Validating a Prognostic Model for Mortality of Psychogeriatric Inpatients

Background: To validate a predictive scoring system for 1-year mortality among psychogeriatric inpatients admitted for acute psychiatric care. Methods: Computerized data were extracted from the District Health Board Database for a university affiliated general hospital. A geriatric risk scoring system developed in the USA was employed to validate mortality within 1-year of hospital discharge. Results: Among 125 psychogeriatric inpatients who were discharged in 2017, [mean age 82.8 (±8.9) years, 82 (65.6%) women] 33 died within 1-year [26.4% of the sample, mean age, 87.7 (±11.1) years, 25 (75.7%) women]. Levine’s mortality index predicted death. A post hoc probit analysis found two factors significantly associated with predicted mortality: metastatic cancer (Chi-square = 5.6;p Conclusions: A geriatric 1-year mortality scoring system accurately predicted mortality among psychogeriatric inpatients. Predicting psychogeriatric mortality should be considered a guideline for ensuring quality of care and appropriate discharge and advanced care planning.

Prevalence and knowledge of hepatitis C in a middle-aged population,Dunedin,New Zealand

AIM:To determine the prevalence of infection with hepatitis C virus(HCV) in those most at risk of advanced liver disease and to identify gaps in knowledge of HCV.METHODS: Questionnaires were mailed to randomly selected residents aged 40-59 to assess the extent of their general knowledge about HCV. The questionnaire assessed demographics, the extent of general knowledge about viral hepatitis, potential risks for infection and the prevalence of risk factors associated with increased progression of liver fibrosis. Anonymised residual laboratory blood samples from 40-59 years old people from Dunedin taken in hospital or in the community, were tested for HCV antibodies and alanine transaminase(ALT), aspartate transaminase(AST), gamma-glutamyl transpeptidase(GGT). Linear regression was performed to examine whether the demographics sex, age, socio-economic status, qualification level and occupation sector(categorical variables) were predictors of level of general knowledge about hepatitis. For the demographics that werefound to be significant predictors of score outcome, multiple regression analysis was used to determine independent effects. χ2 tests were used to compare our selected sample and our responder population demographics, to the demographics of the entire 40-59 years old population in Dunedin using the 2006 NZ census data. Exact confidence intervals for the proportion positive for HCV and HBV were calculated using the binomial distribution.RESULTS: The response rate to the mailed questionnaire was 431/1400(30.8%). On average 59.4% questions were answered correctly. Predictors for higher scores, indicating greater knowledge about symptoms and transmission included sex(female, P < 0.01), higher level of qualification(P < 0.000) and occupation sector(P < 0.000). Sharing intravenous drug utensils was a known risk factor for disease transmission(94.4%), but the sharing of common household items such as a toothbrush was not. 93% of the population were unaware that HCV infection can be asymptomatic. 25% did not know that treatment was available in New Zealand and of those who did know, only 40% assumed it was funded. Six hundred and eighty-two residual anonymised blood samples were tested for HCV antibodies, ALT, AST and GGT. The prevalence for HCV was 4.01%, 95%CI: 2.6%-5.8%. Liver function tests were not useful for identifying likelyhood of HCV infection.CONCLUSION: Prevalence of HCV in our population is high, and the majority have limited knowledge of HCV and its treatment.

Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.

An integrative Tai Chi program for patients with breast cancer undergoing cancer therapy:study protocol for a randomized controlled feasibility study

Background： Breast cancer patients experience various side effects during cancer therapy, often resulting in reduced quality of life and poor adherence to treatment. A limited range of proven interventions has been developed to target such side effects. While Tai Chi offers benefits for the health and well-being of breast cancer survivors, the effectiveness of Tai Chi across the treatment continuum has not been evalu- ated. Improved patient education and support has been suggested as a priority for breast cancer care. This pilot study assesses the feasibility of a randomized controlled trial （RCT） to evaluate the effectiveness of ＂an integrative Tai Chi＂ （ANITA） program for breast cancer patients undergoing cancer therapy. Methods/design： This is a single-centre, two-arm feasibility RCT. Twenty-four patients with breast cancer who have undergone surgical treatment will be recruited from the Dunedin Hospital （New Zealand） over a 12-month period （from August 2017 to July 2018）. Subject to informed consent, patients will be ran- domized to receive standard cancer treatment alone or standard cancer treatment plus the ANITA pro- gram, consisting of peer support, health education, and Tai Chi Ruler exercise. The program runs alongside the patient＇s adjuvant cancer therapy, which may include chemotherapy, radiation therapy, antibody treatment, and/or antihormonal therapy. Analysis in this study will focus on process evaluation of participant recruitment, retention, treatment fidelity, acceptability of the program, and occurrence of adverse events. Clinical outcomes （i.e., fatigue, sleep quality, anxiety and depression and quality of life） will be assessed at baseline, and at 12 weeks and 24 weeks post-randomization. Discussion： Outcomes from this study will inform the feasibility and methodology for a future fully- powered RCT.