Anxiety, Depression, and Pain: Considerations in the Treatment of Patients with Uncontrolled Hypertension

PURPOSE OF REVIEW: The association between mental health, pain, and treatment-resistant hypertension is an important consideration for treating physicians. We review and discuss the connection between conditions of anxiety, depression, and chronic pain and their effect on uncontrolled hypertension. RECENT FINDINGS: There is significant co-occurrence of hypertension with anxiety, depression, and chronic pain which may lead to undertreatment of hypertension and undertreatment of the underlying mental health disorder. The association between mental health and hypertension is complex and is modulated by physiologic and environmental factors. Physicians treating patients with hypertension should be cognizant of the role anxiety, depression, and chronic pain play in treatment efficacy and compliance. Patients undergoing treatment should be screened for mental health disorders at treatment initiation and frequently thereafter to ensure optimal overall health and compliance

Automated palliative care trigger for admitted emergency department patients

Background: Identifying ED patients at high-risk for mortality may allow clinicians to best direct early palliative care consultation or initiate discussion on goals of care. This study\u27s objective was to develop an automated electronic medical record (EMR) trigger in the ED that would identify patients admitted to the hospital who are at high-risk for 30-day mortality and may benefit from early palliative care consultation. Methods: We established a prospective data collection tool within the EMR to gather data on comorbidities, demographics, and physiologic abnormalities. We included all consecutive adult ED patients requiring hospitalization at a single urban center over 6 months. Patients enrolled in hospice, psychiatric or labor and delivery admissions, and those transferred to another hospital were excluded. The primary outcome was death within 30-days. A palliative trigger score with multivariate logistic regression was derived with a sensitivity analysis excluding patients placed in observation. Model comparison used the area under the receiver operating curve (AUC). Results: A total of 10,019 consecutive patient hospitalizations were included, of whom 5,165 (51.6%) were female, 6,838 (68.3%) African American, and 1,739 (12.4%) admitted to an intensive care unit (ICU). The mean age was 58.4 years. Thirty and 60-day mortality was 3.8% and 5.7% respectively. The derived model was accurate in predicting 30-day mortality (AUC 0.89, 95% CI 0.88 - 0.91). Sensitivity analysis excluding observation patients resulted in similar results (AUC 0.87, 95% CI 0.84 - 0.89). Using this model, we constructed a palliative trigger score with a range from 0 - 10 that was based on 22 covariates (median value 3.4, IQR 2.5 - 4.3). Patients (n=888) with a score \u3e 5.1 (90th percentile) had 23.4% mortality at 30-days compared to 1.9% among those (n=9,131) with a score ≤ 5.1 (OR 15.6, 95% CI 12.5 - 19.3). Similarly, those with a score \u3e 5.1 had a 31.4% mortality at 60-days vs. 3.2% (OR 14.1, 95% CI 11.7 - 16.9). Conclusion: With further validation, an automated, palliative care trigger in the EMR has the potential to accurately identify patients at high risk of mortality who may benefit from early palliative care consultation. Such a tool could enhance goals of care discussions early in clinical management

Ici, non ailleurs: Anthologie collective Français 335 (hiver 2013)

http://deepblue.lib.umich.edu/bitstream/2027.42/97541/1/Anthologie_2013.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/97541/3/Release Deep Blue & Jenn B.doc