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    ABSTRACT: Behavioural and psychological disorders in surgical patients treated for malignant diseases are not always adequately appreciated and often neglected. However, they are very important in the therapeutic process because they may severely disturb physical and psychological rehabilitation, the patient's effective struggle with malignancy, environmental relationships and quality of life. Professional preoperative psychological assessment is necessary to facilitate therapy for malignant diseases in those patients who are specifically exposed to a severely stressful situation.
    Przegląd Gastroenterologiczny 01/2014; 9(2):99-104. · 0.38 Impact Factor
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    ABSTRACT: Postoperative delirium is one of the most common adverse outcomes in elderly patients undergoing surgery and is associated with increased morbidity, length of stay, and patient care costs. The purpose of this quality improvement project was to evaluate the effectiveness of a multicomponent strategy to identify and treat general surgical patients 65 years of age or older at risk for and who develop postoperative delirium at Cape Cod Hospital, a community hospital in southern New England. We evaluated 96 patients using the Mini-Cog assessment tool preoperatively and the Confusion Assessment Method (CAM) delirium screening tool or CAM-Intensive Care Unit (CAM-ICU) assessment tool postoperatively. Patients who tested positive during preoperative assessment underwent a postoperative delirium management protocol. We summarized data using descriptive statistics. The results showed an association between compliance and outcomes. High compliance with implementation of CAM and CAM-ICU assessment tools resulted in increased identification of postoperative delirium in the older surgical population. The use of screening tools helped facilitate early identification of postoperative delirium in elderly surgical patients.
    AORN journal 02/2014; 99(2):256-76.
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    ABSTRACT: The practice of psychosomatic medicine in the general hospital setting can be challenging, particularly for the inexperienced trainee. Guidance for how to approach a psychiatric consultation can be nonspecific or lacking altogether. In response, we offer a pedagogical model that emphasizes patient-specific neurological, medical, and contextual variables. A stepwise, "ABC" approach to psychiatric consultation is elaborated, beginning with collection of critical history ("Admission, Background, Consultation Question"), followed by both patient encounter ("Appearance, Behavior, Context") and actual patient examination ("Arousal, Brain/Body, Cognitive Assessment"), ultimately informing any given case formulation. Multiple clinical vignettes illustrate this approach and are offered for educational purposes in dissemination to trainees.
    Academic Psychiatry 07/2014; · 0.81 Impact Factor

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May 28, 2014