17 research outputs found
SUICIDE AND VIOLENCE RISK .1. RELATIONSHIP TO COPING STYLES
Thirty suicidal psychiatric inpatients were compared with 30 nonsuicidal
psychiatric inpatients. A battery of self-report tests was administered
measuring suicide risk, violence risk and coping styles. The suicidal
patients scored higher on both the suicide risk and violence risk. They
also used almost all coping styles less frequently than the nonsuicidal
patients. Among suicidal patients, suicide risk was negatively
correlated with the coping styles of minimization, replacement and
blame. Further, suicide risk and violence risk in suicidal patients were
shown to be predicted by coping styles. These data indicate that
suicidal patients have inadequate mental resources to deal with life
problems. Besides their significance for assessing suicide risk, the
findings may have possible clinical implications for case detection and
early intervention with potential preventive value
Do Treatment Quality Indicators Predict Cardiovascular Outcomes in Patients with Diabetes?
<p>Background: Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been developed and tested against intermediate outcomes. No studies have tested whether these treatment quality indicators also predict hard patient outcomes.</p><p>Methods: A cohort study was conducted using data collected from >10.000 diabetes patients in the Groningen Initiative to Analyze Type 2 Treatment (GIANTT) database and Dutch Hospital Data register. Included quality indicators measured glucose-, lipid-, blood pressure-and albuminuria-lowering treatment status and treatment intensification. Hard patient outcome was the composite of cardiovascular events and all-cause death. Associations were tested using Cox regression adjusting for confounding, reporting hazard ratios (HR) with 95% confidence intervals.</p><p>Results: Lipid and albuminuria treatment status, but not blood pressure lowering treatment status, were associated with the composite outcome (HR = 0.77, 0.67-0.88; HR = 0.75, 0.59-0.94). Glucose lowering treatment status was associated with the composite outcome only in patients with an elevated HbA1c level (HR = 0.72, 0.56-0.93). Treatment intensification with glucose-lowering but not with lipid-, blood pressure-and albuminuria-lowering drugs was associated with the outcome (HR = 0.73, 0.60-0.89).</p><p>Conclusion: Treatment quality indicators measuring lipid-and albuminuria-lowering treatment status are valid quality measures, since they predict a lower risk of cardiovascular events and mortality in patients with diabetes. The quality indicators for glucose-lowering treatment should only be used for restricted populations with elevated HbA1c levels. Intriguingly, the tested indicators for blood pressure-lowering treatment did not predict patient outcomes. These results question whether all treatment indicators are valid measures to judge quality of health care and its economics.</p>