ABSTRACT
Three cohorts of patients, discharged within three, 12-month periods from a tertiary referral Neuropsychiatry/Epilepsy Unit, were asked whether they felt their condition had improved as a result of their admission, how they valued the admission and how easy they had found the admission to manage. They were also asked about their psychological and psychosocial state. For the first cohort a longer admission was more greatly valued and was associated with a better self-perceived outcome, and for the second cohort with the manageability of the admission. Replies to questionnaires sent to the referring doctors of two of the three cohorts of patients indicated that, in addition to their being satisfied with the service, there was a positive correlation between their ratings of patients' improvement and those ratings offered by the patients themselves. Issues relating to length and purpose of admissions, finances and the distribution of assessment and treatment of patients across different services are discussed in the light of the findings.
Subject(s)
Attitude of Health Personnel , Epilepsy/rehabilitation , Neurocognitive Disorders/rehabilitation , Patient Admission , Patient Care Team , Referral and Consultation , Adaptation, Psychological , Adult , Cohort Studies , Epilepsy/psychology , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Neurocognitive Disorders/psychology , Patient Satisfaction , Sick Role , Treatment OutcomeABSTRACT
The objective of the study was to investigate the sociodemographic and psychological factors which are associated with choice or refusal of regional anesthesia for lower segment Caesarean section. A semi-structured questionnaire was administered preoperatively to consecutive women presenting for elective operation at two hospital sites in the same health authority. The questionnaires were administered to 39 pregnant women by two anesthetists, one at each site. Sociodemographic and past and present obstetric and anesthetic details were obtained. The Hospital Anxiety and Depression scale and the FEAR questionnaire were used with an additional visual analog scale to assess fearfulness associated with the proposed operation. A 'panic checklist' of ten items was also constructed to identify procedures associated with feelings of panic. Ten women requested general anesthesia. These women had a similar level of anxiety to the others, but were significantly more depressed, had had more pregnancies overall and more without live babies. There were also more aspects of the procedure at which they thought they might panic. Women who have suffered the loss of a conception with its associated grief and often obstetric intervention are more reluctant to be conscious during an operative delivery for a subsequent baby. Preventive measures should be considered at the time of fetal loss to avoid this. However, preoperatively a simple visual analog scale for fearfulness would identify these women so that any unresolved fears could receive full psychological assessment.
Subject(s)
Anesthesia, General/psychology , Anesthesia, Obstetrical/psychology , Cesarean Section/psychology , Choice Behavior , Mothers/psychology , Adaptation, Psychological , Anxiety/psychology , Depression/psychology , Female , Fetal Death , Humans , Infant, Newborn , Internal-External Control , Panic , Personality Assessment , PregnancyABSTRACT
The theory underlying medical classification is not always given sufficient regard. Here systematic methods developed in biology are summarised and compared with parallel developments in nosology. The classification of the functional psychoses is discussed as an example of a methodological problem in medicine. We consider that cladism could have a useful application in nosology, and could lead to classifications based on the concept of interrelationships of disease.
