Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided.

General-medical hospital admissions from a public inpatient psychiatric health facility: a review of medical complications over 30 months.

BACKGROUND: Medical comorbidity and mortality disproportionately affect adults with serious mental illness, as compared with the general population. OBJECTIVE: This study examined the medical diagnoses of patients transferred from a psychiatric health facility to general-medical hospitals. METHOD: The authors retrospectively reviewed the charts of 81 adult patients admitted to an inpatient psychiatric facility who were subsequently transferred to local general-medical hospitals from January 2005 to June 2007. RESULTS: Of 6,688 separate inpatient admissions, 81 patients (2.1%) were admitted to general-medical hospitals a total of 93 times, and had 108 admitting medical diagnoses. The leading admission indications were infections (N=33; 34%), electrolyte or nutritional abnormalities (N=12; 11%), and cardiovascular disorders (N=12; 11%). Iatrogenic causes related to psychiatric medications accounted for a small proportion of medical admissions (N=8; 7.5%). Over 90% of the patients had chronic medical disorders, and 80% of the patients had a psychotic or bipolar disorder. CONCLUSION: Patients with severe mental illness and chronic medical disorders may experience significant acute medical complications during inpatient psychiatric treatment. Given the complex care issues involved, continued vigilance in treating or preventing these conditions is warranted.

Community based participatory research: a promising approach for increasing epidemiology's relevance in the 21st century.

Despite the advances of modern epidemiology, the field remains limited in its ability to explain why certain outcomes occur and to generate the kind of findings that can be translated into programmes or policies to improve health. Creating community partnerships such that community representatives participate in the definition of the research problem, interpretation of the data, and application of the findings may help address these concerns. Community based participatory research (CBPR) is a framework epidemiologists can apply to their studies to gain a better understanding of the social context in which disease outcomes occur, while involving community partners in the research process, and insuring that action is part of the research process itself. The utility of CBPR principles has been particularly well demonstrated by environmental epidemiologists who have employed this approach in data gathering on exposure assessment and advancing environmental justice. This article provides examples of how popular epidemiology applies many of CBPR's key principles. At this critical juncture in its history, epidemiology may benefit from further incorporating CBPR, increasing the field's ability to study and understand complex community health problems, insure the policy and practice relevance of findings, and assist in using those findings to help promote structural changes that can improve health and prevent disease.