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Biomedical subjects

T J Craig

Publications and source records attributed to T J Craig.

At least 109 records · Page 6Linked to original sources
PubMed1982

A needs assessment strategy for an era of limited resources.

Among the several methods of assessing need for health services, the social indicator and the rates under treatment approaches utilize routinely available data. A well designed community survey, considered by many as the criterion of need within an area, is costly, difficult to mount, and requires considerable expertise. Therefore, it would seem reasonable to attempt to limit the need to utilize this approach. Presented here is a schema which utilizes the social indicator and rates under treatment approaches for an entire catchment area, reserving the survey approach only for those areas in which the two readily available need assessments are at variance, suggesting questionable validity for one or both approaches. Within a suburban middle-class county containing pockets of small town poverty, a social area analysis was undertaken to characterize need for mental health services. Inpatient rates under treatment were developed to measure demand. Key informant and survey approaches were undertaken to study selectively those census tracts which were discordant as to need and demand. This resulted in reducing the size of the population to be surveyed to 25 per cent of the total county, thus more efficiently using the limited resources available for needs assessment purposes.

Cross-Sectional Studies↗
PubMed1982

Ethical aspects of primary preventive measures among the institutionalized elderly.

For the interested physician, the primary prevention of medical illness is often considered a luxury or an optional exercise. This report illustrates the position that physicians caring for the institutionalized elderly have a strong ethical and perhaps legal obligation to institute primary preventive strategies, in view of their responsibilities for total care of the patient. As an example related to cardiovascular mortality and morbidity, primary preventive strategies directed at cigarette smoking and immobilization appear to be clearly indicated. The absence of preventive strategies could be construed as acceptance of intervention designed to increase morbidity and mortality.

Aged↗
PubMed1982

An epidemiologic study of problems associated with violence among psychiatric inpatients.

Approximately 11% of a 1-year sample of psychiatric inpatients from a single catchment area engaged in assaultive behavior before admission to the hospital. Among schizophrenic, alcoholic, and organic brain syndrome patients, assaultiveness was linked to emotional turmoil, as manifested by agitation and anger. In contrast, male patients with other diagnoses showed assaultiveness in the absence of substantial emotional distress, and patients with affective disorders were unlikely to exhibit assaultiveness even when high levels of agitation and anger were reported. The findings suggest that assessment and treatment of violent behavior in psychiatric patients are primarily linked to the nature of the underlying psychopathology.

Adult↗
PubMed1982

The coexistence of parkinsonism-like symptoms and tardive dyskinesia.

The authors used the Simpson-Angus Neurological Rating Scale and the Simpson Abbreviated Dyskinesia Rating Scale to evaluate 132 psychiatric inpatients for the presence of parkinsonism-like symptoms and tardive dyskinesia, respectively. Ninety-four percent of these patients had been on a stable drug regimen for a minimum of 2 weeks before assessment; 91% were being treated with neuroleptics, 42% with antiparkinson agents, and 7% with tricyclic antidepressants. Tardive dyskinesia and parkinsonism-like symptoms coexisted in 17.4% of the 132 patients. Such coexistence poses a therapeutic dilemma for the clinician because drug treatment of improve one neurological condition may exacerbate the other.

Adult↗
PubMed1982

Impact of DSM-III on clinical practice.

The authors compared criterion-based diagnoses (DSM-III) with clinical diagnoses (DSM-II) for 102 psychiatric inpatients. The introduction of specified diagnostic criteria represented a refinement of existing diagnostic practices rather than a qualitatively different approach to diagnoses; however, in the schizophrenia and affective disorder categories, nonwhites and women were more often assigned to worse prognostic category by the DSM-II system than were white men with similar symptoms. The authors suggest that the introduction of DSM-III criteria may ensure more appropriate diagnosis and treatment for nonwhites and women.

Alcoholism↗
PubMed1982

Racial patterns in liaison psychiatry.

A study of 362 consecutive psychiatric referals from the general medical and surgical wards of a university hospital serving a large nonwhite community revealed an association between provision of active liaison and a higher rate of referral for whites than nonwhites. Once referral was made, however, there was no evidence of substantial bias in the consultation process with regard to reason for referral, diagnosis, or recommendations. The findings suggest the need for more systematic studies of need and demand for psychiatric care among nonpsychiatric inpatients, with special emphasis on racial patterns.

Female↗
PubMed1981

Mortality among psychiatric inpatients. Age-adjusted comparison of populations before and after psychotropic drug era.

Comparison of age-adjusted death rates for inpatient and general populations from three pre-drug era and one post-drug era samples revealed a progressive decline in mortality that was most marked among elderly men. When length of stay was considered, the post-drug era sample showed a 30% reduction in mortality among patients hospitalized less than one year and a 50% reduction among longer-stay patients. The findings fail to support an increased mortality risk associated with the use of psychotropic drugs but dramatize the increased need for psychiatric services resulting from the increased survival of patients, especially those with long-term hospital stays.

Adult↗
PubMed1981

A comparison of mental health costs and utilization under three insurance models.

Published reports on utilization and costs of mental health services provided under three insurance models (prepaid, cost-financed and indemnity) reveal consistently greater utilization of outpatient services, lower overall inpatient utilization and comparable costs among prepaid plans in contrast with other two models. The present study suggests that prepaid plans, by facilitating the use of specialty mental health services by a substantially greater proportion of their membership than the other two models, come closer to serving their total population in need as projected by epidemiologic studies. While the data on cost containment are less clear, prepaid plans show a shift in costs away from inpatient and toward outpatient care. However, because of the possibility of bias of differences in population served, treatment philosophy and benefits offered, conclusions drawn from these findings must be tentative until a prospective comparison controlling for these differences can be carried out.

Costs and Cost Analysis↗
PubMed1981

A unique approach to mental health services in an HMO: indemnity benefit and service program.

Three years' experience with a unique combination of an indemnity benefit plus an in-house service program in a prepaid group practice plan's psychiatric department demonstrates enhanced accessibility and increased utilization among formerly unserved segments of the membership plus the flexibility of freedom of choice in choosing service provider and the ability to tailor treatment to patient needs. Overall costs were similar to those reported for other prepaid plans despite the addition of benefits for long-term therapy outside the plan. Flexible use of inpatient and day hospital services enabled the program to migrate, to a large extent, major increases in hospital charges while providing greater continuity of care. This combination of benefits offers the advantages of both an indemnity benefit (Freedom of choice in treatment) and an in-house service program (greater continuity of care, more flexible use of resources, reduction of reliance on hospital care).

Ambulatory Care↗
PubMed1981

Mortality among elderly psychiatric patients: basis for preventive intervention.

Analysis of cause-specific death rates among 750 elderly psychiatric inpatients revealed a markedly increased risk of death from pneumonia and a lesser but still substantial risk of death from cardiovascular disorders during the first year of hospitalization. Although the risks of cardiovascular death are considerably less among longer-stay patients, the pneumonia risks remain high. This suggests differing preventive strategies. To help prevent cardiovascular deaths, more attention should be paid to avoiding transfer trauma and its attendant stress. To help prevent pneumonia deaths, high priority should be given to an aggressive program of immunization, adequate nutrition, reduction of hospital overcrowding, and recognition of early pneumonia symptoms.

Aged↗
PubMed1981

Changes in the prescription of anticholinergic drugs (1970-1977) in a state hospital.

A study of the prescribing patterns of physicians in a state hospital during 1970-1977 revealed a four-fold drop in the use of combinations of drugs with strong anticholinergic properties. This dramatic shift to more rational practices stands in contrast to reports of persistent inappropriate prescribing in other settings. The time pattern of the changes suggests that an active ongoing educational program combined with a drug monitoring system providing feedback to physicians was primarily responsible for the findings. This study clearly documents the fact that physicians' prescribing patterns are amenable to change in the direction of more appropriate practices.

Antidepressive Agents, Tricyclic↗
PubMed1981

Death and deinstitutionalization.

Death rates during a period of rapid deinstitutionalization of a state mental hospital population showed consistent reductions that were statistically significant in the elderly patient population 65 years and older. These reductions were most marked for deaths due to pneumonia; there was a moderate decrease in cardiac deaths, and essentially no change in cancer death rates. The findings suggest that through a variety of mechanisms deinstitutionalization may have had a beneficial effect on the mortality of elderly patients who remained hospitalized. Moreover, the resultant increased need for beds for these patients dramatizes the importance for program planners to base their projections for hospital use on a continuing analysis of trends rather than on static data.

Adolescent↗
PubMed1981

Productivity of mental health professionals in a prepaid health plan.

To determine staff productivity in the psychiatry department of a prepaid health plan, the authors compared hours of direct service with professional time available. Psychiatrists exceeded the time standards set, and other staff achieved about three-fourths of the initial standards. The findings provided a basis for refining the standards for each professional discipline. Establishing flexible productivity standards in a system that promotes open discussion and provides continuing positive feedback promotes more efficient scheduling, which can significantly increase service time in the face of limited resources.

Counseling↗
PubMed1980

Pneumonia and psychotropic drug use in elderly psychiatric patients.

A study of the use of psychotropic drugs among 30 elderly psychiatric patients with pneumonia (15 of whom died), in comparison to the general elderly population of the hospital, revealed a negative association between the use of psychotropic agents and the development of pneumonia. The factors of age, sex, pre-existing illness, and organism virulence/patient resistance were all associated with death from pneumonia. However, the present findings do not support the hypothesis that psychotropic drugs are implicated in pneumonia deaths among elderly psychiatric patients.

Age Factors↗