Population-based comparison of health-related quality of life between healthy subjects and those with specific psychiatric or somatic diseases

Quality of life, symptom severity and level of functioning in people with severe mental illness ready for hospital discharge

WHAT IS KNOWN ON THE SUBJECT?: The quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern. Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries. The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre-discharge. Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital. Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Abstract Introduction There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods A cross-sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life - Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre-discharge. Results Participants reported low social relationship-related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness.

Experienced continuity of care in patients at risk for depression in primary care

BACKGROUND

Existing studies about continuity of care focus on patients with a severe mental illness.

OBJECTIVES

Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure.

METHODS

Explorative study comparing patients at risk for depression with chronic heart failure patients. Continuity of care was measured using a patient questionnaire and defined as ( 1 ) number of care providers contacted (personal continuity); ( 2 ) collaboration between care providers in general practice (team continuity) (six items, score 1-5); and ( 3 ) collaboration between GPs and care providers outside general practice (cross-boundary continuity) (four items, score 1-5).

RESULTS

Most patients at risk for depression contacted several care providers throughout the care spectrum in the past year. They experienced high team continuity and low cross-boundary continuity. In their general practice, they contacted more different care providers for their illness than heart failure patients did (P < 0.01). Patients at risk for depression experienced a slightly better collaboration between these care providers in their practice: a mean score of 4.3 per item compared to 4.0 for heart failure patients (P = 0.03). The perceived cross-boundary continuity, however, was reversed: a mean score of 3.5 per item for patients at risk for depression, compared to 4.0 for heart failure patients (P = 0.01).

CONCLUSION

The explorative comparison between patients at risk for depression and heart failure patients shows small differences in experienced continuity of care. This should be analysed further in a more robust study.

Posterior pilon fractures: a retrospective case series and proposed classification system

BACKGROUND

Posterior malleolus fractures occur in 7% to 44% of ankle fractures and are associated with worse clinical outcomes. Fractures that involve the posteromedial plafond extending to the medial malleolus have been described previously in small case series. Failure to identify this fracture pattern has led to poor clinical outcomes and persistent talar subluxation. The purpose of this study was to report our outcomes following fixation of this posterior pilon fracture and to describe a novel classification system to help guide operative planning and fixation.

METHODS

Eleven patients were identified following fixation of a posterior pilon fracture over a 4-year span; 7 returned at minimum 1-year follow-up to complete a physical examination, radiographs, and RAND-36 (health-related quality of life score developed at RAND [Research and Development Corporation] as part of the Medical Outcomes Study) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot questionnaires. Patient records were reviewed to evaluate for secondary complications or operative procedures.

RESULTS

Our mean postoperative AOFAS ankle/hindfoot score was 82. Anatomical reduction of the plafond was noted radiographically in 7 of 11 patients, with the remainder demonstrating less than 2 mm of articular incongruity. Five of 7 patients demonstrated ankle and hindfoot range of motion within 5 degrees of the uninvolved extremity. Four complications required operative intervention; 2 patients reported continued pain secondary to development of CRPS.

CONCLUSION

The posterior pilon fracture is a challenging fracture pattern to treat, and it has unique characteristics that require careful attention to operative technique. Our results following fixation of this fracture pattern are comparable with results in the literature. In addition, a novel classification scheme is described to guide recognition and treatment of this fracture pattern.

LEVEL OF EVIDENCE

Level IV, retrospective case series.