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Successive prone positioning sessions in mechanically ventilated patients with moderate and severe acute respiratory distress syndrome secondary to COVID-19: case series. Med Intensiva 2022; 46:652-654. [PMID: 36344015 PMCID: PMC9633923 DOI: 10.1016/j.medine.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022]
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Assessment of the effect of respiratory physiotherapy techniques on end-expiratory lung volume through electrical impedance tomography in healthy subjects. Med Intensiva 2021; 45:e53-e55. [PMID: 34839887 DOI: 10.1016/j.medine.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
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Factors associated with length of stay and readmission in acute psychiatric inpatient services in Portugal. Psychiatry Res 2020; 293:113420. [PMID: 32861099 DOI: 10.1016/j.psychres.2020.113420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
Assessing the factors that influence duration and number of hospitalizations may support mental health services planning and delivery. This study examines the factors associated with length of stay and readmission in Portuguese psychiatric inpatient services during 2002, 2007 and 2012. Data from all admissions were extracted from clinical files. Logistic regression models estimated the association between length of stay (<17 vs ≥17 days) and number of admissions per year (1 vs >1 admission) with sociodemographic, clinical, and contextual factors. Older age, a diagnosis of psychosis, and compulsory admission were associated with higher odds of longer length of stay. Being married, secondary education, suicide attempt, a diagnosis of substance use and "other mental disorders", being admitted in 2012, and two of the psychiatric inpatient services associated with lower odds of longer length of stay. Being retired (or others), a diagnosis of psychosis, compulsory admission, and psychiatric service were associated with increased odds of readmission. Older age, and secondary and higher education were associated with lower odds of readmission. The findings indicate that multiple factors influence length of stay and readmission. Identifying these factors provides useful evidence for clinicians and policy makers to design more targeted and cost-effective interventions.
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Assessment of the effect of respiratory physiotherapy techniques on end-expiratory lung volume through electrical impedance tomography in healthy subjects. Med Intensiva 2020; 45:S0210-5691(20)30264-3. [PMID: 33071024 DOI: 10.1016/j.medin.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
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Improving access to integrated mental health services in community-based settings in Portugal. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Scientific evidence has proven greater effectiveness of community-based mental health care offering a diversity of services. Among the main barriers to mental health treatment are difficulties in the access and poor integration with general health services.
Description of the problem
The current Portuguese National Mental Health Plan promoted the transition from psychiatric hospital-based care to care provided by a network of services in the community with the inpatient unit in the local general hospital. In this presentation we will describe the main aspects of the mental health reform and some figures illustrating the functioning of one of the new mental health departments.
Results
Since 2006 three large psychiatric hospitals were closed and mental health departments are now in place according to the new model.
One example, the HFF department of psychiatry, has developed an innovative comprehensive and integrated model based in the general hospital and the community, ensuring a close coordination with primary care teams and all other relevant stakeholders in the community, offering diverse answers to patients’ needs, and preventing drop-outs.
Between 2000 and 2011, the number of admissions went from 486 to 451, first admissions from 40% to 36%, and the average number of patients treated in day hospital from 12 to 24. Liaison psychiatry consultations (2713 to 3684), community teams’ visits (10,201 to 14,756), and home visits (236 to 980) have increased significantly, while rehabilitation programs were developed in two day centers in the community.
Conclusions
The Portuguese model of mental health care, based on the principles of accessibility and equity, community involvement, recovery and human rights, and continuity of care, has promoted greater accessibility, higher quality of care, and less stigma. An important integration of mental health and general health services has taken place allowing for a close collaboration between services.
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P1773Impact of coronary artery calcium score on cardiovascular risk stratification: a multicenter analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P6318Mitral annulus calcification: predictors and outcomes in patients with interventioned severe aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P6054Calcium score of the mitral valve assessed by CT angiography correlates with the severity of mitral regurgitation and mitral valve area in patients with severe aortic stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
IntroductionThe association between economic crises and mental health problems can be attributed to a number of factors. Among these, age seems to be an important determinant.ObjectivesThe aim of this study was to assess whether mental health of the Portuguese population following the onset of the 2008 recession, differs by age groups.MethodsA follow-up study (2015) on the population aged 18 to > 65 years old, using the National Mental Health Survey (n = 911). The age-group prevalence of mental health distress assessed by the ten-item Kessler's Psychological Distress Scale (K10) was calculated using Chi2 statistics and mental distress as a categorical variable (P < 0.05).ResultsMean mental distress score differed significantly according to age group, χ2(3) = 10.684, P < = 0.05. The results showed that the older groups (50–64 and 65 = years old) were more frequently under mental distress (17–19%) compared to younger people (18–49 = years old), which were less likely to report being distressed (8–12%).ConclusionsAge seems to be an important determinant of distress levels during the economic crisis in Portugal. Older adults reported to be more distressed compared to younger individuals. There are several hypotheses for a differential expression of psychological distress between age groups such as working status and retirement, which can express differential access to coping resources under such contextual negative pressure of economic recession. Further research on age groups is thus needed to better understand how recession generates adverse effects on mental well-being.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Services utilization for mental health problems in Portugal during the economic crisis: Preliminary results of the national mental health survey follow-up. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionDuring economic crises additional mental health risks emerge and social inequalities in health can widen. In order to ensure universal coverage of mental health care and to reduce the impact of the crisis, it is crucial to assess the needs of the population to be able to reorganize mental health care accordingly.ObjectivesTo analyse the use of services for mental health problems in Portugal during the economic crisis.MethodsIn this follow-up epidemiological study, a probability sub-sample of respondents to the 2008 national mental health survey (n = 911) was re-interviewed in 2015. Socio-demographic variables and treatment patterns were assessed using a structured interview, and psychological distress was measured using the Kessler-10 Scale. Descriptive analysis was conducted to characterize the use of services for mental health problems.ResultsIn total, 27.9% of the respondents sought treatment for mental health problems in the previous 5 years, and GPs were the most contacted professionals. Only 57.7% (n = 119) of the respondents with moderate or severe psychological distress (n = 197) reported recognizing they needed treatment. Among people with moderate or severe psychological distress who recognized their need for treatment, most received treatment (80.5%, n = 105), which was minimally adequate for 74.4% (n = 81). Low perceived need and structural barriers were the main obstacles for access to care.ConclusionsUnder-treatment, low continuity of care and low adequacy of treatment are problems that the Portuguese health system must address in order to meet the mental health challenges of the economic crisis.FundingEEA Grants: Programa Iniciativas em Saúde Pública.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Financial difficulties, economic hardship and psychological distress during the economic recession in Portugal. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionPortugal is one of the European countries most affected by the Great Economic Recession. Mental health outcomes are likely to deteriorate during this period, with greater proportional impact among those more socially disadvantaged. Self-reported measures of financial difficulties and economic hardship are likely to be associated with psychological distress during this period.ObjectivesTo characterize the relationship between psychological distress and self-reported measures of financial difficulties and type of material deprivation during the Economic Recession in Portugal.MethodsA follow-up epidemiological survey was conducted in 2015, with a probability sub-sample of 911 respondents of the 2008 World Mental Health Survey Initiative Portugal. Psychological distress was evaluated by the Kessler-10 scale. Financial difficulties were assessed by asking the responds if they had enough money for their daily activities. Type of material deprivation considered difficulties in acquiring essential goods, paying debts or buying other goods (clothes or leisure activities). Chi-square analysis were used to evaluate the association between psychological distress, financial difficulties and type of material deprivation.ResultsA statistically significant association (P < 0.05) between psychological distress and financial difficulties was found. Among the respondents that reported not having enough money, 22% reported psychological distress. Regarding the type of material deprivation, a statistically significant association was only found for essential goods.ConclusionsDuring the economic crisis, financial difficulties and material deprivation in essential goods were associated with increased levels of psychological distress, potentially widening social and health inequalities across the Portuguese population.FundingEEA Grants, Programa Iniciativas em Saúde Pública.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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A RCT of a staff training intervention to promote quality of care in long-term residential facilities–the PromQual study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionThe shift of hospital-based to community-based mental health care, introduced the need to assess and promote quality of residential services.ObjectivesThis RCT aimed at assessing the effectiveness of a staff training intervention to improve quality of care in residential facilities.MethodsTwenty-three units with at least 12-hour on-site staff support per day in Portugal were assessed with the quality instrument for rehabilitative care (QuIRC) filled online by the manager. A random sample of service users were interviewed using standardised measures of autonomy, experiences of care, quality of life, and the time user diary (TUD) for level of activity. The intervention group units (n = 12) received workshops and a four-week hands-on training of the staff versus TAU in the control group (n = 11). All units and users were reassessed at 8-months. The staff knowledge gained during the workshops was assessed using pre- post-test. Generalized linear mixed effects models were used.ResultsThe residential units were mainly in the community (n = 17, 73.9%), and had QuIRC mean scores above 50% in the following dimensions : living environment, self-management and autonomy, social inclusion, and human rights. Service users’ level of activity (TUD) at 8-months did not differ between intervention and control groups. At 8 months, all QuIRC dimensions scored higher in the Intervention group, without reaching statistical significance. Pre- post-tests comparison showed a significant increase in the knowledge acquired by the staff.ConclusionsThe intervention had impact on the staff's knowledge without reaching significant change of users’ activity and quality of care of the units.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Topic: Inguinal Hernia - Post op chronic pain: incidence, evaluation, legal consequences, therapy, follow up. Hernia 2015; 19 Suppl 1:S361. [PMID: 26518850 DOI: 10.1007/bf03355395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Suicide, economic crisis and material deprivation in Portugal in the last 20 years. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Assessment of the occupational exposure in real time during interventional cardiology procedures. RADIATION PROTECTION DOSIMETRY 2015; 165:304-309. [PMID: 25848113 DOI: 10.1093/rpd/ncv052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interventional cardiology (IC) procedures can be complex, requiring the operators to work near the patient, during long exposure times. Owing to scattered radiation in the patient and the fluoroscopic equipment, the medical staff are exposed to a non-uniform radiation field and can receive high radiation doses. In this study, it is proposed to analyse staff doses obtained in real time, during IC procedures. A system for occupational dosimetry in real time was used. In order to identify some parameters that may affect the staff doses, Monte Carlo (MC) calculations, using MCNPX v.2.7.0 code and voxel phantoms, were performed. The data obtained from measurements, together with MC simulations, allowed the identification of actions and behaviours of the medical staff that could be considered a risk under routine working conditions. The implementation of this monitoring system for exposure of personnel may have a positive effect on optimisation of radiological protection in fluoroscopically guided cardiac procedures.
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Characteristics and Quality of Care of Residential Units for People with Long-term Mental Illness in Portugal. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)32083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Research priorities for public mental health in Europe: recommendations of the ROAMER project. Eur J Public Health 2015; 25:249-54. [DOI: 10.1093/eurpub/cku232] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Estimation of the collective ionizing dose in the Portuguese population for the years 2011 and 2012, due to nuclear medicine exams. Rev Esp Med Nucl Imagen Mol 2015; 34:1-8. [DOI: 10.1016/j.remn.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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Estimation of the collective ionizing dose in the Portuguese population for the years 2011 and 2012, due to nuclear medicine exams. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Assessment of the dose distribution inside a cardiac cath lab using TLD measurements and Monte Carlo simulations. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2014.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Impact of incomplete revascularization in octagenary patients with multivessel disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Revascularization strategy of multivessel disease in diabetic patients - FREEDOM in very old patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Study of nuclear medicine practices in Portugal from an internal dosimetry perspective. RADIATION PROTECTION DOSIMETRY 2012; 149:438-443. [PMID: 21795254 DOI: 10.1093/rpd/ncr319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Nuclear medicine practices involve the handling of a wide range of pharmaceuticals labelled with different radionuclides, for diagnostic and therapeutic purposes. This work intends to evaluate the potential risks of internal contamination of nuclear medicine staff in several Portuguese nuclear medicine services and to conclude about the requirement of a routine internal monitoring. A methodology proposed by the International Atomic Energy Agency (IAEA), providing a set of criteria to determine the need, or not, for an internal monitoring programme, was applied. The evaluation of the risk of internal contaminations in a given set of working conditions is based on the type and amount of radionuclides being handled, as well as the safety conditions with which they are manipulated. The application of the IAEA criteria showed that 73.1% of all the workers included in this study should be integrated in a routine monitoring programme for internal contaminations; more specifically, 100% of workers performing radioimmunoassay techniques should be monitored. This study suggests that a routine monitoring programme for internal exposures should be implemented in Portugal for most nuclear medicine workers.
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Trauma Association of Canada Annual Scientific Meeting abstractsErythroopoietin resuscitated with normal saline, Ringer’s lactate and 7.5% hypertonic saline reduces small intestine injury in a hemorrhagic shock and resuscitation rat model.Analgesia in the management of pediatric trauma in the resuscitative phase: the role of the trauma centre.Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices.Does computed tomography for penetrating renal injury reduce renal exploration? An 8-year review at a Canadian level 1 trauma centre.The other side of pediatric trauma: violence and intent injury.Upregulation of activated protein C leads to factor V deficiency in early trauma coagulopathy.A provincial integrated model of improved care for patients following hip fracture.Sports concussion: an Olympic boxing model comparing sex with biomechanics and traumatic brain injury.A multifaceted quality improvement strategy to optimize monitoring and management of delirium in trauma patients: results of a clinician survey.Risk factors for severe all-terrain vehicle injuries in Alberta.Evaluating potential spatial access to trauma centre care by severely injured patients.Incidence of brain injury in facial fractures.Surgical outcomes and the acute care surgery service.The acute care general surgery population and prognostic factors for morbidity and mortality.Disaster preparedness of trauma.What would you like to know and how can we help you? Assessing the needs of regional trauma centres.Posttraumatic stress disorder screening for trauma patients at a level 1 trauma centre.Physical and finite element model reconstruction of a subdural hematoma event.Abdominal wall reconstruction in the trauma patient with an open abdomen.Development and pilot testing of a survey to measure patient and family experiences with injury care.Occult shock in trauma: What are Canadian traumatologists missing?Timeliness in obtaining emergent percutaneous procedures for the severely injured patient: How long is too long?97% of massive transfusion protocol activations do not include a complete hemorrhage panel.Trauma systems in Canada: What system components facilitate access to definitive care?The role of trauma team leaders in missed injuries: Does specialty matter?The adverse consequences of dabigatran among trauma and acute surgical patients.A descriptive study of bicycle helmet use in Montréal.Factor XIII, desmopressin and permissive hypotension enhance clot formation compared with normotensive resuscitation: uncontrolled hemorrhagic shock model.Negative pressure wound therapy for critically ill adults with open abdominal wounds: a systematic review.The “weekend warrior:” Fact or fiction for major trauma?Canadian injury preventon curriculum: a means to promote injury prevention.Penetrating splenic trauma: Safe for nonoperative management?The pediatric advanced trauma life support course: a national initiative.The effectiveness of a psycho-educational program among outpatients with burns or complex trauma.Trauma centre performance indicators for nonfatal outcomes: a scoping review.The evaluation of short track speed skating helmet performance.Complication rates as a trauma care performance indicator: a systematic review.Unplanned readmission following admission for traumatic injury: When, where and why?Reconstructions of concussive impacts in ice hockey.How does head CT correlate with ICP monitoring and impact monitoring discontinuation in trauma patients with a Marshall CT score of I–II?Impact of massive transfusion protocol and exclusion of plasma products from female donors on outcome of trauma patients in Calgary region of Alberta Health Services.Primary impact arthrodesis for a neglected open Weber B ankle fracture dislocation.Impact of depression on neuropsychological functioning in electrical injury patients.Predicting the need for tracheostomy in patients with cervical spinal cord injury.Predicting crumping during computed tomography imaging using base deficit.Feasibility of using telehomecare technology to support patients with an acquired brain injury and family care-givers.Program changes impact the outcomes of severely injured patients.Do trauma performance indicators accurately reflect changes in a maturing trauma program?One-stop falls prevention information for clinicians: a multidisciplinary interactive algorithm for the prevention of falls in older adults.Use of focused assessment with sonography for trauma (FAST) for combat casualties in forward facilities.Alberta All-terrain Vehicle Working Group: a call to action.Observations and potential role for the rural trauma team development course (RTTDC) in India.An electronic strategy to facilitate information-sharing among trauma team leaders.Development of quality indicators of trauma care by a consensus panel.An evaluation of a proactive geriatric trauma consultation service.Celebrity injury-related deaths: Is a gangster rapper really gangsta?Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?Intra-abdominal injury in patients who sustain more than one gunshot wound to the abdomen: Should non-operative management be used?Retrospective review of blunt thoracic aortic injury management according to current treatment recommendations.Telemedicine for trauma resuscitation: developing a regional system to improve access to expert trauma care in Ontario.Comparing trauma quality indicator data between a pediatric and an adult trauma hospital.Using local injury data to influence injury prevention priorities.Systems saving lives: a structured review of pediatric trauma systems.What do students think of the St. Michael’s Hospital ThinkFirst Injury Prevention Strategy for Youth?An evidence-based method for targeting a shaken baby syndrome prevention media campaign.The virtual mentor: cost-effective, nurse-practitioner performed, telementored lung sonography with remote physician guidance.Quality indicators used by teaching versus nonteaching international trauma centres.Compliance to advanced trauma life support protocols in adult trauma patients in the acute setting.Closing the quality improvement loop: a collaborative approach.National Trauma Registry: “collecting” it all in New Brunswick.Does delay to initial reduction attempt affect success rates for anterior shoulder dislocation (pilot study)?Use of multidisciplinary, multi-site morbidity and mortality rounds in a provincial trauma system.Caring about trauma care: public awareness, knowledge and perceptions.Assessing the quality of admission dictation at a level 1 trauma centre.Trauma trends in older adults: a decade in review.Blunt splenic injury in patients with hereditary spherocytosis: a population-based analysis.Analysis of trauma team activation in severe head injury: an institutional experience.ROTEM results correlate with fresh frozen plasma transfusion in trauma patients.10-year trend of assault in Alberta.10-year trend in alcohol use in major trauma in Alberta.10-year trend in major trauma injury related to motorcycles compared with all-terrain vehicles in Alberta.Referral to a community program for youth injured by violence: a feasibility study.New impaired driving laws impact on the trauma population at level 1 and 3 trauma centres in British Columbia, Canada.A validation study of the mobile medical unit/polyclinic team training for the Vancouver 2010 Winter Games.Inferior vena cava filter use in major trauma: the Sunny-brook experience, 2000–2011.Relevance of cellular microparticles in trauma-induced coagulopathy: a systemic review.Improving quality through trauma centre collaboratives.Predictors of acute stress response in adult polytrauma patients following injury.Patterns of outdoor recreational injury in northern British Columbia.Risk factors for loss-to-follow up among trauma patients include functional, socio-economic, and geographic determinants: Would mandating opt-out consent strategies minimize these risks?Med-evacs and mortality rates for trauma from Inukjuak, Nunavik, Quebec.Review of open abdomens in McGill University Health Centre.Are surgical interventions for trauma associated with the development of posttraumatic retained hemothorax and empyema?A major step in understanding the mechanisms of traumatic coagulopathy: the possible role of thrombin activatable fibrinolysis inhibitor.Access to trauma centre care for patients with major trauma.Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted.Improving trauma system governance. Can J Surg 2012. [DOI: 10.1503/cjs.006312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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P-618 - The place of subjectivity in psychiatric research: addressing stigma. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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P-760 - Neurosyphilis: four case reports of immunocompetent patients presenting initially to psychiatry. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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P-1177 - “Porta aberta” - a psychoeducational programme for bipolar disorders’ patients. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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P-195 - Electroconvulsive therapy in bipolar mixed states: a case series. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Poster Session 4: Friday 9 December 2011, 14:00-18:00 * Location: Poster Area. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011. [DOI: 10.1093/ejechocard/jer216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Dosimetry in the multi kilo-Gray range using optically-stimulated luminescence (OSL) and thermally-transferred OSL from quartz. RADIAT MEAS 2011. [DOI: 10.1016/j.radmeas.2011.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Quality of care in longer term mental health institutions in Portugal. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionDeinstitutionalisation of the mentally ill is an ongoing process in European countries. Quality of care in residential facilities, however, was seldom assessed in part due to the lack of adequate instruments.ObjectivesTo assess the quality of care in Portuguese residential facilities for long term mental patients.MethodsQuality of care in residential facilities was assessed with the toolkit developed by the DEMoBinc study using interviews with the units’ managers, and the users.ResultsThe 20 units assessed across Portugal were mainly located in the city; 13 were in a hospital setting and 7 in the community. Most of the units (90%) had no maximum length of stay, and 60% were mixed-gender; 85% of the users were not compulsory. Most of the units (60%) had no one-bedrooms, and their aim was rehabilitative in 40%, and rehabilitative plus providing support in 40%. The rate of patients with a bank account was 49.4%, 32.4% were in charge of their finances, while only 14.1% had voted.In hospital vs. community units patients were more frequently men (80.5 vs. 53.8%) and older (51.1 ± 13.7 vs. 43.3 ± 9.6, p < .001). In community units the treatment was more frequently explained (50 vs. 26.3%), patients’ involvement was higher (40.4 vs. 19.5%), while mean GAF scores (64.9 vs. 60.2) did not differ.ConclusionsPortuguese results show that in spite of the effort to create new facilities for the longer term mentally ill, a lot still has to be done to improve the quality of care they provide.
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Frequent users of an acute psychiatric inpatient unit: A 5-year retospective study. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionA small subset of patients with above average admissions to psychiatric inpatient units is recognized in clinical practice. These frequent users tend to be younger and to have a diagnosis of schizophrenia or affective disorder. Social conditions and the severity of the illness seem to be associated with this increased number of admissions.Aims/ObjectivesTo study demographic and clinical characteristics of frequent and non-frequent users of a psychiatric inpatient unit.MethodsRetrospective data of all the patients admitted to a psychiatric inpatient unit from January 2004 to December 2008 were reviewed. Frequent-users were defined as patients with 3 or more admissions over that period of time, and non-frequent users as those with less than 3 admissions. The two groups were compared in terms of age, gender, ethnicity, psychiatric diagnosis and compulsory admissionsResultsIn a total of 2018 admissions and 1348 patients, the frequent-user group represented 10.2% (n = 137) of the patients and 28.9%(n = 584) of the admissions. Frequent-users were significantly younger (39.5 vs. 44.5 years, p = .001), more frequently black (22.6 vs. 19.4%, p < .001) and compulsorily admitted (27.7 vs. 14%, p < .001) than non-frequent users. Patients with bipolar disorder (p = .001), schizophrenia (p = .003) belonged significantly more to frequent-users group, while unipolar depressive patients (p = .016) and other diagnosis (p = .011) was more significantly represented in the non-frequent users group. Frequency of admission did not differ with gender.ConclusionsThe results concerning age and psychiatric diagnosis are consistent with previous studies. Compulsory admissions and black ethnicity were significantly higher among frequent- users.
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Abstracts. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Identification of potential biomarkers of PRIS (Propofol Infusion Syndrome): A prospective study. Toxicol Lett 2010. [DOI: 10.1016/j.toxlet.2010.03.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract: P1436 EFFECT OF PIOGLITAZONE ON HDL, INSULIN AND ADIPONECTIN CONCENTRATIONS IN YOUNG WOMEN WITH UNCOMPLICATED SYSTEMIC LUPUS ERYTHEMATOSUS. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The DEMoBinc Study in Portugal: Development and First Results. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The DEMoBinc study's main objective is to develop an instrument for assessing the living conditions, the quality of care, and the human rights of long-term mentally ill patients in psychiatric and social residential care. It started on March 2007, with 11 centres and 10 countries participating.The Portuguese centre has carried out a national literature review of mental health legislation, standards of care related with residential care for mental patients, and mandatory procedures for physical restraint and seclusion.A three-round Delphi exercise with four groups of experts - advocates, mental health professionals, service users, and carers - was also developed. In the first round the participants were asked to state the ten more important components of care helping recovery in institutional care for the long-term mentally ill. The results were sent back to be rated for their importance on a 5-point scale. Finally, the participants were asked to confirm or change their own scores in comparison with the calculated group median. Between twelve and 18 participants by group were contacted, and the overall rate of participation was 73%.A pilot study using the first draft of the DEMoBinc instrument was done, and refinement of the instrument is being carried out in twenty institutions and will be completed during the next months.The results of the Portuguese centre on the national literature review, the Delphi exercise, and the first phase refinement of the DEMoBinc instrument will be presented and discussed.
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Gender Differences in Patients Admitted to Psychiatry: A 4-year Retrospective Study. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)71017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction:Gender differences in mental health disorders may serve as a useful heuristic for integrating epidemiological and psychobiological data. The vast majority of mental disorders may express major gender-related variations in prevalence, natural history, symptoms, prognosis, and treatment outcome.Aims:To compare demographic and clinical characteristics of women and men admitted to a psychiatric unit.Methods:Retrospective data of all the patients admitted to a psychiatric inpatient unit, from January 2004 to December 2007, were reviewed. The demographic and clinical characteristics of the two genders were compared.Results:Of a total of 1114 patients admitted, 53.1% were women. They differed significantly from male inpatients in being older (46.7 vs. 40.7 years), less frequently black (14.6 vs. 25.4%), more frequently diagnosed with bipolar and delusional disorders, and in receiving fewer diagnosis of schizophrenia. Women had a longer average length of stay, a different seasonal pattern in admissions, with a much lower rate of admissions than men in December (38.6 vs. 61.4%), and a lower percentage of patients with three or more readmissions. Only 37.2% of the 180 compulsory admissions were of women.Conclusion:There are significant differences in clinical and demographic characteristics of female and male psychiatric inpatients. While some results may be explained by gender specific biological factors (as in the type of diagnosis), others are probably associated with different gender roles (as in the seasonality of admissions).
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PSIC - early intervention community program for schizophrenia. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study. J Adv Nurs 2001; 36:355-63. [PMID: 11686750 DOI: 10.1046/j.1365-2648.2001.01983.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS AND OBJECTIVES The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission. DESIGN The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. RESEARCH METHODS AND INSTRUMENTS: In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care. RESULTS Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse. CONCLUSIONS The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.
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Changes in symptoms, lipid and hormone levels after the administration of a cream with phytoestrogens in the Climacteric--preliminary report. INTERNATIONAL JOURNAL OF FERTILITY AND WOMEN'S MEDICINE 2001; 46:296-9. [PMID: 11795688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To establish the changes in lipid and hormone levels, as well as in symptoms, after topical application of a cream with phytoestrogens in postmenopausal women. METHODS 30 postmenopausal women were studied. At baseline and 1 month after the beginning of treatment, levels of FSH, estradiol, estrone, testosterone, androstenedione, dehydroepiandrosterone, total cholesterol, HDL-C, LDL-C, and triglycerides were measured. Climacteric symptoms were evaluated with a modified Kupperman's index (KI). The subjects received a cream with phytoestrogens (n = 15) or placebo (cold cream) (n = 15) in a randomized, double-blind manner. Statistically significant differences were determined by Student's t test. RESULTS No differences were found in hormones, lipids, or in KI between the groups. When comparing each group separately, only a significant decrease in KI was found, in both groups, at the end of the treatment. CONCLUSIONS This cream with phytoestrogens had an effect only in climacteric symptoms, but similar to the placebo. The lack of effect in the other variables was probably due to the administration route, or to a lack of effect of this product.
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Abstract
Apolipoprotein a, is a high molecular weight glycoproteic component of Lp(a), a molecule associated with coronary arterial disease. Apo(a) exhibits considerable size heterogeneity due to variable repetitions of the carbohydrate-containing structural unit, termed kringle. There are five different kringle forms and 10 different kringle 4 types. Apo(a) polymorphism and molecular weight depend on the number of copies of kringle 4 type 2. In this paper we describe a modified 3.75% and 6% discontinuous polyacrylamide gel system and Western-blot technique that shortness the assay time and improves the identification of apo(a) isoforms with a theoretical error of less than 1 kringle. The assay uses a standard curve prepared with five different recombinant apo(a) molecules, detected up to 50 ng of protein in Lp(a), showed a maximal resolution of 2 kringles and, with the use of third degree polynominal regression analysis, had an error of 0.01275. The inter-assay coefficient of variation was 1.7, 2, and 1.4 for the 14 K, 18 K, and 22 K phenotypes, whereas the intra-assay coefficient of variation was 0.32%, 0.18%, and 0.17%, respectively. It is possible that this modified method will diminish the number of putative null alleles so far detected in various studies, but most of all, we are certain that it can be of use in epidemiological studies due to its ease of use, speed, low cost, and enhanced number of samples that can be tested.
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COMPRI—An Instrument to Detect Patients With Complex Care Needs: Results From a European Study. PSYCHOSOMATICS 2001; 42:222-8. [PMID: 11351110 DOI: 10.1176/appi.psy.42.3.222] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors developed a screening instrument to detect patients in need of complex care coordination at admission to a general hospital. On the basis of a series of risk factors for care complexity, the authors constructed a short, care complexity prediction instrument (COMPRI) and assessed its qualities. The COMPRI is an easily administered screening instrument that detects patients at risk for complex care needs for whom care coordination is indicated. COMPRI's predictive power exceeds all currently available case-mix instruments.
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Risk Factors for Complex Care Needs in General Medical Inpatients: Results From a European Study. PSYCHOSOMATICS 2001; 42:213-21. [PMID: 11351109 DOI: 10.1176/appi.psy.42.3.213] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors linked admission risk factors to a series of indicators for complex care delivery to enable detection of patients in need of care coordination at the moment of admission to the general hospital. The authors found 13 risk factors to be predictive of more than one indicator of care complexity. An admission risk screening procedure to detect patients in need of care coordination should focus on these risk factors and should include predictions made by doctors and nurses at admission and information collected from the patient and the medical chart.
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Abstract
There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between complexity indicators, highlighting differences between length of stay (LOS), objective complexity (such as medications or consultations), complexity ratings by the nurse, and complexity ratings by the doctor. Their findings illustrate limitations in the use of LOS as a sole indicator for care complexity. The authors show how objective and subjective complexity indicators can be used for early and valid detection of patients needing interdisciplinary care.
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Abstract
The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.
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European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study. PSYCHOSOMATICS 2000; 41:330-8. [PMID: 10906355 DOI: 10.1176/appi.psy.41.4.330] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse. German psychosomatic C-L services saw virtually no such patients, although in other C-L services these patients constituted one-quarter to one-third of the patients referred. The second difference lays in the remaining group of referred patients. This group is best characterized by two dimensions. One describes the severity of psychopathology -- ranging from organic mental conditions to somatization. The other describes the clarity of the physical diagnosis -- ranging from patients referred by surgical wards to those referred by general medicine and neurology wards.
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Quality assurance in liaison psychiatry. European Consultation-Liaison Workgroup. ACTA MEDICA PORT 1997; 10:863-9. [PMID: 9522480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As far as we know, there is no experience of quality management in mental health care in Portugal. This study fills a gap in the area of consultation-liaison psychiatry. Due to its multidisciplinarity and to the complexity of the problems it deals with, consultation-liaison psychiatry seems a privileged field for the development of this kind of programme. The authors describe the different steps necessary for the implementation of a quality management study in one of the national centres and report some preliminary results that show the success it has attained.
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