bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of the Resource Intensity of Inpatients in Urban and Rural Nonteaching Hospitals
Authors: Long Michael J. , Fisher James C. , Dreachslin Janice L. 
Published: May 2005

PL 98–21 mandated a prospective payment system based on diagnosis related groups (DRGs) for all Medicare inpatients. The predetermined payment for each DRG is intended to reflect the resources used to treat patients within the DRG. Eventually, the system will allow for one payment level for each DRG in rural hospitals and a higher payment level for the same DRG in urban hospitals. This represents an equitable approach, provided there is not a predominance of high severity cases in rural hospitals and that higher costs in urban hospitals are reflective of higher priced exogenous factors beyond the control of the hospital. Equitability also requires that DRGs capture the resource intensity of treatment for a given classification of patients, equally for urban and rural patients. This work compares the pediatric population of urban hospitals without a pediatric residency program with that of rural hospitals in terms of major diagnostic category, DRG, disease severity, length of stay, and charges. It also compares the capacity of DRGs to explain the variation in resource consumption in urban and rural hospitals. A sample of 116,721 discharges from 130 urban hospitals and a sample of 54,073 discharges from 97 rural hospitals are used in this work. The results indicate that there is no difference in the patient populations of these two hospital groups. The results also indicate that DRGs explain only 50 percent of the variance in the resource variables, but this obtains equally for both populations.
Effects of Postpartum Psychiatric Illnesses on Family Planning
Authors: Peindl Kathleen S. , Zolnik Edmund J. , Wisner Katherine L. , Hanusa Barbara H. 
Published: May 2005

Objective: We investigated the relationship between postpartum psychiatric episodes and subsequent family planning. Our hypothesis was that women who had a postpartum illness would plan to have fewer children. Method: We conducted a mail survey of members of the self-help group Depression After Delivery (DAD). The membership was asked about changes in family planning after a postpartum illness. Two groups were defined: women who took action to prevent further pregnancies after the illness (CHANGE) and women who did not take action to prevent future pregnancies (NO CHANGE). Results: Among respondents 32 percent changed their family plans after suffering a postpartum illness. Fear of recurrence, effects on the family, treatment costs and severity of the episode manifested by suicide or infanticide attempt, hospitalization, and prescribed medication were reasons given for altering plans. Conclusions: The postpartum illness dramatically changed some women's reproductive plans. Prevention strategies for these illnesses need to be addressed when women are making decisions about having other children.
Degree of Closeness: Does it Affect the Bereaved's Attitudes toward Selected Funeral Practices?
Authors: Swanson Elizabeth A. , Bennett Teresa F. 
Published: May 2005

This research project investigated the attitudes of bereaved individuals toward selected funeral practices. Six selected variables (three characteristics of the bereaved and three conditions of the death situation) were correlated to nineteen components of the funeral. The characteristics were sex, closeness to the deceased, and religious preference; the conditions were timing of the death, viewing at the funeral home and location of the funeral service. In this study, closeness of relationship to the deceased emerged as a significant variable in assessing attitudes toward certain funeral practices. The intent of this article is to present and discuss the empirical data related to this variable.
Nocturnal Psychophysiological Correlates of Somatic Conditions and Sleep Disorders
Authors: Kales Joyce D. , Kales Anthony 
Published: May 2005

Modern sleep research studies have provided the practicing physician with considerable new information concerning the basic psychophysiology of sleep, the effects of medical conditions on sleep and the role of maturational and emotional factors in producing certain sleep disorders. Medical and psychiatric disorders, sleep disorders and drug-induced sleep stage alterations are studied in the sleep laboratory using the same techniques developed to analyze sleep patterns in normal subjects. After initial sleep laboratory adaptation, a profile of the sleep characteristics of various clinical conditions is obtained. This profile can be compared to sleep profiles of normal subjects as well as to the effects on sleep of subsequent experimental or therapeutic procedures. Various studies have shown that coronary artery, duodenal ulcer and nocturnal headache patients experience angina, increased gastric acid secretion and migraine or cluster headaches, respectively during REM sleep. Adult nocturnal asthmatic episodes occur out of all sleep stages while attacks of dyspnea in asthmatic children occur in all stages except stage 4 sleep. Hypothyroid patients show decreases in stages 3 and 4 sleep, while in hyperthyroid patients the percentage of time spent in stages 3 and 4 sleep is markedly increased. Enuretic episodes occur predominantly in non-rapid eye movement (NREM) sleep. Sleepwalking and night terror episodes occur exclusively out of NREM sleep, particularly from stages 3 and 4 sleep. Most child somnambulists and children with night terrors “outgrow” this disorder, suggesting a delayed maturation of the central nervous system. Stimulant drugs are effective in the treatment of the sleep attacks of narcolepsy and in treating certain cases of hypersomnia, while imipramine is an effective treatment for the auxiliary symptoms of narcolepsy. Psychological disturbances are frequent in adult somnambulism and night terrors as well as in hypersomnia and insomnia. Proper pharmacologic treatment to provide symptomatic relief for insomnia is recommended to enhance the psychotherapeutic process.
Unionization, Strikes, Threatened Strikes, and Hospitals—The View from Hospital Management
Authors: Match Robert K. , Goldstein Arnold H. , Light Harold L. 
Published: May 2005

The history of union organizing efforts in the hospital field is discussed in this article, along with the factors judged necessary for successful union organizing. The role played by labor legislation in the unionization of hospital workers is shown, and the influences of the National Labor Relations Act, the Taft-Hartley amendments, and labor legislation at the local level are described. Management has largely resisted unionization because of the social nature of hospitals. Competitive market forces do not confront the not-for-profit hospitals, which are dependent upon third-party reimbursement. While strikes are an integral and essential part of collective bargaining in industry, they are, in fact, detrimental to hospitals because of these institutions' concern with human life. Despite laws and assurances from labor leaders that strikes will not occur, strikes have been used as a method for resolving disputes, though they are basically inconsistent with the economic characteristics and objectives of the hospital. The authors conclude that arbitration awards should be made by arbitrators appointed from outside of the local region of the hospital involved, and that, because of the catastrophic effect of strikes upon patients as well as employees, arbitration awards should be required, should be binding upon both parties, and should be federally enforced.
Religious Attendance and Cause of Death over 31 Years
Authors: Oman Doug , Kurata John H. , Strawbridge William J. , Cohen Richard D. 
Published: May 2005

Objective: Frequent attendance at religious services has been reported by several studies to be independently associated with lower all-cause mortality. The present study aimed to clarify relationships between religious attendance and mortality by examining how associations of religious attendance with several specific causes of death may be explained by demographics, socioeconomic status, health status, health behaviors, and social connections. Method: Associations between frequent religious attendance and major types of cause-specific mortality between 1965 and 1996 were examined for 6545 residents of Alameda County, California. Sequential proportional hazards regressions were used to study survival time until mortality from circulatory, cancer, digestive, respiratory, or external causes. Results: After adjusting for age and sex, infrequent (never or less than weekly) attenders had significantly higher rates of circulatory, cancer, digestive, and respiratory mortality ( p < 0.05), but not mortality due to external causes. Differences in cancer mortality were explained by prior health status. Associations with other outcomes were weakened but not eliminated by including health behaviors and prior health status. In fully adjusted models, infrequent attenders had significantly or marginally significantly higher rates of death from circulatory (relative hazard [RH] = 1.21, 95 percent confidence interval [CI] = 1.02 to 1.45), digestive (RH = 1.99, p < 0.10, 95 percent CI = 0.98 to 4.03), and respiratory (RH = 1.66, p < 0.10, 95 percent CI = 0.92 to 3.02) mortality. Conclusions: These results are consistent with the view that religious involvement, like high socioeconomic status, is a general protective factor that promotes health through a variety of causal pathways. Further study is needed to determine whether the independent effects of religion are mediated by psychological states or other unknown factors.
System Design for Communication Packages
Authors: Stratton Charles R. 
Published: May 2005

System design for communication packages involves assessing communication needs and designing a set of communication vehicles to meet these needs. An earlier article dealt with needs assessment. After presenting three axioms of communication system design, this article reviews the basic input for design—the needs assessment matrix—and then discusses the implications of this input and additional design considerations. Finally, the article presents a seven-step process that can be used to formalize communication system design. The charts and diagrams referred to are to be found in the earlier article.
Counseling for Depression by Primary Care Providers
Authors: Meredith Lisa S. , Mazel Rebecca M. 
Published: May 2005

Objective: Primary care providers (PCPs) deliver a significant amount of depression care, yet little is known about the content of clinical encounters with depressed patients. We describe the extent to which PCP's encounters with depressed and non-depressed patients involve psychotherapeutic counseling relative to other types of counseling during primary care visits. Method: Cross-sectional evaluation of audiotaped office visits between October 1997 and September 1998 with 154 patients of 27 PCPs at three Veterans' Health Administration clinics in California. Using the Roter Interaction Analysis System, we coded conversation into mutually exclusive talk categories and developed specific measures of depression counseling coded for sequences of depression talk. Analysis of variance and covariance was used to evaluate differences in counseling by depression type adjusted for encounter length, previous depression treatment, patient characteristics, and provider clustering. Results: PCPs delivered significantly more depression care (assessed using coded audiotapes of patient visits) to their patients with major depression compared with patients who had no depression or symptoms but no disorder. However, counseling using psychotherapeutic techniques did not differ by depression level and was equivalent for patients with major depression and subthreshold relative to non-depressed. Encounters with patients who had major depression included more talk about depression, devoted more time to discussing depression, and included more depression talk per minute. PCP encounters with depressed patients also included less biomedical talk compared to other groups. Conclusions: Findings suggest that PCPs do provide depression counseling to their patients who need it the most. Whether counseling is associated with appropriate treatment and subsequent outcomes will require additional research.
Should Physicians Screen for Depression in Elderly Medical Inpatients?: Results of a Decision Analysis
Authors: Koenig Harold G. , Ford Stephen M. , Blazer Dan G. 
Published: May 2005

Objective: We wish to determine whether or not elderly medical inpatients should be screened for depressive disorder using either 1) a self-rated depression scale (Geriatric Depression Scale), 2) “usual clinical assessment,” or 3) neither, assuming that treatment with tricyclic antidepressants (TCAs) is the primary mode of intervention. Method: Based on recent data from epidemiological studies on the prevalence and course of depression, the test characteristics of available screening tests, and the efficacy and side-effects of traditional antidepressants, decision analysis is used to help decide whether or not clinicians should screen for depression in this setting. Results: These calculations indicate that if screening is done solely to identify depressed patients for treatment with TCAs, then the highest utility lies in not screening; however, the difference in utilities between that decision and the decisions to either screen with GDS or screen by usual clinical assessment was only .04 units on a 0 to 100 scale, making the decision virtually a toss-up. Furthermore, even a small variation in one of several clinical factors or test characteristics could give screening a higher utility. In particular, if psychotherapy is considered as the primary intervention, then the utility of screening exceeds that of not screening. Conclusion: Characteristics of the screening test, clinical setting, types and safety of available treatments, each impact on the usefulness of screening and must be kept in mind when diagnosing and treating depressed medically ill elders hospitalized in acute care settings.
The Use of Placebos: A Study of Ethics and Physicians' Attitudes
Authors: Shapiro Arthur K. , Struening Elmer L. 
Published: May 2005

A questionnaire was sent to 240 physicians in large cities throughout the United States to assess ethical attitudes towards the use of placebos in treatment and research. Confirmed hypotheses were that critical attitudes towards the use of placebos correlated with older age of physicians, more time spent in private practice, less research activity, and degree of defensiveness about treatment. The major attitudinal difference between clinicians and researchers was found in clinical graduate psychoanalysts and analytically-oriented researchers.
Teaching Normal and Abnormal Behavior to Primary Care Physicians
Authors: Halbreich Uriel 
Published: May 2005

Objective: This article delineates the framework for a curriculum on psychiatry, normal and abnormal human behavior for primary care physicians (PCPs). Methods: Curricula have been surveyed. Members of the Education Committee of the Association of Medicine and Psychiatry, as well as Family Physicians and General Internists involved in education have been consulted. Their recommendations are integrated. Results and Conclusions: The curriculum should be developed according to the needs of PCPs and from their perspective. Patient and problem-oriented, its content can be divided into: a) personal skills that should be developed; and b) knowledge of symptoms, their differential diagnosis (DDX) and management within the PCP's, facilities and abilities.
The Transfer of Care: U.S. Mental Health Policy since World War II
Authors: Brown Phil 
Published: May 2005

Recent criticism of mental health policy has raised many questions about the so-called “mental health revolution.” Following World War II, the federal government and the growing mental health lobby planned the first nationally oriented system of psychiatric treatment, rehabilitation, and prevention. The rapidly expanding National Institute of Mental Health coordinated that policy, particularly through its Community Mental Health Centers program. Custodial state hospitals were depopulated and their patients “dumped” in nursing and boarding homes, which now constitute the largest arena for and most expensive form of psychiatric care. While there has been some progress in decreasing the hospital population and in improving conditions, as well as in providing services to certain people who otherwise would never receive them, failures have been more dominant. Admission and readmission rates have climbed precipitously. Unplanned hospital discharge has led to hundreds of thousands of ex-patients living in dangerous, nontherapeutic nursing homes where the main concern is profit. They, and many others, are maintained on psychiatric drugs, another source of profit as well as a dangerous technology. Community mental health programs have maintained psychiatry's traditional class, race, and sex biases, and have incurred widespread intrusion into communities. This article shows that such problems are part of an interconnected system in which the driving forces are fiscal crisis, ideological justifications for dumping patients, attempts to pass responsibility from state governments to federal and local bodies, restrictions on government and insurance reimbursements, the free enterprise economics of the nursing home and drug industries, and the professionalist practices of the mental health field.
Psychologic Distress as a Longterm Predictor of Medical Utilisation
Authors: Van Hemert Albert M. , Bakker Carla H. , Vandenbroucke Jan P. , Valkenburg Hans A. 
Published: May 2005

Objective: To study baseline psychologic distress as a predictor of self-reported medical utilisation after nine years of follow-up. Methods: In 1975–1978 we measured psychologic distress with a neuroticism scale in a general population sample of 826 women aged forty-five to sixty-four years. In the same study, and in a follow-up study nine years later, medical utilisation was quantified as the main outcome in terms of current treatment by a physician and current use of medication. Results: The age and educational class adjusted odds ratio of baseline physician contact and use of medication for the upper versus the lower quintile of the neuroticism score were 3.3 (95% confidence interval (c.i.): 2.0–5.2) and 3.6 (95% c.i.: 2.2–5.7), respectively. When the baseline neuroticism scores were related to utilisation at follow-up the adjusted odds ratios were 2.1 (95% c.i.: 1.2–3.1) and 2.8 (95% c.i.: 1.8–4.5). However, in the subgroup of 352 women who did not report initial medical utilisation the odds ratios were 1.1 (95% c.i.: 0.5–2.4) and 1.4 (95% c.i.: 0.6–3.1). Conclusion: Although an association between psychologic distress and medical utilisation was confirmed, psychologic distress did not predict utilisation in middle-aged women characterised at baseline as non-utilisers.
Engineering Alumni Speak Out about Speech
Authors: Estrin Herman A. 
Published: May 2005

“The engineer who cannot express himself on any subject of which he has knowledge, clearly and extemporaneously, is seriously handicapped. Even junior engineers are frequently asked to make oral reports at high-level meetings. The impression that the engineer makes on the people at the meeting may determine his future.” “Leaders in industry have one quality in common—they speak well. If you aspire to lead, concentrate on improving your speech in college. Time for this asset is a most valuable commodity afterwards.” (The quotations above were made by alumni who were surveyed concerning the importance of speech, especially for the engineer.)
Murder of the Elderly: An Analysis of Increased Vulnerability
Authors: Kunkle Sheryl , Humphrey John A. 
Published: May 2005

The vulnerability of older persons to murder is investigated. Data on all homicide victims sixty years of age or older in North Carolina during two time frames, 1972–1973 and 1976–1977, form the basis for the analysis. Available evidence for the U.S. indicates that the elderly are considerably less prone to criminal victimization than are younger persons. This is particularly the case for aggravated assault. Dussich and Eichman have posited that the relative low visibility of the elderly, due to social isolation and lack of mobility, make them less vulnerable to crimes against the person [1]. However this study finds that: 1) in the U.S. murder among the aged is rising faster than any other age group, 2) in North Carolina the sole rise in homicide is among the elderly, and 3) sharpest increases are noted among older black women, white women and white men. An exception to this trend are black men, previously the highest risk group of older adults, who showed a decline in homicide victimization.
Medical Disorders in the Schizophrenic Patient
Authors: Vieweg Victor , Levenson James , Pandurangi Anand , Silverman Joel 
Published: May 2005

Objective: The primary purpose of this review of medical disorders in the schizophrenic patient is to provide the clinician interested in Consultation/ Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject. Method: The authors used the Index Medicus and Medline to find recent review articles and research articles related to medical disorders in the schizophrenic patient. Also, the authors described their clinical experience in Consultation/Liaison psychiatry working with schizophrenic patients in a large, tertiary-care academic medical center. Results: The authors divided their review into: 1) mortality and morbidity in schizophrenia, 2) differential diagnosis, 3) specific comorbidity management problems, 4) caring for schizophrenics on medical/surgical wards, and 5) antipsychotic drugs in the medical setting. Schizophrenia remains an important subject for Consultation/Liaison psychiatrists. Conclusions: Schizophrenia and its protean manifestations confound the care of the medical patient. The psychosis of schizophrenia may impair the patient's capacity to recognize or articulate emerging medical illness, or to respond to therapeutic interventions. The psychiatrist caring for and consulting on patients with medical illnesses bears major responsibility for understanding the complex interface of schizophrenia and medical illnesses. Psychiatrists need to educate our medical and surgical colleagues how schizophrenia alters the usual presentation, clinical course, and response to treatment of common medical and surgical illnesses.
Lessons Learned: Outcomes and Methodology of a Coping Skills Intervention Trial Comparing Individual and Group Formats for Patients with Cancer
Authors: Edgar Linda , Rosberger Zeev , Collet Jean-Paul 
Published: May 2005

Objective: Nucare, a short-term psychoeducational coping skills training intervention was evaluated in a randomized controlled clinical trial (RCT) of 225 newly diagnosed breast and colon cancer patients. Method: Measures of psychosocial distress, well being and optimism were evaluated every four months during a one-year period. Patients were randomized to one of four arms: Nucare presented in an individual basis; Nucare presented in a group format; a non-directive supportive group; and a no-intervention control. The interventions were provided in five sessions of ninety minutes each. Results: Patients with breast cancer who received Nucare presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms. Conclusions: We were unable to develop functioning groups within the RCT. Partial explanations for the latter finding include the structural limitations of the RCT: the groups were small, difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group. The positive changes in women with breast cancer who received Nucare persisted at 12 months.