マンセイ シッカン デ セイシン ショウジョウ オ テイスル カンジャ エノ チイキ セイシンカ イリョウ モデル ジギョウ オヨビ ソノ ヒョウカ : セイシン カンゴ センモン カンゴフ ト リエゾン チーム ノ ヤクワリ

The purpose of this study was to show the effectiveness of psychiatric liaison consultation team for the people with chronic illness in the general hospital. Psychiatric liaison consultation team was constructed by certified nurse specialist (CNS), psychiatrist, clinical psychologist, nurse and social worker. Case manager was CNS and team intervened to the patients according to the standard of intervention by team. Intervention had been implemented by CNS mainly. Thirty one patients who consented to this study were intervened by CNS and team between July of 2007 and Feb.2008. They had chronic illness which was SLE, cancer and other physical illness without mental illness. BPRS, GAF, and LSP were written by CNS at the time of baseline before intervention and at the end time of intervention. Furthermore patients wrote CES-D and SF-36 by themselves at the baseline and the end point of intervention. Those questionnaires were returned by mail. CSQ was written by patients at the end of intervention. Thirty one patients had high depression score at the baseline and after intervention depressive state was improved. And they had lower SF-36 compared with that of the people who had chronic illness in another study. Furthermore they needed to be supported psychosocially by CNS to prevent worse their symptom. And they had psychosocial needs and those needs should be intervened by interdisciplinary team. In conclusion, the role of CNS and interdisciplinary team were discussed in order to meet the patients\u27 needs and to prevent worse their symptom in the general hospitals

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era