32 research outputs found
Psychological distress in medical seeking ED care for somatic reasons: results of a systematic review
No full textObjectives: The aim of this systematic literature review is to investigate (A) currently used instruments for assessing psychological distress, (B) the prevalence of psychological distress in medical emergency department (ED) patients with acute somatic conditions and (C) empirical evidence on how predictors are associated with psychological distress.
Methods: We conducted an electronic literature search using three databases to identify studies that used validated instruments for detection of psychological distress in adult patients presented to the ED with somatic (non-psychiatric) complaints. From a total of 1688 potential articles, 18 studies were selected for in-depth review.
Results: A total of 13 instruments have been applied for assessment of distress including screening questionnaires and briefly structured clinical interviews. Using these instruments, the prevalence of psychological distress detected in medical ED patients was between 4% and 47%. Psychological distress in general and particularly depression and anxiety have been found to be associated with demographic factors (eg, female gender, middle age) and illness-related variables (eg, urgency of triage category). Some studies reported that coexisting psychological distress of medical patients identified in the ED was associated with physical and psychological health status after ED discharge. Importantly, during routine clinical care, only few patients with psychological distress were diagnosed by their treating physicians.
Conclusions: There is strong evidence that psychological distress is an important and prevalent cofactor in medically ill patients presenting to the ED with harmful associations with (subjective) health outcomes. To prove causality, future research should investigate whether screening and lowering psychological distress with specific interventions would result in better patient outcomes
Medical patients’ affective well-being after emergency department admission: The role of personal and social resources and health-related variables
No full textBackgroundMedical emergency admissions are critical life events associated with considerable stress. However, research on patients’ affective well-being after emergency department (ED) admission is scarce. This study investigated the course of affective well-being of medical patients following an ED admission and examined the role of personal and social resources and health-related variables.MethodsIn this longitudinal survey with a sample of 229 patients with lower respiratory tract infections and cardiac diseases (taken between October 2013 and December 2014), positive and negative affect was measured at ED admission (T1) and at follow-up after 7 days (T2), and 30 days (T3). The role of personal and social resources (emotional stability, trait resilience, affect state, and social support) as well as health-related variables (self-rated health, multimorbidity, and psychological comorbidity) in patients’ affective well-being was examined by controlling for demographic characteristics using regression analyses.ResultsThe strength of the inverse correlation between positive and negative affect decreased over time. In addition to health-related variables, higher negative affect was predicted by higher psychological comorbidity over time (T1–T3). In turn, lower positive affect was predicted by lower self-rated health (T1–T2) and higher multimorbidity (T3). In terms of personal and social resources, lower negative affect was predicted by higher emotional stability (T2), whereas higher positive affect was predicted by stronger social support (T1–T2).ConclusionKnowledge about psychosocial determinants–personal and social resources and health-related variables–of patients’ affective well-being following ED admission is essential for designing more effective routine screening and treatment.</div
Der Verlust der Selbstpflegefähigkeit bei internistisch stationären Patienten: Identifizierung von Faktoren, die mit einem Verlust der Selbstpflegefähigkeit assoziiert sind
No full textHintergrund: Der Verlust der Selbstpflegefähigkeit während einer Hospitalisation stellt einen Risikofaktor für unerwünschte Ereignisse dar und erhöht das Risiko eines weiteren poststationären Behandlungsbedarfes. Ziel dieser Studie war es, bei hospitalisierten Patienten Risikofaktoren für einen Verlust der Selbstpflegefähigkeit zu identifizieren, damit gezielt weitere Schritte zur Prävention entwickelt werden können.Methode: In die vorliegende Studie wurden 1498 internistische stationäre Patienten eingeschlossen. Mittels Regressionsanalysen wurden demografische und klinische Merkmale untersucht, die mit einem Verlust der Selbstpflegefähigkeit zwischen Spitaleintritt und 30 Tage später zusammenhängen.Ergebnisse: Insgesamt haben 10,5% der Patienten während der Hospitalisation einen Verlust der Selbstpflegefähigkeit erlitten. Bestehende prästationäre Einschränkungen in körperbezogene Fähigkeiten (OR = 1,30; 95% CI = 1,08, 1,56; p Schlussfolgerung: In dieser Studie konnten insgesamt fünf Merkmale identifiziert werden, die einen Verlust der Selbstpflegefähigkeit voraussagen können. Die hier gefundenen Merkmale können während der Hospitalisation zur Identifizierung von Risikopatienten dienen. Diese Patienten könnten somit von einer frühen gezielten Förderung der Selbstpflegekompetenzen profitieren. Da Pflegefachpersonen maßgeblich am Erhalt der Selbstpflegefähigkeit beteiligt sind, sollte die Thematik des Verlustes der Selbstpflegefähigkeit stärker in die Ausbildung und den klinischen Alltag integriert werden.Introduction: Loss of self-care ability during hospitalization poses a risk for unwanted incidents that could require further post stationary treatment. The objective of this paper is to identify risk factors in order to develop preventive actions against loss of self-care ability for hospitalized patients.Method: Data of 1498 medical inpatients were evaluated by regression analysis to determine factors that have an influence on loss of self-care ability between admission and day 30 after admission.Results: Overall, 10,5% of the patients suffered from loss of self-care ability during hospitalization. Existing pre-stationary disabilities in physical-related activities of daily living (OR = 1,30; 95% CI = 1,08, 1,56; p Discussion: This study identified a total of five predictors of loss of self-care ability. These predictors can be used to identify risk patients during hospitalization. Thus, these patients could benefit from early specific treatments to enhance their self-care competencies. As nurses are significantly involved in preserving self-care capabilities, the topic of loss of self-care ability should be more integrated into nursing education and nursing clinical practice
Unraveling the Link between Malnutrition and Adverse Clinical Outcomes: Association of Acute and Chronic Malnutrition Measures with Blood Biomarkers from Different Pathophysiological States.
No full textBACKGROUND AND AIMS
Malnutrition is associated with poor clinical outcomes. Whether there is a causal relationship or it merely mirrors a severe patient condition remains unclear. We examined the association of malnutrition with biomarkers characteristic of different pathophysiological states to better understand the underlying etiological mechanisms.
METHODS
We prospectively followed consecutive adult medical inpatients. Multivariable regression models were used to investigate the associations between malnutrition - as assessed using the Nutritional Risk Screening (NRS 2002) - and biomarkers linked to inflammation, stress, renal dysfunction, nutritional status and hematologic function.
RESULTS
A total of 529 patients were included. In a fully adjusted model, malnutrition was significantly associated with the inflammatory markers procalcitonin (0.20, 95% CI 0.03-0.37), proadrenomedullin (0.28, 95% CI 0.12-0.43) and albumin (-0.39, 95% CI -0.57 to -0.21), the stress marker copeptin (0.34, 95% CI 0.17-0.51), the renal function marker urea (0.23, 95% CI 0.07-0.38), the nutritional markers vitamin D25 (-0.22, 95% CI -0.41 to -0.02) and corrected calcium (0.29, 95% CI 0.10-0.49) and the hematological markers hemoglobin (-0.27, 95% CI -0.43 to -0.10) and red blood cell distribution width (0.26, 95% CI 0.07-0.44). Subgroup analysis suggested that acute malnutrition rather than chronic malnutrition was associated with elevated biomarker levels.
CONCLUSION
Acute malnutrition was associated with a pronounced inflammatory response and an alteration in biomarkers associated with different pathophysiological states. Interventional trials are needed to prove causality
Evaluating student motivation in constructivistic, problem based introductory computer science courses
No full textAbstract: Keeping students motivated is a particularly challenging goal in undergraduate service courses such as introductory computer science for the natural sciences. Our experience shows that to jump-start motivation, students must experience an increase in their problem-solving competence, a capability that is built upon a combined mastery of concepts and skills. To achieve this, we integrate and support problem-solving from the beginning, in conjunction with a self-directed construction of knowledge structures for deep and sustainable learning. Student motivation was monitored during two introductory computer science courses involving a total of 500 students. A process analysis was used to investigate the relationship between motivation and task-specific aspects of problem-based learning. Our findings indicate that solving a sequence of selected, small problems representing fundamental concepts leads to an increase in motivation, provided these are followed-up with tasks that are ambitious rather than trivial
Assessment as an Instrument to Evaluate Quality of Instruction
No full textAbstract: We propose that the assessment of instruction include cognitive competence levels, based on Bloom's taxonomy. Quality control must include the entire instructional process, including assessment. We briefly describe how we organize our instructional process around a student-centered, problem-based learning approach, which allows students to reach the applicationoriented competence levels asked for in the exams. The results of exams are useful beyond grading, they can be used to evaluate the quality of the entire instructional process. Some quantitative results illustrate how we have used information provided by exams from the past three years as quality measures and to document the development of our course. Keywords: assessment, application oriented learning, evaluation, multiple choice test, Bloom's taxonomy, problem-based learning, blended learning
A microscopic derivation of nuclear collective rotation-vibration model, axially symmetric case
No full textWe derive a microscopic version of the successful phenomenological hydrodynamic model of Bohr-Davydov-Faessler-Greiner for collective rotation-vibration motion of an axially symmetric deformed nucleus. The derivation is not limited to small oscillation amplitudes. The nuclear Schrodinger equation is canonically transformed to collective co-ordinates, and then linearized using a constrained variational method. The associated constraints are imposed on the wavefunction rather than on the particle co-ordinates. The approach yields three self-consistent, time-reversal invariant, cranking-type Schrodinger equations for the rotation-vibration and intrinsic motions, and a self-consistency equation. For harmonic oscillator mean-field potentials, these equations are solved in closed forms and applied to the ground-state rotational bands in some axially-symmetric nuclei. The results are compared with those of other models and related measured data.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
Association of nutritional risk and adverse medical outcomes across different medical inpatient populations
No full textOBJECTIVE
The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital.
METHODS
We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index <95 points), hospital length of stay, hospital readmission rates, and quality of life (QoL; adapted from EQ5 D); all parameters were measured at 30 d.
RESULTS
Of 3186 patients (mean age 71 y, 44.7% women), 887 (27.8%) were at risk for malnutrition with an NRS ≥3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction < 0.05) based on age and main diagnosis groups.
CONCLUSION
Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients
Psychological distress in medical patients 30 days following an emergency department admission: results from a prospective, observational study
No full textBACKGROUND: Psychological distress in medical patients admitted to the emergency department (ED) is not well studied. Our aim was to investigate the extent of psychological distress in a broad and unselected medical patient sample 30 days after ED admission and its association with socio-demographic and clinical variables. METHOD: We used data from a prospective observational cohort study including 1575 consecutive adult medical patients presenting to the ED with acute somatic conditions. Outcome variables were patient's psychological distress measured by the 4-item Patient Health Questionnaire (PHQ-4) and self-rated health assessed 30 days after ED admission using telephone interviews. Risk factors included socio-demographic variables (e.g. gender, marital status), clinical presentation (e.g. illness severity, main initial diagnosis) and course of illness (e.g. rehospitalisation, length of hospital stay). RESULTS: A total of 38 % of patients had evidence for psychological distress 30 days after ED admission. Multivariate analysis found female gender (adjusted odds ratio [aOR] 1.35, 95 % confidence interval [CI] 1.02 to 1.78), comorbid psychiatric disorder (aOR 1.63, 95 % CI 1.08 to 2.62), discharge to a post-acute care institution (aOR 1.47, 95 % CI 1.03 to 2.09), unplanned rehospitalisation (aOR 2.38, 95 % CI 1.47 to 3.86), and unplanned visit at general practitioner (aOR 4.75, 95 % CI 2.57 to 8.80) to be associated with distress at day 30 following ED admission. CONCLUSIONS: One month after ED admission a significant number of patients still show a moderate amount of psychophysical distress. Strongest related variables were course of illness, in particular unplanned general practitioner visits. Future interventional studies should assess possibilities to reduce distress in patients at increased risk. TRIAL REGISTRATION: NCT01768494 , January 9, 2013 (registration date), February 25, 2013 (enrolment of first participant)
Standardised regression coefficients indicating associations with patients’ affective state at ED (T1).
No full textStandardised regression coefficients indicating associations with patients’ affective state at ED (T1).</p
