Comparison of quality of life of schizophrenic patients in different forms of psychiatric care

Health related quality of life and severity of psychopathological symptoms were evaluated in 90 patients with schizophrenia, hospitalized in a psychiatric ward in a day hospital or followed by the therapist in a community care center. No statistical differences were found in the quality of life evaluation between patients from all three settings. The quality of life did not correlate with the severity of schizophrenic symptoms. Older patients and those more frequently hospitalized were more pessimistic in evaluation of their quality of life. Health status transition, as compared to the situation one year before, correlated inversely with patients' age. Male patients as well as patients from schizophrenic families evaluated their quality of life as worse.     

Fine needle tissue aspiration for accurate localization of histological specimens from complex structures

There is little information available regarding quality of life following critical illness. The consequences of a stay in an intensive care unit (ICU) can result in considerable psychological and physical morbidity. At the Homerton Hospital, London, UK an intensive care follow-up outpatient clinic was established to ascertain patients' experiences after discharge from the ICU. This exploratory study examines narrative data collected from 26 patients by means of unstructured client-led interviews. Themes are derived that have implications for staff, patients and relatives. The findings suggest that patients experience a variety of psychological and physical symptoms. Patients experienced vivid dreams, flashbacks, relocation and convalescent stress as well as profound tiredness and weakness. These are consistent with previous research findings. New themes were identified which suggest that mood changes, inability to cope, the need to talk about their ICU experience and indistinct memories of the ICU made recovery at home difficult for both the patients and their families. As a result of these findings, the role of a clinical nurse specialist has developed in order to improve liaison between and within departments, the hospital and the community. Future research will aim to focus on the role of the critical care/community liaison clinical nurse specialist and in improving outcomes through the use of action research.     

Assessing the quality of psychiatric hospital care: a German approach

OBJECTIVE: The German Ministry of Health commissioned a nonprofit organization to develop a tool for assessing the quality of psychiatric hospital care. METHODS: The authors were members of an expert group established to develop an assessment tool that could be used by professional caregivers, patients, patients' relatives, managers, purchasers, and mental health care planners. RESULTS: A three-dimensional model was developed in which 23 quality standards may be applied to 28 areas of practice. For each application, questions can be asked at four levels to stimulate ongoing quality management: the individual treatment process, the individual outcome, the treatment unit, and the hospital as a whole. The authors provide sample questions to illustrate the approach. CONCLUSIONS: The approach to quality assessment embodied in the model is comprehensive and addresses ethical issues, but it is also complicated and difficult to handle. Unlike models developed in the United States, it is not intended to be objective or standardized, and it does not yield a score. To some extent, the model's approach to assessment may reflect German cultural values and traditions.     

Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning

BACKGROUND: There is evidence that high expressed emotion (EE) in relatives of patients with schizophrenia is associated with higher levels of burden of care, and with worse perception of patient's social functioning. However, it is not clear whether changes in EE levels over time are associated with changes in relatives' burden of care and their perception of patients' social functioning. METHODS: Fifty patients with a diagnosis of schizophrenia and 50 relatives were included in the study soon after patients' admission to hospital. Thirty-six relatives and 31 patients were re-assessed 9 months after patients' discharge. Both assessments included patients' symptomatology and relatives' EE levels, burden of care, and perception of patients' social functioning. RESULTS: Twenty-three relatives (64%) had the same EE level in both assessments, nine (25%) had changed from high to low EE, and four (11%) from low to high EE. Improvement in burden and perception of patients' social role performance were significantly more accentuated among relatives who changed from high to low EE than among relatives who had a stable EE level. Variables that best predicted changes in EE levels were changes in burden scores and number of hours of contact between patients and relatives at follow-up. CONCLUSIONS: Change in EE is associated with change in circumstances and burden. Findings support the idea that EE is better understood in an integrative model.     

Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients

BACKGROUND and PURPOSE: A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. METHODS: One hundred four consecutive patients >40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. RESULTS: There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. CONCLUSIONS: The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services.     

Quality of life survey among day release patients at View Road Hospital

OBJECTIVES: The aim of this study was to identify factors that contributed to the chronic patient's quality of life from both the patients' and staff's point of view. We were also interested in any lack of congruence between staff and patient perception as these could have significant implications for planning long-term care. METHOD: Fifty of the patients under the Day Release Scheme at View Road Hospital and their staff were given a modified questionnaire concerning the patients' quality of life. RESULTS: Generally the patients reported satisfaction with life domain items covering their living conditions. The majority felt safe in the current setting, enjoyed their work, their regular outings and parole to the nearby shopping centers. Significant differences were observed between the staff and patients' perception in life domain items relating to general well-being, knowledge and education, relationships, in-patient care, leisure and vocational rehabilitation. The staff group perceived having good food, money, good treatment and in employment as being important to their patients' well-being. Patients emphasised having money, family support or a partner, being employed, having time for recreational activities and eating good food. Having good health, medication and feeling at peace were also considered important by many of our patient. CONCLUSIONS: The findings of the study are discussed with regard to implications in planning rehabilitation services and improving the quality of care given to patients.     

Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review

OBJECTIVE: To investigate whether for patients with incurable cancer comprehensive home care programmes are more effective than standard care in maintaining the patients' quality of life and reducing their "readmission time" (percentage of days spent in hospital from start of care till death). DESIGN: Systematic review. METHODS: A computer aided search was conducted using the databases of Medline, Embase, CancerLit, and PsychLit. The search for studies and the assessment of the methodological quality of the relevant studies were performed by two investigators, blinded from each other. Prospective, controlled studies investigating the effects of a home care intervention programme on patients' quality of life or on readmission time were included in the analyses. RESULTS: Only 9 prospective controlled studies were found; eight were performed in the United States and 1 in the United Kingdom. Their methodological quality was judged to be moderate (median rating 62 on a 100 point scale). None of the studies showed a negative influence of home care interventions on quality of life. A significantly positive influence on the outcome measures was seen in 2 out of the 5 studies measuring patients' satisfaction with care, in 3/7 studies measuring physical dimensions of quality of life, in 1/6 studies measuring psychosocial dimensions, and in 2/5 studies measuring readmission time. The incorporation of team members' visits to patients at home or regular multidisciplinary team meetings into the intervention programme seemed to be related to positive results. CONCLUSIONS: The effectiveness of comprehensive home care programmes remains unclear. Given the enormity of the problems faced by society in caring for patients with terminal cancer, further research is urgently needed.     

"Medical Ethics Patient Forum". Results of a model project

BACKGROUND: The patients' forum Medical Ethics is an innovative model project, which aims at intensifying the dialogue between health care professionals and patients as well as their relatives. METHODS AND RESULTS: Practical experiences and data from a complementing evaluative study are reported. By means of a sophisticated instrument of moral psychology, the Moralisches-Urteil-Test (M-U-T), differences are revealed between the participating groups--doctors, health care professionals, patients, medical students etc.--referring to more cognitive or emotional orientations in moral judgment, respectively. These differences contradict common assumptions. CONCLUSION: On the ground of the data presented as well as by subjective estimations of participants it is shown that the ethics discussion with patients is not only successful, but that it is also valuable for teaching by fostering new insights and experiences.     

Outcomes of inpatients treated on a VA psychiatric unit and a substance abuse treatment unit

OBJECTIVE: The utility of the Treatment Outcome Profile (TOP) for measuring the effectiveness of acute inpatient psychiatric and substance abuse treatment was tested, including its internal reliability, validity, and sensitivity to treatment gains. The relationship between patients' satisfaction with services and treatment gains in quality of life, symptoms, and level of functioning was explored. METHODS: A pre-post research design was used with consecutive admissions to an inpatient psychiatric unit (N = 66) and a substance abuse treatment unit (N = 88) at a VA medical center. At admission and at discharge, the TOP, a self-report instrument assessing quality of life, symptoms, level of functioning, and patient satisfaction with services (at discharge only) was completed. Multivariate analysis of variance and univariate analysis of variance were used to test differences in scores between admission and discharge. RESULTS: Patients demonstrated significant treatment gains. Overall, compared with patients on the substance abuse unit, those receiving psychiatric treatment were more impaired at admission and had lower levels of self-reported therapeutic gain at discharge. Improvement for both groups occurred in quality of life, symptoms, and level of functioning. Both groups reported high levels of patient satisfaction, comparable with levels in other service industries. A high positive correlation (alpha = .61) was found between patient satisfaction and overall self-reported treatment gain. CONCLUSIONS: The results indicate that it is important to compare treatment effectiveness as well as costs when seeking less costly alternatives to inpatient care. The TOP is a valid and sensitive outcome measurement tool. Patient satisfaction is an important outcome variable and positively related to treatment gains in quality of life, symptoms, and level of functioning.     

Exposure to different spectra of light, continuous light and treatment with melatonin affect reproduction in the Indian desert gerbil Meriones hurrianae (Jerdon)

The present article aims to examine premorbid personality traits of psychiatric patients with various diagnoses by asking their close relatives to retrospectively rate the patients' usual self with a questionnaire designed for the five-factor model of personality, a rapidly emerging comprehensive theory of personality structure. Data for 140 patients and 84 controls were analyzed. Although psychiatric patients as a group were characterized by high neuroticism and low conscientiousness when compared with the healthy controls, there were only a few traits that distinguished a particular diagnostic group from either the normal control or from the rest of the patients: neurotic disorder patients had higher neuroticism scores than the normal controls; unipolar depressives had a higher conscientiousness score than the rest of the patient group. No salient premorbid trait was noted for patients with organic mental disorders, schizophrenic disorders or bipolar disorders.     

Evaluation of quality of life in oncology

Studies of quality of life are more and more becoming an integral part of cancer care in situations when treatment of cancer patients is burdened with significant toxicity, and results of survival of these patients are unsatisfactory. Modern concept of health-related quality of life measurement means consensus about its two basic features: multidimensionality of concept, and essentially subjective experience in a treated person. As a minimum, domains of physical, psychological and social are assessed, and the patient is considered to be the primary source of information. The most widely used instruments for quality of life assessment are questionnaires, especially developed for cancer patients, with supplemental items for particular diagnosis. These instruments must satisfy the basic psychometric properties-validity and reliability. Quality of life studies are focused mostly on phase III trials, where differences between treatment arms for tumour response and survival are expected to be small. Another approach is developed in parallel which, based upon quality of life measurement, initiates decisions for the treatment of a set of patients up to health policy level. In these "cost-utility" studies, efficacy and cost of the treatment, and improvement of patients' quality of life are independently estimated, and then integrated in medical decision making.     

What is the role of the HIV liaison psychiatrist?

In this article we review the field of HIV liaison psychiatry and illustrate the manner in which psychiatric care can contribute to the health and quality of life of this group of patients. To illustrate our discussion we review experience and findings in relation to affective illness, cognitive impairments, and personality disorder in HIV infection. We also highlight some of the areas where psychiatric care of people with HIV infection is unique from other types of psychiatric liaison work.     

Diminished hyperaemic response of the hepatic artery to portal venous occlusion (the buffer response) in Asian hybrid minipigs: a comparison of the response to that observed in dogs

This study is part of a larger study of the effect of integrity-promoting care in a Swedish nursing home ward. Compared with assessments on a control ward, improvements were found in the patients' behaviour and in the quality of care after a three-month intervention period. This paper reports on parts of a questionnaire survey on the nursing staff's opinions of their working conditions and demented patients. Most staff members on both the intervention ward and the control ward found their jobs meaningful, engaging and stimulating, but they also felt that they had a heavy work-load. Most of the staff members experienced mental strain because of the patients' disturbed behaviour. Many did not think that the care on their ward would have been good enough for their own close relatives, if they had been suffering from dementia. Only slight changes were found in the staff members opinions after the intervention.     

Detection and treatment of psychiatric illness in a general medical ward: a modified cost-benefit analysis

This article describes a prospective, randomized, controlled trial of screening and treatment for psychiatric disorder in medical in-patients. The study has assessed whether increased recognition of psychiatric disorder among medical in-patients improves clinical outcome and reduces the costs of care, and whether routine involvement of a psychiatrist in the assessment and care of medical in-patients with probable psychiatric disorder is superior to the efforts of the physicians alone. A total of 218 medical in-patients who scored over the screening threshold for psychiatric disorder on the General Health Questionnaire were randomly allocated to one of two intervention groups or a control group. Six months later their mental health, subjective health status, quality of life, and costs of care was reassessed. Mental health and quality of life at 6 months were similar in the two intervention groups and the control group. Patients whose physicians were told the results of the screening test had lower costs for subsequent admissions, but this was probably due to differences between the groups in terms of employment status. Treatments recommended by psychiatrists broke down when patients were discharged home, leading to inadequate treatment of psychiatric disorders. We have not been able to show that routine screening for psychiatric disorder produces any benefit, either in better outcome for patients or reduced costs for the NHS. Further research should: consider examining a more homogeneous group in terms of costs of care; screen only for disorders likely to respond to a specific treatment; and ensure that treatment recommendations are carried out.     

Patient's capable of managing--basic process of psychiatric nursing in a hospital environment

The aim is to describe the basic process of psychiatric nursing in a hospital environment and to produce a practical theory of psychiatric nursing by the grounded theory method. The data were collected by means of observation and interviews and analysed simultaneously, so that the preliminary results and experience gained in the field shaped the data collection process. The data were subjected to continuous comparison analysis and classified into categories by open coding. The basic process was identified by means of axial coding and theoretical memos. The selective coding consisted of related categories grouped around a core category. The basic process of psychiatric nursing involves the patient's needs for care, the helping methods available and the objectives of care. The patient needs help because of his/her inability to manage in daily life, and the role of nursing is to help the patient to manage. The basis of psychiatric nursing lies in caring for the needs of the patient by employing various helping methods. Patient management consisted of three categories, each subsuming three subcategories. Examination of the content of these led to the identification of different types of psychiatric nursing, labelled as confirming, educating and catalytic. The results suggest that collaborative methods in psychiatric nursing enable and support the patient's participation in his/her care and show that both nurses and patients consider collaboration a good helping method, although requiring a change in attitudes and activities for both the nurse and the patient. In spite of changes in psychiatric nursing, there has been no essential development, as most of the care provided is still normative and traditional and the patient is a passive recipient.     

Incorporating concepts of end-of-life care into a psychiatric nursing course

Providing quality care to patients who are at the end of life is recognized as an important aspect of health care. Nurse educators are in a unique position to influence future care by imparting essential information on this topic to students during their basic nursing education. The author offers support for the suggestion that select end-of-life concepts be included in psychiatric-mental health nursing courses and presents suggestions for incorporating such concepts into psychiatric nursing clinical learning experiences.     

Predictors of missed appointments for psychiatric consultations in a primary care clinic

OBJECTIVE: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. METHODS: The charts of 180 patients consecutively referred for psychiatric consultations at a university-affiliated primary care clinic were reviewed. Ninety patients missed appointments for these consultations. Parametric and nonparametric tests were used to compare patients who missed and did not miss appointments on demographic and clinical variables, as well as measures related to patients' interactions with the clinic and the referring clinician. RESULTS: Logistic regression analysis revealed three significant predictors of missed appointments. Patients with mild distress and those with significant resistance to seeing a psychiatrist were more likely to miss appointments, as were those who had to wait longer between the referral and the appointment date. CONCLUSIONS: The results suggest that shortening the wait for a psychiatric consultation, reserving consultation for more severe cases, and working to reduce patients' resistance to consultation will reduce the number of missed appointments.     

Family interactions and the course of schizophrenia in African American and white patients.

Relatives' critical and intrusive behavior with patients, patients' odd or unusual thinking with relatives, and the course of schizophrenia were examined. Seventy-one African American and White patients (each with 1 relative) completed 2 problem-solving discussions. Relatives' critical and intrusive behavior with patients and patients' odd or unusual thinking with relatives were assessed, and patients were followed for 2 years. For African American patients, high levels of relatives' critical and intrusive behavior were associated with better outcome. For White patients, low levels of both relatives' critical and intrusive behavior and patients' odd or unusual thinking with relatives were associated with better outcome. The results suggest that during family interactions, seemingly negative behaviors may be perceived as a sign of caring and concern by African Americans. For Whites, the combination of patients' odd or unusual thinking with relatives and relatives' critical and intrusive behavior toward patients may be especially predictive of an adverse course. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' perceptions of care and safety within psychiatric settings.

There is growing concern over institutional measures of control (e.g., seclusion, restraint) and other potentially harmful or traumatic experiences within psychiatric hospitals. The purpose of the present study was to examine the relationship between demographic variables, potentially harmful and/or traumatic psychiatric experiences, and patients' perceptions of care and safety in psychiatric settings among 142 public-sector psychiatric patients. Data revealed 45.1% of patients reported they had been to a psychiatric facility they would never want to return to, and the majority of patients did not communicate with staff after a distressing event occurred. There were no significant differences in perceptions of care and safety by race, gender, or age. However, patients who reported potentially harmful or traumatic psychiatric events were significantly more likely to report that they had been to a psychiatric facility they would not want to return to. Encouragingly, most patients (84.5%) reported that psychiatric facilities have become safer in recent years. These data suggest the need to better understand how adverse psychiatric events influence how patients view their care and their subsequent engagement in that care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital-based advanced home-care, models from Eken?s, Finland

In 1995, advanced home treatment services were introduced at V?stra Nyland district hospital in Finland. For selected patients the new services constitute an alternative where hospitalisation would otherwise be necessary. Some of the hospital bed resources were moved to the patients' homes together with a trained team with immediate responsibility for the patients and providing 24-hour care, backed up by access to hospital resources in terms of specialised knowledge and sophisticated technology. Two years' experience of 500 patients so treated showed their diseases to have represented the complete spectrum of specialists fields. The most common diagnoses were oncological and infectious diseases. Although preliminary assessment suggests advanced home care to be a cheaper alternative than hospitalised care, the preeminent advantage from the patients' point of view was improved quality of life.