiatry has often ignored spiritual and religious dimension in health and illness while religions influenced the treatment of mental disorders directly by defining mental disorders as evil spirit possessions and prescribing exorcism as treatment. It has been a long way to prevail looking for natural over supra-natural explanations for mental disorders. Psychiatry and religion as social practices should be regarded as allies against pseudoscientific nonsense and superstitions. This alliance is based on the next evidence: 1. religious and spiritual well-being is an important component of mental health as well as of health in general; 2. research and empirical evidence reveals that healthy-minded and distorted or sick faith are quite distinct in the effects in the lives of the faithful; 3. psychiatrists are professionally expected to always respect and be sensitive to the spiritual and religious beliefs and practices of their patients; 4. religious and spiritual beliefs and practice is very important aspect of person-centered psychiatry. The enduring task for both psychiatry and religion is to enable human beings to live their lives with courage, sense, and optimism, to strive towards creating conditions of well-being and individual, public and global mental health as well as to dispel beliefs and patterns which trap people in lives of misery and mental disorders. Psychiatry and religion in creative dialogues as allies can significantly contribute to the healing of our broken world and promoting compassionate society and empathic civilization. When psychiatry and religion see each other as opponents or even enemies this is only because of their mutual misreading and pseudoscientific

Hamlet and psychiatry intertwined.

Science.gov (United States)

Rotstein, Sarah

2018-05-01

This article considers selected landmarks in the history of psychiatry and their impact on Hamlet productions, including Burton's Anatomy of Melancholia, Emil Kraepelin's manic-depression, Freud's oedipal complex and R.D. Laing's 'divided self'. Additionally, this article considers the way Shakespeare's Hamlet has influenced the course of psychiatry. The linkages between psychiatry and Hamlet have existed since the 17th century, and perhaps Shakespeare's Hamlet should have a place on every psychiatrist's shelf.

Psychosocial Issues in Geriatric Rehabilitation.

Science.gov (United States)

Rodriguez, Ricardo M

2017-11-01

Geriatric patients present multiple age-related challenges and needs that must be taken into account during the rehabilitation process to achieve expected goals. This article examines the importance of identifying and managing psychosocial issues commonly observed in older adults and presents strategies to optimize their rehabilitation process. Depression, anxiety, fear of falling, adjustment issues, neurocognitive disorders, and caregiver support are discussed as a selection of factors that are relevant for geriatric patients undergoing rehabilitation. An argument is made for the importance of comprehensive geriatric assessment in older adults to identify salient issues that may impact rehabilitation and quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Attitudes of Medical Students toward Psychiatry and Psychiatry as a Career: A Systematic Review

Science.gov (United States)

Lyons, Zaza

2013-01-01

Objective: The discipline of psychiatry, and psychiatry as a career option, have been negatively regarded by medical students for decades. There is a large amount of literature on attitudes of students and the factors that attract them to and detract from psychiatry. The aim of this article is to systematically review this literature from 1990 to…

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

Science.gov (United States)

Adelman, Ronald D.; Ansell, Pamela; Breckman, Risa; Snow, Caitlin E.; Ehrlich, Amy R.; Greene, Michele G.; Greenberg, Debra F.; Raik, Barrie L.; Raymond, Joshua J.; Clabby, John F.; Fields, Suzanne D.; Breznay, Jennifer B.

2011-01-01

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area…

PALLIATIVE CARE IN GERIATRICS: CURRENT ISSUES AND PROSPECTS

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I. P. Рonomareva

2016-01-01

Full Text Available The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

THE STUDY OF CARDIAC ABNORMALITY IN GERIATRIC POPULATION OF RURAL CENTRAL INDIA

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Aman Chaturvedi

2017-09-01

Full Text Available BACKGROUND Health care of elderly in the society has emerged as an increasingly important issue in the recent years. As the elderly proportion of our population expands, maintaining health and wellness of the aged will continue to be an important research priority in the near future. This study was undertaken to determine cardiac abnormalities in geriatric population by echocardiography in rural central India. The aim of this study is to map the spectrum of cardiac abnormality in geriatric population of rural central India. MATERIALS AND METHODS The study was carried out on subjects from September 2014 – August 2016. All geriatric subjects i.e. above the age of 60 years who were admitted in medicine ward or who attended medicine OPD were considered for the study. All the preliminary biodata was collected, history taking and physical examination were done, ECG was recorded and finally 2D echo was performed in MMode, 2D echo, Doppler (CW and PW and TDI. All observations were recorded on a standard proforma sheet, statistical analysis was performed and results and conclusions drawn. RESULTS In present study, there was higher prevalence of major diseases. On M-Mode echocardiography, left atrial enlargement, LV hypertrophy/dilatation was found in significant number of subjects. On 2D echo, Myocardial Scarring/Thinning, valvular Degeneration was found significantly higher in elderly males, mitral and aortic calcification was found most frequently with prevalence higher in males. On Doppler echocardiography, diastolic dysfunction was common in elderly with very few subjects having normal diastolic function, most of the subjects having grade II diastolic dysfunction. Aortic, mitral and tricuspid regurgitation was common in elderly, and stenotic lesions of aortic and mitral valve were common. CONCLUSION We recommend that echocardiography should become an investigative norm in the elderly, this will aid in early detection of cardiovascular abnormalities

Psychiatry beyond the current paradigm.

LENUS (Irish Health Repository)

Bracken, Pat

2012-12-01

A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry\\'s identity as essentially \\'applied neuroscience\\'. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.

Cross-cultural issues in forensic psychiatry training.

Science.gov (United States)

Layde, Joseph B

2004-01-01

Forensic psychiatry was officially recognized as a subspecialty by the American Board of Medical Specialties in the 1990's. In 1994, the American Board of Psychiatry and Neurology (ABPN) gave its first written examination to certify forensic psychiatrists. In 1996, the Accreditation Council for Graduate Medical Education (ACGME) began to officially accredit one-year residency experiences in forensic psychiatry, which follow a 4-year residency in general psychiatry. The extra year of training, colloquially known as a fellowship, is required for candidates who wish to receive certification in the subspecialty of forensic psychiatry; since 2001, completion of a year of training in a program accredited by ACGME has been required for candidates wishing to take the ABPN forensic psychiatry subspecialty examination. With the formal recognition of the subspecialty of forensic psychiatry comes the need to examine special issues of cultural importance which apply specifically to forensic psychiatry training. This paper examines the current literature on cross-cultural issues in forensic psychiatry, sets out several of the societal reasons for the importance of emphasizing those issues in forensic psychiatric training, and discusses how those issues are addressed in the curriculum of one forensic psychiatry fellowship at the Medical College of Wisconsin (MCW). While much has been written about cross-cultural issues in general psychiatry, very little has appeared in the literature on the topic of cross-cultural issues in forensic psychiatry.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

OpenAIRE

Jennifer C. Reneker; Kyra Weems; Vincent Scaia

2016-01-01

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at th...

Prevalence and determinants for malnutrition in geriatric outpatients

NARCIS (Netherlands)

van Bokhorst-de van der Schueren, M.A.E.; Lonterman-Monasch, S.; de Vries, O.J.; Danner, S.A.; Kramer, M.H.H.; Muller, M.

2013-01-01

Background & aims: Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. Methods: From 2005 to

Health policy 2016: implications for geriatric urology.

Science.gov (United States)

Suskind, Anne M; Clemens, J Quentin

2016-03-01

The US healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore, will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. The Affordable Care Act has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination and risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues.

AGGRESSION IN PSYCHIATRY - A QUALITATIVE STUDY FOCUSING ON THE CHARACTERIZATION AND PERCEPTION OF PATIENT AGGRESSION BY NURSES WORKING ON PSYCHIATRIC-WARDS

NARCIS (Netherlands)

FINNEMA, EJ; DASSEN, T; HALFENS, R

The present study focuses on the characterization and perception of patient aggression by nurses working in a psychiatric hospital in The Netherlands. Data have been collected by interviewing nurses working on open and closed wards. The results have been compared and related to the existing

Evaluation of geriatric changes in dogs

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Soumyaranjan Pati

2015-03-01

Full Text Available Aim: The present study has been envisaged to ascertain the old age for critical management of geriatric dogs considering the parameters of externally visible changes, haemato-biochemical alterations and urine analysis in geriatric dogs approaching senility. Materials and Methods: The study was undertaken in the Department of Veterinary Pathology in collaboration with Teaching Veterinary Clinic complex spanning a period of 1 year. For screening of geriatric dogs, standard geriatric age chart of different breeds was followed. The external characteristics such as hair coat texture, dental wear and tear, skin texture and glaucoma were taken as a marker of old age. Haematology, serum biochemistry and urine analysis were also included in the study. Results: External visible changes like greying of hair, dull appearance of hair coat, glaucoma, osteoarthritis, dental wear and tear were commonly encountered in the aged dogs. The haemoglobin, total erythrocyte count and packed cell volume showed a decreasing trend in the geriatric groups. Biochemical values like total protein, albumin, calcium level showed a decreasing trend while urea level with an increasing trend in geriatric dogs without any much alteration in serum glutamicoxaloacetic transaminse, serum glutamic-pyruvate transaminase, cholesterol and creatinine. Physical examination of urine revealed yellow, amber, red, deep red color with turbidity and higher specific gravity. Chemical examination revealed presence of protein, glucose, ketone bodies, blood and bilirubin on some cases. The culture and sensitivity test of the urine samples revealed presence of bacteria with sensitive and resistance to some antibiotics. Conclusion: External visible changes are still the golden standard of determining the old age in dogs. Haemato-biochemical evaluation can be useful for correlating with the pathophysiological status of the animal. Biochemical analysis of urine can be employed rightly as kidney

Low frequency of asymptomatic carriage of toxigenic Clostridium difficile in an acute care geriatric hospital: prospective cohort study in Switzerland

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Daniela Pires

2016-06-01

Full Text Available Abstract Background The role of asymptomatic carriers of toxigenic Clostridium difficile (TCD in nosocomial cross-transmission remains debatable. Moreover, its relevance in the elderly has been sparsely studied. Objectives To assess asymptomatic TCD carriage in an acute care geriatric population. Methods We performed a prospective cohort study at the 296-bed geriatric hospital of the Geneva University Hospitals. We consecutively recruited all patients admitted to two 15-bed acute-care wards. Patients with C. difficile infection (CDI or diarrhoea at admission were excluded. First bowel movement after admission and every two weeks thereafter were sampled. C. difficile toxin B gene was identified using real-time polymerase chain-reaction (BD MAXTMCdiff. Asymptomatic TCD carriage was defined by the presence of the C. difficile toxin B gene without diarrhoea. Results A total of 102 patients were admitted between March and June 2015. Two patients were excluded. Among the 100 patients included in the study, 63 were hospitalized and 1 had CDI in the previous year, and 36 were exposed to systemic antibiotics within 90 days prior to admission. Overall, 199 stool samples were collected (median 2 per patient, IQR 1-3. Asymptomatic TCD carriage was identified in two patients (2 %. Conclusions We found a low prevalence of asymptomatic TCD carriage in a geriatric population frequently exposed to antibiotics and healthcare. Our findings suggest that asymptomatic TCD carriage might contribute only marginally to nosocomial TCD cross-transmission in our and similar healthcare settings.

Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

Science.gov (United States)

O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

2008-09-01

Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

[Can psychiatry become neuropsychiatry?].

Science.gov (United States)

Slosarczyk, Mariusz

2005-01-01

Today more and more often there are prognoses that in the future psychiatry will have been absorbed by neurology. It would be thanks to the stormy progress of research on the neurophysiological, genetic and molecular foundations of mental disorders. The aim of the article is to assess the possibility as well as the supposed consequences of such an evolution of psychiatry. The considerations concern the peculiarity of the object of interest and the methods used in psychiatry in relation to the neurological object and methodology. This way the appraisal of raison d'etre of one common science: neuropsychiatry becomes possible. The question of fundamental importance for the evaluation of similarities and differences between the psychiatric and neurological perspectives is the way the psychophysical issue and especially the problem of the mind-brain relation are approached. The article presents the manners of solving these problems proposed by the contemporary philosophy of the mind. Together with parting with the full of errors and simplifications heritage of Descartes it appears the necessity to regard the presence of subjective mental states both conscious and unconscious in model of mind-brain relation. The example of such a solution is the biological naturalism of John Searle. The psychical life of the man in its subjective dimension remains the peculiar area of interests for psychiatry irrespective of the progress in research on the biological base of mental disorders. The especially valuable cognitive and therapeutic tool in this aspect is psychotherapy constituting the integral part of psychiatry. The present state of knowledge does not indicate that the psychotherapeutic wing of psychiatry can lose its importance and rather somewhat the contrary. The progress of neurobiology does not have to threaten the autonomy of psychiatry by any means and the maintenance of this autonomy depends decisively on the psychiatrists themselves.

Canonical ward identities in generalized QCD

International Nuclear Information System (INIS)

Li Ziping

1995-01-01

The canonical Ward identities for a system with singular higher-order Lagrangian are derived and some application to the generalized QCD are given. The new relations of the Ward identities for gauge ghost field proper vertices are obtained which differ from the usual Ward-Takahashi identities arising from BRS invariance. The expressions for PCAC and generalized PCAC of AVV vertices are also obtained

Positive psychiatry: its time has come.

Science.gov (United States)

Jeste, Dilip V; Palmer, Barton W; Rettew, David C; Boardman, Samantha

2015-06-01

Traditionally, psychiatry has been defined and practiced as a branch of medicine focused on the diagnosis and treatment of mental illnesses. Based on growing empirical evidence, we believe that this definition warrants expansion to include the concept of positive psychiatry. In the present article, we provide a critical overview of this emerging field and a select review of relevant scientific literature. Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions involving positive psychosocial characteristics (PPCs) in people who suffer from or are at high risk of developing mental or physical illnesses. It can also benefit nonclinical populations. Positive psychiatry has 4 main components: (1) positive mental health outcomes (eg, well-being), (2) PPCs that comprise psychological traits (resilience, optimism, personal mastery and coping self-efficacy, social engagement, spirituality and religiosity, and wisdom-including compassion) and environmental factors (family dynamics, social support, and other environmental determinants of overall health), (3) biology of positive psychiatry constructs, and (4) positive psychiatry interventions including preventive ones. There are promising empirical data to suggest that positive traits may be improved through psychosocial and biological interventions. As a branch of medicine rooted in biology, psychiatry, especially with the proposed conceptualization of positive psychiatry, is well poised to provide major contributions to the positive mental health movement, thereby impacting the overall health care of the population. © Copyright 2015 Physicians Postgraduate Press, Inc.

Positive Psychiatry: Its Time Has Come

Science.gov (United States)

Jeste, Dilip V.; Palmer, Barton W.; Rettew, David C.; Boardman, Samantha

2017-01-01

Traditionally, psychiatry has been defined and practiced as a branch of medicine focused on the diagnosis and treatment of mental illnesses. Based on growing empirical evidence, we believe that this definition warrants expansion to include the concept of positive psychiatry. In the present article we provide a critical overview of this emerging field and a select review of relevant scientific literature. Positive psychiatry may be defined as the science and practice of psychiatry that seeks to understand and promote well-being through assessment and interventions involving positive psychosocial characteristics (PPCs) in people who suffer from or are at high risk of developing mental or physical illnesses. It can also benefit non-clinical populations. Positive psychiatry has 4 main components: (1) positive mental health outcomes (e.g., well-being), (2) PPCs that comprise psychological traits (resilience, optimism, personal mastery and coping self-efficacy, social engagement, spirituality and religiosity, and wisdom - including compassion) and environmental factors (family dynamics, social support, and other environmental determinants of overall health), (3) biology of positive psychiatry constructs, and (4) positive psychiatry Interventions including preventive ones. There are promising empirical data to suggest that positive traits may be improved through psychosocial and biological interventions. As a branch of medicine, rooted in biology, psychiatry, especially with the proposed conceptualization of positive psychiatry, is well poised to provide major contributions to the positive mental health movement, thereby impacting the overall healthcare of the population. PMID:26132670

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

Directory of Open Access Journals (Sweden)

Cokorda Istri Devi Larayanthi

2013-04-01

Full Text Available Sleep is an unconscious condition that is relatively more responsive to internal stimuli. Insomnia is a sleep disorder with characteristic difficulty of initiating sleep or difficulty in maintaining sleep. Insomnia is divided into 2 primary insomnia and secondary insomnia. Conection with age, the function of organs in the body decreases. So that geriatric patients are susceptible to illnesses, especially insomnia. Many of the causes of insomnia in geriatric mental disorders, psychiatric, general medical conditions, medications, certain substances, and others. Management of insomnia in geriatric patients were divided into 3 method: 1 manage underlying cause, 2 nonpharmacological therapies such as cognitive behavior therapy (CBT, and 3 pharmacological therapies such as benzodiazepine and non-benzodiazepine that eszopiclone and Ramelteon. Pharmacological treatment in geriatrics should follow the rule "start low, go slow", starting dose of ½ of the adult dose, and its use in the short term.

["Great jobs"-also in psychiatry?].

Science.gov (United States)

Spiessl, H; Hübner-Liebermann, B

2003-09-01

Against the background of a beginning shortage of psychiatrists, results from interviews with 112 employees of an automotive company with the topic "Great Job" are presented to discuss their relevance to psychiatry. The interviews were analysed by means of a qualitative content analysis. Most employees assigned importance to great pay, constructive collaboration with colleagues, and work appealing to personal interests. Further statements particularly relevant to psychiatry were: successful career, flexible working hours, manageable job, work-life balance, well-founded training, no bureaucracy within the company, and personal status in society. The well-known economic restrictions in health care and the still negative attitude towards psychiatry currently reduce the attraction of psychiatry as a profession. From the viewpoint of personnel management, the attractors of a great job revealed in this study are proposed as important clues for the recruitment of medical students for psychiatry and the development of psychiatric staff.

[Ethical dilemmas of contemporary psychiatry].

Science.gov (United States)

Filaković, Pavo; Pozgain, Ivan

2008-01-01

Ethics in the contemporary psychiatry, as well as in medicine in general, is based on the two core ethical traditions: deontological and theological. Good ethical decision takes into the consideration both traditions, and is preceded with ethical dilemmas to provide the best possible care to the patients in that moment. In the article are presented most recent research results of the literature about ethical dilemmas in psychiatry. Ethical dilemmas in everyday practice as well as compliance with the patients, psychiatric consultations, informed consent, treatment of personality disorders, pharmacological investigations, forensic psychiatry, forced hospitalisation, promotion of mental health, and dealing with the stigma of the mental diseases are showed in the article. The authors emphasize the necessity of constant questioning of ethical dilemmas in the contemporary psychiatry, because of the special status of psychiatry as a potentially risky field in practice, and because of intensive pharmacological investigations in psychiatric patients.

Analysis and Management of Geriatric Anxiety.

Science.gov (United States)

Sallis, James F.; Lichstein, Kenneth L.

1982-01-01

Reviews the prevalence, negative health implications, and clinical management of geriatric anxiety. Proposes an interactive model of geriatric anxiety whereby physical disease and anxiety processes enter into reciprocal stimulation as a function of diminished capacity to withstand stress and hypervigilance of stress symptomatology. Outlines…

Teaching geriatric fellows how to teach: a needs assessment targeting geriatrics fellowship program directors.

Science.gov (United States)

Rivera, Veronica; Yukawa, Michi; Aronson, Louise; Widera, Eric

2014-12-01

The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

[Clinical audit on drug prescriptions for elderly patients hospitalized in a unit of psychiatry].

Science.gov (United States)

Humaraut, C; Caron, J; Bayonne, L; Moalic, Y

2016-02-01

increased from 30% to 60% (P≤0.01). In parallel to the improvement of these criteria, it was noted that the average number of psychotropic drugs prescribed was significantly reduced (from 3.3 to 2.79 psychotropic/patients, P=0.078). The involvement of a pharmacist in cross-professional meetings of a care unit of psychiatry for the elderly has contributed in setting up a clinical audit focused on the drug management of these patients. This work enabled measurement of the progress made in the use of anticholinergic drugs, following the guidelines. In the mean time, it has been highlighted that the standards used are difficult to comply with regarding some criteria. For instance, the use of neuroleptics in the case of elderly patients hospitalized in the unit of psychiatry and not in the unit of geriatrics requires specific adjustments. Indeed, there are patients whose disorders have led to psychiatric hospitalization, which may require a combination of two neuroleptics. This paved the way for us to develop, within a working group representative of all professionals involved, a list fitting our medical practice and integrated into a guidebook adapted to the drug therapy management of elderly patients in psychiatry. The approach being successful, this targeted clinical audit will be extended to patients aged 75 years and over, hospitalized in other care units of the hospital. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

WATER AND SALT METABOLISM IN THE GERIATRIC SYNDROMES

Directory of Open Access Journals (Sweden)

Carlos G. Musso

2010-01-01

Full Text Available Geriatrics has already described four syndromes of its own: confusional syndrome, incontinence (fecal and/or urinary, and gait disorders and immobility syndrome, naming them geriatric giants. This name reflects their prevalence and great importance in the elderly. Ageing process induces many changes in renal physiology such as a reduction in glomerular filtration rate (senile hyponatremia, and water and sodium reabsorbtion capability. Besides, there are particular water and salt metabolism alteration characteristics of the geriatric syndromes, such as dehydration and hypernatremia in psychiatric disturbances as well as hyponatremia in patients suffering from immobility syndrome. The geriatric giants and nephrogeriatric physiology changes, are a good example of feed-back between geriatric syndromes, clinical entities characteristics in the elderly that predispose and potentiate each other, leading to catastrophic clinical events.

Effects of inpatient geriatric interventions in a German geriatric hospital: Impact on ADL, mobility and cognitive status.

Science.gov (United States)

Bordne, S; Schulz, R-J; Zank, S

2015-06-01

Given the demographic changes, the need for effective geriatric intervention is obvious. Geriatric care aims to maintain the highest possible level of independence and quality of life and to reduce the risk of need for care. This study investigated the benefits of geriatric care on functional performance, mobility and cognition. This study involved a retrospective analysis of clinical data from 646 patients. At hospital admission and discharge functional status was assessed using the Barthel index. Mobility was evaluated by means of the Tinetti test and cognition by the mini-mental state examination (MMSE). A follow-up was conducted on 112 patients 2-5 months after hospital discharge. Statistical analysis included t-tests including Cohen's d for effect size and multivariate regression analysis. The mean age of the study population was 81.1 ± 7.1 years including 439 women (68%) and 207 men (32%). There were significant average improvements for activities of daily living (ADL), mobility and cognition comparing discharge and admission scores. For functional and mobility status, effect sizes were medium to high. Regression analyses showed that ADL improvement was predicted by functional, mobile and cognitive status at admission. Follow-up analyses revealed a high percentage of former patients still living at home and an overall maintenance of ADL levels. Geriatric patients seem to experience long-term improvements during geriatric treatment, which appears to fulfill its aim of recovering independence. For a better understanding of relevant factors for the recreation of geriatric patients, further research is needed, e.g. with respect to the impact of the nutritional status.

The Magnitude of Atherogenic Dyslipidaemia among Geriatric ...

African Journals Online (AJOL)

The Magnitude of Atherogenic Dyslipidaemia among Geriatric Nigerians with ... June 2011 on 122 consecutive geriatric patients with systemic hypertension ... of dyslipidaemia and a marker of dyslipidaemic cardiometabolic risk among them.

Simulation for ward processes of surgical care.

Science.gov (United States)

Pucher, Philip H; Darzi, Ara; Aggarwal, Rajesh

2013-07-01

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. Copyright © 2013 Elsevier Inc. All rights reserved.

[Endoprostheses in geriatric traumatology].

Science.gov (United States)

Buecking, B; Eschbach, D; Bliemel, C; Knobe, M; Aigner, R; Ruchholtz, S

2017-01-01

Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.

Geriatric and Student Perceptions following Student-led Educational Sessions

Directory of Open Access Journals (Sweden)

Kristin Janzen

2018-01-01

Full Text Available Objective: The objective of this study was to measure the effect of student-led educational events on geriatric patient and student participant perceptions in a community setting. Methods: Students led three events at a senior community center, focusing on learning and memory, sleep hygiene, and arthritis pain. The participants were geriatric patients who themselves were providers of support to homebound peers (“clients” through an independently organized program. Geriatric participants completed pre- and post-event surveys to measure changes in familiarity with the topics. Student participants also completed pre- and post-event surveys that tracked changes in their comfort in working with the geriatric population. Results: Each event demonstrated at least one positive finding for geriatric patients and/or their clients. Students reported increased comfort in working with and teaching the geriatric population following the first and third events, but not the second. Conclusion: Student-led educational sessions can improve perceived health-related knowledge of geriatric participants while simultaneously exposing students to the geriatric patient population. Overall, both students and geriatric participants benefited from these events. Practice Implications: Incorporation of single, student-led educational events could be mutually beneficial to students and the elderly population in the community and easily incorporated into any healthcare curriculum. Funding:This work was supported by a Butler University Innovation Fund Grant. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Research

Nigerian Journal of Psychiatry

African Journals Online (AJOL)

The Nigerian Journal of Psychiatry publishes original scientific papers, review articles, short reports and opinion papers in all areas of psychiatry and related fields, such as sociology, applied anthropology and neurosciences. Vol 14, No 1 (2016). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT ...

YouTube and 'psychiatry'.

Science.gov (United States)

Gordon, Robert; Miller, John; Collins, Noel

2015-12-01

YouTube is a video-sharing website that is increasingly used to share and disseminate health-related information, particularly among younger people. There are reports that social media sites, such as YouTube, are being used to communicate an anti-psychiatry message but this has never been confirmed in any published analysis of YouTube clip content. This descriptive study revealed that the representation of 'psychiatry' during summer 2012 was predominantly negative. A subsequent smaller re-analysis suggests that the negative portrayal of 'psychiatry' on YouTube is a stable phenomenon. The significance of this and how it could be addressed are discussed.

[Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966)].

Science.gov (United States)

Afschar-Hamdi, Sima; Schepker, Klaus

2017-09-01

Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966) The patient admissions at the children's ward of the State Psychiatric Hospital Weissenau in the years 1951, 1956, 1961 and 1966 were analyzed regarding documented coercive measures. Shortage of staff, mainly inadequately skilled personnel, a mixing of age groups in the patient cohort, neurological and psychiatric disorders and of patients who were in need of nursing and of those who needed treatment constituted the general work environment. Coercive measures against patients, mostly disproportionate isolations, were a constant part of daily life on the ward. This affected in particular patients who had to stay longer at the hospital and whose stay was financed by public authority. The uselessness of such measures was known, which can be seen e. g. in the Caretaker's Handbook of that time and the comments in the patient files. The situation still escalated in some cases (for example by transfer to an adult ward). For a long time, coercive measures against patients were part of everyday life at the children's ward of the Weissenau; the actual figures are suspected to be much higher.

[Geriatric Trauma Center DGU®: Evaluation of clinical and economic parameters : A pilot study in a german university hospital].

Science.gov (United States)

Knobe, M; Böttcher, B; Coburn, M; Friess, T; Bollheimer, L C; Heppner, H J; Werner, C J; Bach, J-P; Wollgarten, M; Poßelt, S; Bliemel, C; Bücking, B

2018-04-19

Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU). A comparison of three different treatment models (6 months each) was performed: A: Standard treatment in Orthopaedic Trauma; B: Special care pathways with improvement of the quality management system and implementation of standard operating procedures; C: Interdisciplinary treatment with care pathways and collaboration with geriatricians (ward round model). In the 151 examined patients (m/w 47/104; 83.5 (70-100) years; A: n = 64, B: n = 44, C: n = 43) pathways with orthogeriatric comanagement (C) improved frequency of postoperative mobilization (p = 0.021), frequency of osteoporosis prophylaxis (p = 0.001) and the discharge procedure (p = 0.024). In comparison to standard treatment (A), orthogeriatric comanagement (C) was associated with lower rates of mortality (9% vs. 2%; p = 0.147) and cardio-respiratory complications (39% vs. 28%; p = 0.235) by trend. In this context, there were low rates of myocardial infarction (6% vs. 0%), dehydration (6% vs. 0%), cardiac dysrhythmia (8% vs. 0%), pulmonary decompensation (28% vs. 16%), electrolyt dysbalance (34% vs. 19%) and pulmonary edema (11% vs. 2%). Duration of stay in an intensive care unit was 29 h (A) and 18 h (C) respectively (p = 0.205), with consecutive reduction in costs. A sole establishment of a special care pathway for older hip fracture patients (B) showed a lower rate of myocardial infarction (A: 11%, B: 0%, C: 0%; p = 0.035). There was a clear tendency to a better overall

Incidence of in-hospital falls in geriatric patients before and after the introduction of an interdisciplinary team-based fall-prevention intervention.

Science.gov (United States)

von Renteln-Kruse, Wolfgang; Krause, Tom

2007-12-01

Falls are among the most common unwanted events in older hospital inpatients, but evidence of effective prevention is still limited compared with that in the community and in long-term care facilities. This article describes a prevention program and its effects on the incidence of falls in geriatric hospital wards. It was a prospective cohort study with historical control including all 4,272 patients (mean age 80, 69% female) before and 2,982 (mean age 81, 69% female) after introduction of the intervention. The intervention included fall-risk assessment on admission and reassessment after a fall; risk alert; additional supervision and assistance with the patients' transfer and use of the toilet; provision of an information leaflet; individual patient and caregiver counseling; encouragement of appropriate use of eyeglasses, hearing aids, footwear, and mobility devices; and staff education. Measurements included standardized fall-incidence reporting, activity of daily living and mobility status, number of falls and injurious falls, and number of patients who fell. Before the intervention was introduced, 893 falls were recorded. After the intervention was implemented, only 468 falls were recorded (incidence rate ratio (IRR)=0.82, 95% confidence interval (CI)=0.73-0.92), 240 versus 129 total injurious falls (IRR=0.84, 95% CI=0.67-1.04), 10 versus nine falls with fracture (IRR=1.40, 95% CI=0.51-3.85) and 611 versus 330 fallers. The relative risk of falling was significantly reduced (0.77, 95% CI=0.68-0.88). A structured multifactorial intervention reduced the incidence of falls, but not injurious falls, in a hospital ward setting with existing geriatric multidisciplinary care. Improvement of functional competence and mobility may be relevant to fall prevention in older hospital inpatients.

Psychiatry in the Deep South: a pilot study of integrated training for psychiatry residents and seminary students.

Science.gov (United States)

Stuck, Craig; Campbell, Nioaka; Bragg, John; Moran, Robert

2012-01-01

The authors describe an interdisciplinary training experience developed for psychiatry residents and seminary students that assessed each group's beliefs and attitudes toward the other's profession. The training was designed to enhance awareness, positive attitudes, and interaction between the disciplines. From 2005 to 2008, PGY-2 general-psychiatry residents and PGY-5 child-psychiatry residents (N=30) participated alongside psychology interns (N=13) and seminary students (N=41). The intervention consisted of two 3-hour sessions. Measurements addressed demographics, participants' spirituality, and attitudes toward mental illness, mental-health practitioners, and clergy. The psychiatry residents' knowledge regarding the training of clergy was significantly increased by the training sessions. The seminary students' attitudes and knowledge of psychiatry/psychology changed significantly in a positive direction. This pilot course had a positive impact on both groups of participants. This model could be modified for other psychiatry programs, to include clergy students of different religious faiths as relevant to the demographics of the training location.

Ward identities at finite temperature

International Nuclear Information System (INIS)

DOlivo, J.C.; Torres, M.; Tututi, E.

1996-01-01

The Ward identities for QED at finite temperature are derived using the functional real-time formalism. They are verified by an explicit one-loop calculation. An effective causal vertex is constructed which satisfy the Ward identity with the associated retarded self-energy. copyright 1996 American Institute of Physics

Focus group reflections on the current and future state of cognitive assessment tools in geriatric health care

Directory of Open Access Journals (Sweden)

Whitehead JC

2015-06-01

Full Text Available Jocelyne C Whitehead,1 Sara A Gambino,1 Jeffrey D Richter,2 Jennifer D Ryan1,3,41Rotman Research Institute, Baycrest, 2Independent Human Factors Consultant, Toronto, ON, Canada; 3Department of Psychology, 4Department of Psychiatry, University of Toronto, Toronto, ON, CanadaObjective: This study provides insight into the thoughts and opinions of geriatric health-care professionals toward cognitive assessments and the use of emerging technologies, such as eye-tracking, to supplement current tools.Methods: Two focus group sessions were conducted with nurses and physicians who routinely administer neurocognitive assessments to geriatric populations. Video recordings of the focus group sessions were transcribed and a thematic analysis was performed.Results: Participants reported the need for assessment and diagnostic tools that are accessible and efficient, and that are capable of accommodating the rapid growth in the aging population. The prevalence of more complex ailments experienced by older adults has had repercussions in the quality of care that the clients receive, and has contributed to lengthy wait times and resource shortages. Health-care professionals stated that they are hampered by the disjointed structure of the health-care system and that they would benefit from a more efficient allocation of responsibilities made possible through tools that did not require extensive training or certification. Eyetracking-based cognitive assessments were thought to strongly complement this system, yet it was thought that difficulty would be faced in gaining the support and increased uptake by health-care professionals due to the nonintuitive relationship between eyetracking and cognition.Conclusion: The findings suggest that health-care professionals are receptive to the use of eyetracking technology to assess for cognitive health as it would conserve resources by allowing frontline staff to administer assessments with minimal training

Enhancing Geriatric Curriculum in Nursing School

Science.gov (United States)

Collins, Kevin

2013-01-01

People are living longer. The average age of the population is increasing, and is expected to keep growing. Any person age 65 and older is now considered "geriatric." However, although growing, this population is not receiving adequate nursing care, and results in increased pain, falls, and even death. Geriatric curriculum is becoming…

The geriatric polytrauma: Risk profile and prognostic factors.

Science.gov (United States)

Rupprecht, Holger; Heppner, Hans Jürgen; Wohlfart, Kristina; Türkoglu, Alp

2017-03-01

In the German population, the percentage of elderly patients is increasing, and consequently there are more elderly patients among trauma cases, and particularly cases of polytrauma. The aim of this study was to present clinical results and a risk profile for geriatric polytrauma patients. Review of 140 geriatric (over 65 years of age) polytrauma patients who received prehospital treatment was performed. Severity of trauma was retrospectively assessed with Hannover Polytrauma Score (HPTS). Age, hemoglobin (Hb) level, systolic blood pressure (BP), Glasgow Coma Scale (GCS) score, timing of and necessity for intubation were analyzed in relation to mortality and in comparison with younger patients. Geriatric polytrauma patients (n=140) had overall mortality rate of 65%, whereas younger patients (n=1468) had mortality rate of 15.9%. Despite equivalent severity of injury (HPTS less age points) in geriatric and non-geriatric groups, mortality rate was 4 times higher in geriatric group. Major blood loss with Hb polytrauma patients. Additional risk factors include very low GCS score and systolic BP <80 mm Hg, for instance, as potential clinical indicators of massive bleeding and traumatic brain injury. Such parameters demand early and rapid treatment at prehospital stage and on admission.

Do we need community geriatrics?

LENUS (Irish Health Repository)

O'Hanlon, S

2012-01-30

Community geriatrics has evolved as a specific aspect of geriatric medicine in the UK. In Ireland there is uncertainty as to how it should be planned. This is the first national survey of consultants, specialist registrars and general practitioners to seek their opinions. Most consultants and GPs reported already having a community aspect to their current practice, e.g. nursing home visits or community hospital visits, whereas most SpRs did not. Forty three of 62 respondents (69%) agreed that there is a need for community geriatricians and that there should be integration with hospital medicine. Fifty seven of 62 respondents (92%) felt that there would be a beneficial effect on GP services, though some expressed concern about work overlap. Thirteen of the 25 SpRs (52%) in training hoped to begin practice in community geriatrics in the future.

The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors)

NARCIS (Netherlands)

Klopotowska, J.E.; Wierenga, P.C.; de Rooij, S.E.; Stuijt, C.C.; Arisz, L.; Kuks, P.F.; Dijkgraaf, M.G.; Lie-A-Huen, L.; Smorenburg, S.M.

2011-01-01

The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs) during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical

Biological therapy in geriatric patients

International Nuclear Information System (INIS)

Mego, M.

2012-01-01

Targeted biological therapy, alone or in combination with conventional chemotherapy, make significant progress in the treatment of patients with malignancy. Its use as opposed to high-dose chemotherapy is not limited by age, nevertheless, we have relatively little knowledge of the toxicity and effectiveness in geriatric patients. Aim of this article is to give an overview of the biological effectiveness and toxicity of anticancer therapy in geriatric patients, based on published data. (author)

Superconformal Ward identities and the supertorus

International Nuclear Information System (INIS)

Grundberg, J.; Nakayama, R.

1987-12-01

We derive superconformal Ward identities in the context of superspace supergravity. From these Ward identities we extract operator product expansions and the case of a supertorus is studied in some detail. (orig.)

Hierachy of needs of geriatric patients.

Science.gov (United States)

Majercsik, E

2005-01-01

The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique based on a motivational approach. The process was based on the method of paired comparisons, and a duly composed questionnaire was administered to the geriatric patients who were proven to have consistent thinking and surpassed a pre-established threshold in the Mini Mental State Examination. The evaluation of the responds leads to a numerical derivation (on an interval scale) of the hierarchy of needs. The received hierarchy of needs proved to oppose the general hypothesis of Maslow's motivation theory. This may induce a necessary shift in the approach to the care of the elderly, and accentuate the self-actualization and esteem needs beside the overtly emphasized physiological care. Copyright (c) 2005 S. Karger AG, Basel

Psychiatrie in meervoud. De wetenschappelijke oriëntaties van de Nederlandse psychiatrie in het interbellum (1918-1940

Directory of Open Access Journals (Sweden)

Joost Vijselaar

2010-09-01

Full Text Available Psychiatry in multiplicity According to a widespread interpretation, the history of psychiatry is characterized by a strong opposition between biological and psychological paradigms, which would dominate consecutive periods in history. The image of a swinging pendulum is a popular metaphor to describe this idea. The culture of Dutch psychiatry in the interwar years (1918-1940 seems to gainsay this image. Psychological, biological and socials models of explanation and therapy were used alongside each other without apparent debate and conflict. Influential professors of psychiatry like H.C. Rümke (Utrecht University even pleaded for a conscious integration of these approaches. Some historians have interpreted this stance as a sign of scientific ‘vagueness’ and ‘anarchy’. Analyzing the work of three major representatives of Dutch psychiatry in the Interbellum (Leendert Bouman, Han Rümke and Lammert van der Horst, the authors (former students of the master Historical and Comparative Studies of the Sciences and the Humanities shed light on the psychiatric climate of this era, dealing with themes like the openness of psychiatry to other sciences, the interactions of psychiatry and literature, and the relationship between theory and clinical practice. As a result a further qualification of the image of the pendulum is argued for.

Malignancies of gastrointestinal tract in geriatric patients

International Nuclear Information System (INIS)

Bystricky, B.

2017-01-01

Incidence of gastrointestinal cancer rises with age. In spite of this fact, older patients are underrepresented in clinical trials. We need to take into account several variables prior to selection of therapy in these patients. These are physiologic aging processes, comorbidities, functional and cognitive status. There are several assessment tools in geriatric population – the most used is comprehensive geriatric assessment (CGA). A close cooperation with geriatrician is useful before starting cancer treatment. This article reviews treatment algorithms in selected malignancies of GI tract in geriatric patients. (author)

Reported implementation lessons from a national quality improvement initiative; Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

Science.gov (United States)

White, Mark; Butterworth, Tony; Wells, John S G

2017-10-01

To explore the experiences of participants involved in the implementation of the Productive Ward: Releasing Time to Care™ initiative in Ireland, identifying key implementation lessons. A large-scale quality improvement programme Productive Ward: Releasing Time to Care™ was introduced nationwide into Ireland in 2011. We captured accounts from ward-based teams in an implementation phase during 2013-14 to explore their experiences. Semi-structured, in-depth interviews with a purposive sample of 24 members of ward-based teams from nine sites involved in the second national phase of the initiative were conducted. Interviews were analysed and coded under themes, using a seven-stage iterative process. The predominant theme identified was associated with the implementation and management of the initiative and included: project management; training; preparation; information and communication; and participant's negative experiences. The most prominent challenge reported related to other competing clinical priorities. Despite the structured approach of Productive Ward: Releasing Time to Care™, it appears that overstretched and busy clinical environments struggle to provide the right climate and context for ward-based teams to engage and interact actively with quality improvement tools, methods and activities. Findings highlight five key aspects of implementation and management that will help facilitate successful adoption of large-scale, ward-based quality improvement programmes such as Productive Ward: Releasing Time to Care™. Utilising pre-existing implementation or quality frameworks to assess each ward/unit for 'readiness' prior to commencing a quality improvement intervention such as Productive Ward: Releasing Time to Care™ should be considered. © 2017 John Wiley & Sons Ltd.

Higher Physiotherapy Frequency Is Associated with Shorter Length of Stay and Greater Functional Recovery in Hospitalized Frail Older Adults: A Retrospective Observational Study.

Science.gov (United States)

Hartley, P; Adamson, J; Cunningham, C; Embleton, G; Romero-Ortuno, R

2016-01-01

Extra physiotherapy has been associated with better outcomes in hospitalized patients, but this remains an under-researched area in geriatric medicine wards. We retrospectively studied the association between average physiotherapy frequency and outcomes in hospitalized geriatric patients. High frequency physiotherapy (HFP) was defined as ≥0.5 contacts/day. Of 358 eligible patients, 131 (36.6%) received low, and 227 (63.4%) HFP. Functional improvement (discharge versus admission) in the modified Rankin scale was greater in the HFP group (1.1 versus 0.7 points, Pphysiotherapy frequency and intensity in geriatric wards.

Health Policy 2016 – Implications for Geriatric Urology

Science.gov (United States)

Suskind, Anne M.; Clemens, J. Quentin

2016-01-01

Purpose of Review The U.S. healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. Recent Findings The Affordable Care Act (ACA) has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Summary Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination, risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues. PMID:26765043

‎ Factors Affecting the Choice of Psychiatry as a Specialty in ‎Psychiatry Residents in Iran

Science.gov (United States)

Sadr, Seyed Saeed; Nayerifard‎‎, Razieh; Samimi Ardestani, Seyed Mehdi; Namjoo, Massood

2016-01-01

Objective: The aim of this study was to investigate the current factors affecting the choice of ‎psychiatry as a specialty and to detect the main factors in their choice.‎ Method: This descriptive study included 75 first year psychiatry residents in the academic year of ‎‎2014/2015. A Likert-type anonymous questionnaire consisting of academic and ‎demographic data with 43 questions, which evaluated the reason for choosing ‎psychiatry as a specialty, was given to the residents.‎ Results: The participants had a positive opinion about 28 items of the questionnaire, meaning that ‎these items had a positive effect in choosing psychiatry as a specialty (questions with P ‎value less than 0.05 and a positive mean). More than 80% of the residents had a positive ‎opinion about six items of the questionnaire (amount of intellectual challenge, variety of ‎knowledge fields relevant to psychiatry, emphasis on the patient as a whole person, the ‎importance of treating mental illnesses in the future, work pressure and stress of the ‎field during residency and coordinating with the person's life style). The participants ‎had a negative opinion about two items of the questionnaire (questions with a P value ‎less than 0.05 and a negative mean). They included experiencing mental illness ‎personally through relatives or close friends as well as the income in psychiatry. ‎Moreover, 36% of the residents with a more definite opinion mentioned that they chose ‎psychiatry as a specialty because of the limitations in residency exam.‎ Conclusion: Assistants had a positive opinion about most of the questions and this positive attitude ‎seemed to be an important factor in their specialty choice. However, attending to the ‎preventing factors may increase the selection of psychiatry as a specialty.‎ PMID:27928251

American Geriatrics Society

Science.gov (United States)

... Learn More Social Media Facebook Twitter LinkedIn Instagram Social Media Bar Right Menu Annual Meeting Donate to our Foundation Contact Us American Geriatrics Society 40 Fulton St., 18th Floor New York, NY ...

Comprehensive geriatric assessment

African Journals Online (AJOL)

2007-09-14

Sep 14, 2007 ... i.e. difficulty performing simple physical and mental tasks necessary for daily life. ... Definition. Comprehensive geriatric assessment (CGA) is a multidimensional .... The formation of a programme of therapy is decided on.

Psychiatry and music

OpenAIRE

Nizamie, Shamsul Haque; Tikka, Sai Krishna

2014-01-01

Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry...

Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks.

Science.gov (United States)

Trachsel, Manuel; Irwin, Scott A; Biller-Andorno, Nikola; Hoff, Paul; Riese, Florian

2016-07-22

As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness. Based on the WHO definition of palliative care, a, a working definition of palliative psychiatry is proposed. Palliative psychiatry focuses on mental health rather than medical/physical issues. We propose that the beneficiaries of palliative psychiatry are patients with severe persistent mental illness, who are at risk of therapeutic neglect and/or overly aggressive care within current paradigms. These include long-term residential care patients with severe chronic schizophrenia and insufficient quality of life, those with therapy-refractory depressions and repeated suicide attempts, and those with severe long-standing therapy-refractory anorexia nervosa. An explicitly palliative approach within psychiatry has the potential to improve quality of care, person-centredness, outcomes, and autonomy for patients with severe persistent mental illness. The first step towards a palliative psychiatry is to acknowledge those palliative approaches that already exist implicitly in psychiatry. Basic skills for a palliative psychiatry include communication of diagnosis and prognosis, symptom assessment and management, support for advance (mental health) care planning, assessment of caregiver needs, and referral to specialized services. Some of these may already be considered core skills of psychiatrists, but for a truly palliative approach they should be exercised guided by an awareness of the limited functional prognosis and lifespan of patients with severe persistent mental illness.

Assessing the appropriateness of parenteral nutrition use in hospitalized patients. A comparison on parenteral nutrition bag prescription in different wards and nutritional outcomes.

Science.gov (United States)

Ponta, Monica Laura; Rabbione, Laura; Borgio, Cristina; Quirico, Eliana; Patrito, Elena; Petrachi, Maria Novella; Girotto, Elisabetta; Sillano, Marisa; Geninatti, Silvio; Zanardi, Michela; Pezzana, Andrea

2018-06-01

Our aim is to assess parenteral nutrition (PN) bag prescription in hospitalized patients and evaluate clinical outcomes linked to PN therapy. We performed an observational longitudinal retrospective study on PN prescription in a General Public Hospital in Turin, Italy, on ninety-five patients receiving PN prescribed by the Nutrition Support Team (NST). We described patients' demography and assessed nutritional outcomes, as well as PN bag prescription in different wards. Medians were calculated for several clinical parameters before and after PN therapy. A z-test for proportions has been performed to better understand the impact of various conditions on clinical outcomes and to compare differences between administered nutrients and required amounts. The NST resulted responsible for only 18% of bags prescribed in the geriatrics ward and for 48% in the surgery wards. PN was not able to fulfill nutritional requirements resulting in a median lack of 3.1 calories and 0.23 g of proteins per kilogram of reference body weight per day. Despite this, PN therapy was able to improve total blood proteins and calcium blood levels in our cohort. The NST changed the prescription in 55.8% of the pre-existing PN regimens. More strict adherence to guidelines is needed in order to maximize effectiveness of PN and observe a positive impact on clinical parameters. Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

[Medical student curriculum in psychiatry in Poland].

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Bilikiewicz, A

1999-01-01

The author describes present medical student curricula in psychiatry in Polish medical schools based on the questionnaire sent to all the lecturers of the subject in Poland. The questionnaire contained questions concerning the schedule of lectures, seminars and classes (the list of topics) as well as the number of hours of the forms of activities like interpersonal training, discussion groups, internship, etc. We also asked on which year of studies the course in psychiatry took place. The questionnaire included our request to describe the level of integration of psychiatry and other pre-clinical and clinical subjects as well as to enclose a recommended reading list (handbooks and other items of literature). The last question dealt with the problem of assessment of lectures and classes by students. The results of the questionnaire reveal great differences in the curricula of psychiatry in various schools in Poland. The differences lie both in the courses and the number of hours devoted to teaching psychiatry (in most schools it was 120 hours or less). In 7 schools students learn psychiatry in the 6th i.e. the last year of their studies. In 2 schools lectures in psychiatry are given in the th year. In Kraków and Gdańsk the courses in psychiatry consist of 150 and 160 hours respectively. The author proposes unification of the curricula in psychiatry concerning both the number of hours of classes and lectures, and topics as well as introducing the diagnostic and classifying criteria ICD-10 (WHO) since Poland is going to join EU.

The Introduction of Western Psychiatry into Korea (II Psychiatric Education in Korea during the Forced Japanese Annexation of Korea (1910-1945

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CHUNG Wonyong,

2006-12-01

Full Text Available In the second report in our series on the historical investigation on the introduction of western psychiatry into Korea, authors deal with the status of psychiatric education during the Japanese forced annexation of Korea. The first lecture on psychiatry in Korea under the title "Mental Diseases" was held in Dae-han-eui-won around 1910. In 1913, the Department of Psychiatry branched off from the Department of Internal Medicine of Chosen-sotoku-fu-iing, the Colonial Governmental Clinic, the successor of Dae-han-eui-won. The chairman, Professor Suiju Sinji; and the Korean assistant Sim Ho-seop administered the psychiatric ward with 35 beds. Since 1913, an Australian missionary psychiatrist, Dr. McLaren began to teach neurology and psychiatry at Severance Union Medical College and established a Department of Psychiatry in 1923. Dr. McLaren was a faithful Christian and open minded toward Oriental religious thought such as in Buddhism and Taoism. He devoted himself to the humanitarian care of mentally ill patients and served there until 1937 when he had to leave the land due to Japanese persecution. His disciple, Dr. Lee Jung Cheol succeeded the chair of the Psychiatric Department of Severance Medical College and served until 1939. In 1916, Keijo(Seoul Medical College was established and in 1928, Keijo Teikoku Daigaku(Imperial University. From 1929 to 1941, the Department of Neurology and Psychiatry of Keijo Imperial University grew under the chairmanship of Professor Kubo Kioji followed by Professor Watanabe until 1945. Many assistants including a few Koreans were gathered to the Department for training and research. The main textbook used for the psychiatric education for medical students in Korea was on Kraepelinian German Psychiatry translated and edited by Japanese psychiatrists. Lectures and clerkships for Neurology and Psychiatry were allocated generally in the curriculum for senior students for weekly 1-3 hours. Postgraduate professional

Nutritional status assessment in geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group.

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Camina-Martín, M Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, J Antonio; Redondo-del-Río, M Paz

2015-07-01

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, because elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología, SEGG) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories seeks to aid in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment associated to laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is to further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 Elsevier Ireland Ltd. All rights

[Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology NutritionWork Group].

Science.gov (United States)

Camina-Martín, María Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, José Antonio; Redondo-Del-Río, María Paz

2016-01-01

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 SEGG. Published by Elsevier

An Overview of Otorhinolaryngeal Problems in Geriatrics

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Girija Shankar Mohanta

2018-06-01

Full Text Available Summary: Background: The increase of geriatric population, as well as their age-related problems, is of great concern for the society and for the governments all over the world and also in India. The main objectives were to overview and find the prevalence of Oto-rhino-laryngological problems in the geriatric population. Method: A prospective study of geriatric patients was undertaken in ENT & HNS Department, S.C.B Medical College & Hospital, Cuttack, India, from November 2014 to August 2016.Inclusion criteria –The patients of age 60 yrs & above who attended ENT outpatient department were studied. Among 3563 patients studied, 363 patients were admitted. The patients were segregated according to sex (male/female, ages (60–64 yr group, 65–69 yr group, 70 yr & above, disease ratio, and prevalence of diseases, associated co-morbidities, and socio-economic aspects. Results: Total patients studied were 3563. The otological problems were being prevalent in geriatrics among study population (51.77% in which presbycusis was the highest with 17.71% of total and 34.21% of otological problems. The problems related to nose were 13.03%, among which epistaxis was 4.98% of total and 37.60% of nasal problems. The neck and throat problems were 35.20%. The problems were more in males (63.65% than in females (36.35%. Conclusion: The hearing loss is the most prevalent diagnosis amongst all otologic problems and epistaxis amongst nasal symptoms. The emergence of head & neck cancers among the geriatric population is a great concern in a developing country like India. Keywords: Oto-rhino-laryngological problems, geriatric populations

The oncologic and the geriatric patient

International Nuclear Information System (INIS)

Philotheou, Geraldine M

2002-01-01

The oncologic and the geriatric patient have special needs in the nuclear medicine department. The nuclear medicine technologists must be knowledgeable and compassionate when dealing with these patients. The diagnosis of cancer will have a sociological and psychological impact on the patient, to which the technologist must relate in an empathetic way. Furthermore, the technologist should take cognisance of the patient's physical condition and be able to modify the examination accordingly. Dealing with the geriatric patient should be correctly placed on the continuum between a gerontological and geriatric approach taking into consideration normal changes due to aging. The patient experience when undergoing the high technology nuclear medicine diagnostic procedure is unique and all effort must be made to ensure the success of the examination and the satisfaction of the patient (Au)

Senile anorexia in acute-ward and rehabilitations settings.

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Donini, L M; Savina, C; Piredda, M; Cucinotta, D; Fiorito, A; Inelmen, E M; Sergi, G; Domiguez, L J; Barbagallo, M; Cannella, C

2008-10-01

The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia. four different Units cooperated to this research study. Patients were recruited from geriatric acute and rehabilitation wards in Italy. Each Research Unit, for the estimation of the prevalence of anorexia in elderly subjects evaluated all the patients aged over 65 recruited from April 2006 to June 2007. Nutritional status, depression, social, functional and cognitive status, quality of life, health status, chewing, swallowing, sensorial functions were evaluated in anorexic patients and in a sample of "normal eating" elderly subjects. 96 anorexic subjects were selected in acute and rehabilitation wards (66 women; 81.5 +/- 7 years; 30 men: 81.8 +/- 8 years. The prevalence of anorexia in the sample was 33.3% in women and 26.7% in men. Anorexic subjects were older and more frequently needed help for shopping and cooking. A higher (although not statistically significant) level of comorbidity was present in anorexic subjects. These subjects reported constipation and epigastrium pain more frequently. Nutritional status parameters (MNA, anthropometry, blood parameters) were significantly worst in anorexic subjects whereas CRP was higher. Chewing and swallowing efficiencies were significantly impaired and eating patterns were different for anorexic subjects with a significant reduction of protein rich foods. consequences of anorexia can be extremely serious and deeply affect both patient's mobility, mortality and quality of life. Therefore, it is of utmost importance to perform a special evaluation of the nutritional risk, to constantly evaluate the nutritional status and feeding intake of older patients, to identify and treat the

Ward identities for conformal models

International Nuclear Information System (INIS)

Lazzarini, S.; Stora, R.

1988-01-01

Ward identities which express the symmetry of conformal models are treated. Diffeomorphism invariance or locally holomorphic coordinate transformations are used. Diffeomorphism invariance is then understood in terms of Riemannian geometry. Two different sets of Ward identities expressing diffeomorphism invariance in a conformally invariant way are found for the free bosonic string. Using a geometrical argument, the correct invariance for a large class of conformal models is given

Predoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools.

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Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2017-08-01

The aim of this study was to assess the current teaching of geriatric dentistry in U.S. dental schools and compare the findings to previous reports. Academic deans at all 67 U.S. dental schools were contacted in November 2015 via email, asking them to complete a questionnaire about the teaching of geriatric dentistry or gerodontology at their institution. Questionnaires were received from 56 of the 67 schools (84% response rate). The results showed that geriatric dentistry was taught in all responding schools; for 92.8% of the respondents, the instruction was compulsory. Among the responding schools, 62.5% were teaching it as an independent course, 25% as an organized series of lectures, and 8.9% as occasional lectures in parts of other courses. In addition, 57.1% had some form of compulsory clinical education in geriatric dentistry. Public schools, as opposed to private schools, were marginally associated with an increased interest in expanding geriatric dentistry teaching (p=0.078). No differences were found between any teaching variables and school location. This study found that the form of education in geriatric dentistry in U.S. dental schools differed in many ways, but the teaching of geriatric dentistry had increased among all respondents and had been increasing for over 30 years. Future research is needed to determine the impact of this teaching on services to the geriatric community.

Psychiatry and Islam.

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Pridmore, Saxby; Pasha, Mohamed Iqbal

2004-12-01

To explore psychiatry in Islam, with a view to informing Western psychiatrists working with Islamic patients, and Islamic medical students studying in Western countries. The first necessary step was to acquire some understanding of Islam, Sharia and Sharia law, as the basis on which the available psychiatric literature was considered. Standard textbooks on Islam and English-language papers in the psychiatric literature were examined. Discussions with knowledgeable Muslim people were conducted. Islam shares roots with the other Abrahamic, monotheistic religions: Judaism and Christianity. A central issues is unity: the unity of God, unity with God and unity within the Islamic community. Islam is more than a religion, because it informs all aspects of behaviour and has been described as 'a comprehensive way of life'. Individualism is less important than the welfare of the community. The Sharia is a list of rules and regulations derived from authentic sources. Psychiatric services in Islam, according to Western standards, are somewhat limited. This issue is being addressed through epidemiological studies, provision of new services and policy development. Although mental health legislation is not universal, forensic psychiatry has a role, in many ways similar to that in the West. Islam is based on unity and core values of compassion, justice and benevolence. Islamic psychiatry has a proud early history, and advances are occurring. There is an opportunity for the profession of psychiatry to bridge religious, ethnic and cultural boundaries.

The history of Italian psychiatry during Fascism.

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Piazzi, Andrea; Testa, Luana; Del Missier, Giovanni; Dario, Mariopaolo; Stocco, Ester

2011-09-01

Specific features characterized Italian psychiatry during Fascism (1922-45), distinguishing it from Nazi psychiatry and giving rise to different operational outcomes, so we have investigated the state of Italian psychiatry during this period. We review the historical situation that preceded it and describe the social and health policies that Fascism introduced following new legislative and regulatory acts. We examine the preventive and therapeutic role played by psychiatry (the electric shock was an Italian invention) and, thanks to the Enciclopedia Italiano published during those years, we are able to highlight psychiatry's relationship to psychology, psychoanalysis, philosophy and religion. The shortcomings of Italian psychiatric research and practice are also seen in terms of what the State failed to do rather than what it did.

Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors

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Prochaska, Judith J.; Fromont, Sebastien C.; Louie, Alan K.; Jacobs, Marc H.; Hall, Sharon M.

2016-01-01

Objective Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States. Method The authors recruited training directors to complete a survey of their program’s curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents’ skills for addressing nicotine dependence in psychiatric patients. Results Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents’ skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time. Conclusions The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders. PMID:17021144

Anomalous N=2 superconformal Ward identities

International Nuclear Information System (INIS)

Ketov, Sergei V.

2000-01-01

The N=2 superconformal Ward identities and their anomalies are discussed in N=2 superspace (including N=2 harmonic superspace), at the level of the low-energy effective action (LEEA) in four-dimensional N=2 supersymmetric field theories. The (first) chiral N=2 supergravity compensator is related to the known N=2 anomalous Ward identity in the N=2 (abelian) vector mulitplet sector. As regards the hypermultiplet LEEA given by the N=2 non-linear sigma-model (NLSM), a new anomalous N=2 superconformal Ward identity is found, whose existence is related to the (second) analytic compensator in N=2 supergravity. The celebrated solution of Seiberg and Witten is known to obey the (first) anomalous Ward identity in the Coulomb branch. We find a few solutions to the new anomalous Ward identity, after making certain assumptions about unbroken internal symmetries. Amongst the N=2 NLSM target space metrics governing the hypermultiplet LEEA are the SU(2)-Yang-Mills-Higgs monopole moduli-space metrics that can be encoded in terms of the spectral curves (Riemann surfaces), similarly to the Seiberg-Witten-type solutions. After a dimensional reduction to three spacetime dimensions (3d), our results support the mirror symmetry between the Coulomb and Higgs branches in 3d, N=4 gauge theories

Psychological medicine and the future of psychiatry.

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Sharpe, Michael

2014-02-01

Psychological medicine (liaison psychiatry) aims to integrate psychiatry into other areas of medicine. It is currently enjoying considerable expansion. The degree to which it can take advantage of this opportunity will be important not only for its own future, but also for the survival of psychiatry as a medical discipline.

Approach to the pressure sores in geriatric patients

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Emre İnözü

2012-09-01

Full Text Available Objectives: The aim of this study was to evaluate the follow-up results of nutritionally supported geriatric patientswho were admitted for their pressure sores then plannedtheir treatment.Materials and methods: In this study, we analyzed thehospitalized geriatric pressure sore patients in our clinicwho were admitted between 2006 and 2011. We calculatedBody Mass Index and the blood albumin levels of allhospitalized geriatric patients. In this patient group proteinenergy malnutrition and deficiency were analyzed andproper nutrition support was provided accordingly. Afterrecovering from malnutrition further treatment surpassed.Results: The mean albumin levels of the hospitalized patientswas 2,53 ± 0,25 g/dL after nutritional support thoselevels increased to mean 3,95 ± 0,42 g/dL . Of all thosepatients 75% were operated when their general conditionallowed us for a surgery. Due to their high risk wedid not perform any surgical operation to the remaining25%.. Post operative mean hospitalization period was 12(8-21 days. Majority of the patients (78.6% were treatedsuccessfully either with surgical or conservative treatmentmodalities.Conclusions: The success of the geriatric pressure soretreatment is highly related with the proper nutritional supportfor the ongoing malnutrition-like pathologies. Beforeoperation nutritional support not only makes a healthygranulation tissue but also yields fast and reliable woundhealing. Despite their chronic health problems many ofour geriatric patients were treated surgically for their pressuresores.Key words: Pressure sore, geriatric medicine, malnutrition,nutritional support

Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group

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Kemuyama Nobuo

2010-01-01

Full Text Available Abstract Background The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. Methods The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC", "hospitalization in the psychiatry ward (HIPW", or "non-hospitalization (NH", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. Results The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS, general health performance (GAS, psychiatric symptoms (BPRS, and life events (LCU, while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. Conclusion There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a

Nursing Education Trial Using a Virtual Nightingale Ward.

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Tsuji, Keiko; Iwata, Naomi; Kodama, Hiromi; Hagiwara, Tomoko; Takai, Kiyako; Sasaki, Yoko; Nagata, Yoshie; Matsumoto, Maki

2017-01-01

Nursing department students are expected to correctly grasp the entire concept of nursing through their education. The authors created a movie of a Nightingale ward (virtual ward, hereafter) with an architectural computer design software for education. The students' reaction to the virtual ward was categorized into three viewpoints: that of nurses, of patients, and of nurses and patients in common. Most of the reactions in each viewpoint were: "easy to observe patients" in the nurses' viewpoint; "no privacy" in the patients' viewpoint; and "wide room" in the common viewpoint, respectively. These reactions show the effectiveness of using a virtual ward in nursing education. Because these reactions are characteristics of a Nightingale ward, and even students, who have generally less experiences, recognized these characteristics from the both viewpoints of nurses and patients.

Graduate and Undergraduate Geriatric Dentistry Education in a Selected Dental School in Japan

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Kitagawa, Noboru; Sato, Yuji; Komabayashi, Takashi

2010-01-01

Geriatric dentistry and its instruction are critical in a rapidly aging population. Japan is the world’s fastest-aging society, and thus geriatric dentistry education in Japan can serve as a global model for other countries that will soon encounter the issues that Japan has already confronted. This study aimed to evaluate geriatric dental education with respect to the overall dental education system, undergraduate geriatric dentistry curricula, mandatory internships, and graduate geriatric education of a selected dental school in Japan. Bibliographic data and local information were collected. Descriptive and statistical analyses (Fisher and Chi-square test) were conducted. Japanese dental schools teach geriatric dentistry in 10 geriatric dentistry departments as well as in prosthodontic departments. There was no significant differences found between the number of public and private dental schools with geriatric dentistry departments (p = 0.615). At Showa University School of Dentistry, there are more didactic hours than practical training hours; however, there is no significant didactic/practical hour distribution difference between the overall dental curriculum and fourth-year dental students’ geriatric dental education curriculum (p=0.077). Graduate geriatric education is unique because it is a four-year Ph.D. course of study; there is neither a Master’s degree program nor a certificate program in Geriatric Dentistry. Overall, both undergraduate and graduate geriatric dentistry curricula are multidisciplinary. This study contributes to a better understanding of geriatric dental education in Japan; the implications of this study include developing a clinical/didactic curriculum, designing new national/international dental public health policies, and calibrating the competency of dentists in geriatric dentistry. PMID:21985207

Financing Academic Departments of Psychiatry

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Liptzin, Benjamin; Meyer, Roger E.

2011-01-01

Objective: The authors describe the many financial challenges facing academic departments of psychiatry and the resulting opportunities that may arise. Method: The authors review the history of financial challenges, the current economic situation, and what may lie ahead for academic departments of psychiatry. Results: The current environment has…

[Challenges of implementing a geriatric trauma network : A regional structure].

Science.gov (United States)

Schoeneberg, Carsten; Hussmann, Bjoern; Wesemann, Thomas; Pientka, Ludger; Vollmar, Marie-Christin; Bienek, Christine; Steinmann, Markus; Buecking, Benjamin; Lendemans, Sven

2018-04-01

At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics. In 2015, a geriatric trauma center certification in the form of a conglomerate network structure was agreed upon for the first time in Germany. For this purpose, the requirements for certification were observed. Both structure and organization were defined in a manual according to DIN EN ISO 9001:2015. Between 2008 and 2016, an increase of 70% was seen in geriatric trauma cases in our hospital, with a rise of up to 360% in specific diagnoses. The necessary standards and regulations were compiled and evaluated from our hospitals. After successful certification, improvements were necessary, followed by a planned re-audit. These were prepared by multiprofessional interdisciplinary teams and implemented at all locations. A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.

Geriatric fall-related injuries | Hefny | African Health Sciences

African Journals Online (AJOL)

Background: Falls are the leading cause of geriatric injury. ... and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. Methods: All injured patients with an age ≥ 60 years who were admitted to ...

[Where is going philosophy of psychiatry ?].

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Basso, Elisabetta

2016-12-01

This contribution provides a critical outline of the current trends in the field of "philosophy of psychiatry" by following their developments in the last decade. The first part of the paper focuses on the evolution of this field from a strictly conceptual approach to a perspective more attentive to the social, practical, and clinical dimension of psychiatry. The second part of the paper points out that the need of a mutual commitment of philosophy and psychiatry is perceived according to different ways by the countries involved in this research area. The paper deals especially with the case of France, where the enthusiasm for the "new philosophy of psychiatry" has not had the same impact on the philosophical scene as in the English speaking countries. In conclusion, the paper shows that the field of philosophy of psychiatry stands as a fertile ground for new forms of interaction between the analytic, and the continental philosophical traditions. This interaction takes place, more particularly, as regards such topics as normativity, language, and interpretation.

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

OpenAIRE

Cokorda Istri Devi Larayanthi

2013-01-01

Sleep is an unconscious condition that is relatively more responsive to internal stimuli. Insomnia is a sleep disorder with characteristic difficulty of initiating sleep or difficulty in maintaining sleep. Insomnia is divided into 2 primary insomnia and secondary insomnia. Conection with age, the function of organs in the body decreases. So that geriatric patients are susceptible to illnesses, especially insomnia. Many of the causes of insomnia in geriatric mental disorders, psychiatric, gene...

Leptin and psychiatry | Moosa | African Journal of Psychiatry

African Journals Online (AJOL)

African Journal of Psychiatry. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 6, No 3 (2003) >. Log in or Register to get access to full text downloads.

The Psychiatry OSCE: a 20-year retrospective.

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Hodges, Brian D; Hollenberg, Elisa; McNaughton, Nancy; Hanson, Mark D; Regehr, Glenn

2014-02-01

Twenty years ago researchers at the University of Toronto launched the Psychiatry Skills Assessment Project (PSAP), a research program exploring Objective Structured Clinical Examinations (OSCEs) in psychiatry. Between 1994 and 2005 PSAP produced publications on the feasibility, reliability, validity, ethics, and practical concerns of OSCEs in psychiatry. The current review has two parts: a review of the state of the art of OSCEs in psychiatry 20 years after they were introduced and documentation of the impact of the PSAP research program. A literature search identified all publications on OSCEs and psychiatry. Articles were coded thematically, and locations of agreement and controversies were identified. Bibliometric analysis identified citations of PSAP research papers, which were analyzed thematically. As of May 2013, there were 250 publications related to OSCEs in psychiatry (not including 10 PSAP papers), published in 29 different countries and ten languages. Prominent topics were the validity and acceptability of OSCEs and SPs, systems issues in adopting OSCEs in psychiatry, and the effects on learning. Eighty-eight percent of all publications cited PSAP work (300 citations). Citations were employed for four purposes: as evidence/justification (54 %); to frame replication research (14 %); to support adaptation of OSCEs in other countries and professions (15 %); and for debate (18 %). Over the past 20 years, use of OSCEs has grown steadily in psychiatry, and several national certification organizations have adopted OSCEs. PSAP work, introduced two decades ago, continues to provide a scholarly foundation for psychometric, practical, and ethical issues of interest to this field.

Medical students' recognition and application of geriatrics principles in a new curriculum.

Science.gov (United States)

Nanda, Aman; Farrell, Timothy W; Shield, Renée R; Tomas, Maria; Campbell, Susan E; Wetle, Terrie

2013-03-01

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Delivery of pharmaceutical services at ward level in a teaching hospital.

Science.gov (United States)

Schellack, N; Martins, V; Botha, N; Meyer, J C

2009-03-01

Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are

Mental illness: psychiatry's phlogiston.

Science.gov (United States)

Szasz, T

2001-10-01

In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness.

Anthology of Venezuelan psychiatry.

Science.gov (United States)

Rojas-Malpica, Carlos; Portilla-Geada, Néstor de la; Téllez Pacheco, Pedro

2016-04-01

Reception of Psychiatry in Venezuela since the 19th Century to the late 20th Century merits a historical approach. The following work proposes to research some of the very origins of Venezuelan psychiatry and its possible influence on contemporary mental health practice. Through documental research, the early works of local authors from the 19th Century through 20th Century finals: Carlos Arvelo, Lisandro Alvarado, Francisco Herrera Luque, Jose Luis Vethencourt and Jose Solanes, are subjected to study. This journey illustrates a descriptive panoramic view which allows to better comprenhend the current state of our psychiatry. In a brief introduction the most important events are described, since the arrival of Pinel's ideas, followed by the early research paperworks published and the beginnings of the academic teachings of this specialty in Venezuela and displaying the main contemporary research groups thorough the country.

Finnish psychiatry--past and present.

Science.gov (United States)

Pylkkänen, Kari

2012-03-01

The history of Finnish psychiatry has been characterized by polarizations: priority in hospitals vs. outpatient care, centralized vs. decentralized organization, independent vs. integrated administration, biological vs. psychological treatments, private vs. public production, special psychiatric policies vs. general health policies. The independent psychiatric organizations on District level lasted from the 1920s until 1990. Since then, the formerly independent psychiatry was subordinated to General Hospital administration and the centralized system of state planning and financing of healthcare was gradually decentralized and run down. During the heavy Finnish economic recession of the early 1990 s, the cuts of the public sector were unfortunately focused most heavily on psychiatric services. The main focus of research and teaching has shifted from earlier emphasis on psychoanalytical approach to biological psychiatry since the late 1980s. The administrative position of psychiatry has been repeatedly changing and unstable during the last 20 years. At the level of the contents of the services, however, there have been many very positive and promising developments. Psychiatry has come closer to other specialties from its formerly isolated position, when the separate administrations have been integrated. Provision of outpatient services has increased remarkably, while the number of hospital beds has decreased radically. Interest and resources in research have increased remarkably, and numerous new and good quality psychiatric research reports are being published.

Lean business model and implementation of a geriatric fracture center.

Science.gov (United States)

Kates, Stephen L

2014-05-01

Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Ward nurses' knowledge of computed tomography scanning.

Science.gov (United States)

Majeed, M A; Nayeemuddin, M; Christie, M

Patients benefit from and are reassured by advance information on procedures that they are to undergo. Ward nurses should have adequate knowledge of radiological investigations to ensure proper patient preparation and good interdepartmental communication to avoid delays and cancellations. This study was conducted to assess the ward nurses' knowledge of the process of computed tomography (CT) scanning. One hundred and twenty qualified nurses were asked to complete a questionnaire regarding CT scanning. The findings revealed a suboptimal level of awareness about the process. This is probably due to lack of formal teaching for nurses on the wards in regards the different radiological procedures and patient preparation. There is a strong case for better educational talks on rapidly changing radiological techniques for ward staff to ensure high-quality patient care.

Factors Influencing Depression among Elderly Patients in Geriatric Hospitals

OpenAIRE

Jee, Young Ju; Lee, Yun Bok

2013-01-01

[Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem ...

Senior Medical Students' Attitudes toward Psychiatry as a Career Choice before and after an Undergraduate Psychiatry Internship in Iran

Science.gov (United States)

Amini, Homayoun; Moghaddam, Yasaman; Nejatisafa, Ali-Akbar; Esmaeili, Sara; Kaviani, Hosein; Shoar, Saeed; Shabani, Amir; Samimi-Ardestani, Mehdi; Akhlaghi, Amir Abbas Keshavarz; Noroozi, Alireza; Mafi, Mostafa

2013-01-01

Objectives: The study aimed to assess 1) the attitudes of medical students in the sixth and seventh years (known as interns in Iran) toward psychiatry as a career choice, and 2) the degree of attractiveness of psychiatry as a career choice, with regard to various defined aspects, before and after an undergraduate psychiatry internship (similar to…

Hospital-acquired complications in a randomized controlled clinical trial of a geriatric consultation team.

Science.gov (United States)

Becker, P M; McVey, L J; Saltz, C C; Feussner, J R; Cohen, H J

1987-05-01

As part of a controlled clinical trial of a geriatric consultation team (GCT), we investigated whether a GCT could affect the incidence of hospital-acquired complications in elderly patients. One hundred eighty-five patients, aged 75 years and older, were randomized into an intervention (N = 92) and a control (N = 93) group. Members of the intervention group received a GCT consultation and were routinely followed up throughout their hospitalization. The incidence of hospital-acquired complications for the entire study population was 38%. The type and rate of hospital-acquired complications in the intervention and control groups were not significantly different. Functional status on admission and admission to the psychiatry service were predictive for the occurrence of a hospital-acquired complication. In a broadly selected population such as this, the intensity of care available through a GCT was unable to reduce the occurrence of hospital-acquired complications. However, since this is only one aspect of a GCT function, and others may be of great importance, such aspects, and more targeted populations, must be evaluated before final conclusions can be reached about GCT efficiency.

Divergent Fates of the Medical Humanities in Psychiatry and Internal Medicine: Should Psychiatry Be Rehumanized?

Science.gov (United States)

Rutherford, Bret R.; Hellerstein, David J.

2008-01-01

Objective: To determine the degree to which the medical humanities have been integrated into the fields of internal medicine and psychiatry, the authors assessed the presence of medical humanities articles in selected psychiatry and internal medicine journals from 1950 to 2000. Methods: The journals searched were the three highest-ranking…

Geriatric syndromes in patients with chronic kidney disease

Directory of Open Access Journals (Sweden)

Tomasz Gołębiowski

2016-06-01

Full Text Available The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than among general population. The causes of higher prevalence of those syndromes are not well known, but uremic environment and overall renal replacement therapy may have an important impact on its progress. The patient with geriatric syndrome require comprehensive treatment as well as physical rehabilitation, psychiatric cure and support in everyday activities.Herein below we would like to review recent literature regarding to particular features of main geriatric syndromes in a group of nephrological patients.

Developing non-technical ward-round skills.

Science.gov (United States)

Harvey, Rachel; Mellanby, Edward; Dearden, Effie; Medjoub, Karima; Edgar, Simon

2015-10-01

Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an a priori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin et al. Ninety-seven per cent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum. © 2015 John Wiley & Sons Ltd.

Altered Synchronizations among Neural Networks in Geriatric Depression.

Science.gov (United States)

Wang, Lihong; Chou, Ying-Hui; Potter, Guy G; Steffens, David C

2015-01-01

Although major depression has been considered as a manifestation of discoordinated activity between affective and cognitive neural networks, only a few studies have examined the relationships among neural networks directly. Because of the known disconnection theory, geriatric depression could be a useful model in studying the interactions among different networks. In the present study, using independent component analysis to identify intrinsically connected neural networks, we investigated the alterations in synchronizations among neural networks in geriatric depression to better understand the underlying neural mechanisms. Resting-state fMRI data was collected from thirty-two patients with geriatric depression and thirty-two age-matched never-depressed controls. We compared the resting-state activities between the two groups in the default-mode, central executive, attention, salience, and affective networks as well as correlations among these networks. The depression group showed stronger activity than the controls in an affective network, specifically within the orbitofrontal region. However, unlike the never-depressed controls, geriatric depression group lacked synchronized/antisynchronized activity between the affective network and the other networks. Those depressed patients with lower executive function has greater synchronization between the salience network with the executive and affective networks. Our results demonstrate the effectiveness of the between-network analyses in examining neural models for geriatric depression.

76 FR 54536 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-09-01

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

78 FR 55778 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2013-09-11

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting.... App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

77 FR 49865 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-08-17

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

A prospective study assessing agreement and reliability of a geriatric evaluation

OpenAIRE

Locatelli, Isabella; Monod, St?fanie; Cornuz, Jacques; B?la, Christophe J.; Senn, Nicolas

2017-01-01

Background The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. Method...

How new is the new philosophy of psychiatry?

Directory of Open Access Journals (Sweden)

Denys Damiaan

2007-10-01

Full Text Available Abstract In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry. According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Philosophers and psychiatrists face a “new philosophy of psychiatry”. However, the optimism which the “new” philosophy of psychiatry celebrates is precisely the exiling of philosophy from the foundations of psychiatry. The 150 year old belief that psychopathology cannot do without philosophical reflection has virtually disappeared from common psychiatric education and daily clinical practice. Though the discipline of psychiatry is particularly suited to contributions from philosophy, the impact of philosophy on psychiatry nowadays remains limited. With some exceptions, philosophical papers are embedded in a philosophical context inscrutable to ordinary psychiatrists. Much current philosophical work is perceived by psychiatrists as negativistic. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and enrich both disciplines. The views developed here should not discredit the value and importance of Natalie Banner and Tim Thornton’s paper and the excellent series “International Perspectives in Philosophy and Psychiatry.” As Jaspers said “Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way”.

How new is the new philosophy of psychiatry?

Science.gov (United States)

Denys, Damiaan

2007-01-01

In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry. According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Philosophers and psychiatrists face a “new philosophy of psychiatry”. However, the optimism which the “new” philosophy of psychiatry celebrates is precisely the exiling of philosophy from the foundations of psychiatry. The 150 year old belief that psychopathology cannot do without philosophical reflection has virtually disappeared from common psychiatric education and daily clinical practice. Though the discipline of psychiatry is particularly suited to contributions from philosophy, the impact of philosophy on psychiatry nowadays remains limited. With some exceptions, philosophical papers are embedded in a philosophical context inscrutable to ordinary psychiatrists. Much current philosophical work is perceived by psychiatrists as negativistic. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and enrich both disciplines. The views developed here should not discredit the value and importance of Natalie Banner and Tim Thornton’s paper and the excellent series “International Perspectives in Philosophy and Psychiatry.” As Jaspers said “Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way”. PMID:17949505

[Gottfried Benn and psychiatry].

Science.gov (United States)

Scherbaum, N

1994-04-01

As a young physician the poet Gottfried Benn (1886-1956) gave up a promising career in psychiatry after short period in practice. A psychodynamic analysis of this failure stresses the importance of the relationship of father and son in adolescence for the maturing of ego identity and ego ideal. At the beginning of this century psychiatry was a medical field with strong materialistic and biologistic positions. Benn embraced this position and tried to distance himself from his father, who was a charismatic priest with psychotherapeutic ambition. Benn experienced difficulty in competing with his father and this can be attributed to disturbances in his relationship to his mother in early childhood. The consequence was e.g. a narcissistic vulnerability in adulthood. The contrast of the splendid success in brain research with its inapplicability in routine therapy was characteristic of the state of psychiatry at the time of Benn's failure.

76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-03-31

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 14... pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities...

75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-09-03

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities...

77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-03-13

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 11... matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care...

75 FR 11638 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-03-11

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 22... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2013-01-30

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting.... App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 10... matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care...

ORIGINAL ARTICLES

African Journals Online (AJOL)

Robin A Ernsley, MD. Do/artmmt ofOccupational Therapy, University ofStellenbosch, Tygerberg, ... cognitive impairment. Finally, 's' is for signs on physical ... in neurology and psychiatry, with research training in geriatric psychiatry. It is clear ...

The future of psychiatry as clinical neuroscience.

Science.gov (United States)

Reynolds, Charles F; Lewis, David A; Detre, Thomas; Schatzberg, Alan F; Kupfer, David J

2009-04-01

Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics.The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry's mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management.

psychiatry

African Journals Online (AJOL)

and into the 20th century a medical, organic approach to mental illness evolved. ... effective, psychiatry must fit the African cultural pattern.4. South Africa is a .... patient become a more mature and rational person, not merely as well as he once ... patients, for example catharsis following an emotional reliving of the trauma ...

Development of statewide geriatric patients trauma triage criteria.

Science.gov (United States)

Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia

2011-06-01

The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the

[Geriatric rehabilitation care: Doing the right things right].

Science.gov (United States)

de Vos, A J B M; van Balen, R; Gobbens, R J J; Bakker, T J E M

2018-02-01

Geriatric rehabilitation concerns short-term integrated multidisciplinary care aimed at functional recovery and social participation for relatively frail elderly. Given the geriatric clients' complex care issues, nurses should possess sufficient and appropriate competencies in order to identify and assess the relevant symptoms and intervene effectively. Yet, nurses experience a certain apprehensiveness to perform their tasks and express difficulties in multidisciplinary communication and collaboration in a constructive manner. In addition to the client's and informal care giver's perception of their input in the geriatric rehabilitation process, this study provides an in-depth understanding of the way nurses perceive their role in geriatric rehabilitation. This descriptive study entails a quantitative and a qualitative component. The quantitative component concerns questionnaires for clients, informal care givers, nurses, and team leaders. The qualitative component aims to obtain in-depth information (i. e. opinions, meanings, and reflections) with regard to the decision making process and the performance of the rehabilitation care by means of open-ended questions (in the questionnaire) and semi-structured interviews. Clients and informal care givers rate specific themes in geriatric rehabilitation in a more negative light than nurses and team leaders do. These themes concern the provision of information in the hospital (prior to admission in the rehabilitation facility), involvement in the draw-up of the treatment plan and rehabilitation goals, geriatric rehabilitation as a 24/7 activity, and taking into account the client's other life events. The latter three findings in particular, are caused by nurses' apprehensiveness to perform their tasks adequately. Nurses working in geriatric rehabilitation, experience apprehensiveness to perform their tasks adequately. Uncertainty about the client's reaction or fear of damaging the relationship of trust, results

Attitudes of Medical Students towards Psychiatry: Effects of Training, Courses in Psychiatry, Psychiatric Experience and Gender

Science.gov (United States)

Kuhnigk, Olaf; Strebel, Bernd; Schilauske, Joerg; Jueptner, Markus

2007-01-01

Objective: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. Methods: Five hundred and eight medical students in their second, fifth, ninth and tenth…

Translational Epidemiology in Psychiatry

Science.gov (United States)

Weissman, Myrna M.; Brown, Alan S.; Talati, Ardesheer

2012-01-01

Translational research generally refers to the application of knowledge generated by advances in basic sciences research translated into new approaches for diagnosis, prevention, and treatment of disease. This direction is called bench-to-bedside. Psychiatry has similarly emphasized the basic sciences as the starting point of translational research. This article introduces the term translational epidemiology for psychiatry research as a bidirectional concept in which the knowledge generated from the bedside or the population can also be translated to the benches of laboratory science. Epidemiologic studies are primarily observational but can generate representative samples, novel designs, and hypotheses that can be translated into more tractable experimental approaches in the clinical and basic sciences. This bedside-to-bench concept has not been explicated in psychiatry, although there are an increasing number of examples in the research literature. This article describes selected epidemiologic designs, providing examples and opportunities for translational research from community surveys and prospective, birth cohort, and family-based designs. Rapid developments in informatics, emphases on large sample collection for genetic and biomarker studies, and interest in personalized medicine—which requires information on relative and absolute risk factors—make this topic timely. The approach described has implications for providing fresh metaphors to communicate complex issues in interdisciplinary collaborations and for training in epidemiology and other sciences in psychiatry. PMID:21646577

Delirium: Issues in diagnosis and management

African Journals Online (AJOL)

Additional articles identified by hand-searching in major journals of medicine and psychiatry, and a review of ..... advise from geriatrics consultants, geriatric specialty ..... Ann Rev. Nurs Res 1993;11:3-30. 37. Dyer CB, Ashton CM, Teasdale TA.

Civil forensic psychiatry - Part 1: an overview.

Science.gov (United States)

Samuels, Anthony H

2018-02-01

Objectives This paper provides an overview for general and forensic psychiatrists of the complexity and challenge of working in the civil medico-legal arena. It covers expert evidence, ethics, core concepts in civil forensic psychiatry and report writing. Conclusions Civil forensic psychiatry is an important sub-speciality component of forensic psychiatry that requires specific skills, knowledge and the ability to assist legal bodies in determining the significance of psychiatric issues.

Teaching Psychiatry Residents to Teach: A National Survey

Science.gov (United States)

Crisp-Han, Holly; Chambliss, R. Bryan; Coverdale, John

2013-01-01

Objective: Because there have been no previously published national surveys on teaching psychiatry residents about how to teach, the authors surveyed United States psychiatry program directors on what and how residents are taught about teaching. Methods: All psychiatry training programs across the United States were mailed a semistructured…

The cost of dysphagia in geriatric patients

Directory of Open Access Journals (Sweden)

Westmark S

2018-06-01

Full Text Available Signe Westmark,1 Dorte Melgaard,1,2 Line O Rethmeier,3 Lars Holger Ehlers3 1Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; 2Department of Physiotherapy and Occupational Therapy, North Denmark Regional Hospital, Hjørring, Denmark; 3Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark Objectives: To estimate the annual cost at the hospital and in the municipality (social care due to dysphagia in geriatric patients.Design: Retrospective cost analysis of geriatric patients with dysphagia versus geriatric patients without dysphagia 1 year before hospitalization.Setting: North Denmark Regional Hospital, Hjørring Municipality, Frederikshavn Municipality, and Brønderslev Municipality.Subjects: A total of 258 hospitalized patients, 60 years or older, acute hospitalized in the geriatric department.Materials and methods: Volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for data collection. A Charlson Comorbidity Index score measured comorbidity, and functional status was measured by Barthel-100. To investigate the cost of dysphagia, patient-specific data on health care consumption at the hospital and in the municipality (nursing, home care, and training were collected from medical registers and records 1 year before hospitalization including the hospitalization for screening for dysphagia. Multiple linear regression analyses were conducted to determine the relationship between dysphagia and hospital and municipality costs, respectively, adjusting for age, gender, and comorbidity.Results: Patients with dysphagia were significantly costlier than patients without dysphagia in both hospital (p=0.013 and municipality costs (p=0.028 compared to patients without dysphagia. Adjusted annual hospital costs in patients with dysphagia were 27,347 DKK (3,677 EUR, 4,282 USD higher than patients without dysphagia at the hospital, and annual health care costs in the

Fried frailty phenotype assessment components as applied to geriatric inpatients

OpenAIRE

Bieniek, Joanna; Wilczy?ski, Krzysztof; Szewieczek, Jan

2016-01-01

Joanna Bieniek, Krzysztof Wilczynski, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in ...

History of psychiatry and the psychiatric profession.

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Beer, Michael D

2009-11-01

The present article reviews the English language literature on the history of psychiatry published within the previous year. Research has been conducted in the history of clinical syndromes, famous people and psychiatrists, psychiatric institutions, treatments and legislations. The importance of the sociocultural contexts has been shown, particularly in research emanating from Europe and North America, which addresses late 18th to late 20th century issues. Much varied and important research on the history of psychiatry is being performed around the world. This scholarship provides insight into the cultural context and ways in which psychiatry was practised in the past and can help shed light on the way in which psychiatry is conducted today.

Geriatric Oncology Program Development and Gero-Oncology Nursing.

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Lynch, Mary Pat; DeDonato, Dana Marcone; Kutney-Lee, Ann

2016-02-01

To provide a critical analysis of current approaches to the care of older adults with cancer, outline priority areas for geriatric oncology program development, and recommend strategies for improvement. Published articles and reports between 1999 and 2015. Providing an interdisciplinary model that incorporates a holistic geriatric assessment will ensure the delivery of patient-centered care that is responsive to the comprehensive needs of older patients. Nursing administrators and leaders have both an opportunity and responsibility to shape the future of geriatric oncology. Preparations include workforce development and the creation of programs that are designed to meet the complex needs of this population. Copyright © 2015 Elsevier Inc. All rights reserved.

Oral health and nutritional status in a group of geriatric rehabilitation patients.

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Andersson, Pia; Westergren, Albert; Karlsson, Siv; Rahm Hallberg, Ingalill; Renvert, Stefan

2002-09-01

The aims of this study were to evaluate the oral health status and nutritional status in a group of geriatric rehabilitation patients, and to analyse the relationship between these two parameters. Nurses at the ward performed structured assessments of oral and nutritional status using the Revised Oral Assessment Guide and the Subjective Global Assessment form in 223 newly admitted patients. Most oral health problems were found among patients who stayed longer at the hospital and were more dependent on help as compared with the healthier patients. Thirty-four per cent of the patients were either severely undernourished, at risk or suspected to be undernourished (UN). Oral health problems were more common among UN patients (p oral health problem was found on teeth or dentures (48%). Problems related to the tongue and lips were also common among UN patients (56 and 44%, respectively). Oral health status was correlated (r = 0.32) to nutritional status. Problems with swallowing had the strongest association to the nutritional status (OR 6.05; 95% CI 2.41-15.18). This study demonstrated that poor oral health status was related to undernourishment.

Psychiatry and psychotherapy: past and future.

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Neill, J R; Ludwig, A M

1980-01-01

The place of psychotherapeutics in psychiatry is again in question. In many ways the situation recapitulates that of the late 19th century when psychotherapeutics first came upon the medical scene. The psychiatric hegemony over psychotherapeutics was the outcome of three fierce internecine "battles", (1) the "medicalization" of psychotherapeutics (1870-1910); (2) securing the psychiatric monopoly of psychotherapeutics (1890-1930); and (3) the "medicalization" of psychoanalysis (1920-1940). Three "revolutions" in psychiatry have occurred, since the stable halcyon 1950s, that have loosened the knot which binds psychotherapeutics to psychiatry. The emergence of specific psychopharmacologic therapies, the resurgence of the laboratory tradition (behaviorism) and the community-mental-health movement have diluted the importance of psychotherapeutics in treatment and widened the therapeutic franchise. In addition, there is evidence that the function of psychotherapeutics in society is itself changing. The future of psychotherapeutics in psychiatry is discussed in light of these developments.

Dental Students' Self-Assessed Competence in Geriatric Dentistry.

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Kiyak, H. Asuman; Brudvik, James

1992-01-01

A study of four classes of dental students (n=172) exposed to both didactic and clinical geriatric dental training found that the students perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, notably treatment planning, preventive dentistry, referrals, and providing care in alternative settings.…

Psychological background of prevention and treatment in geriatrics

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Nazarov M.l.

2015-03-01

Full Text Available Confidentiality as the component of an interpersonal "patient — medical practitioner" contact formation can be considered as a corner stone of geriatric practice. Major psychological pitfalls of geriatric practice have been reviewed. The main issue of the paper is psychological substantiation of treatment and prevention of elderly.

Reviving post-take surgical ward round teaching.

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Force, Jade; Thomas, Ian; Buckley, Frances

2014-04-01

Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff. © 2014 John Wiley & Sons Ltd.

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.

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Mohile, Supriya Gupta; Velarde, Carla; Hurria, Arti; Magnuson, Allison; Lowenstein, Lisa; Pandya, Chintan; O'Donovan, Anita; Gorawara-Bhat, Rita; Dale, William

2015-09-01

Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes. Copyright © 2015 by the National Comprehensive Cancer Network.

Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (OGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013

DEFF Research Database (Denmark)

Singler, K.; Stuck, A. E.; Masud, T.

2014-01-01

using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end...... at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties...

The transition from staff nurse to ward leader.

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Spencer, Caroline; Al-Sadoon, Tara; Hemmings, Laura; Jackson, Karen; Mulligan, Paul

Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it.

Training Psychiatry Addiction Fellows in Acupuncture.

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Serafini, Kelly; Bryant, Katurah; Ikomi, Jolomi; LaPaglia, Donna

2016-06-01

Acupuncture has been studied as an adjunct for addiction treatments. Because many hospitals, outpatient clinics, and facilities are integrating acupuncture treatment, it is important that psychiatrists remain informed about this treatment. This manuscript describes the National Acupuncture Detoxification Association (NADA) protocol and its inclusion as part of the curriculum for psychiatry addictions fellows. Psychiatry and psychology fellows completed the NADA training (n = 20) and reported on their satisfaction with the training. Overall, participants stated that they found the training beneficial and many were integrating acupuncture within their current practice. Results support the acceptability of acupuncture training among psychiatry fellows in this program.

Curriculum content in geriatric dentistry in USA dental schools.

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Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2018-03-01

The aim of this study was to re-examine the teaching of geriatric dentistry in the USA dental schools, to identify curriculum content and compare the findings to previous reports. All dental schools in the United States were contacted via email with a questionnaire to assess the teaching of geriatric dentistry. Non-responding schools were sent a minimum of three reminder emails to complete the survey. A statistical analysis was performed. Descriptive statistics were conducted to profile the variables of interest. Bivariate analysis was performed to explore if any of the variables were related using Fisher's exact test, non-parametric Wilcoxon rank-sum test and the Kruskal-Wallis test. Fifty-six of the 67 dental schools completed the questionnaire. Geriatric dentistry was taught in all dental schools; for 92.8%, the course was compulsory. We found that 62.5% were teaching it as an independent course, 25% as an organised series of lectures and 8.9% as occasional lectures in parts of other courses. Clinically, 84.2% have some form of compulsory education in geriatric dentistry. Public schools were marginally associated with an increased interest in expanding the geriatric dentistry curriculum (P = .078). No differences were found between these variables and school location. Geriatric dentistry is now required in 92.8% of dental schools. The teaching of traditional topics has not changed much; however, the number of gerontological topics has increased. Clinical teaching needs to be expanded, as in only 57.1% of schools was it a requirement. The ageing imperative will require research to determine the impact of teaching on services to the geriatric community. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students, Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

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Stanislaw Gorski

2017-01-01

Full Text Available Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students, targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards. Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization, received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

25 CFR 117.23 - Transactions between guardian and ward.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Transactions between guardian and ward. 117.23 Section... COMPETENCY § 117.23 Transactions between guardian and ward. Business dealings between the guardian and his ward involving the sale or purchase of any property, real or personal, by the guardian to or from the...

Multiresistant pathogens in geriatric nursing – infection control in residential facilities for geriatric nursing in Germany

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Peters, Claudia

2014-09-01

Full Text Available [english] Background: The increase of multidrug-resistant organisms (MDROs causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff.Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs.Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution.Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work.

[Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine].

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Müller-Werdan, U; Heppner, H-J; Michels, G

2018-04-18

Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process.

Women and Teaching in Academic Psychiatry

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Hirshbein, Laura D.; Fitzgerald, Kate; Riba, Michelle

2004-01-01

Objective: This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. Background: Although women have…

Developing skills in clinical leadership for ward sisters.

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Fenton, Katherine; Phillips, Natasha

The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.

Factors influencing French medical students towards a career in psychiatry.

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Andlauer, Olivier; Guicherd, William; Haffen, Emmanuel; Sechter, Daniel; Bonin, Bernard; Seed, Kitty; Lydall, Gregory; Malik, Amit; Bhugra, Dinesh; Howard, Rob

2012-09-01

There is a need to increase the recruitment to psychiatry in France. Our aim in this study was to compare factors influencing career choice between French medical students considering and not considering psychiatry as a specialty. Quantitative cross-sectional online survey on 145 French students in their last year of medical school. 22.7% of our sample considered choosing a career in psychiatry. A preference for a career in psychiatry was associated with more frequent history of personal/familial mental illness, higher ratings of psychiatric teaching, more weeks of compulsory psychiatry teaching and placement, during which students had more often met patients in recovery and been asked their opinion on patients. Students considering psychiatry as a career also emphasized more the need for a good work-life balance, and presented better attitudes toward psychiatry. Improving opportunities of interactions between students and psychiatrists or psychiatric patients might help to improve recruitment in psychiatry.

Evaluation of the Structure of Morning Report Sessions of the Wards of Type One Educational Hospitals and Comparison with Announced Standards of the Ministry of Health and Medical Education

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Shahram Yazdani

2013-07-01

Full Text Available Background and Objectives: Morning report is a long-standing method that its promotion has an important role in medical education. The present research was done with the aim of studying the structure of morning report sessions of the wards of type one educational hospitals and comparison with announced standards of the Ministry of Health and Medical Education.Methods: This study was performed in five main educational hospitals included wards of Obstetrics and Gynecology, Internal Medicine, Pediatrics, Surgery, Psychiatry, Neurology, Emergency Medicine, Orthopedic Surgery, Infectious Disease, and Intensive Care Unit wards were evaluated 8 approved standards 3 times for each one, and totally 73 cases. The studied standards consisted of the time of patient introduction, number of patients, duration of session, appropriateness of the session place, the venue, near ward place, Availability of teaching aids, number of sessions per week and a simple reception during the session.Results: Mean time for introduction of each patient was 4.4 minutes, mean number of introduced patients was 3.2 cases, mean duration of the session was 47.4 minutes, presentation in the ward (61.6%, appropriateness of place capacity 95.9%, and mean number of sessions per week was 4.2. No simple reception was seen in any sessions. Abundance of teaching aids was 79.5% for physical examination bed Negatoscope 89%, white board 93.2%, computer 87.7%, printer 19.2%, internet 17.8%, and video projector 83.6%.Conclusion: The results of this study showed that the general structure of morning report in the studied university was appropriate and fulfilled 6 out of 8 Standards. Also, the simple reception was not standard, and the standard of teaching aids was appropriate for 5 out of 7, and printer and internet were inappropriate.

The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

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2013-01-01

Background The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. Methods In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. Results The primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of

EPA guidance on improving the image of psychiatry.

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Möller-Leimkühler, A M; Möller, H-J; Maier, W; Gaebel, W; Falkai, P

2016-03-01

This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.

Neuropsychiatrie of biologische psychiatrie; een toekomstvisie in historisch perspectief.

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Verhoeven, W M; Tuinier, S

1999-06-01

Neuropsychiatry or Biological Psychiatry There is an urgent need to reconsider the position of psychiatry within the neurosciences because of the exploding knowledge about the relationship between brain and behaviour and the delay in implementation of new findings due to the separation of neurology and psychiatry. Biological psychiatry and psychopharmacology originate from the discovery by chance of psycho-active compounds in the early fifties and have contributed to the scientification of psychiatry. The impact of biological psychiatry for the pathophysiology of psychiatric disorders, however, is limited as a result of its biased orientation on neurotransmitters and receptors. The neuropsychiatric paradigm integrates knowledge from several domains, such as functional neuroanatomy, genetics and endocrinology and opens new vistas for the involvement of neuronal circuits in the initiation and maintenance of behavioural disturbances. In addition, novel and more specific treatment modalities may emerge.

Genetics and Psychiatry: Myth or Reality?

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Juli, Giada; Juli, Rebecca; Juli, Luigi

2017-09-01

Greek mythology and philosophical speculations were the first human productions on madness and psychiatry. Likewise, the origins of genetics sink their roots in a very remote and difficult time. This work tries to give an idea of the relationship between genetics and psychiatry through the myth and reality.

New image of psychiatry, mass media impact and public relations.

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Jakovljević, Miro; Tomić, Zoran; Maslov, Boris; Skoko, Iko

2010-06-01

The mass media has a powerful impact on public attitudes about mental health and psychiatry. The question of identity of psychiatry as a medical profession as well as of the future of psychiatry has been the subject of much controversial discussion. Psychiatry today has the historical opportunity to shape the future of mental health care, medicine and society. It has gained in scientific and professional status by the tremendous increase of knowledge and treatment skills. Psychiatry should build up new transdisciplinary and integrative image of a specialized profession, promote it and make it public. Good public relations are very important for the future of psychiatry.

Exercise Promotion in Geriatric Oncology.

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Burhenn, Peggy S; Bryant, Ashley Leak; Mustian, Karen M

2016-09-01

Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals.

Positive and negative volume-outcome relationships in the geriatric trauma population.

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Matsushima, Kazuhide; Schaefer, Eric W; Won, Eugene J; Armen, Scott B; Indeck, Matthew C; Soybel, David I

2014-04-01

In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly, or to the case volume among all trauma patients treated by an institution. To test the hypothesis that outcomes of trauma care for geriatric patients are affected differently by the volume of geriatric cases and nongeriatric cases of an institution. This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39 431 eligible geriatric trauma patients (aged >65 years) in the Pennsylvania Trauma Outcomes Study. In-hospital mortality, major complications, and mortality after major complications (failure to rescue). Between 2001 and 2010, 39 431 geriatric trauma patients and 105 046 nongeriatric patients were captured in a review of outcomes in 20 state-designated levels 1 and 2 trauma centers. Larger volumes of geriatric trauma patients were significantly associated with lower odds of in-hospital mortality, major complications, and failure to rescue. In contrast, larger nongeriatric trauma volumes were significantly associated with higher odds of major complications in geriatric patients. Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients. These findings offer the possibility that outcomes might be improved with differentiated pathways of care for geriatric trauma patients.

[The mobile geriatrics team, global patient management].

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Bach, Fréderiue; Bloch, Frédéric

2013-01-01

The mobile geriatric team of Cochin hospital in Paris is responsible for the management and orientation of fragile elderly patients over the age of 75 admitted to emergency departments. It carries out a multi-disciplinary assessment, contributes to the creation of the care project and life project of geriatric patients and is involved in organising the patient's return home. This article focuses on the role of the social assistant through two clinical cases.

Why medical students choose psychiatry - a 20 country cross-sectional survey

Science.gov (United States)

2014-01-01

Background Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. Methods Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students’ career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students’ attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. Results 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were “quite likely”, and 25% were “definitely not” considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry. Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p psychiatry before medical school, OR 10.8 (5.38 to 21.8, p psychiatry special study module, OR 1.45 (1.05 to 2.01, p = 0.03) or elective OR 4.28 (2.87- 6.38, p psychiatry club, OR 3.25 (2.87 to 6.38, p psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally. PMID

78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment

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2013-02-25

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting....S.C. App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee has been... and the Under Secretary for Health on all matters pertaining to geriatrics and gerontology. The...

What Is Psychiatry?

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Full Text Available ... Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In Join General Residents and Fellows Medical Students International close menu Psychiatrists Education Practice Cultural Competency ...

Training Psychiatry Addiction Fellows in Acupuncture

Science.gov (United States)

Serafini, Kelly; Bryant, Katurah; Ikomi, Jolomi; LaPaglia, Donna

2015-01-01

Objective Acupuncture has been studied as an adjunct for addictions treatment. Because many hospitals, outpatient clinics, and facilities are integrating acupuncture treatment, it is important that psychiatrists remain informed about this treatment. This manuscript describes the National Acupuncture Detoxification Association (NADA) protocol and its inclusion as part of the curriculum for psychiatry addictions fellows. Methods Psychiatry and psychology fellows completed the NADA training (N = 20) and reported on their satisfaction with the training. Results Overall, participants stated that they found the training beneficial and many were integrating acupuncture within their current practice. Conclusions Results support the acceptability of acupuncture training among psychiatry fellows in this program. PMID:26048457

Older adults in jail: high rates and early onset of geriatric conditions.

Science.gov (United States)

Greene, Meredith; Ahalt, Cyrus; Stijacic-Cenzer, Irena; Metzger, Lia; Williams, Brie

2018-02-17

The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults. This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth. All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older. Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

[The composition and antimicrobial resistance of isolates from lower respiratory tract and blood in hospitalized patients in respiratory ward: a multicenter national study in China].

Science.gov (United States)

Tang, X; Zhuo, C; Xu, Y C; Zhong, N S

2018-04-12

Objective: To investigate the species and antimicrobial resistance of bacterial pathogens isolated from hospitalized patients in respiratory ward in China. Methods: This was a multicenter retrospective study based on a national epidemiological network called China Antimicrobial Resistance Surveillance System (CARSS). The non-repetitive strains isolated from lower respiratory tract and blood samples in 91 hospitals from seven geographic regions of CARSS were reviewed. The distribution of specimen type, hospital level (secondary and tertiary hospital), patient age group [geriatric (>65 years old), adult (15 to 65 years old), pediatric (28 days to 14 years old ) and newborn group (≤28 days)] and ward type (respiratory intensive care unit and general respiratory ward) were analyzed for MRSA, PRSP, CREC, CRKP, CRPA, CRAB, ESBL-EC and ESBL-KP. The categorical variables were analyzed by chi-square test using SPSS 16.0 statistical software. P respiratory tract (LRT), 2 649 isolates from blood and 5 017 isolates from other samples (urine and secretions)] from 48 752 inpatients (without illness type information) were enrolled in the study. 90.2% (45 491/50 417) isolates were obtained from 63 tertiary hospitals. According to patients' age, all cases were divided into 4 groups, i. e. geriatric(46.0%, 23 177/50 417), adult(29.9%, 15 092/50 417), pediatric(24.0%, 12 112/50 417) and newborn group(0.0%, 36/50 417). All isolates were obtained from respiratory intensive care unit (6.2%, 3 129/50 417) or general respiratory wards (93.8%, 47 288/50 417). The majority of bacterial pathogens were isolated from lower respiratory and blood culture samples, which accounted for 90.0% of all the samples (45 400/50 417). Sputum accounted for 81.6% (41 131/50 417) of samples, and the leading 4 isolates were K . pneumonia (18.9%, 7 784/41 131), P . aeruginosa (13.6%, 5 580/41 131), A . baumanni (11.3%, 4 644/41 131) and S . pneumonia (11.1%, 4 564/41 131). Blood samples accounted for 5.3% (2

[Ten years of early complex geriatric rehabilitation therapy in the DRG system].

Science.gov (United States)

Kolb, G; Breuninger, K; Gronemeyer, S; van den Heuvel, D; Lübke, N; Lüttje, D; Wittrich, A; Wolff, J

2014-01-01

Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation. Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work. The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.

What Is Psychiatry?

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Full Text Available ... mental disorders with psychotherapy and some specialize in psychological testing and evaluation. More Resources World Psychiatric Association American Association of Child and Adolescent Psychiatry American Association ...

What Is Psychiatry?

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Full Text Available ... What Is the Difference Between a Psychiatrist and Psychologist? A psychiatrist is a medical doctor (completed medical school and residency) with special training in psychiatry. A ...

Historical aspects of Mexican psychiatry.

Science.gov (United States)

Bayardo, Sergio Javier Villaseñor

2016-04-01

Mexican psychiatry initiated since pre-Hispanic times. Historically, treatments were a mixture of magic, science and religion. Ancient Nahuas had their own medical concepts with a holistic view of medicine, considering men and cosmos as a whole. The first psychiatric hospital appeared in 1566 and a more modern psychiatric asylum emerged until 1910. International exchanges of theoretical approaches started in the National University with the visit of Pierre Janet. There were other important figures that influenced Mexican psychiatry, such as Erich Fromm, Henri Ey, Jean Garrabé and Yves Thoret. Regarding Mexican psychiatrists, some of the most important contributors to Mexican psychiatry were José Luis Patiño Rojas, Manuel Guevara Oropeza and Ramón de la Fuente Muñiz. This article includes excerpts from "Clinical Psychiatry", a book by Patiño Rojas where he tries to understand and describe the inner world experienced by patients with schizophrenia; also, the thesis conducted by Guevara Oropeza ("Psychoanalisis"), which is a critical comparison between the theories of Janet and Freud. Finally, we include "The study of consciousness: current status" by Ramón de la Fuente, which leads us through the initial investigations concerning consciousness, its evolution, and the contributions made by psychology, philosophy and neurobiology.

The role of the ward manager in promoting patient safety.

Science.gov (United States)

Pinnock, David

In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.

Notes on a Few Issues in the Philosophy of Psychiatry*

Science.gov (United States)

Singh, Ajai R.; Singh, Shakuntala A.

2009-01-01

The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, non-malfeasance, autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy

Choosing child and adolescent psychiatry: factors influencing medical students.

Science.gov (United States)

Volpe, Tiziana; Boydell, Katherine M; Pignatiello, Antonio

2013-11-01

To examine the factors influencing medical students to choose child and adolescent psychiatry as a career specialty. Quantitative and qualitative methods were used. A web-based survey was distributed to child and adolescent psychiatrists at the University of Toronto. In-depth interviews were held with select child and adolescent psychiatrists as well as a focus group with psychiatry residents. Retrospective accounts of the factors that influenced their decision to choose psychiatry and/or child and adolescent psychiatry as a specialty were collected. Ninety-two percent of participants indicated that recruitment of child psychiatrists in Canada is a problem. The recent decision by the Royal College of Physicians and Surgeons to recognize child and adolescent psychiatry as a subspecialty and introduce an extra year of training was identified as a further challenge to recruitment efforts. Other deterrents included lower salary than other subspecialties, lack of exposure during training, stigma, and lack of interest in treating children. Recruitment into psychiatry was enhanced by good role modeling, early exposure in medical school, an interest in brain research, and career and lifestyle issues. A rebranding of the role and perception of psychiatry is needed to attract future psychiatrists. Early exposure to innovations in child and adolescent psychiatry and positive role models are critical in attracting medical students. Recruitment should begin in the first year of medical school and include an enriched paediatric curriculum.

[Concepts of inhibition in psychiatry].

Science.gov (United States)

Auroux, Y; Bourrat, M M; Brun, J P

1978-01-01

Following a historical approach, the authors first describe the original development of the concept of inhibition in neurophysiology and then analyze the subsequent adaptations made in psychiatry around such concept including those of: -- Pavlov, Hull, Watson and the behaviorists, -- Freud and the Freudian School, -- clinicians and psychopharmacologists. The concept of inhibition has thus various meanings in psychiatry. Although some unity is achieved on the semiological level, this aspect cannot explain the extent of the process.

Undergraduate Teaching in Geriatrics and Pediatrics in Portuguese Medical Schools: An Observational Study.

Science.gov (United States)

Amaral, Mariana; Matias, Filipa; Massena, Lígia; Cardoso, Nuno

2016-12-30

Motivated by the contracting nature of the Portuguese age pyramid, and thereby the ever increasing geriatric population, the aim of this study was to compare the number of European Credit Transfer and Accumulation System Credits dedicated to Geriatrics with Pediatrics in Portuguese Medical Schools. An observational, descriptive and cross-sectional study was conducted and included six Portuguese Medical Schools that have six years of training and a total of 360 credits. The study plans were obtained from the medical schools' websites or requested. Schools were grouped in modular/classic teaching methodology and the courses were categorized in mandatory/optional and specific/related. The credits of Geriatrics and Pediatrics were compared. Four schools had classical methodology and two had a modular one. Overall, they had more credits dedicated to Pediatrics than Geriatrics. Three schools offered mandatory courses specifically oriented to Geriatrics (1.5 - 8 credits) compared to all schools mandatory courses courses on Pediatrics (5.7 - 26.5 credits). The ratio of averages of mandatory specific courses (Pediatrics/Geriatrics) was 12.4 in the classical and 1.5 in the modular group. Pediatrics teaching has revealed to be superior to Geriatrics in all categories. Based on our results, we consider the Portuguese Geriatrics' undergraduate teaching sub-optimal. Nowadays, geriatric population is quantitatively similar to pediatric population. Efforts should be made to adequate Geriatrics teaching to our reality in order to provide a more adequate health care to this age group.

Computational Psychiatry

Science.gov (United States)

Wang, Xiao-Jing; Krystal, John H.

2014-01-01

Psychiatric disorders such as autism and schizophrenia arise from abnormalities in brain systems that underlie cognitive, emotional and social functions. The brain is enormously complex and its abundant feedback loops on multiple scales preclude intuitive explication of circuit functions. In close interplay with experiments, theory and computational modeling are essential for understanding how, precisely, neural circuits generate flexible behaviors and their impairments give rise to psychiatric symptoms. This Perspective highlights recent progress in applying computational neuroscience to the study of mental disorders. We outline basic approaches, including identification of core deficits that cut across disease categories, biologically-realistic modeling bridging cellular and synaptic mechanisms with behavior, model-aided diagnosis. The need for new research strategies in psychiatry is urgent. Computational psychiatry potentially provides powerful tools for elucidating pathophysiology that may inform both diagnosis and treatment. To achieve this promise will require investment in cross-disciplinary training and research in this nascent field. PMID:25442941

The Future of Psychiatry as Clinical Neuroscience

Science.gov (United States)

Reynolds, Charles F.; Lewis, David A.; Detre, Thomas; Schatzberg, Alan F.; Kupfer, David J.

2009-01-01

Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics. The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry’s mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management. PMID:19318776

77 FR 44721 - Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face to...

Science.gov (United States)

2012-07-30

... Physical Therapy; Hospice and Palliative Care from All Physicians; Geriatric Psychiatry from Psychiatry... related to therapy services. Chava Sheffield, (410) 786-2298, for issues related to certified registered... of Certain Physician Pathology Services G. Therapy Services H. Primary Care and Care Coordination I...

Neurology referrals to a liaison psychiatry service.

LENUS (Irish Health Repository)

Fitzgerald, P

2012-02-03

The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.

Are computational models of any use to psychiatry?

Science.gov (United States)

Huys, Quentin J M; Moutoussis, Michael; Williams, Jonathan

2011-08-01

Mathematically rigorous descriptions of key hypotheses and theories are becoming more common in neuroscience and are beginning to be applied to psychiatry. In this article two fictional characters, Dr. Strong and Mr. Micawber, debate the use of such computational models (CMs) in psychiatry. We present four fundamental challenges to the use of CMs in psychiatry: (a) the applicability of mathematical approaches to core concepts in psychiatry such as subjective experiences, conflict and suffering; (b) whether psychiatry is mature enough to allow informative modelling; (c) whether theoretical techniques are powerful enough to approach psychiatric problems; and (d) the issue of communicating clinical concepts to theoreticians and vice versa. We argue that CMs have yet to influence psychiatric practice, but that they help psychiatric research in two fundamental ways: (a) to build better theories integrating psychiatry with neuroscience; and (b) to enforce explicit, global and efficient testing of hypotheses through more powerful analytical methods. CMs allow the complexity of a hypothesis to be rigorously weighed against the complexity of the data. The paper concludes with a discussion of the path ahead. It points to stumbling blocks, like the poor communication between theoretical and medical communities. But it also identifies areas in which the contributions of CMs will likely be pivotal, like an understanding of social influences in psychiatry, and of the co-morbidity structure of psychiatric diseases. Copyright © 2011 Elsevier Ltd. All rights reserved.

Congenital cataract screening in maternity wards is effective

DEFF Research Database (Denmark)

Magnusson, Gunilla; Bizjajeva, Svetlana; Haargaard, Birgitte

2013-01-01

AIM: To study which eye-screening protocol prevails in Swedish maternity/neonatal wards, evaluate efficacy in a prospective study, and compare results with earlier Swedish retrospective results. METHODS: Surveys were sent in 2006 to maternity/neonatal and women's health departments regarding...... with earlier retrospective results was performed. RESULTS: Eye screening is routine protocol at a rate of 90% of Swedish maternity wards. Sixty-one children were included in the study. An increase was shown in case referrals from maternity wards compared to ten years ago (64% versus 50%). Detection...

Clinical thinking in psychiatry.

Science.gov (United States)

Wells, Lloyd A

2015-06-01

I discuss the lack of precision in the term 'clinical reasoning' and its relationship to evidence-based medicine and critical thinking. I examine critical thinking skills, their underemphasis in medical education and successful attempts to remediate them. Evidence-based medicine (and evidence-based psychiatry) offer much but are hampered by the ubiquity and flaws of meta-analysis. I explore views of evidence-based medicine among psychiatry residents, as well as capacity for critical thinking in residents before and after a course in philosophy. I discuss decision making by experienced doctors and suggest possible futures of this issue. © 2015 John Wiley & Sons, Ltd.

Shrink rethink: rebranding psychiatry.

Science.gov (United States)

Crabb, Jim; Barber, Lee; Masson, Neil

2017-11-01

Negative public attitudes towards psychiatry hinder individuals coming for treatment and prevent us from attracting and retaining the very brightest and best doctors. As psychiatrists we are skilled in using science to change the thoughts and behaviours of individuals, however, we lack the skills to engage entire populations. Expertise in this field is the preserve of branding, advertising and marketing professionals. Techniques from these fields can be used to rebrand psychiatry at a variety of levels from national recruitment drives to individual clinical interactions between psychiatrists and their patients. © The Royal College of Psychiatrists 2017.

Factors Affecting Recruitment into Child and Adolescent Psychiatry Training

Science.gov (United States)

Shaw, Jon A.; Lewis, John E.; Katyal, Shalini

2010-01-01

Objective: The authors studied the factors affecting the recruitment into child and adolescent psychiatry training in the United States. Methods: Medical students (n = 154) and general and child and adolescent psychiatry residents (n = 111) completed a questionnaire to evaluate career choice in child psychiatry (n = 265). Results: Compared with…

[Geriatrics, a form of holistic health care. A bright spot in difficult financial economic times?].

Science.gov (United States)

Dillmann, E B

1984-02-01

Geriatrics has a functional aim, also in a clinical setting; it determines meaningful priorities in the process of diagnosis and treatment of the vulnerable elderly patient and is of a horizontal nature within the other specializations. Additional tasks of geriatrics are the development of adjusted methods for examination and treatment, the pursuing of early onset diagnostics, to supply specific information and the training of geriatric specialists. Clinical geriatric examination should only take place after evaluating the patient in his or her living conditions at home. The patient should thereby fulfil the geriatric trias, that no admission in a nursery home or psychiatric hospital is indicated, that examination at home or at the outpatient department is impossible and that an emergency situation necessitates admission. Ambulantory geriatric care is indispensable for the well functioning of a clinical geriatric department and the two should form an unbreakable tie, which could eventually be transformed into a personal union. A geriatric department in a general hospital is limited in its indications for the admission of geriatric patients, has high operating costs and should be restricted in size per regio, having a minimal capacity of 25 to 30 beds. The geriatric team is broad in composition and strong in coherence. The period of admission of the patient should not exceed six weeks. A regional social-geriatric circuit combines a geriatric department of a general hospital with the ambulantory social-geriatric service, the admission and indication committee of nursing homes into a well tuned system of provisions for the aged.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Psychiatry Curricula in Undergraduate Medical Education

Science.gov (United States)

Sawyer, Michael Gifford; Giesen, Femke; Walter, Garry

2008-01-01

A study to review the amount of time devoted to child psychiatry in undergraduate medical education is conducted. Results conclude that relatively low priority is given to child psychiatry in medical education with suggestions for international teaching standards on the subject.

The ward round--patient experiences and barriers to participation.

Science.gov (United States)

Swenne, Christine Leo; Skytt, Bernice

2014-06-01

Patients' participation is essential to their well-being and sense of coherence, as well as to their understanding of and adherence to prescribed treatments. Ward rounds serve as a forum for sharing information between patient and caregiver. The purpose of the ward round is to obtain information and plan medical and nursing care through staff-patient communication. The aim and objective of this study was to investigate patients' experiences during the ward round and their ability to participate in their care. The study was qualitative and descriptive in design. Fourteen inpatients at a cardiovascular ward were interviewed. Qualitative content analysis was used for the analysis. The ethics of scientific work were adhered to. Each study participant gave his/her informed consent based on verbal and written information. The study was approved by the Research Ethics Committee at Uppsala University. The analysis revealed one theme and three subthemes related to patients' experiences of ward rounds. The main theme was handling of information from the daily ward round while waiting for private consultation. The subthemes were making the best of the short time spent on ward rounds; encountering traditional roles and taking comfort in staff competency; and being able to choose the degree to which one participates in the decision-making process. Several aspects of traditional ward round routines could be improved in regard to the two-way information exchange process between caregivers and patient. Patients' and caregivers' ability to communicate their goals and the environment in which the communication occurs are of great importance. The information provided by nurses is easier to understand than that provided by physicians. The atmosphere must be open; the patient should be treated with empathy by staff; and patients' right to participate must be acknowledged by all healthcare professionals involved. © 2013 Nordic College of Caring Science.

Attitudes of Flemish physiotherapy students towards mental health and psychiatry.

Science.gov (United States)

Probst, Michel; Peuskens, Jos

2010-03-01

In general, psychiatry is not very popular among healthcare providers, although no information is available concerning the attitudes of physiotherapy students towards mental heath. This study examined the attitudes of physiotherapy students towards psychiatry considering the subject's gender, previous experience with psychiatry and the impact of a specific course. This experimental study compared the attitudes of physiotherapy students (n=219) with those of students without a biomedical background (n=112) towards psychiatry. All students were between 17 and 28 years of age, and completed an established international questionnaire entitled 'Attitudes Towards Psychiatry'. Within the group of physiotherapy students, the effect of a 65-hour course on psychiatric rehabilitation on their attitudes was evaluated. Attitudes towards psychiatry were moderately positive [mean (SD) 103.3 (9.9)]. There was a small but significant difference between physiotherapy students and non-medical students (Cohen's d=0.31). Female students had a more positive attitude towards psychiatry than their male peers (Cohen's d=0.44). Prior experience with mental illness was associated with more positive attitudes (Cohen's d=0.68). Attitudes increased in positivity after completion of a psychiatry course (Cohen's d=0.72). To ensure basic physiotherapeutic treatment for the mentally ill, physiotherapy education should aim to promote positive attitudes towards mental illness as well as psychiatry. High-quality courses and personal interaction with patients are the best strategies to achieve this goal.

State of psychiatry in Denmark

DEFF Research Database (Denmark)

Bauer, Jeanett Østerby; Okkels, Niels; Munk-Jørgensen, Povl

2012-01-01

of common mental disorders, in particular depression and anxiety. Furthermore, 'new' diagnostic groups are represented in the treatment statistics with steeply increasing incidences, e.g. attention deficit hyperactivity disorder (ADHD) and eating disorders, especially in the outpatient part...... to the somatic specialities, handicapping development in psychiatry. Action has been taken to increase research activity in psychiatry. This is facilitated by an increasing interest among medical students and young graduate physicians attracted by the neuropsychiatric paradigm, rapidly implemented in Danish...

Cardiopulmonary disease in the geriatric dog and cat

Energy Technology Data Exchange (ETDEWEB)

Miller, M. S.; Tilley, L. P.; Smith, F.W.K. Jr.

1989-01-15

The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs.

Cardiopulmonary disease in the geriatric dog and cat

International Nuclear Information System (INIS)

Miller, M.S.; Tilley, L.P.; Smith, F.W.K. Jr.

1989-01-01

The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs

Rezension : Wissen um den Wahn. Foucaults Geschichte der Psychiatrie ; zu "Foucaults Geschichte der Psychiatrie"

OpenAIRE

Krause, Robert

2006-01-01

Aus dem umfangreichen Werk des französischen Philosophen und Sozialhistorikers Michel Foucault (1926-1984) ist ein weiteres Buch auf Deutsch erschienen. Der Band „Die Macht der Psychiatrie" geht auf eine Reihe von Vorlesungen zurück, die Foucault im Wintersemester '73/'74 am Collège de France gehalten hat. Die in Frankreich bereits im Jahr 2003 veröffentlichten 12 Vorlesungen sind der Geschichte der Psychiatrie gewidmet und konzentrieren sich vor allem auf ihre Frühphase. Wesentlich gestützt ...

Choosing Child and Adolescent Psychiatry: Factors Influencing Medical Students

Science.gov (United States)

Volpe, Tiziana; Boydell, Katherine M.; Pignatiello, Antonio

2013-01-01

Objective: To examine the factors influencing medical students to choose child and adolescent psychiatry as a career specialty. Method: Quantitative and qualitative methods were used. A web-based survey was distributed to child and adolescent psychiatrists at the University of Toronto. In-depth interviews were held with select child and adolescent psychiatrists as well as a focus group with psychiatry residents. Retrospective accounts of the factors that influenced their decision to choose psychiatry and/or child and adolescent psychiatry as a specialty were collected. Results: Ninety-two percent of participants indicated that recruitment of child psychiatrists in Canada is a problem. The recent decision by the Royal College of Physicians and Surgeons to recognize child and adolescent psychiatry as a subspecialty and introduce an extra year of training was identified as a further challenge to recruitment efforts. Other deterrents included lower salary than other subspecialties, lack of exposure during training, stigma, and lack of interest in treating children. Recruitment into psychiatry was enhanced by good role modeling, early exposure in medical school, an interest in brain research, and career and lifestyle issues. Conclusions: A rebranding of the role and perception of psychiatry is needed to attract future psychiatrists. Early exposure to innovations in child and adolescent psychiatry and positive role models are critical in attracting medical students. Recruitment should begin in the first year of medical school and include an enriched paediatric curriculum. PMID:24223044

The Theory and Practice of Consultation-Liaison (CL Psychiatry in Trinidad and Tobago with Reference to Suicidal Behavior

Directory of Open Access Journals (Sweden)

Hari D. Maharajh

2008-01-01

Full Text Available Consultation-Liaison Psychiatry (CL Psychiatry is not a well-established discipline in developing countries. It is a multifaceted area that incorporates clinical, teaching, and research activities both within the hospital and extramurally in community health services. Our purpose was first to define the role of CL Psychiatry, to review essential steps in the process, and to advise on how to set up services. Second, a 1-year retrospective analysis was conducted on all patients referred. A total of 708 persons were referred for psychiatric consultation, of which 41% (291 were referred because of suicidal behavior. Sixty-six percent were female and there was an over-representation of Indo-Trinidadians (67%. Twenty-six percent of all cases of suicidal behavior were diagnosed with clinical depression, 3% were suffering from a psychotic illness (schizophrenia, and 8% (24/291 were under the influence of alcohol. The most vulnerable group was the 25- to 35-year-old age group, accounting for 27% (78/291 of attempters, with the largest number of female attempters. The 36- to 55-year-old males were most likely to attempt suicide (35/99. Ingestion of a toxic substance was the most popular method among all races, genders, and age groups. Of all referrals, 95% originated from medical wards. The most common reason cited for attempts was depressed mood, secondary to a domestic dispute with a family member or significant other. Among Caribbean countries, Trinidad and Tobago has high rates of suicide and suicidal behavior, depression, and alcoholism. CL psychiatrists have a major role to play in the delivery of services to these groups, facilitating the transition of care from admission in the emergency room to discharge and follow-up in the community.

Epigenetics and Child Psychiatry: Ethical and Legal Issues.

Science.gov (United States)

Thomas, Christopher R

2015-10-01

Epigenetics has the potential to revolutionize diagnosis and treatment in psychiatry, especially child psychiatry, as it may offer the opportunity for early detection and prevention, as well as development of new treatments. As with the previous introduction of genetic research in psychiatry, there is also the problem of unrealistic expectations and new legal and ethical problems. This article reviews the potential contributions and problems of epigenetic research in child psychiatry. Previous legal and ethical issues in genetic research serve as a guide to those in epigenetic research. Recommendations for safeguards and guidelines on the use of epigenetics with children and adolescents are outlined based on the identified issues. Copyright © 2015 John Wiley & Sons, Ltd.

What Is Psychiatry?

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Training in psychiatry throughout Europe.

Science.gov (United States)

Brittlebank, Andrew; Hermans, Marc; Bhugra, Dinesh; Pinto da Costa, Mariana; Rojnic-Kuzman, Martina; Fiorillo, Andrea; Kurimay, Tamas; Hanon, Cecile; Wasserman, Danuta; van der Gaag, Rutger Jan

2016-03-01

Psychiatry is the largest medical specialty in Europe. Despite efforts to bring harmonisation, training in psychiatry in Europe continues to be very diverse. The Union Européenne des Médecins Spécialistes (UEMS) has issued as from 2000 a charter of requirements for the training in psychiatry with an additional European Framework for Competencies in Psychiatry in 2009. Yet these have not been implemented throughout Europe. In this paper, the diversity in training throughout Europe is approached from different angles: the cultural differences between countries with regards to how mental health care is considered and founded on, the cultural differences between people throughout Europe in all states. The position of psychotherapy is emphasised. What once was the cornerstone of psychiatry as medical specialty seems to have become a neglected area. Seeing the patient with mental health problems within his cultural context is important, but considering him within his family context. The purpose of any training is enabling the trainee to gain the knowledge and acquire the competencies necessary to become a well-equipped professional is the subject of the last paragraph in which trainees consider their position and early career psychiatrists look back to see whether what they were trained in matches with what they need in the working situation. Common standard for training and certification are a necessity within Europe, for the benefit of the profession of psychiatrist but also for patient safety. UEMS is advised to join forces with the Council of National Psychiatric Associations (NPAs) within the EPA and trainings and early career psychiatrist, to discuss with the users what standards should be implemented in all European countries and how a European board examination could ensure professional quality of psychiatrists throughout the continent.

gerIatrIc ImperatIve

African Journals Online (AJOL)

developments of geriatric medicine in the medical schools and hospitals of Europe .... including physical, mental, social, economic, functional and environmental .... occupational therapy and speech therapy has grown over the years, further ...

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

OpenAIRE

John Ebnezar; Yogita Bali; Rakesh John

2017-01-01

Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

Common geriatric emergencies in a rural hospital in South‑Eastern ...

African Journals Online (AJOL)

Common geriatric emergencies in a rural hospital in South‑Eastern Nigeria. ... by emergency health conditions that predispose them to higher risk of disability and ... The geriatric patients seen within the study period who met the selection ...

Review of fall risk assessment in geriatric populations using inertial sensors

OpenAIRE

Howcroft, Jennifer; Kofman, Jonathan; Lemaire, Edward D

2013-01-01

Background Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Methods Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological f...

Basic Geriatrics Knowledge Among Internal Medicine Trainees in a Teaching Hospital in Saudi Arabia.

Science.gov (United States)

Al-Aama, Tareef

2016-06-01

To assess the basic knowledge of medical trainees, in the absence of a structured geriatrics curriculum, around a variety of geriatric medicine components that are considered essential for the care of the rapidly increasing elderly population. Eighty-three trainees at different levels of training in internal medicine were asked about a variety of common geriatric conditions. Those included: delirium, falls, geriatric syndromes, pain, cognitive impairment, and medications. The trainees' knowledge about common geriatric condition was overall poor. The most pronounced deficits included: the lack of familiarity in diagnosing geriatric syndromes (63 %) or managing them (67 %), the underestimation of the prevalence of delirium (49 %), and the tendency to undertreat pain (64 %). Poor familiarity with polypharmacy and its impact, as well as inappropriate prescription practices in the elderly were also observed. In the absence of a structured geriatric medicine curriculum, internal medicine trainees' knowledge about important geriatric conditions is poor, even if their internal medicine knowledge is overall adequate. This would translate into suboptimal care for this vulnerable and rapidly expanding segment of the population.

Postdoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools.

Science.gov (United States)

Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2017-10-01

The aim of this study was to determine the number and size of postdoctoral teaching programs in geriatric dentistry in U.S. dental schools and other health professions educational institutions and those programs with Health Resources and Services Administration (HRSA) funding. In 2015, all 67 U.S. dental schools were contacted via email with a questionnaire to ask if they had a postdoctoral program in geriatric dentistry; if they did, they were asked to report the length and size of the program. Directors of all 16 HRSA-funded geriatric fellowships were also invited to participate in the survey. Fifty-six of the 67 (83.6%) dental schools and 15 of the 16 (93.8%) HRSA-funded programs completed the questionnaire. Postdoctoral geriatric dentistry programs were reported in 12 dental schools and six medical institutions, although only six programs were currently accepting fellows. The length of the programs was 12-36 months. The maximum number of residents in any program was ten. The oldest program was in Minnesota; it began in 1981. The newest program was beginning in 2017 at Boston University as a revised version of its previous HRSA-funded program. The loss of HRSA funding has had a major negative impact on the number of training programs. Future research is needed to determine how the loss of HRSA-funded programs has affected the availability of educators in geriatric dentistry for dental schools and the services provided to the geriatric community.

Generalized ward identities for non-local transformation

International Nuclear Information System (INIS)

Li Ziping; Li Ruijie

2002-01-01

Based on the phase-space generating functional of Green function for a system with a singular higher-order Lagrangian, the generalized canonical Ward identities under the local and non-local transformation in phase space for such a system have been derived. Starting from the configuration-space generating functional for a gauge-invariant system, the generalized Ward identities were deduced under the local, non-local and global transformation, respectively. The applications to the non-Abelian Chern-Simons theories with higher derivatives were given. Some relationships among the proper vertices have been deduced, in which one does not need to carry out the integration over canonical momenta in phase-space generating functional. The Ward-Takahashi identities for BRS transformation are also obtained

Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.

Science.gov (United States)

Geduldig, Emma T; Kellner, Charles H

2016-04-01

This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

Directory of Open Access Journals (Sweden)

John Ebnezar

2017-01-01

Full Text Available Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

Measuring pharmacogenetics in special groups: geriatrics.

Science.gov (United States)

Seripa, Davide; Panza, Francesco; Daragjati, Julia; Paroni, Giulia; Pilotto, Alberto

2015-07-01

The cytochrome P450 (CYP) enzymes oxidize about 80% of the most commonly used drugs. Older patients form a very interesting clinical group in which an increased prevalence of adverse drug reactions (ADRs) and therapeutic failures (TFs) is observed. Might CYP drug metabolism change with age, and justify the differences in drug response observed in a geriatric setting? A complete overview of the CYP pharmacogenetics with a focus on the epigenetic CYP gene regulation by DNA methylation in the context of advancing age, in which DNA methylation might change. Responder phenotypes consist of a continuum spanning from ADRs to TFs, with the best responders at the midpoint. CYP genetics is the basis of this continuum on which environmental and physiological factors act, modeling the phenotype observed in clinical practice. Physiological age-related changes in DNA methylation, the main epigenetic mechanisms regulating gene expression in humans, results in a physiological decrease in CYP gene expression with advancing age. This may be one of the physiological changes that, together with increased drug use, contributed to the higher prevalence of ADRs and TFs observed in the geriatric setting, thus, making geriatrics a special group for pharmacogenetics.

Why medical students choose psychiatry - a 20 country cross-sectional survey.

Science.gov (United States)

Farooq, Kitty; Lydall, Gregory J; Malik, Amit; Ndetei, David M; Bhugra, Dinesh

2014-01-15

Recruitment to psychiatry is insufficient to meet projected mental health service needs world-wide. We report on the career plans of final year medical students from 20 countries, investigating factors identified from the literature which influence psychiatric career choice. Cross sectional electronic or paper survey. Subjects were final year medical students at 46 medical schools in participating countries. We assessed students' career intentions, motivations, medical school teaching and exposure to psychiatry. We assessed students' attitudes and personality factors. The main outcome measure was likelihood of specializing in psychiatry. Multilevel logistic regression was used to examine the joint effect of factors upon the main outcome. 2198 of 9135 (24%) of students responded (range 4 to 91%) across the countries. Internationally 4.5% of students definitely considered psychiatry as a career (range 1 to 12%). 19% of students (range 0 to 33%) were "quite likely", and 25% were "definitely not" considering psychiatry. Female gender, experience of mental/physical illness, media portrayal of doctors, and positive attitudes to psychiatry, but not personality factors, were associated with choosing psychiatry. Quality of psychiatric placement (correlation coefficient = 0.22, p school, experience of psychiatric enrichment activities (special studies modules and university psychiatry clubs), experience of acutely unwell patients and perceived clinical responsibility were all associated with choice of psychiatry.Multilevel logistic regression revealed six factors associated with students choosing psychiatry: importance of own vocation, odds ratio (OR) 3.01, 95% CI 1.61 to 5.91, p school, OR 10.8 (5.38 to 21.8, p student selection and psychiatry teaching which affect career choice. Addressing these factors may improve recruitment to psychiatry internationally.

What Is Psychiatry?

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Geriatric dentistry content in the curriculum of the dental schools in Chile.

Science.gov (United States)

León, Soraya; Araya-Bustos, Francisca; Ettinger, Ronald L; Giacaman, Rodrigo A

2016-09-01

The purpose of this study was to identify the status of pre-doctoral geriatric dentistry education among all Chilean dental schools. Chile is one of the most rapidly ageing countries in Latin America. Consequently, specific knowledge and training on the needs of elderly populations need to be emphasised in dental schools. The current extent and methods of teaching geriatric dentistry among the dental schools in Chile are unknown. A web-based questionnaire was developed and sent to all 19 Chilean dental schools to identify which schools had a formal programme on geriatric dentistry and ask about their format, content and type of training of the faculty who taught in the programmes. Data were analysed, and a comparison was made among the schools. Sixteen (84%) of the participant schools reported teaching at least some aspects of geriatric dentistry, using various methodologies, but only 7 (37%) had specific courses. Of those schools reporting a didactic content on geriatric dentistry, 71% included clinical training, either in the school's dental clinics or in an extramural service. Contents mostly included demographics of ageing, theories of ageing and medical conditions. More than half of the faculty (57%) stated that they had formal training in geriatric dentistry, 43% were trained in prosthodontics, public health or other areas. Although most dental schools taught geriatric dentistry, only some had a specific course. Most schools with formal courses followed the international curriculum guidelines for geriatric dentistry. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Humanities and Geriatric Education: a Strategy for Recruitment?

Science.gov (United States)

Frank, Christopher; Martin, Ruth Elwood

2015-01-01

Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees’ attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on how humanities curriculum can be used in geriatric teaching. PMID:25825611

[Antibiotic prescription usage and assessment in geriatric patients].

Science.gov (United States)

Dinh, Aurélien; Davido, Benjamin; Salomon, Jérôme; Le Quintrec, Jean-Laurent; Teillet, Laurent

2016-01-01

Due to the high risk of infection, the geriatric population is regularly subjected to antibiotics. Faced with bacterial resistance, particularly among elderly dependent patients, it is essential to promote proper use and correct prescription of antibiotics. A study evaluated antibiotic prescription in a geriatric hospital with 598 beds and highlighted the importance of collaboration between geriatricians and infectious disease specialists. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Geriatric syndromes in patients with chronic kidney disease

OpenAIRE

Tomasz Gołębiowski; Hanna Augustyniak-Bartosik; Wacław Weyde; Marian Klinger

2016-01-01

The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than ...

Geriatric Rehabilitation Patients’ Perceptions of Unit Dining Locations

OpenAIRE

Baptiste, Françoise; Egan, Mary; Dubouloz-Wilner, Claire-Jehanne

2014-01-01

Background Eating together is promoted among hospitalized seniors to improve their nutrition. This study aimed to understand geriatric patients’ perceptions regarding meals in a common dining area versus at the bedside. Methods An exploratory qualitative study was conducted. Open-ended questions were asked of eight patients recruited from a geriatric rehabilitation unit where patients had a choice of meal location. Results Eating location was influenced by compliance with the perceived rules ...

Forensic psychiatry, one subspecialty with two ethics? A systematic review.

Science.gov (United States)

Niveau, Gérard; Welle, Ida

2018-04-10

Forensic psychiatry is a particular subspecialty within psychiatry, dedicated in applying psychiatric knowledge and psychiatric training for particular legal purposes. Given that within the scope of forensic psychiatry, a third party usually intervenes in the patient-doctor relationship, an amendment of the traditional ethical principles seems justified. Thus, 47 articles, two book chapters and the guidelines produced by the World Psychiatric Association, the American Association of Psychiatry and the Law, as well as by the Royal Australian and New Zealand College of psychiatrists, were analyzed. The review revealed that the ethics of correctional forensic psychiatry and those of legal forensic psychiatry do not markedly differ from each other, but they are incongruent in terms of implementation. In an effort to better understand which ethical principles apply to forensic psychiatry, a chronological review of the literature published from 1950 to 2015 was carried out. The ethics of correctional forensic psychiatry are primarily deontological. The principle of justice translates into the principle of health care equivalence, the principle of beneficence into providing the best possible care to patients, and the principle of respect of autonomy into ensuring confidentiality and informed consent. The ethics of legal forensic psychiatry are rather consequentialist. In this latter setting, the principle of justice is mainly characterized by professionalism, the principle of beneficence by objectivity and impartiality, and the principle of respect of autonomy by informed consent. However, these two distinct fields of forensic psychiatry share in common the principle of non maleficence, defined as the non collaboration of the psychiatrist in any activity leading to inhuman and degrading treatment or to the death penalty.

Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

Science.gov (United States)

Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

2018-01-01

Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

[Medical students and psychiatry. A survey of students' opinion].

Science.gov (United States)

Giberti, F; Corsini, G; Rovida, S

1994-06-01

In the last years research on the didactics of Psychiatry and opinions of medical students on Psychiatry has gained great interest. The authors think that this research could be useful for the improvement of didactics, for better understanding the meanings of professional choice, the identity of psychiatrist and their relationship with colleagues in other medical field. The goal of this research work was a preliminary survey of Genoese University Medical Student's opinions about psychiatry didactics, and choice of specialization. A questionnaire was submitted to all the students who passed Clinical Psychiatry examination in the period from November 1987 to December 1988. The students were divided in two randomized groups: the first group of students (224) was submitted to the questionnaire immediately after Clinical Psychiatry examination; while to the second group of students (66) the questionnaire was mailed. The aim of the questions was to assess the student's opinions on psychiatry, psychoanalysis, psychotherapy, the career they wanted to take up, and the difficulties of studying psychiatry: 69% of the students of the first group and 42% of the students of the second group answered the questionnaire. Female students answered that they preferred psychiatric specialization more than their male colleagues did, but the difference has no statistical importance. In most cases, the students who answered that they have taken into account psychiatry as a choice of specialisation, are more interested in medical specialties (primary care, etc.) than in surgical specialties. Most of the medical students declare some emotional troubles (anxiety, sleeplessness, problem in social relations).(ABSTRACT TRUNCATED AT 250 WORDS)

Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

International Nuclear Information System (INIS)

Lurkittikul, N; Kittithreerapronchai, O

2014-01-01

The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients

Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

Science.gov (United States)

Lurkittikul, N.; Kittithreerapronchai, O.

2014-06-01

The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.

Communication skills in psychiatry training.

Science.gov (United States)

Ditton-Phare, Philippa; Halpin, Sean; Sandhu, Harsimrat; Kelly, Brian; Vamos, Marina; Outram, Sue; Bylund, Carma L; Levin, Tomer; Kissane, David; Cohen, Martin; Loughland, Carmel

2015-08-01

Mental health clinicians can experience problems communicating distressing diagnostic information to patients and their families, especially about severe mental illnesses such as schizophrenia. Evidence suggests that interpersonal communication skills can be effectively taught, as has been demonstrated in the specialty of oncology. However, very little literature exists with respect to interpersonal communication skills training for psychiatry. This paper provides an overview of the communication skills training literature. The report reveals significant gaps exist and highlights the need for advanced communication skills training for mental health clinicians, particularly about communicating a diagnosis and/or prognosis of schizophrenia. A new communication skills training framework for psychiatry is described, based on that used in oncology as a model. This model promotes applied skills and processes that are easily adapted for use in psychiatry, providing an effective platform for the development of similar training programs for psychiatric clinical practice. © The Royal Australian and New Zealand College of Psychiatrists 2015.

The chiral Ward-Takahashi identity in the ladder approximation

International Nuclear Information System (INIS)

Kugo, Taichiro; Mitchard, M.G.

1992-01-01

We show that the ladder approximation to the Schwinger-Dyson and Bethe-Salpeter equations preserves the Ward-Takahashi identity for the axial vector vertex if and only if we use the gluon momentum as the argument of the running coupling constant. However, in the usual Landau gauge this is inconsistent with the vector Ward identity. We propose a new method for making the ladder approximation scheme consistent with both vector and axial vector Ward identities. (orig.)

[Rehabilitation for musculoskeltal disorders in geriatric patients].

Science.gov (United States)

Shirado, O

1997-07-01

Aging is typically accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness in any organs. Musculoskeltal system is one of the most involved organs in geriatric patients. Appropriate roles in geriatric rehabilitation for musculoskeltal disorders should be emphasized not only to treat the disorders, but also to prevent many complications cause by specific disease or injury. Representative management methods in geriatric rehabilitation are introduced in this section. Rest is often effective, especially in the acute phase of illness or injury. However, cautions should be paid in disuse syndrome which may be produced by prolonged bed rest. Major manifestations in this syndrome includes muscle weakness and atrophy, joint contracture, decubitus, osteoporosis, ectopic ossification, cardiovascular impairment, pneumonia, urological and mental problems. Physical agents such as heat, cold, light and pressure have been used as therapeutic agents. Electrical stimulation is often effective in the treatment of low-back pain syndrome. Traction is the act of drawing, or a pulling force. Its mechanism to relieve pain seems to immobilize the injured parts, to increase peripheral circulation by massage effect and to improve muscle spasm. Brace is very effective to control acute pain in musculoskeltal system. However, long-term wear of brace should be avoided to prevent the disuse syndrome. Exercise is one of the most important rehabilitation modalities. This includes stretching and muscle strengthening programs. Education of body mechanism in activity of daily living is essential in rehabilitation of geriatric patients.

Teaching geriatric medicine at the Queen's University of Belfast.

Science.gov (United States)

Stout, R W

1983-01-01

Undergraduate teaching at the Queen's University, Belfast, takes place in the fourth year of a five year curriculum. It lasts three weeks and this is divided into two parts. First, held within the university department, is topic-based teaching including seminars, discussions, case histories and visits. The second phase of two weeks consists of attachment of two to four students to geriatric medical units both in and outside Belfast. The whole of this module is situated within a combined course involving community medicine, general practice, geriatric medicine and mental health lasting 12 weeks and involving one-third of the year of 150 students each time. In addition to the three weeks teaching in geriatrics, joint discussion groups are held.

Optimizing Lighting Design for Hospital Wards by Defining User Zones

DEFF Research Database (Denmark)

Thuesen, Niels; Stidsen, Lone; Kirkegaard, Poul Henning

2011-01-01

of lighting design, so it has the ability to support the different users activity and behavior on the ward. By using RFID tracking and manual observations we have analyzed and evaluated the ward functionality as working environment for the staff. The method creates a higher understanding of the ward...... of lighting design in private and public settings are often not similar. The purpose of this article is therefore present a approach dividing the hospital ward in 3 user zones for patients, staff and visitors. The main user of the zone should be in control of the light scenario and thereby a refining...

Should general psychiatry ignore somatization and hypochondriasis?

Science.gov (United States)

Creed, Francis

2006-10-01

This paper examines the tendency for general psychiatry to ignore somatization and hypochondriasis. These disorders are rarely included in national surveys of mental health and are not usually regarded as a concern of general psychiatrists; yet primary care doctors and other physicians often feel let down by psychiatry's failure to offer help in this area of medical practice. Many psychiatrists are unaware of the suffering, impaired function and high costs that can result from these disorders, because these occur mainly within primary care and secondary medical services. Difficulties in diagnosis and a tendency to regard them as purely secondary phenomena of depression, anxiety and related disorders mean that general psychiatry may continue to ignore somatization and hypochondriasis. If general psychiatry embraced these disorders more fully, however, it might lead to better prevention and treatment of depression as well as helping to prevent the severe disability that may arise in association with these disorders.

Common geriatric emergencies in a rural hospital in South-Eastern ...

African Journals Online (AJOL)

2011-11-02

Nov 2, 2011 ... epidemiologically recognized as constitutional risk factor ... Materials and Methods: This was a descriptive hospital-based study of 216 geriatric patients who .... (hypertension and hypertension-related heart failure) the ... [7,8] This finding has ... measured with sphygmomanometer, majority of geriatric.

[Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry

NARCIS (Netherlands)

Schaub, R.M.; Baat, C. de

2006-01-01

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational

Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry

NARCIS (Netherlands)

Schaub, R.M.; de Baat, C.

2006-01-01

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational

What Is Psychiatry?

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Full Text Available ... illnesses and the relationships with genetics and family history, to evaluate medical and psychological data, to make ... written examination for a state license to practice medicine, and then complete four years of psychiatry residency. ...

What Is Psychiatry?

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Full Text Available ... must complete medical school and take a written examination for a state license to practice medicine, and ... most psychiatrists take a voluntary written and oral examination given by the American Board of Psychiatry and ...

What Is Psychiatry?

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Full Text Available ... Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some ... additional specialized training after their four years of general psychiatry training. They may become certified in: Child ...

What Is Psychiatry?

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Full Text Available ... APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In Join General Residents and Fellows Medical Students International close menu Psychiatrists Education Practice Cultural Competency Awards & Leadership Opportunities Advocacy & APAPAC Meetings Search ...

What Is Psychiatry?

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Full Text Available ... information specifically addressed to individuals in the European Economic Area. As described in the Privacy Policy, this ... training, most psychiatrists take a voluntary written and oral examination given by the American Board of Psychiatry ...

What Is Psychiatry?

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Full Text Available ... become a psychiatrist, a person must complete medical school and take a written examination for a state ... A psychiatrist is a medical doctor (completed medical school and residency) with special training in psychiatry. A ...

What Is Psychiatry?

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Full Text Available ... Reporting on Mental Health Conditions APA Blogs Annual Meeting Goldwater Rule Advocacy & APAPAC APA Sites APA Publishing APA Learning Center APA Foundation APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In ...

What Is Psychiatry?

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What can philosophy do for psychiatry?

Science.gov (United States)

Fulford, Kenneth WM; Stanghellini, Giovanni; Broome, Matthew

2004-01-01

This article illustrates the practical impact of recent developments in the philosophy of psychiatry in five key areas: patient-centred practice, new models of service delivery, neuroscience research, psychiatric education, and the organisation of psychiatry as an international science-led discipline focused on patient care. We conclude with a note on the role of philosophy in countering the stigmatisation of mental disorder. PMID:16633476

Teaching Programs in Geriatric Optometry.

Science.gov (United States)

Rosenbloom, Albert A.

1985-01-01

Results of a survey of U.S. and Canadian optometry programs concerning curriculum design, clinical and residency training programs, continuing education, and research projects planned or under way in geriatric optometry are presented and discussed. (MSE)

Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training.

Science.gov (United States)

Maggiore, Ronald J; Gorawara-Bhat, Rita; Levine, Stacie K; Dale, William

2014-01-01

The aging of the U.S. population continues to highlight emerging issues in providing care generally for older adults and specifically for older adults with cancer. The majority of patients with cancer in the U.S. are currently 65 years of age or older; therefore, training and research in geriatrics and geriatric oncology are viewed to be integral in meeting the needs of this vulnerable population. Yet, the ways to develop and integrate best geriatrics training within the context of hematology/oncology fellowship remain unclear. Toward this end, the current study seeks to evaluate the prior and current geriatric experiences and perspectives of hematology/oncology fellows. To gain insight into these experiences, focus groups of hematology/oncology fellows were conducted. Emergent themes included: 1) perceived lack of formal geriatric oncology didactics among fellows; 2) a considerable amount of variability exists in pre-fellowship geriatric experiences; 3) shared desire to participate in a geriatric oncology-based clinic; 4) differences across training levels in confidence in managing older adults with cancer; and 5) identification of specific criteria on how best to approach older adults with cancer in a particular clinical scenario. The present findings will help guide future studies in evaluating geriatrics among hematology/oncology fellows across institutions. They will also have implications in the development of geriatrics curricula and competencies specific to hematology/oncology training. © 2013.

Patients' feelings about ward nursing regimes and involvement in rule construction.

Science.gov (United States)

Alexander, J

2006-10-01

This study compared two acute psychiatric ward nursing regimes, focusing on ward rules as a means of investigating the relationship between the flexibility/inflexibility of the regimes and patient outcomes. Previous studies identified an association between ward rules and patient aggression. A link between absconding and nurses' attitudes towards rule enforcement has also been explored. However, an in-depth exploration of ward rules from the perspective of nurses and patients had not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients' responses to the rules; to evaluate the impact of rules and rule enforcement on nurse-patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design. The relevance of sociological theory emerged from the data analysis. During this process, the results were moved up to another conceptual level to represent the meaning of lived experience at the level of theory. For example, nurses' descriptions of their feelings in relation to rule enforcement were merged as role ambivalence. This concept was supported by examples from the transcripts. Other possible explanations for the data and the connections between them were checked by returning to each text unit in the cluster and ensuring that it fitted with the emergent theory. The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non-participant observations provided a context for the interview data. Measures of the Ward Atmosphere Scale, the Hospital-Hostel Practices Profile, ward incidents and levels of as required (PRN) medication were obtained. The analysis of the quantitative data was assisted by spss, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data. A series of

What Is Psychiatry?

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Non-perturbative construction of the Luttinger-Ward functional

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M.Potthoff

2006-01-01

Full Text Available For a system of correlated electrons, the Luttinger-Ward functional provides a link between static thermodynamic quantities on the one hand and single-particle excitations on the other. The functional is useful in deriving several general properties of the system as well as in formulating the thermodynamically consistent approximations. Its original construction, however, is perturbative as it is based on the weak-coupling skeleton-diagram expansion. Here, it is shown that the Luttinger-Ward functional can be derived within a general functional-integral approach. This alternative and non-perturbative approach stresses the fact that the Luttinger-Ward functional is universal for a large class of models.

Developing a general ward nursing dashboard.

Science.gov (United States)

Russell, Margot; Hogg, Maggie; Leach, Stuart; Penman, Mags; Friel, Susan

2014-12-15

The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice.

What Is Psychiatry?

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What Is Psychiatry?

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Full Text Available ... APA Foundation APA Annual Meeting Psychiatric News PsychiatryOnline Workplace Mental Health Sign In Join General Residents and ... panic disorder, PTSD, anxiety, obsessive-compulsive disorder, borderline personality disorder and eating disorders. Antipsychotic medications – used to ...

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Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review

Science.gov (United States)

Keijsers, Carolina J P W; van Hensbergen, Larissa; Jacobs, Lotte; Brouwers, Jacobus R B J; de Wildt, Dick J; ten Cate, Olle Th J; Jansen, Paul A F

2012-01-01

AIMS Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals. METHODS Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms ‘pharmacology’ and ‘education’ in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared. RESULTS Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1–935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated. CONCLUSIONS Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given. PMID:22416832

University psychiatry in Italy: organisation and integration of university clinics and the National Health Service

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Pier Maria Furlan

2013-09-01

Full Text Available INTRODUCTION: In the Italian psychiatric system, community-based care has become increasingly important and widespread since the national reform of 1978. This report aims to provide an overview of the involvement of university medical schools in this process, considering their responsibility for teaching and training specialist practitioners and professionals. METHODS: The study was carried out between early 2010 and February 2011. An 18-items, self-administered, questionnaire was designed to investigate the number of faculty members that are responsible both for running a clinical ward and for providing community-based healthcare. RESULTS: Nine out of 53 faculty members (17% manage a Mental Health Department, 9 (17% manage a University Department, and 2 (3.8% manage both types of department. Less than half of the teachers have full responsibility (hospital and community; however the percentage reaches 73.2% if we include the hospital wards open to the community emergencies. The remaining 26.8% have no responsibility for community psychiatry. Moreover there were undoubtedly still too many universities with specialisation schools that are without an appropriate network of facilities enabling them to offer complex psychiatric training. DISCUSSION: As expected, there were several types of healthcare management that were not uniformly distributed throughout Italy and there were also marked differences between mental health care provision in the North, Centre, and South of Italy. The university involvement in clinical responsibility was great, but at the management level there was a lack of equality in terms of clinical care, which risks being reflected also on the institutional functions of teaching and research.

Psychiatry in Australia | Kaplan | South African Journal of Psychiatry

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South African Journal of Psychiatry. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 2 (2004) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected ...

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Full Text Available ... and insomnia. Hypnotics – used to induce and maintain sleep. Mood stabilizers – used to treat bipolar disorder. Stimulants – ... psychiatry Pain medicine Psychosomatic (mind and body) medicine Sleep medicine Some psychiatrists choose additional training in psychoanalysis ...

[250 years of English psychiatry].

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Freeman, H

1996-08-01

The history of British psychiatry is considered from five main viewpoints: clinical practice, the institutional basis, the legislative basis, lay perspectives of-mental disorder, and European influences. Its philosophical basis can be traced back to the work of the seventeenth-century philosophers. Thomas Hobbes and John Locke. In Scotland, both 'philosophy of mind' and new clinical methods flourished during its Enlightenment; the concept of 'neurosis' was developed by William Cullen. Around 1800, James Prichard's concept of 'moral insanity' became the foundation of modern work on personality disorder and psychopathy. The psychotic illness of King George III, beginning in 1788, led to greater public sympathy for the mentally ill. Attitudes since then have varied, with 'antipsychiatry' becoming very influential in the 1960s. By the mid-eighteenth century, specialised institutions for the mentally ill existed in a number of cities, there were also units attached to charitable general hospitals, but none of these continued after about 1830. The neglect of patients in private madhouses, prisons, and poorhouses led to increasing concern by Parliament, which resulted in the development of public asylums throughout the country. Severe legal restrictions on their activities were modified in 1930 and completely reformed in 1959. From the mid-nineteenth century, French and German influences became increasingly strong, but British universities played no active part in psychiatry until the 1950s. Psycho-analysis did not develop strongly in Britain, where the main contribution was through translation and biography, but some leading analysts came as refugees in the 1930s-as did other psychiatrists from central Europe. Another important influence was that of Adolf Meyer at the Institute of Psychiatry, London, particularly through Sir Aubrey Lewis; physical treatment methods also came to Britain from Europe. In the second half of this century, the most important British

Positioning and change in a hospital ward

DEFF Research Database (Denmark)

Kjærbeck, Susanne

2017-01-01

Purpose This paper focuses on communication about hygiene in a hospital ward and with the relevant infection control organization. The purpose of this paper is to examine the function of the hygiene coordinator as a key change agent and the communicative challenges and role conflicts implied in her...... practice. The author suggests strategies for improving communication on hygiene on ward level. Design/methodology/approach The empirical material consists of interviews and recordings of communicative events in relation to a breakout of dangerous bacteria in the ward. Change communication is used...... as a contextualizing frame of understanding, and positioning theory and analysis are applied to shed light upon the core challenges of communicating as a change agent when the coordinator's professional position and collegial relations do not support it. Findings It is shown how these challenges are connected...

Attitude of medical students towards psychiatry: the case of Jimma ...

African Journals Online (AJOL)

Background: The inability to attract medical graduates to specialize in psychiatry has always been a serious challenge to psychiatry training programs. Therefore, the aim of this study was to assess the attitude of medical students towards psychiatry. Methods: A comparative cross-sectional survey was conducted among 122 ...

Survey of Threats and Assaults by Patients on Psychiatry Residents

Science.gov (United States)

Dvir, Yael; Moniwa, Emiko; Crisp-Han, Holly; Levy, Dana; Coverdale, John H.

2012-01-01

Objective: The authors sought to determine the prevalence of threats and assaults by patients on psychiatry residents, their consequences, and the perceived adequacy of supports and institutional responses. Method: Authors conducted an anonymous survey of 519 psychiatry residents in 13 psychiatry programs across the United States. The survey…

Geriatric dentistry education and context in a selection of countries in 5 continents.

Science.gov (United States)

Marchini, Leonardo; Ettinger, Ronald; Chen, Xi; Kossioni, Anastassia; Tan, Haiping; Tada, Sayaka; Ikebe, Kazunori; Dosumu, Elizabeth Bosede; Oginni, Fadekemi O; Akeredolu, Patricia Adetokunbo; Butali, Azeez; Donnelly, Leeann; Brondani, Mario; Fritzsch, Bernd; Adeola, Henry A

2018-05-01

To summarize and discuss how geriatric dentistry has been addressed in dental schools of different countries regarding to (1) teaching students at the predoctoral level; (2) advanced training, and (3) research. A convenience sample of faculty members from a selection of high, upper-middle and lower-middle income countries were recruited to complete the survey. The survey had 5 open-ended main topics, and asked about (1) the size of their elderly population, (2) general information about dental education; (3) the number of dental schools teaching geriatric dentistry, and their teaching methods; (4) advanced training in geriatric dentistry; (5) scholarship/research in geriatric dentistry. (1) There is great variation in the size of elderly population; (2) duration of training and content of dental education curriculum varies; (3) geriatric dentistry has not been established as a standalone course in dental schools in the majority of the countries, (4) most countries, with the exception of Japan, lack adequate number of dentists trained in geriatric dentistry as well as training programs, and (5) geriatric dentistry-related research has increased in recent years in scope and content, although the majority of these papers are not in English. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

Russian and Soviet forensic psychiatry: troubled and troubling.

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Healey, Dan

2014-01-01

Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent "totalitarian" regime, reformed and stagnated under "mature socialism" and then embraced capitalism and "managed democracy" at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the second half of the nineteenth century debates about the role of psychiatry in criminal justice took place against a backdrop of increasingly alarming terrorist activity, and call for revolution. While German influence, with its preference for hereditarianism, was strong, Russian psychiatry was inclined toward social and environmental explanations of crime. When revolution came in 1917, the new communist regime quickly institutionalized forensic psychiatry. In the aftermath of revolution, the institutionalization of forensic psychiatry "advanced" with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. The abuses of Soviet psychiatry under Stalin and more intensively after his death in the 1960s-80s remain under-researched and key archives are still classified. The return to democracy since the late 1980s has seen mixed results for fresh attempts to reform both the justice system and forensic psychiatric practice. © 2013.

Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

Science.gov (United States)

McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.

2009-01-01

This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a…

Attitudes towards psychiatry of undergraduate medical students at Bayero University, Nigeria

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N C Aghukwa

2010-12-01

Full Text Available Background. This study determined and compared responses of 5th- and 6th (final-year medical students on their attitudes to psychiatry as a profession. Also elicited were their choices of area of future medical specialisation. Method. A prospective and cross-sectional study using an adapted 27-item self-administered questionnaire to obtain responses from 91 5th- and 6th-year medical students at Bayero University, Kano, Nigeria. Results. More than 60% of the students’ first choices for future specialisation were surgery, obstetrics/gynaecology or internal medicine. Psychiatry was the first preference for less than 2%. More than 75% of the students’ views on the overall merits and efficacy of psychiatry were positive, although they felt that psychiatry had low prestige and status as a profession. In addition, the same proportion considered that psychiatry was scientific, making advances in the treatment of major mental disorders, and helpful in liaison practice. More than 50% stated that psychiatry would not be their choice of last resort for residency education and the same proportion felt that friends and fellow students rather than family members would discourage them from specialising in psychiatry. More than 50% would feel uncomfortable with mentally ill patients, felt that psychiatry would not be financially rewarding, and did not think that psychiatrists abuse their legal power to hospitalise patients. Attitudes of the two groups of students to psychiatry as a profession were not significantly different (p>0.05. Conclusion. A clinical clerkship in psychiatry did not influence the students’ choice of future specialisation.

Cyclical swings: The bête noire of psychiatry.

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Decker, Hannah S

2016-02-01

Progress in psychiatry in the West has been retarded by the proclivity of the discipline to swing violently between 2 approaches to viewing mental illness; that is, emphasizing-to the exclusion of the other-the material-somatic vs the psychical-experiential avenues to knowledge. Each time a shift occurs, the leaders of the new dominant approach emotionally denounce the principles and ideas that came before. We can examine this phenomenon historically by looking at Romantic psychiatry, mid-/late-19th century empirical psychiatry, psychoanalysis, and modern biological psychiatry. Looking at the 2 approaches in treatment today, the gold standard of patient care involves combining empirical/psychological care in 1 person (the psychiatrist) or shared between 2 clinicians working intimately with each other (psychiatrist with psychologist or social worker.) Yet as regards psychiatrists, they are discouraged from paying full attention to the psychological side by the way managed care and third-party payment have combined to remunerate them. Finally, how do we account for the intense swings and denunciations in psychiatry? The author speculates on possible explanations but leaves the question open for her readers. (c) 2016 APA, all rights reserved).

Forensic psychiatry in India: Past, present, and future.

Science.gov (United States)

Nambi, S; Ilango, Siva; Prabha, Lakshmi

2016-12-01

Forensic psychiatry is a subspecialty of psychiatry, in which scientific and clinical expertise is applied to legal issues in legal contexts embracing civil, criminal, correctional, or legislative matters. Forensic psychiatry is still in an infant stage in India and other developing countries. Law is the sanctioning discipline, and Psychiatry is the therapeutic discipline. Due to various reasons, Forensic Psychiatry is reared as Cinderella in our country; "which is much neglected, ignored, misinterpreted, and misunderstood. Legislation forms an integral component in the implementation of Mental Health Care; there is a dynamic relationship between the concept of mental illness, treatment of the mentally ill, and the law. Mental Health legislation is essential in protecting the rights and dignity of persons with Mental Disorders and for implementing effectively the mental health services. "Effective mental health legislation can provide a legal frame work to integrate mental health services in the community as to overcome stigma, discrimination, and exclusion of mentally ill persons. Legislations can also create enforceable standards for high quality medical care and improve access to care and protect civil, political, social, and economic rights of the mentally ill individual, including right to access to education, employment, housing, and social security."

Geriatric Optometry Programs of Promise.

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Verma, Satya B.

1985-01-01

The curriculum design, philosophy, and innovation of four programs in geriatric optometry are described: the Pennsylvania College of Optometry and the colleges of Optometry at the State University of New York, University of Alabama at Birmingham, and University of Houston. (MSE)

Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

Science.gov (United States)

Gabbay, Uri; Bukchin, Michael

2009-01-01

Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity

Practice of geriatric oncology in the setting of a comprehensive cancer center

International Nuclear Information System (INIS)

Droz, J.

2004-01-01

Geriatric oncology is defined by the multidimensional and multidisciplinary approach of the elderly cancer patients. Autonomy, beneficence, non maleficence and justice are the four fundamental principles on which are based the treatment objectives and practical management of these patients. The Comprehensive Geriatric Assessment is the most used tool to detect the functional problems in these elderly patients. The standard oncologic managements of cancer is applies to these patients. However treatment plan and geriatric interventions must be adapted to each individual characteristics of the patients.Thus a strong interdependence between oncologic and geriatric teams is warranted. This implies specific teaching programs during initial medical studies and in the setting of continuous medical education. Furthermore, such wold wide teaching programs may help to the implementation of Geriatric Oncology. In the Geriatric Oncology Program in Lyon we have developed a specific miniassessement to be practiced in an oncologic setting. Geriatric data were obtained by the version of the geriatric multidimensional assessment tool, which we have called minimal comprehensive geriatric assessment” or mini-CGA. This procedure has been designed to collect information on several major domains including medical (co-morbidity), functional, cognitive, affective, social, and environmental aspects. It is essentially based on a very careful medical examination. We also used other evaluation tools previously validated in elderly people. Dependence was measured using three tools: Katz’s Activities of Daily Living (ADLs) scale that focuses on six basic activities of daily living (bathing, dressing, toile ting, transferring, continence, and feeding); Lawton’s Instrumental Activities of Daily Living (IADLs) scale that appraises more complex activities essential for independence in community residence; and the Karnofsky Performance scale (KPS) that is widely used in the oncology setting to

What Is Psychiatry?

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The impact of the educational environment on career choice and attitudes toward psychiatry.

Science.gov (United States)

Mahendran, Rathi; Lim, Haikel A; Verma, Swapna; Kua, Ee Heok

2015-05-01

The educational environment may influence students' attitudes towards medical specialties, which in turn can affect specialty career choices. The present study sought to establish if perceptions of the educational environment in a psychiatry rotation influenced attitudinal changes towards psychiatry in medical students and impacts decisions about psychiatry as a career choice. The modified Attitudes to Psychiatry Scale, Dundee Ready Educational Environment Measure, and questions specific to career choice in psychiatry were administered to 100 undergraduates in a psychiatry rotation. Significant improvements in attitudes toward psychiatry were highly correlated with the educational environment, particularly when it was perceived as providing inspiration and enabling students to recognize the merits of psychiatry and the effectiveness of treatment. However, there was a worsening trend in the stigma to psychiatry in the posting, and only the positive attitudinal change (but not educational environment) influenced a career choice in psychiatry. While the educational environment contributes towards positive attitudinal changes in a specialty rotation, stigma of psychiatry continues to be a limiting factor, which is, unfortunately, not clearly addressed in the curriculum. The findings support the urgent need for interventions in this area.

Novel ethical dilemmas arising in geriatric clinical practice.

Science.gov (United States)

Calleja-Sordo, Elisa Constanza; de Hoyos, Adalberto; Méndez-Jiménez, Jorge; Altamirano-Bustamante, Nelly F; Islas-Andrade, Sergio; Valderrama, Alejandro; García-Peña, Carmen; Altamirano-Bustamante, Myriam M

2015-05-01

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.

The relationship between substance use and exit security on psychiatric wards

NARCIS (Netherlands)

Simpson, A.; Bowers, L.; Allan, T.; Haglund, K.; Muir-Cochrane, E.; Nijman, H.L.I.; Merwe, M. van der

2011-01-01

Aim.  In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Background.  Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming

[A new stage of development of gerontology and geriatrics in Russia: problems of creation of a geriatric care system. Part 1. Relevance, regulatory infrastructure].

Science.gov (United States)

Anisimov, V N; Serpov, V Yu; Finagentov, A V; Khavinson, V Kh

2017-01-01

This article is a 1st part of the analytical review, focused on a new step in development of geriatrics in Russia. Creation of state system geriatric care as important part of state politics in the area of enhancement of quality of life was proved. General aspects of improvement of social support of disable elderly persons in condition of restricted budget and interagency separation was presented. Establishment of unified system of medical social support and gerotechnologies for the elderly was substantiated, as a mechanism facilitated life activity and decreasing of demographic loading on economic status of regions of Russian Federation. Legislative and normative regulations of gerontology and geriatric development were observed as well. Accepted legislative and normative acts were analyzed for period since 1977 to 2014. The necessity of approaches to regulation modernization for elderly was demonstrated. Analytical review on number of legislative state documents issued after meeting of Presidium of State Council of the Russian Federation being in August 2014 was also presented. Applicability of these documents for realization new strategy of gerontology and geriatrics development in Russia was proved.

Psychiatry and humanism in Argentina.

Science.gov (United States)

Niño Amieva, Alejandra

2016-04-01

The authors of the present selection of Latin American Psychiatry texts were characterized by a common deep humanistic attitude. These prolific writers were able to establish or extend the scope of the discipline in which they chose to act, questioning the establishment of rigid boundaries within the framework of a rigorous epistemological reflection. Thus the systematizing spirit of Jose Ingenieros' in the context of positivist evolutionism, resulted in the act of founding a discipline that integrated the biological and the social. In the case of Guillermo Vidal his conception of mental health went beyond the biomedical to consider psychotherapies as an emotional commitment, continence and empathic understanding; with regard to César Cabral his formation and extensive clinical practice resulted in a work defined by the inquiring into the theoretical concepts underlying Psychiatry and Clinical Psychology. This brief selection does not exhaust the issues or the level of ideas and discussions of Psychiatry in Argentina, but constitutes a textual corpus representative of a disciplinary conception understood as scientific and humanistic endeavor.

Clinical application value of impulse oscillometry in geriatric patients with COPD

Directory of Open Access Journals (Sweden)

Liu Z

2017-03-01

Full Text Available Zhonghui Liu,* Lianjun Lin,* Xinmin Liu Geriatrics Department, Peking University First Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Background: The diagnosis and assessment of COPD rely mainly on the use of spirometry, which is an effort-dependent test and requires good patient cooperation. Impulse oscillometry (IOS is a non-volitional method that requires less effort and cooperation and presents advantages for geriatric patients. However, the clinical application value of IOS in geriatric patients with COPD remains unclear. Aim: The aim of this study was to investigate the clinical application value of IOS in geriatric patients with COPD. Subjects and methods: A total of 234 subjects were retrospectively enrolled in this study, including 133 patients with COPD and 101 healthy volunteers. All the participants underwent IOS and spirometry examination. The data were collected and analyzed in the overall group, the geriatric group (aged ≥65 years, and the advanced elderly group (aged ≥80 years. Results: 1 In COPD patients, a significant increase in respiratory impedance (Z5, resonant frequency (Fres, and respiratory resistance (R5, R20, R5–R20 and a decrease in respiratory reactance (X5 were observed in the overall group, the geriatric group, and the advanced elderly group compared with the healthy control subjects. 2 The IOS parameters correlated well with spirometry in COPD. In particular, R5–R20 showed the best correlation with forced expiratory volume in 1 second (FEV1 in the different age groups. 3 Fres and R5–R20 had the best diagnostic efficiency for COPD. The area under the curve (AUC values for Fres, expressed by the receiver operating characteristic (ROC curve, were 0.905, 0.909, and 0.914, for the different age groups, respectively. 4 The optimal cutoff values for Fres to diagnose airflow obstruction from ROC curves was 17.715 in the COPD patients. Its sensitivity and

The eugenic legacy in psychology and psychiatry.

Science.gov (United States)

Pilgrim, David

2008-05-01

Assumptions about genetic differences in human mental characteristics can be traced in large part to the eugenic movement, ascendant at the turn of the 20th century. This paper offers historical case studies, of 'innate general cognitive ability' and 'psychiatric genetics', in order to appraise the eugenic legacy in current psychology and psychiatry. Reviewing the work of representatives, Cyril Burt, Franz Kallmann and Eliot Slater, along with their research networks, it is argued that eugenics remains a quiet but powerful background influence in modern-day psychology and psychiatry. At the turn of the 21st century, eugenics remains an important area of inquiry, reflection and education for those in the inter-disciplinary field of social psychiatry.

Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities

Science.gov (United States)

Bell, Susan P.; Vasilevskis, Eduard E.; Saraf, Avantika A.; Jacobsen, J. Mary Lou; Kripalani, Sunil; Mixon, Amanda S.; Schnelle, John F.; Simmons, Sandra F.

2016-01-01

Background Geriatric syndromes are common in older adults and associated with adverse outcomes. The prevalence, recognition, co-occurrence and recent onset of geriatric syndromes in patients transferred from hospital to skilled nursing facilities (SNFs) are largely unknown. Design Quality improvement project. Setting Acute care academic medical center and 23 regional partner SNFs. Participants 686 Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs. Measurements Nine geriatric syndromes were measured by project staff -- weight loss, decreased appetite, incontinence and pain (standardized interview), depression (Geriatric Depression Scale), delirium (Brief-Confusion Assessment Method), cognitive impairment (Brief Interview for Mental Status), falls and pressure ulcers (hospital medical record utilizing hospital-implemented screening tools). Estimated prevalence, new-onset prevalence and common coexisting clusters were determined. The extent that syndromes were commonly recognized by treating physicians and communicated to SNFs in hospital discharge documentation was evaluated. Results Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for 3 or more co-existing syndromes. Overall the most prevalent syndromes were falls (39%), incontinence (39%), decreased appetite (37%) and weight loss (33%). Of individuals that met criteria for 3 or more syndromes, the most common triad clusters included nutritional syndromes (weight loss, loss of appetite), incontinence and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33–95% of syndromes present as assessed by research personnel. Conclusion Geriatric syndromes in hospitalized older adults transferred to SNF are prevalent and commonly co-exist with the most frequent clusters including nutritional syndromes, depression and incontinence. Despite

Valproic Acid Suppositories for Management of Seizures for Geriatric Patients.

Science.gov (United States)

DiScala, Sandra L; Tran, Nhi N; Silverman, Michael A

This case describes the use of valproic acid suppositories for secondary seizure prophylaxis in a geriatric veteran with a feeding and swallowing disorder. The effectiveness of valproic acid suppositories is outlined to reinforce the need for compounding pharmacies to have this formulation available to meet the needs of geriatric patients.

[Contribution of psychoanalysis to geriatric care for institutionalized patients].

Science.gov (United States)

Charazac, Pierre-Marie

2014-06-01

The contribution of psychoanalysis to geriatric care in nursing home is discussed in three directions: its conception of care, specially on its negative sides; its implication in geriatric units, in their conception and in the analysis of their management of care; the holding of care-givers and nurses by making clear what we call transference and conter-transference and their reflection on their function.

Geritalk: communication skills training for geriatric and palliative medicine fellows.

Science.gov (United States)

Kelley, Amy S; Back, Anthony L; Arnold, Robert M; Goldberg, Gabrielle R; Lim, Betty B; Litrivis, Evgenia; Smith, Cardinale B; O'Neill, Lynn B

2012-02-01

Expert communication is essential to high-quality care for older patients with serious illness. Although the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatric and palliative medicine fellows is often inadequate or unavailable. The current study drew upon the educational principles and format of an evidence-based, interactive teaching method to develop an intensive communication skills training course designed specifically to address the common communication challenges that geriatric and palliative medicine fellows face. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques before the course. Geriatric and palliative medicine fellows were recruited to participate in the course and 100% (n = 18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on a 5-point scale). After the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, P communication skills program, customized for the specific needs of geriatric and palliative medicine fellows, improved fellows' self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. © 2012, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

Geriatric hip fracture management: keys to providing a successful program.

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Basu, N; Natour, M; Mounasamy, V; Kates, S L

2016-10-01

Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

A community-based approach for integrating geriatrics and gerontology into undergraduate medical education.

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Martinez, Iveris L; Mora, Jorge Camilo

2012-01-01

Medical school accreditation requirements require educational opportunities in geriatrics. Twenty-six minimum graduating competencies in geriatrics have recently been identified for medical students. The authors describe how these competencies are being integrated into a new medical curriculum through coursework and community-based experiences. This approach is intended to expose students to older adults from diverse communities and adequately prepare students to address the complex and individual needs of these patients. Initial results indicate proficiency in the minimum geriatric competencies covered. The growth and diversity of the older adult population makes it important to integrate and evaluate geriatrics education in undergraduate medical education.

Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks

OpenAIRE

Trachsel, Manuel; Irwin, Scott A; Biller-Andorno, Nikola; Hoff, Paul; Riese, Florian

2016-01-01

BACKGROUND: As a significant proportion of patients receiving palliative care suffer from states of anxiety, depression, delirium, or other mental symptoms, psychiatry and palliative care already collaborate closely in the palliative care of medical conditions. Despite this well-established involvement of psychiatrists in palliative care, psychiatry does not currently explicitly provide palliative care for patients with mental illness outside the context of terminal medical illness. DISCUSSI...

The role of psychiatry in family violence treatment

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Nastasić Petar

2013-01-01

Full Text Available The aim of the paper is reassessment of the role of psychiatry in the treatment of family violence within the context of contemporary approaches and researches. There are prejudices in the general and professional public that perpetrators of family violence are usually persons with mental disorders and that psychiatry is primarily in charge of their treatment; it has been shown that severe mental disorders do not increase the risk of violence. Application of classical psychiatrics approach to family violence treatment is discussed, as well as the roles of psychiatry in current theoretical and therapeutic approaches to this issue, including systemic family therapy, social psychiatry primarily concerned with their treatment. Studies have shown that severe mental disorders do not increase ecology, unwillingness therapy and model of protection of family violence victims that is developed in Serbia. [Projekat Ministarstva nauke Republike Srbije, br. 47021

Crossing the line--learning psychiatry at the movies.

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Akram, Adil; O'Brien, Aileen; O'Neill, Aidan; Latham, Richard

2009-06-01

Special Study Modules (SSMs) have developed in response to the General Medical Council's recommendations. St George's, University of London runs a 'Psychiatry and Film' SSM for medical students on the 5-year MBBS course. Many films have plots or characters that have a mental illness. Psychiatry & filmmaking share certain skills. Both seek to understand character, motivation and behaviour. Cinema therefore has the potential to be a useful tool for medical educational purposes. Specific to psychiatry, themes such as the accuracy of portrayals of different mental illness, the psychiatrist/patient relationship and living with a mental illness can be explored. General issues such as the role of the psychiatrist in society, medical ethics, professionalism and stigma can also be usefully highlighted for consideration and debate. This may encourage medical students to consider psychiatry as a potential career specialty and help reduce negative attitudes to mental illness.

Postoperative pneumonia-prevention program for the inpatient surgical ward.

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Wren, Sherry M; Martin, Molinda; Yoon, Jung K; Bech, Fritz

2010-04-01

Postoperative pneumonia can lead to increased morbidity, length of hospital stay, and costs. Pneumonia-prevention programs have been successfully implemented in ICU settings, but no program exists for surgical ward patients. A pilot prevention program was designed and implemented based on literature review. The program consisted of education of physicians and ward staff and a standardized postoperative electronic order set consisting of incentive spirometer, chlorhexidine oral hygiene, ambulation, and head-of-bed elevation. Quarterly staff meetings discussed the results of and compliance with the program. The intervention commenced in April 2007. Baseline incidence of inpatient ward pneumonia was calculated from the National Surgical Quality Improvement Program database for fiscal year (FY) 2006 and FY 2007. Postintervention incidence was calculated in the same manner from FY 2007 through FY 2008. Any patient who contracted pneumonia in the ICU was excluded from analysis. There was a significant decrease in ward pneumonia incidence from 0.78% in the preintervention group compared with 0.18% in the postintervention group (p = 0.006), representing an 81% decrease in incidence from 2006 to 2008. The pneumonia-prevention program was very successful in diminishing postoperative pneumonia on the surgical ward. There was a highly statistically significant 4-fold decrease in pneumonia incidence after program implementation. The interventions were not costly but did require ongoing communication and cooperation between physician and nursing leadership to achieve compliance with the measures. This program has great potential for dissemination to hospital surgical wards and could decrease inpatient postoperative pneumonias. Published by Elsevier Inc.

Holomorphic Vector Bundles Corresponding to some Soliton Solutions of the Ward Equation

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Zhu, Xiujuan, E-mail: yzzhuxiujuan@sina.com [Jiangsu Second Normal University, School of Mathematics and Information Technology (China)

2015-12-15

Holomorphic vector bundles corresponding to the static soliton solution of the Ward equation were explicitly presented by Ward in terms of a meromorphic framing. Bundles (for simplicity, “bundle” is to be taken throughout to mean “holomorphic vector bundle”) corresponding to all Ward k-soliton solutions whose extended solutions have only simple poles, and some Ward 2-soliton solutions whose extended solutions have only a second-order pole, were explicitly described by us in a previous paper. In this paper, we go on to present some bundles corresponding to soliton-antisoliton solutions of the Ward equation, and Ward 3-soliton solutions whose extended solutions have a simple pole and a double pole. To give some more interpretation of the bundles, we study the second Chern number of the corresponded bundles and find that it can be obtained directly from the patching matrices. We also point out some information about bundles corresponding to Ward soliton solutions whose extended solutions have general pole data at the end of the paper.

[A new stage of development of gerontology and geriatrics in Russia: Problems o creation of a geriatric care system. Part 2. The structure of the system, scientific approach].

Science.gov (United States)

Anisimov, V N; Serpov, V Yu; Finagentov, A V; Khavinson, V Kh

2017-01-01

The publication is the second part of the analytical review on the new stage of development of gerontology and geriatrics in Russia. Components of social support system for senior citizens and the structure of social-medical care as its crucial components are presented. The problem of positioning of geriatric care within the system of social support for senior citizens, as well as its peculiarities and the algorithm providing geriatric care are discussed. The analysis of this algorithm allowed us to justify the indissoluble link and continuity of individual components of geriatric care and its cost-effectiveness. The position of the Russian Federation Ministry of Health concerning of introduction of geriatric care as an element in the system of medical care for older citizens was looking through. The pilot project «Territory of Care» proposed by the Russian Federation Ministry of Labor and Ministry of Health for establishment of long-term system of medical and social care to citizens of the older generation on the principles of multidisciplinary and interdepartmental interaction was elucidated as well. Some failures of the project have been highlighted and recommendations for its development were stressed. The role of gerontology as a systemic basis for creation of geriatric service in Russia and for the development of an integrated social and medical care to citizens of the older generation was underlined. The main priorities in the field of aging in the forthcoming decade are formulated. The most promising areas of research in the field of gerontology were discussed, the implementation of which will allow to realize the State social policy goals focused on the quality of life of senior citizens. Finally, the position of Gerontological Society of the Russian Academy of Sciences on the creation of mechanisms of scientific support for the renovation of geriatric services, including collaboration with experts in the field of practical medicine, social workers, and

[Use of the critical incident technique in the development of a measurement tool for satisfaction in psychiatry].

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Pourin, C; Daucourt, V; Barberger-Gateau, P

2001-06-01

Health care centers will have to set up a regular survey of their patients' satisfaction, in addition to the discharge questionnaire. Few instruments for measuring satisfaction are at present available. A working group associating 10 psychiatric hospitals in Aquitaine conducted a study on the specificity of this measure in psychiatry. To record the patient's perception on the stay in order to identify areas of satisfaction and dissatisfaction as perceived and reported by himself, using a qualitative approach. The critical incident technique was used in 3 volunteer hospitals, in patients hospitalised in psychiatric wards selected by their doctor. Interview using a semi-structured questionnaire were conducted by an investigator external to the departments. Data were analysed in a qualitative way. 32 interviews could be analysed, and 215 events were extracted. These events were classified in 12 themes. The events identified from these interviews have allowed identification of new areas of patient satisfaction, which could be used to build additional items centered on patients' preoccupations.

Stability of and Factors Related to Medical Student Specialty Choice of Psychiatry.

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Goldenberg, Matthew N; Williams, D Keith; Spollen, John J

2017-09-01

Targeted efforts are needed to increase the number of medical students choosing psychiatry, but little is known about when students decide on their specialty or what factors influence their choice. The authors examined the timing and stability of student career choice of psychiatry compared with other specialties and determined what pre- and intra-medical school factors were associated with choosing a career in psychiatry. Using survey data from students who graduated from U.S. allopathic medical schools in 2013 and 2014 (N=29,713), the authors computed rates of psychiatry specialty choice at the beginning and end of medical school and assessed the stability of that choice. A multivariate-adjusted logistic regression and recursive partitioning were used to determine the association of 29 factors with psychiatry specialty choice. Choice of psychiatry increased from 1.6% at the start of medical school to 4.1% at graduation. The stability of psychiatry specialty choice from matriculation to graduation, at just over 50%, was greater than for any other specialty. However, almost 80% of future psychiatrists did not indicate an inclination toward the specialty at matriculation. A rating of "excellent" for the psychiatry clerkship (odds ratio=2.66), a major in psychology in college (odds ratio=2.58), and valuing work-life balance (odds ratio=2.25) were the factors most strongly associated with psychiatry career choice. Students who enter medical school planning to become psychiatrists are likely to do so, but the vast majority of students who choose psychiatry do so during medical school. Increasing the percentage of medical students with undergraduate psychology majors and providing an exemplary psychiatry clerkship are modifiable factors that may increase the rate of psychiatry specialty choice.

A prospective study assessing agreement and reliability of a geriatric evaluation.

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Locatelli, Isabella; Monod, Stéfanie; Cornuz, Jacques; Büla, Christophe J; Senn, Nicolas

2017-07-19

The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random). Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders. Six out of nine items of the geriatric consultation described in this study (functional

Decision making in geriatric oncology

NARCIS (Netherlands)

Hamaker, M.E.

2012-01-01

The studies in this thesis show that for older cancer patients, tailor-made care should be the standard of care, striking the golden mean between undertreatment and overtreatment and fully taking into account the heterogeneity of this patient population. The comprehensive geriatric assessment will

Applied psychometrics in clinical psychiatry: the pharmacopsychometric triangle

DEFF Research Database (Denmark)

Bech, P; Bech, P

2009-01-01

OBJECTIVE: To consider applied psychometrics in psychiatry as a discipline focusing on pharmacopsychology rather than psychopharmacology as illustrated by the pharmacopsychometric triangle. METHOD: The pharmacopsychological dimensions of clinically valid effects of drugs (antianxiety, antidepress......OBJECTIVE: To consider applied psychometrics in psychiatry as a discipline focusing on pharmacopsychology rather than psychopharmacology as illustrated by the pharmacopsychometric triangle. METHOD: The pharmacopsychological dimensions of clinically valid effects of drugs (antianxiety...... psychometrics in psychiatry have been found to cover a pharmacopsychometric triangle illustrating the measurements of wanted and unwanted effects of pharmacotherapeutic drugs as well as health-related quality of life....

Measuring the stigma of psychiatry and psychiatrists

DEFF Research Database (Denmark)

Gaebel, Wolfgang; Zäske, Harald; Cleveland, Helen-Rose

2011-01-01

The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against...... the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal...... to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists...

Effects on muscle performance of NSAID treatment with piroxicam versus placebo in geriatric patients with acute infection-induced inflammation. A double blind randomized controlled trial.

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Beyer, Ingo; Bautmans, Ivan; Njemini, Rose; Demanet, Christian; Bergmann, Pierre; Mets, Tony

2011-12-30

Inflammation is the main cause of disease-associated muscle wasting. In a previous single blind study we have demonstrated improved recovery of muscle endurance following celecoxib treatment in hospitalized geriatric patients with acute infection. Here we further evaluate NSAID treatment with piroxicam in a double blind RCT and investigate the role of cytokines and heat shock proteins (Hsp) with respect to muscle performance. We hypothesized that NSAID treatment would preserve muscle performance better than antibiotic treatment alone, by reducing infection-associated inflammation and by increasing expression of cytoprotective Hsp. Consecutive admissions to the geriatric ward were screened. 30 Caucasian patients, median age 84.5 years, with acute infection-induced inflammation and serum levels of CRP > 10 mg/L were included and randomized to active treatment with 10 mg piroxicam daily or placebo. Assessment comprised general clinical and biochemical parameters, 25 cytokines in serum, intra-and extracellular Hsp27 and Hsp70, Elderly Mobility Scale (EMS) scores, grip strength (GS), fatigue resistance (FR) and lean body mass (LBM). Patients were evaluated until discharge with a maximum of 3 weeks after treatment allocation. EMS scores, FR and grip work (GW), a measure taking into account GS and FR, significantly improved with piroxicam, but not with placebo. Early decreases in IL-6 serum levels with piroxicam correlated with better muscle performance at week 2. Basal expression of Hsp27 in monocytes without heat challenge (WHC) was positively correlated with FR at baseline and significantly increased by treatment with piroxicam compared to placebo. Profound modifications in the relationships between cytokines or Hsp and changes in muscle parameters were observed in the piroxicam group. Piroxicam improves clinically relevant measures of muscle performance and mobility in geriatric patients hospitalized with acute infection-induced inflammation. Underlying mechanisms may

Professional development and exposure to geriatrics: medical student perspectives from narrative journals.

Science.gov (United States)

Shield, Renée R; Farrell, Timothy W; Campbell, Susan E; Nanda, Aman; Wetle, Terrie

2015-01-01

Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students' professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students' professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students' professional development.

An Innovative Approach for Decreasing Fall Trauma Admissions from Geriatric Living Facilities: Preliminary Investigation.

Science.gov (United States)

Evans, Tracy; Gross, Brian; Rittenhouse, Katelyn; Harnish, Carissa; Vellucci, Ashley; Bupp, Katherine; Horst, Michael; Miller, Jo Ann; Baier, Ron; Chandler, Roxanne; Rogers, Frederick B

2015-12-01

Geriatric living facilities have been associated with a high rate of falls. We sought to develop an innovative intervention approach targeting geriatric living facilities that would reduce geriatric fall admissions to our Level II trauma center. In 2011, a Trauma Prevention Taskforce visited 5 of 28 local geriatric living facilities to present a fall prevention protocol composed of three sections: fall education, risk factor identification, and fall prevention strategies. To determine the impact of the intervention, the trauma registry was queried for all geriatric fall admissions attributed to patients living at local geriatric living facilities. The fall admission rate (total fall admissions/total beds) of the pre-intervention period (2010-2011) was compared with that of the postintervention period (2012-2013) at the 5 intervention and 23 control facilities. A P value fall admissions attributed to local geriatric living facilities (intervention: 179 fall admissions; control: 308 fall admissions). The unadjusted fall rate decreased at intervention facilities from 8.9 fall admissions/bed pre-intervention to 8.1 fall admissions/bed postintervention, whereas fall admission rates increased at control sites from 5.9 to 7.7 fall admissions/bed during the same period [control/intervention odds ratio (OR), 95% confidence interval (CI) = 1.32, 1.05-1.67; period OR, 95%CI = 1.55, 1.18-2.04, P = 0.002; interaction of control/intervention group and period OR 95% CI = 0.68, 0.46-1.00, P = 0.047]. An aggressive intervention program targeting high-risk geriatric living facilities resulted in a statistically significant decrease in geriatric fall admissions to our Level II trauma center.

Reflections on contemporary psychiatry.

Science.gov (United States)

BRILL, N Q

1956-11-01

Valid data on the effectiveness of preventive programs in psychiatry are badly needed but cannot be obtained until reliable statistics on incidence and frequency of emotional disorders are available. There is a suggestion that clear cut neuroses are less frequent but an equally strong suggestion that psychosomatic disorders are increasing in frequency. There is a tendency to look upon the increasing freedom of some aspects of our culture as a great advance over Victorian rigidity and restraint-but to what extent is this related to seeming increases in delinquency?Parents seem to have become increasingly fearful of disciplining, training or frustrating children as a result of what is considered psychiatric teaching. Psychiatry has the responsibility for correcting such a misunderstanding. Psychotherapists who have not resolved their own dependency needs are in no position to help others with the dependency problems which underlie their neurotic difficulties. Psychotherapy involves more than just arranging the world to accommodate itself to the patient (which occasionally needs to be done). The patient too, has a responsibility for his illness and its treatment and must learn that life is characterized by the need to take some chances, by dangers, difficulties, frustrations and unknowns, as well as pleasures, safety, comfort and the familiar. The responsibility for meeting the need for psychiatric services belongs to all of medicine and not just to psychiatry.

Videoconference-based education for psychiatry registrars at the ...

African Journals Online (AJOL)

Videoconference-based education for psychiatry registrars at the University of KwaZulu-Natal, South Africa. J Chipps, S Ramlall, M Mars. Abstract. Objective: Psychiatry registrars form the backbone of specialized psychiatric service provision in South Africa. Medical schools are centralized while clinical services need to be ...

Validation of Geriatric Care Environment Scale in Portuguese Nurses

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João Paulo de Almeida Tavares

2013-01-01

Full Text Available The number of hospitalized older adults in Portugal necessitates a better understanding of the acute care environment for older adults. This study translated and examined the psychometric qualities of the Geriatric Care Environment Scale (GCES among 1,068 Portuguese registered nurses (RNs. Four factors emerged from the exploratory factor analyses: resource availability, aging-sensitive care delivery, institutional values regarding older adults and staff, and continuity of care. The internal consistency of the GCES was α=.919. The GCES was significantly associated with the variables of region, hospital type, unit type, and RNs perception of hospital educational, staff knowledge, difficulty, rewarding, and burdensome in caring for older adults. Nurses who worked in hospitals centers in the northern region and medical and surgery units had more positive perceptions of the geriatric care environment. More positive perception was also found among RNs that reported more educational support, had more knowledge, and felt more rewarding and less difficulty and burden in caring older adults. This process resulted in a valid and reliable measurement of the geriatric care environment Portuguese version which provides hospital leadership with an instrument to evaluate organizational support for geriatric nursing practice and target specific areas that support or hinder care delivery.

Towards Community - Reflections on Community Psychiatry, Culture and Alterity

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Ana Neto

2015-06-01

Full Text Available Introduction: The constant transformation of  communities  and  its relationship  with mental illness has been studied and debated for the past decades, although it is still not clear how it has been incorporated in clinical practice.Aims: The authors propose to review the relevance to Psychiatry, especially Community Psychiatry, of understanding  communities as well as the methodologies and conceptual frameworks that allow that approach.Methods: Selected and critical review of the literature about Community Psychiatry and Culture, Communities, and Social Inequity and Mental Health.Results: The authors start by reviewing the meaning  of  Community and the  defining principles of Community Psychiatry in their relationships with  cultural  sensitivity.  This aspect is illustrated with two examples of the impact of culture and alterity in the understanding of Mental Health and Service Organization, one at the level of International and Global Mental Health, and the other at the local communities’ level. In this context, participatory action research is highlighted.Conclusions: Psychiatry,  in  particular Community  Psychiatry,  by acknowledging a  wide  range  of  methodologies  and  being open  to transdisciplinary  models, is in a privileged position of electing communities as a field of investigation and integrate it in its praxis.

Why study the history of psychiatry?

Science.gov (United States)

Mulder, R T

1993-12-01

The history of psychiatry is being neglected. The major psychiatric textbooks no longer offer any overview of psychiatric history. Possible reasons for this indifference are discussed. It is suggested that a knowledge of our history is not only necessary in a general intellectual sense, but also specifically in enabling us to more easily tolerate the incompleteness and ambiguity of many of our concepts. Furthermore, it may help psychiatry to more convincingly explain the reality and consequences of mental illness to a sceptical public.

Behavior observation of major noise sources in critical care wards.

Science.gov (United States)

Xie, Hui; Kang, Jian; Mills, Gary H

2013-12-01

This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises. © 2013 Elsevier Inc. All rights reserved.

Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

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Brian F Gage

2011-05-01

Full Text Available Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4:489–495.

Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin.

Science.gov (United States)

Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B

2012-06-01

Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

Impact of differences in psychiatry curriculum of undergraduate medical and physiotherapy students on their attitude towards psychiatry.

Science.gov (United States)

Bhise, Manik Changoji; Marwale, Arun Vishwambharrao; Deshmukh, Apoorva Sadgun; Saoji, Sanjeev Gopal

2016-01-01

Negative attitude toward psychiatry (ATP) among medical students is a serious concern. Some studies have concluded that after training in the subject, attitude changes toward positive side. Currently in India, medical students have a less intense course without separate exam or binding to attend training whereas physiotherapy students have more intense course with separate subject exam and binding to attend training in psychiatry. To ascertain and compare the positive and negative ATP in final year MBBS students and final year physiotherapy (BPTh) students who have completed psychiatry curriculum. This is a cross-sectional study with semi-structured pro forma for sociodemographic variables and ATP-30 questionnaire to evaluate ATP of 94 medical and physiotherapy students each. Nonparametric methods were used for statistical analysis with appropriate tests of significance and P value was set at 0.05. Mean ATP-30 score for medical students was 91.9 (standard deviation [SD] =7.0) and that of physiotherapy students was 105.8 (SD = 9.7), this difference in two groups was highly significant (Kruskal-Wallis H = 81.3, df = 1, P students, 36 (41.4%) had negative attitude while only 2 (2.1%) of the physiotherapy students had negative ATP (χ(2) = 41.7, P Physiotherapy students with intense and planned training in psychiatry as an exam subject have significantly more positive ATP than medical students.

The influence of ageism, experience, and relationships with older adults on physical therapy students' perception of geriatrics.

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Blackwood, Jennifer; Sweet, Christina

2017-01-01

Increased exposure to geriatrics throughout a student's professional education has been reported to improve the desire to work in this area; however, factors that influence the perception of geriatric physical therapy may prohibit students from actively seeking those experiences. The purpose of this study was to examine the perceptions of geriatric physical therapy by first-year graduate physical therapy students. A qualitative case study research approach was performed. Three focus groups were completed using students enrolled in their second semester of a graduate-level physical therapy program. Dialogue was reviewed and coded by three raters. Twenty-five subcategories of open-coding terms were triangulated and grouped into 4 themes via axial coding. Four themes emerged: (1) ageism exists in health care, (2) personal and professional experiences serve as a framework for students' perception of geriatrics, (3) interpersonal relationships formed within geriatric practice are highly valued, and (4) additional contextual barriers exist in geriatrics. To meet the needs of a highly skilled geriatric workforce, students should participate in enhanced geriatric experiences in didactic coursework as well as within interprofessional geriatric clinics throughout their education.

Ethical considerations in geriatric neuropsychology.

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Martin, Thomas A; Bush, Shane S

2008-01-01

The practice of geriatric neuropsychology demands specialized training and experience that enables the practitioner to appreciate the unique challenges and opportunities that are encountered when working with older adults. In addition to maintaining advanced knowledge regarding medical and psychological conditions, assessment issues, and treatment needs specific to older persons, clinicians working with older adults must be prepared to recognize and confront ethical dilemmas that arise. For example, ethical challenges related to professional competence, informed consent, assessment, and privacy and confidentiality may be prominent when working with older persons. Maintaining an emphasis on "positive ethics" and utilizing an ethical decision-making model will promote the practitioner's ability to avoid, identify, and resolve ethical challenges. The present article reviews (1) the concept of positive ethics, (2) a comprehensive ethical decision-making model, and (3) ethical issues that are commonly encountered by geriatric neuropsychologists. A case vignette is presented to illustrate the application of the aforementioned tools to promote ethical practice.

Psychiatry in Pakistan: 1947-2006: a new balance sheet.

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Gadit, Amin A Muhammad

2007-09-01

This review deals with the evolution of psychiatry in Pakistan since its inception in 1947. It describes the situation of psychiatric services, education and research through the years 1947-2006, presenting a picture of existing mental health scenario, suggesting the ways for improvement and comment on possible future developments. It concludes with the prediction of a revolutionary change in the current shape of psychiatry throughout the world and especially in Pakistan whereby psychiatry will change to organic-based discipline of a wider "Neurosciences".

The feminization of psychiatry? Some ruminations.

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Kirkpatrick, Martha

2004-01-01

This article considers the position of women in psychiatry today from the historical perspective of feminism. Feminism in medicine demands the inclusion of the traditional priorities of women: collaboration and cooperation over competition and hierarchy, compassionate care over technology and automation, flexible care for the individual in a social context over the study of units of diseased organs. These themes, in addition to the care of women and children, were prominent in the lives of early women physicians and again in the 1970s and 1980s. The number of women in psychiatry has increased. However, their influence is scant and feminist goals are again submerged. At the same time psychiatry has become increasingly interested in the organ (brain) at the expense of the individual person. Women need a new awakening. They must use their new presence to assert feminine values in patient care and protect themselves from becoming provider units on the assembly line.

Strengthening the role of the ward manager: a review of the literature.

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Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

2014-09-01

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

Screening for Psychopathology Symptoms in Mexican Psychiatry Residents

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Rios, Francisco Javier Mesa; Munoz, Maria Del Carmen Lara

2011-01-01

Background: Various rates of alcoholism, drug abuse, mental illness, and suicide among physician have been reported, generally higher than those in the general population. Psychiatry residents, as other specializing physicians, seem to be prone to suffering them. The prevalence of psychological symptoms among psychiatry residents has not been…

Encompassing Sexual Medicine within Psychiatry: Pros and Cons

Science.gov (United States)

Segraves, Robert Taylor

2010-01-01

Objective: This article examines the positive and negative aspects of psychiatry encompassing sexual medicine within its purview. Methods: MEDLINE searches for the period between 1980 to the present were performed with the terms "psychiatry," "sexual medicine," and "sexual dysfunction." In addition, sexual medicine texts were reviewed for chapters…

Evaluation of Professional Role Competency during Psychiatry Residency

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Grujich, Nikola N.; Razmy, Ajmal; Zaretsky, Ari; Styra, Rima G.; Sockalingam, Sanjeev

2012-01-01

Objective: The authors sought to determine psychiatry residents' perceptions on the current method of evaluating professional role competency and the use of multi-source feedback (MSF) as an assessment tool. Method: Authors disseminated a structured, anonymous survey to 128 University of Toronto psychiatry residents, evaluating the current mode of…

Handing over patients from the ICU to the general ward

DEFF Research Database (Denmark)

Bunkenborg, Gitte; Bitsch Hansen, Tina; Hølge-Hazelton, Bibi

2017-01-01

AIM: To explore nursing practice and perception of engaging in communicative interaction when handing over multi-morbid patients from the ICU to general medical or surgical wards. BACKGROUND: Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing...... focused ethnography was applied to the study. METHODS: Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU...... towards patient status and the handing over process" emerged from observation notes. From transcribed focus group interviews, the theme "Balancing and negotiating when passing on, consuming and adapting knowledge" was identified. CONCLUSION: A lack of shared goals regarding handing over patients from...

Generalized on-shell ward identities in string theory

International Nuclear Information System (INIS)

Lee, Jen-Chi

1994-01-01

It is demonstrated that an infinite set of string-tree level on-shell Ward identities, which are valid to all σ-model loop orders, can be systematically constructed without referring to the string field theory. As examples, bosonic massive scattering amplitudes are calculated explicitly up to the second massive excited states. Ward identities satisfied by these amplitudes are derived by using zero-norm states in the spectrum. In particular, the inter-particle Ward identity generated by the D 2 xD 2' zero-norm state at the second massive level is demonstrated. The four physical propagating states of this mass level are then shown to form a large gauge multiplet. This result justifies our previous consideration on higher inter-spin symmetry from the generalized worldsheet σ-model point of view. (author)

Characterization of indoor bioaerosols from a hospital ward in a ...

African Journals Online (AJOL)

Characterization of indoor bioaerosols from a hospital ward in a tropical ... assessment of indoor air quality and determine pathogenic microorganisms due to particle fall-out. Key words: Indoor air, bioaerosols, hospital ward, tropical setting ...

Geriatric health care in India - Unmet needs and the way forward

Directory of Open Access Journals (Sweden)

Prabha Adhikari

2017-01-01

Full Text Available India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly.

Analysis of Ward identities in supersymmetric Yang-Mills theory

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Ali, Sajid; Bergner, Georg; Gerber, Henning; Montvay, Istvan; Münster, Gernot; Piemonte, Stefano; Scior, Philipp

2018-05-01

In numerical investigations of supersymmetric Yang-Mills theory on a lattice, the supersymmetric Ward identities are valuable for finding the critical value of the hopping parameter and for examining the size of supersymmetry breaking by the lattice discretisation. In this article we present an improved method for the numerical analysis of supersymmetric Ward identities, which takes into account the correlations between the various observables involved. We present the first complete analysis of supersymmetric Ward identities in N=1 supersymmetric Yang-Mills theory with gauge group SU(3). The results indicate that lattice artefacts scale to zero as O(a^2) towards the continuum limit in agreement with theoretical expectations.

Evaluating Psychiatry Residents as Physician-Managers: Development of an Assessment Tool

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Sockalingam, Sanjeev; Stergiopoulos, Vicky; Maggi, Julie D.; Zaretsky, Ari; Stovel, Laura; Hodges, Brian

2013-01-01

Objectives: With the emergence of physician-manager (PM) curricula in medical education, more effective assessment tools are needed to evaluate psychiatry trainees in this role. The aim of this study was to determine psychiatry residents', program directors', and PM educators' perceptions about PM role-assessment. Methods: Psychiatry residents at…

Impact of clerkship in the attitudes toward psychiatry among Portuguese medical students

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Almeida José C

2010-08-01

Full Text Available Abstract Background Given the shortage of human resources and the launching of a new Mental Health Plan, recruitment of psychiatrists is currently a major concern in Portugal, as well as in several other countries. Medical students' attitude toward psychiatry has been pointed as a predictor of recruitment. This study aims to evaluate the medical students' perception of psychiatry before and after a clerkship, and the impact on their intention to pursue psychiatry as a future specialty option. Methods Two self-report questionnaires were administered to all 6th year students in a medical school in Lisbon, before and after a 4-weeks full-time psychiatric clerkship, in order to evaluate attitudes toward psychiatry and intention to follow psychiatry in the future. Statistical analysis included Wilcoxon and Chi-square tests. Results 153 students (60.8% female filled in both questionnaires (no dropouts. After the clerkship, there was a significant improvement regarding the overall merits of psychiatry, efficacy, role definition and functioning of psychiatrists, use of legal powers to hospitalize patients and specific medical school factors. There was also a significant increase of students decided or considering the possibility to take a residency in psychiatry. However, perceptions of low prestige and negative pressure from family and peers regarding a future choice of psychiatry remained unchanged in about one-third of the students. Conclusions The results indicate clearly that the clerkship had a favorable overall impact on the student attitude towards psychiatry, as well as in the number of students considering a future career in psychiatry. Attitudes toward psychiatry seems a promising outcome indicator of the clerkship's quality, but further research is needed in order to assess its reliability as a sound predictor of recruitment.

Theory of mind and psychiatry: an introduction.

Science.gov (United States)

Ang, Giap Kian; Pridmore, Saxby

2009-04-01

'Theory of mind' (ToM) arose from the study of primates and their social organization, and scholars in many fields - philosophy, anthropology, psychology, psychiatry and neuroscience - have contributed to this expanding topic. In this paper, we provide an overview of aspects of ToM of relevance to psychiatry. We briefly describe the origins of ToM in primates and humans and some relevant neurobiology, and then touch on possible contributions to psychopathology. We searched for articles on PubMed and Medline, using the terms 'theory of mind', 'mirror neuron system' and 'psychiatry'. There is evidence that ToM deficits are important in certain psychiatric disorders. While more research is required, an appreciation of ToM will have an impact on our further understanding and management of at least some mental disorders, including autism and schizophrenia.

The Recruitment Problem in Psychiatry: A Critical Commentary

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Stampfer, Hans

2011-01-01

The continuing shortfall in recruitment to Psychiatry is examined with suggestions for affirmative action. Recruitment may improve in the near future because of the high demand for psychiatrists, the incentives offered, greater competition for other specialties and a pool of international graduates willing to work in Psychiatry. There remains the…

Child Psychiatry: What Are We Teaching Medical Students?

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Dingle, Arden D.

2010-01-01

Objective: The author describes child and adolescent psychiatry (CAP) undergraduate teaching in American and Canadian medical schools. Methods: A survey asking for information on CAP teaching, student interest in CAP, and opinions about the CAP importance was sent to the medical student psychiatry director at 142 accredited medical schools in the…

The implication of transcultural psychiatry for clinical practice.

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Moldavsky, Daniel

2003-01-01

This article deals with the main concepts of Transcultural Psychiatry and their applications to everyday psychiatric practice. Transcultural psychiatry has undergone a conceptual reformulation in the last two decades. Having started with a comparative approach, which focused on the diverse manifestations of mental disorders among different societies, it broadened its scope, aiming at present to incorporate social and cultural aspects of illness into the clinical framework. Therefore, transcultural psychiatry now focuses more on what is called the illness experience than on the disease process, the latter understood as illness as it is viewed by health practitioners. Western medicine, of which psychiatry is a part, is grounded in positivist epistemological principles that stress the biological processes of disease. The intention of the paper is to develop an interest in alternative but also complementary ways of thinking. Modern transcultural psychiatry interprets some epidemiological and clinical aspects of major mental disorders (such as schizophrenia and depression) in a different light. However, it also distances itself from the absolute relativism of antipsychiatry, centering on clinical facts and helping clinicians in their primary task of alleviating suffering. An important contribution in addressing this task is the formulation of a cultural axis within the DSM model of multiaxial evaluation. A clinical vignette of a cultural formulation applied to a clinical discussion of a case is described.

Becoming 'ward smart' medical students.

Science.gov (United States)

Walker, Beth; Wallace, Deirdre; Mangera, Zaheer; Gill, Deborah

2017-10-01

A small number of medical students elect to work as health care assistants (HCAs) during or prior to their undergraduate training. There is a significant body of evidence in the literature regarding the impact of HCA experience on student nurses; however, little research has examined the effects of such experience on medical students. All fourth-year medical students with self-declared experience as HCAs from a single UK medical school were invited to participate in focus groups to explore their experiences and perceptions. Ten students from the year group took part. Participants felt that their experience as HCAs enhanced their learning in the workplace through becoming 'ward smart', helping them to become socialised into the world of health care, providing early meaningful and humanised patient interaction, and increasing their understanding of multidisciplinary team (MDT) members' roles. Little research has examined the effects of [HCA] experience on medical students DISCUSSION: Becoming 'ward smart' and developing a sense of belonging are central to maximising learning in, from and through work on the ward. Experience as a HCA provides a range of learning and social opportunities for medical students, and legitimises their participation within clinical communities. HCA experience also seems to benefit in the 'hard to reach' dimensions of medical training: empathy; humanisation of patient care; professional socialisation; and providing a sense of belonging within health care environments. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Microbiological assessment of indoor air of teaching hospital wards ...

African Journals Online (AJOL)

Thus, the objective of this study is to provide fundamental data related to the microbial quality of indoor air of Jimma University Specialized Hospital wards, to estimate the health hazard and to create standards for indoor air quality control. METHODS: The microbial quality of indoor air of seven wards of Jimma University ...

Mental Status and Functional Behavior In Male Geriatric Patients

OpenAIRE

Mayer, Gregory Lee

1989-01-01

It was the goal of this study to examine the ecological validity of a number of measures of mental status for geriatric individuals. Subjects were 40 alert, ambulatory male VA patients. Mental status instruments included the Mini-Mental State Examination (MMSE), the Wechsler Memory Scale (WMS) and the Vocabulary subtest of the WAIS-R. Measures of functional behavior included the Woodcock-Johnson Scales of Independent Behavior (SIB) and the Parachek Geriatric Behavior Rating Scale (PGBRS). Sig...

Ward Identities for the 2PI effective action in QED

International Nuclear Information System (INIS)

Reinosa, Urko; Serreau, Julien

2007-01-01

We study the issue of symmetries and associated Ward-like identities in the context of two-particle-irreducible (2PI) functional techniques for abelian gauge theories. In the 2PI framework, the n-point proper vertices of the theory can be obtained in various different ways which, although equivalent in the exact theory, differ in general at finite approximation order. We derive generalized (2PI) Ward identities for these various n-point functions and show that such identities are exactly satisfied at any approximation order in 2PI QED. In particular, we show that 2PI-resummed vertex functions, i.e. field-derivatives of the so-called 2PI-resummed effective action, exactly satisfy standard Ward identities. We identify another set of n-point functions in the 2PI framework which exactly satisfy the standard Ward identities at any approximation order. These are obtained as field-derivatives of the two-point function φ, which defines the extremum of the 2PI effective action. We point out that the latter is not constrained by the underlying symmetry. As a consequence, the well-known fact that the corresponding gauge-field polarization tensor is not transverse in momentum space for generic approximations does not constitute a violation of (2PI) Ward identities. More generally, our analysis demonstrates that approximation schemes based on 2PI functional techniques respect all the Ward identities associated with the underlying abelian gauge symmetry. Our results apply to arbitrary linearly realized global symmetries as well

Ward identities of higher order Virasoro algebra

International Nuclear Information System (INIS)

Zha Chaozeng; Dolate, S.

1994-11-01

The general formulations of primary fields versus quasi-primary ones in the context of high order Virasoro algebra (HOVA) and the corresponding Ward identity are explored. The primary fields of conformal spins up to 8 are given in terms of quasi-primary fields, and the general features of the higher order expressions are also discussed. It is observed that the local fields, either primary of quasi-primary, carry the same numbers of central charges, and not all the primary fields contribute to the anomalies in the Ward identities. (author). 6 refs

Summative Evaluation on the Hospital Wards. What Do Faculty Say to Learners?

Science.gov (United States)

Hasley, Peggy B.; Arnold, Robert M.

2009-01-01

No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…

Abstracts from the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society Quebec City, April 2012

OpenAIRE

Auais, M.; Morin, S.; Finch, L.; Sara, A.; Mayo, N.; Charise, A.; Islam, A.; Muir, Susan; Montero-Odasso, Manuel; Kennedy, C.C.; Papaioannou, A.; Ioannidis, G.; Giangregorio, L.M.; Adachi, J.D.; Thabane, L.

2012-01-01

The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/...

Psychiatry Morbidity and Mortality Rounds: Implementation and Impact

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Goldman, Stuart; Demaso, David R.; Kemler, Beth

2009-01-01

Objective: This study assessed the implementation of psychiatry morbidity and mortality rounds (M&Ms) on the clinical and educational practice in a children's hospital. Methods: Attendees to monthly M&Ms between July 2005 and May 2007 included staff and trainees from psychiatry, psychology, nursing, and social work. Cases were selected based on a…

An Investigation of Psychiatry Residents' Important Experiences

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Long, Jody

2011-01-01

This research study was conducted to explore the phenomenon of the third-year experiences of the psychiatry residents. A review of the literature identified themes and subthemes related to the third-year of psychiatry education. The study was conducted at a university health science center. Data were collected from five residents using participant…

An under-diagnosed geriatric syndrome: sleep disorders among older adults.

Science.gov (United States)

Tufan, Asli; Ilhan, Birkan; Bahat, Gulistan; Karan, Mehmet Akif

2017-06-01

Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered 'yes' to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.

What Do Psychiatric Residents Think of Addiction Psychiatry as a Career?