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Saarento O, Kastrup M, Hansson L. The Nordic comparative study on sectorized psychiatry: characteristics of repeat users of emergency outpatient services in two Nordic psychiatric services. A 1-year follow-up study. Eur Psychiatry 2020; 13:35-40. [DOI: 10.1016/s0924-9338(97)86749-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/1997] [Accepted: 09/02/1997] [Indexed: 10/18/2022] Open
Abstract
SummaryTo characterise frequent use of psychiatric emergency outpatients services, this paper reports results from a prospective investigation of use of psychiatric services by new patients in two Nordic psychiatric services, Frederiksberg in Denmark and Oulu in Finland. One year treated incidence cohorts were used. Total number of patients included was 1,055. The repeat user was defined as a patient having at least three emergency outpatient contacts during a 1-year follow-up. The repeat users constituted 15.8% of the sample and 70.8% of all the emergency contacts in Frederiksberg. In Oulu the respective figures were 9.3% and 33.8%. The number of planned outpatient contacts or the number of hospital admissions of the repeat users did not differ from the non-repeaters. Repeaters in Frederiksberg were more likely to be self-referrals, male, divorced or unmarried, living with their parents, without their own housing, unemployed, aged between 25 and 44 years, and to have a diagnosis of dependency or personality disorder. In Oulu they did not differ from the other patients with regard to sociodemographic or diagnostic characteristics.
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Abstract
With the strong focus on terrorism in recent years, there is an increasing concern that the fundamental rights of refugees and asylum seekers may be violated in the interest to combat acts of terrorism. It may also lead to increasing racism and discrimination towards these populations.Racism and discrimination encompass the negative stereotypes and prejudicial beliefs that people may hold, as well as inequitable practices that may result hereof.Knowledge about the mental health consequences of racism and discrimination is of clear clinical relevance for psychiatrists worldwide, as a significant proportion of psychiatric patients will have a background as refugees and asylum seekers. Many of them have experiences of war, strife, persecution and torture that further ads to their mental distress.The paper will outline the psychiatric symptomatology related to racism as well as ethical dilemmas and educational needs for the psychiatric profession.Further the role of national psychiatric associations in combating racism and discrimination by e.g. defining best practices and revising medical training curricula will be outlined.http://www.mariannekastrup.dk/Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kastrup M. Ethical challenges in the use of coercion. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The use of coercive measures remains one of the great challenges in psychiatry.Increased focus on patient rights and autonomy, concern from user and relatives organizations as well as from human rights organizations all have contributed to that the use of all kinds of coercion is high on the agenda. And yet, we are still faced with that a number of psychiatric patients will experience that coercive measures are used as part of their treatment.The EPA Ethical Committee carried out a survey comprising the European associations of psychiatry in which a questionnaire was circulated regarding what the different associations found were the major ethical challenges in their respective countries.Among the issues that have given rise to particular concern are the use of physical restraints including why some countries avoid physical restraints while other – e.g. Denmark – use it extensively. Why do we find such large differences? Is this due to different approaches to coercion, different traditions? Shortage of resources?Another concern is that certain groups seem more likely to be subject to coercion compared to others. Thus, it has been demonstrated that patients belonging to ethnic minority groups are more likely to experience this.The paper will focus on ethical problems and issues of concern related to the use of coercion. The focus will be on facets of international relevance with the aim to remain critical towards the use and when needed to strengthen the quality of coercive treatment care. URL:http://www.mariannekastrup.dkDisclosure of interestThe author has not supplied his declaration of competing interest.
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Kastrup M. Transcultural issues in diagnostic process. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Diagnostic systems and methods must respond to patients’ diversity in expressions of mental distress, social and cultural context and the meanings given to illness. Due to increasing migration and globalisation the challenge of considering diagnosis in the context of culture has become increasingly significant in Europe. And globalization has further led to changes in value systems and our awareness of patients with ethnic minority background.Over recent decades, there has been an increasing development of psychiatric diagnosing with nosological categorisation combined with multi-axial schemas. Diagnosis, besides identifying a disorder and distinguishing one disorder from another disorder - differential diagnosis, has also an aim to include an overall understanding of the patient's situation.We witness an upsurge in the attention paid to the cultural limitations to psychiatric diagnostic practice and treatment modalities. Guidelines for the psychiatric profession are in critical focus from a transcultural perspective. Some claim their universality independent of cultural context; others find cultural adaptation useful and necessary.Do the diagnoses and clinical and ethical guidelines give meaning in the cultural setting? Are they compatible with the cultural values of the therapist and those of the patient and the family? Several sources claim the biomedical paradigm for being Western with insufficient consideration of the socio-political context.The cultural formulation developed as part of DSM-IV and now DSM-5 is one model to support a systematic review of culture and context in psychiatric diagnosing.The paper will discuss the advantages and shortcomings of current diagnostic categories and guidelines vis-à-vis the universe of traumatized refugees with other ethnic backgrounds.URL:http://www.mariannekastrup.dk/Disclosure of interestThe author has not supplied his declaration of competing interest.
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Treskatsch S, Balzer F, Knebel F, Habicher M, Braun JP, Kastrup M, Grubitzsch H, Wernecke KD, Spies C, Sander M. Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. Int J Cardiovasc Imaging 2015; 31:1327-35. [PMID: 26047772 DOI: 10.1007/s10554-015-0689-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/01/2015] [Indexed: 01/20/2023]
Abstract
Monoplane hemodynamic TEE (hTEE) monitoring (ImaCor(®) ClariTEE(®)) might be a useful alternative to continuously evaluate cardiovascular function and we aimed to investigate the feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. After IRB approval we reviewed the electronic data of cardiac surgery patients admitted to our intensive care between 01/01/2012 and 30/06/2013 in a case-controlled matched-pairs design. Patients were eligible for the study when they presented a sustained hemodynamic instability postoperatively with the clinical need of an extended hemodynamic monitoring: (a) hTEE (hTEE group, n = 18), or (b) transpulmonary thermodilution (control group, n = 18). hTEE was performed by ICU residents after receiving an approximately 6-h hTEE training session. For hTEE guided hemodynamic optimization an institutional algorithm was used. The hTEE probe was blindly inserted at the first attempt in all patients and image quality was at least judged to be adequate. The frequency of hemodynamic examinations was higher (ten complete hTEE examinations every 2.6 h) in contrast to the control group (one examination every 8 h). hTEE findings, including five unexpected right heart failure and one pericardial tamponade, led to a change of current therapy in 89% of patients. The cumulative dose of epinephrine was significantly reduced (p = 0.034) and levosimendan administration was significantly increased (p = 0.047) in the hTEE group. hTEE was non-inferior to the control group in guiding norepinephrine treatment (p = 0.038). hTEE monitoring performed by ICU residents was feasible and beneficially influenced the postoperative management of cardiac surgery patients.
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Affiliation(s)
- S Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - F Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - F Knebel
- Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Habicher
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - J P Braun
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Hildesheim GmbH, Hildesheim, Germany
| | - M Kastrup
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - H Grubitzsch
- Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - C Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Sander
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Bhugra D, Gupta S, Schouler-Ocak M, Graeff-Calliess I, Deakin N, Qureshi A, Dales J, Moussaoui D, Kastrup M, Tarricone I, Till A, Bassi M, Carta M. EPA Guidance Mental Health Care of Migrants. Eur Psychiatry 2014; 29:107-15. [DOI: 10.1016/j.eurpsy.2014.01.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 11/28/2022] Open
Abstract
AbstractMigration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.
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Jensen NK, Johansen KS, Kastrup M, Krasnik A, Norredam M. Continuity of care in the psychiatric health care system - a patient persepctive of immigrants, refugees and ethnic Danes. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt124.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kastrup M, Nolting MJ, Ahlborn R, Braun JP, Grubitzsch H, Wernecke KD, Spies C. An electronic tool for visual feedback to monitor the adherence to quality indicators in intensive care medicine. J Int Med Res 2012; 39:2187-200. [PMID: 22289534 DOI: 10.1177/147323001103900615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Evidence-based medicine is often inadequately implemented in intensive care units (ICU); the aim of this study was to improve its implementation via a technical feedback system, using key performance indicators (KPI). The study evaluated 205 patients treated in a cardiac surgical ICU over a 6-month period (3 months before and 3 months after implementation of the feedback system). KPI adherence rates for sedation, delirium and pain monitoring, and completion of a weaning protocol before and after the implementation of the feedback system, were compared. Adherence rates for pain and delirium monitoring, and implementation of the weaning protocol, were significantly increased by the intervention. Adherence to KPIs for sedation, which were high at baseline, could not be further improved. Daily display of KPI implementation had a positive effect on adherence to standard operating procedures. Adherence to guidelines may be improved by using this feedback system as part of the clinical routine.
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Affiliation(s)
- M Kastrup
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Medicine Berlin, Germany
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Perez Fernandez CM, Steffen I, Pinkernelle JG, Dossow VV, Kastrup M, Hamm B, Grieser C, Stelter L. Pulmonale Veränderungen septischer ARDS-Patienten im CT: Korrelation von Überlebensrate und pumonalem/extrapulmonalem septischen Fokus. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Grieser C, Pérez Fernández C, Steffen IG, Goldmann A, Kastrup M, Engert U, Deja M, Lojewski C, Hamm B, Denecke T. „Acute Respiratory Distress Syndrom“ bei Schweinegrippenpneumonie - prognostische Wertigkeit der Computertomographie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, Goepfert M, Gogarten W, Grosse J, Heller A, Heringlake M, Kastrup M, Kroener A, Loer S, Marggraf G, Markewitz A, Reuter D, Schmitt D, Schirmer U, Wiesenack C, Zwissler B, Spies C. S3-Leitlinie zur intensivmedizinischen Versorgung herzchirurgischer Patienten. Z Herz- Thorax- Gefäßchir 2010. [DOI: 10.1007/s00398-010-0790-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, Goepfert M, Gogarten W, Grosse J, Heller AR, Heringlake M, Kastrup M, Kroener A, Loer SA, Marggraf G, Markewitz A, Reuter D, Schmitt DV, Schirmer U, Wiesenack C, Zwissler B, Spies C. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system. Ger Med Sci 2010; 8:Doc12. [PMID: 20577643 PMCID: PMC2890209 DOI: 10.3205/000101] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Indexed: 01/20/2023]
Abstract
Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefässchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).
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Affiliation(s)
- M. Carl
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Alms
- Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Germany
| | - J. Braun
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Dongas
- Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - J. Erb
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Goetz
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M. Goepfert
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - W. Gogarten
- Department of Anaesthesiology and Intensive Care, University of Muenster, Germany
| | - J. Grosse
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. R. Heller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M. Heringlake
- Department of Anesthesiology, University of Luebeck, Germany
| | - M. Kastrup
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
| | - A. Kroener
- Department of Cardiothoracic Surgery, University of Cologne, Germany
| | - S. A. Loer
- Department of Anesthesiology, VU University Hospital Center, Amsterdam, The Netherlands
| | - G. Marggraf
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, Essen, Germany
| | - A. Markewitz
- Department of Cardiovascular Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - D. Reuter
- Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - D. V. Schmitt
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Germany
| | - U. Schirmer
- Department of Anesthesiology, Heart and Diabetic Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - C. Wiesenack
- Department of Anaesthesia, University Hospital of Regensburg, Germany
| | - B. Zwissler
- Clinic of Anesthesiology, Ludwig Maximilian University, Munich, Germany
| | - C. Spies
- Department of Anesthesiology and Intensive Care, Charité University Medicine Berlin, Charité Campus Mitte and Campus Virchow Klinikum, Berlin, Germany
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Kastrup M, von Dossow V, Seeling M, Ahlborn R, Tamarkin A, Conroy P, Boemke W, Wernecke KD, Spies C. Key performance indicators in intensive care medicine. A retrospective matched cohort study. J Int Med Res 2010; 37:1267-84. [PMID: 19930832 DOI: 10.1177/147323000903700502] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Expert panel consensus was used to develop evidence-based process indicators that were independent risk factors for the main clinical outcome parameters of length of stay in the intensive care unit (ICU) and mortality. In a retrospective, matched data analysis of patients from five ICUs at a tertiary university hospital, agreed process indicators (sedation monitoring, pain monitoring, mean arterial pressure [MAP] >or= 60 mmHg, tidal volume [TV] <or= 6 ml/kg body weight, peak inspiratory pressure [PIP] <or= 35 cmH(2)O and blood glucose [BG] >or= 80 and <or= 130 mg/dl) were validated using a prospective dataset of 4445 consecutive patients. After matching for age, sex and ICU, 634 patients were analysed. Logistic regression of the 634 patients showed that monitoring analgesia and sedation, MAP >or= 60 mmHg and BG >or= 80 mg/dl were relevant for survival. Linear regression of the 634 patients showed that analgesia monitoring, PIP <or= 35 cmH(2)O and TV <or= 6 ml/kg were associated with reduced length of ICU stay. Linear regression on all 4445 patients showed analgesia, sedation monitoring, MAP >or= 60 mmHg, BG >or= 80 mg/dl and <or= 130 mg/dl, PIP <or= 35 cmH(2)O and TV <or= 6 ml/kg were associated with reduced length of ICU stay, indicating that adherence to evidence-based key process indicators may reduce mortality and length of ICU stay.
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Affiliation(s)
- M Kastrup
- Department of Anaesthesiology and Intensive Care, Campus Virchow-Klinikum and Campus Charité Mitte, Charité University Medicine Berlin, Berlin, Germany
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von Dossow V, Moshirzadeh M, Kastrup M, Wernecke KD, Konertz W, Spies C. Performance of the A-line Autoregressive Index (AAI) and of the Bispectral Index (BIS) at assessing depth of short-term sedation following cardiac surgery. J Int Med Res 2009; 37:611-20. [PMID: 19589243 DOI: 10.1177/147323000903700303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the correlation and agreement between the Bispectral Index (BIS) or A-line Autoregressive Index (AAI) and a clinical scoring system, the Ramsay Sedation Scale (RSS), in 40 patients after elective cardiac surgery and admission to the intensive care unit. All patients received sedation with propofol according to the study protocol. BIS, AAI and RSS were documented at two different levels of sedation: deep sedation RSS 4 - 6; and slight sedation/extubation RSS 2 - 3. Both the BIS and AAI agreed well with the RSS (eta-coefficients of 0.902 and 0.836, respectively, for mean overall RSS stages). The systems agreed well among each other (overall intra-class correlations of 0.670 for consistency and 0.676 for absolute agreement). There was significant discrimination between RSS 2 - 3 and RSS 4 - 6 with BIS and AAI (BIS mean difference of 24.73, 95% confidence intervals [CI] 21.08 - 28.37; AAI mean difference of 20.90, 95% CI 14.64 - 27.16). In conclusion, BIS and AAI correlated well with RSS overall and also at different levels of sedation.
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Affiliation(s)
- V von Dossow
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - University Medicine Berlin, Berlin, Germany
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15
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Schiferer A, Panzer S, Reesink HW, Baulig W, Bélisle S, Gerrard C, Grubitzsch H, von Heymann C, Isetta C, Janvier G, Kastrup M, Lassnigg A, Lehot JJ, Raivio P, Schmid ER, Schmidlin D, Suojaranta-Ylinen R, Vuylsteke A, Westerlind A, Zuckermann A, Hiesmayr M. Red cell transfusion in elective cardiac surgery patients. Vox Sang 2009; 97:172-82. [DOI: 10.1111/j.1423-0410.2009.01186.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kastrup M. How Art may be a Tool for Understanding Other Cultures and their Perception of Illness. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cultural background has a significant influence upon how we perceive illness, our attitudes to illness and our help-seeking behaviour.But culture is only one of many influences on our health related beliefs and behaviours. Other factors include e.g. individual factors related to age, gender, sociodemographic background, but also environmental factors such as urban or rural setting, pollution, globalization.If we want to understand and assess the impact of culture in a particular clinical case, the use of art may be a valuable tool to facilitate this understanding and serve as a bridge over cultural incongruities.The paper will discuss ways in which the application of artistic elements in the therapeutic process may serve as a useful intervention and ultimately as a vehicle to increase the cultural competence of mental health staff. In an increasingly complex, globalised world with patient populations originating from all parts of the world this may prove to be a profitable instrument.
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17
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Kastrup M. Diagnostic Differences Among Different Ethnic Groups Contacting Mental Health Services. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aim:A nationwide register study was carried out in Denmark comprising 50,877 persons aged 18-66, who were registered in 2003 in the Danish Psychiatric Register or the National Patient Register with a psychiatric ICD-10 diagnosis with the aim to compare diagnostic profiles and use of services.Method:The study is a register survey linking Psychiatric/and National Patient Register with Statistical Bureau data.Results:Of the population 87.1% were ethnic Danes, 7.8% migrants, 4.0% descendants with one Danish born parent, 0.7% descendants with both parents born outside Denmark and 0.3% foreign adoptees. Males comprised 49%, women 51% of the population. The 5 ethnic groups had significant differences in utilization of care, in diagnostic distribution and in the use of coercion. Diagnostically, contacts due to schizophrenia were significantly higher among non-Danish patients and highest among young descendant males. Personality disorders were significantly higher among women than men and highes in adopted and descendant young women. PTSD had a preponderance among migrant men. Substance abuse was higher among men in all ethnic groups, but lower among migrant groups compared to Danes. Self-mutilating behaviour was seen more frequently among female descendants from non-Western countries than among migrant women from non-Western countries as well as among young adopted women.Conclusion:Significant diagnostic differences were observed. Possible explanatory models to these findings will be discussed.
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Nachtigall I, Deja M, Tafelski S, Tamarkin A, Schaller K, Halle E, Gastmeier P, Wernecke KD, Bauer T, Kastrup M, Spies C. Adherence to Standard Operating Procedures is Crucial for Intensive Care Unit Survival of Elderly Patients. J Int Med Res 2008; 36:438-59. [DOI: 10.1177/147323000803600308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Elderly patients account for 42–52% of intensive care unit (ICU) admissions and for almost 60% of all ICU days in the USA and up to 50% receive inappropriate antibiotic treatment. The aim of this study was to evaluate whether adherence to Standard Operating Procedures (SOPs) reduced ICU mortality in an elderly population. The study included consecutive patients ( n = 228) aged ≤ 60 years with an ICU stay of > 72 h. SOPs were based on evidence-based medicine guidelines for diagnosis and treatment of infections, and on local resistance rates. According to preset indicators of quality management standards and assessment of different degrees of adherence, an implementation rate > 70% was considered adherent (high adherence group [HAG]) and ≤ 70% was considered non-adherent (low adherence group [LAG]). Patients in the HAG ( n = 137) had significantly reduced mortality compared with LAG patients ( n = 91): 5.8% versus 19.8%, respectively. It was concluded that adherence to SOPs based on evidence-based medicine that consider local resistance rates for antibiotic treatment in elderly ICU patients is associated with a lower mortality rate.
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Affiliation(s)
- I Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Deja
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Tamarkin
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Schaller
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - E Halle
- Institute for Microbiology and Hygiene, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - P Gastmeier
- Medical School Hannover, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - KD Wernecke
- Institute of Medical Biometrics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, and SOSTANA GmbH Berlin, Berlin, Germany
| | - T Bauer
- Helios Clinic Emil von Behring, Clinic for Respiratory Diseases Heckeshorn, Berlin, Germany
| | - M Kastrup
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Heymann A, Sander M, Krahne D, Deja M, Weber-Carstens S, MacGuill M, Kastrup M, Wernecke KD, Nachtigall I, Spies CD. Hyperactive delirium and blood glucose control in critically ill patients. J Int Med Res 2007; 35:666-77. [PMID: 17900406 DOI: 10.1177/147323000703500511] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Delirium is a common complication of critically ill patients and is often associated with metabolic disorders. One of the most frequent metabolic disorders in intensive care unit (ICU) patients is hyperglycaemia. The aim of this retrospective study of 196 adult ICU patients was to determine if there is an association between hyperactive delirium and blood glucose levels in ICU patients. Hyperactive delirium was diagnosed using the delirium detection score. Blood glucose levels were monitored by blood gas analysis every 4 h. Hyperactive delirium was detected in 55 (28%) patients. Delirious patients showed significantly higher blood glucose levels than non-delirious patients Higher overall complication rates, length of ventilation, ICU stay and mortality rates were seen in the delirium group. In a multivariate analysis, glucose level, alcohol abuse, APACHE II score, complication by hospital-acquired pneumonia and a diagnosis of polytrauma on-admission all significantly influenced the appearance of delirium.
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Affiliation(s)
- A Heymann
- Department of Anaesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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20
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Carl M, Alms A, Braun J, Dongas A, Erb J, Goetz A, Göpfert M, Gogarten W, Grosse J, Heller A, Heringlake M, Kastrup M, Kröner A, Loer S, Marggraf G, Markewitz A, Reuter M, Schmitt DV, Schirmer U, Wiesenack C, Zwissler B, Spies C. [Guidelines for intensive care in cardiac surgery patients: haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine]. Thorac Cardiovasc Surg 2007; 55:130-48. [PMID: 17377871 DOI: 10.1055/s-2007-964939] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors, are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anaesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess available monitoring methods and their risks as well as the differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium-sensitizers and the use of intra-aortic balloon pumps. The guideline has been developed according to the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).
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21
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Braun JP, Schwilk B, Kuntz L, Kastrup M, Frei U, Schmidt D, Behrends B, Schleppers A, Kaisers U, Spies C. [Analysis of personnel costs after reorganization of intensive care using calculated diagnosis-related groups comparative data. An investigation at the Charité Berlin]. Anaesthesist 2007; 56:252-8. [PMID: 17106707 DOI: 10.1007/s00101-006-1113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In an extensive project intensive care units (ICUs) of the Charité University Hospital were reorganized. The aim of this investigation was to determine if staff costs after this reorganization are financed by modular profits of diagnosis-related groups (DRGs). METHODS Staff costs of all non-pediatric intensive care units, including ICUs, intermediate care units and post-anaesthesia care units (PACUs) in the Charité University Hospital were compared with the modular profits of all DRGs of patients older than 14 years in 2005. These DRGs were converted into the German refined DRG (GDRG) system 4.0 from 2006 with calculations based on actual income for medical doctors and nurses in 2006. Due to changed wage agreements for the incomes of physicians in 2006 there was an increase of costs. For the other professional groups an increase in income is expected, which cannot be estimated at present. RESULTS The calculation revealed that staff costs of the ICUs at the Charité University Hospital based on a current German mean base rate of 2,836 EUR were 4.2% above the modular profits of the DRGs. As a result of a structural reorganization of the ICUs, the costs of staff could be adapted to the modular profits. Under the conditions of the actual reduced base rate of Berlin of 2,955 EUR the costs and profits were nearly equal. As the financial impact of the reorganization of the ICUs will take full effect in the coming years, it can be anticipated that with an expected base rate of 2,949 EUR in 2010 the intensive care medicine of a University hospital in Germany can become profitable. DISCUSSION The spectrum of intensive care medicine at the Charité University Hospital covers the maximum range of operative and non-operative medicine. After an extensive reorganization of the ICUs under the aspect of staff costs, intensive care medicine can become profitable under the 4.0 G-DRG system. With consequent reorganization the cost efficiency of staff can be optimized, particularly in the setting of high-end intensive care medicine.
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Affiliation(s)
- J P Braun
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charitéplatz 1, 10117 Berlin.
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22
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Braun JP, Buhner S, Kastrup M, Dietz E, Langer K, Dohmen PM, Lochs H, Spies C. Barrier function of the gut and multiple organ dysfunction after cardiac surgery. J Int Med Res 2007; 35:72-83. [PMID: 17408057 DOI: 10.1177/147323000703500107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We studied the influence of sequential involvement of the gastrointestinal (GI) tract on the development of multiple organ dysfunction (MOD) after cardiopulmonary bypass (CPB). One hundred and forty-six patients undergoing elective cardiac surgery were included in this prospective observational study. Standardized oral inert-sugar tests (sucrose, lactulose, mannitol, sucralose) were performed before and after CPB in different patients. Enzyme-linked immunosorbent assay of plasma levels of endotoxin core antibodies (EndoCAb) were performed peri-operatively. The functional mucosal surface was calculated from the amount of mannitol absorbed from the GI tract. Lower urine concentrations of absorbed mannitol were observed pre-operatively in patients developing MOD. In binary logistic regression this was an independent parameter. Decreased plasma concentrations of EndoCAb after surgery were seen in every patient, but were more significant in patients developing MOD. A reduced pre-operative functional mucosal surface may predict the early occurrence of MOD after surgery.
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Affiliation(s)
- J P Braun
- Department of Anesthesiology and Intensive Care, Charité Campus Mitte and Charité Virchow Klinikum, Charité Universitätsmedizin, Berlin, Germany.
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Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Grosse J, Schirmer U. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand 2007; 51:347-58. [PMID: 17096667 DOI: 10.1111/j.1399-6576.2006.01190.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In Germany, more than 100,000 patients are monitored and treated in 80 intensive care units (ICUs) following cardiac surgery each year. The controversies concerning the different methods of hemodynamic monitoring and the appropriate agents for volume therapy and inotropic support are well known. However, little is known about how monitoring and treatment are currently performed. METHODS A questionnaire with 39 questions was sent to the leading physicians of 80 ICUs in Germany, treating patients after cardiac surgery. The questions to be answered covered the current practice of hemodynamic monitoring, volume replacement, inotropic/vasopressor support and transfusions in patients after cardiac surgery. RESULTS Sixty-nine per cent of the questionnaires were completed and returned. All ICUs used basic monitoring as recommended by the societies. The use of advanced hemodynamic monitoring included the pulmonary artery catheter (58.2%), transesophageal echocardiography (38.1%) and transpulmonary dilution techniques (13%). Crystalloids (21.2%) and colloids (73%) were used for volume replacement. Epinephrine (41.8%) and dobutamine (30.9%) were the first-choice inotropic drugs for the treatment of low cardiac output syndrome, followed by phosphodiesterase inhibitors (14.5%). Second-choice drugs for the treatment of low cardiac output syndrome were enoximone (29%), milrinone (25%) and dobutamine (25%). A written transfusion protocol and a transfusion threshold for red blood cells existed in 59% and 79% of ICUs, respectively. CONCLUSION Hemodynamic monitoring and the variability in clinical practice with regard to volume replacement, transfusion triggers and the use of vasopressors/inotropes in cardiac surgery patients tend to follow the results of traditional experience rather than current scientific knowledge. Guidelines are therefore necessary to help to improve the standards of intensive care after cardiac surgery and thus the outcome of patients.
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Affiliation(s)
- M Kastrup
- Department of Anesthesiology and Intensive Care Medicine, Charité--Universitätsmedizin Berlin, Berlin, Germany
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24
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Saarento O, Kastrup M. An overview of the Nordic comparative study on sectorized psychiatry 1987 - 2000. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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25
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Martin J, Kuhlen R, Kastrup M, Schleppers A, Spies C. Die Standard-operating-procedures-Tauschbörse Anästhesiologie, Intensivmedizin, Schmerztherapie und Notfallmedizin. Anaesthesist 2005; 54:495-6. [PMID: 15785950 DOI: 10.1007/s00101-005-0843-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J Martin
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinik am Eichert, Göppingen.
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Braun JP, Döpfmer U, Kastrup M, Roots I, Borges A, Schneider M, Dohmen P, Kox W, Spies C. Levosimendan. Anaesthesist 2004; 53:163-7. [PMID: 14991194 DOI: 10.1007/s00101-003-0637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Levosimendan is a recently developed drug which is not yet approved for clinical routine use in Germany. The clinical use is limited to a few selected cases and it has been used as a salvage therapy in patients with severe heart insufficiency. As a potent inodilator it has been given to patients with severe heart failure, when all other therapeutic options have failed. However, in some European countries levosimendan is used in clinical routine situations and the European Society of Cardiologists has included the drug in their guidelines for treatment of acute heart failure. The following article describes the main pharmacological characteristics of levosimendan and summarises the indications for this new drug for physicians working in the field of anaesthesia or intensive care.
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Affiliation(s)
- J-P Braun
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Charité, Berlin.
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von Heymann C, Pruß A, Kastrup M, Marz S, Braun J, Kiesewetter H, Kox W, Spies C. Quality Management Regarding the Use of Blood Products with Special Respect to the Self-Inspection Program – a Report from a University Hospital. Transfus Med Hemother 2003. [DOI: 10.1159/000070548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
The study provides an overview of the historical aspects of multiaxial classification. Particular reference is paid to the multiaxial formats of ICD-10, DSM-IV and the WPA International Guidelines for Diagnostic Assessment (IGDA). The IGDA proposes a tetraaxial format with quality of life as one axis as well as an axis on symptomatology, an axis on adaptive functioning and an axis on environmental/psychosocial conditions. The axis on quality of life is added in recognition of the increasing importance placed upon the patient's perception of his/her capacity of self fulfillment and the attention paid to quality of life as a major descriptor of health status as well as an outcome measure of clinical care.
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Kastrup M. Psychiatric services to traumatized populations. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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30
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Beck DH, Schenk MR, Kastrup M, Schoeffel C, Kox WJ. Rectal and oral acetaminophen. Acta Anaesthesiol Scand 2001; 45:519. [PMID: 11300395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
The Geneva Declaration of 1948 states that doctors shall not permit considerations of religion, nationality, race, party politics or social standing to intervene between their duty as a doctor and their patients. They shall not use their medical knowledge contrary to the laws of humanity. The UN Principles of Medical Ethics also reminds doctors that their professional relation to persons deprived of their liberty is solely to evaluate, protect or improve their health. Similarly, the Hawaii Declaration from 1983 and the Madrid Declaration from 1996 outline the ethical duties of the psychiatric profession. Thus, there is no doubt as to the professional role as it is delineated in the medical ethics codes. The presence of such codes is, however, only one of the necessary steps to prevent the abuse of psychiatry; others include educational interventions or the establishment of international networks.
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Affiliation(s)
- M Kastrup
- Rehabilitation and Research Center for Tortured Victims, Copenhagen, Denmark
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Affiliation(s)
- T Wenzel
- World Psychiatric Association Section on Psychological Consequences of Torture and Persecution, Vienna, Austria
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33
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Saarento O, Oiesvold T, Sytema S, Göstas G, Kastrup M, Lönnerberg O, Muus S, Sandlund M, Hansson L. The Nordic Comparative Study on Sectorized Psychiatry: continuity of care related to characteristics of the psychiatric services and the patients. Soc Psychiatry Psychiatr Epidemiol 1998; 33:521-7. [PMID: 9803819 DOI: 10.1007/s001270050089] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The problem addressed in this paper is how continuity of care is related to characteristics of psychiatric services, previous events in a patient's pattern of care and patient characteristics. The present paper is a part of a Nordic Comparative Study on Sectorized Psychiatry in seven catchment areas in four Nordic countries. One-year-treated-incidence cohorts were used. Each patient was followed for 1 year after the first contact with the psychiatric service. Continuity of care was measured by the time from discharge from hospital to the first subsequent day-patient or outpatient contact. Notable findings were large differences in the continuity of care in the seven services, high proportions of discharges without any aftercare contacts and long time lags between discharges and aftercare contacts in most of the catchment areas. A Cox regression analysis revealed that aftercare following hospitalisation seems to be more probable if the outpatient services are located geographically close to the patients, if the hospitalisation lasted between 2 and 4 weeks, if there was a community care contact shortly before the hospital admission and if the patient is not retired and not divorced. Staff resources were not related to continuity of care.
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Affiliation(s)
- O Saarento
- Department of Psychiatry, University of Oulu, Finland.
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Saarento O, Kastrup M, Lönnerberg O, Göstas G, Muus S, Sandlund M, Oiesvold T, Hansson L. The Nordic Comparative Study on Sectorized Psychiatry: patients who use only psychiatric in-patient care in comprehensive community-based services--a 1-year follow-up study. Acta Psychiatr Scand 1998; 98:98-104. [PMID: 9718234 DOI: 10.1111/j.1600-0447.1998.tb10049.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the present paper a sample of patients using psychiatric in-patient care only is characterized and analysed with regard to characteristics of the psychiatric services. This paper forms part of the Nordic Comparative Study on Sectorized Psychiatry, designed to investigate contact rates and use of psychiatric care by new patients in 7 catchment areas in 4 Nordic countries during a 1-year follow-up. One-year treated incidence cohorts were used. The logistic regression analysis revealed that the variable 'psychiatric service' was one of the statistically significant determinants of using only in-patient care during the follow-up. The diagnostic groups with the highest probability of using only in-patient care were dependencies and functional psychoses. The following factors were associated with a high risk of using only in-patient care: older age, being referred by another psychiatrist, having received previous psychiatric in-patient care, male sex, being retired, and not living with one's parents or a partner. Patients who used only in-patient care had fewer admissions and days in in-patient care than others during the 1-year follow-up period. Lack of 24-hour emergency services in out-patient care correlated positively with the use of only in-patient care.
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Affiliation(s)
- O Saarento
- Department of Psychiatry, University of Oulu, Finland
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Kastrup M, Aadamsoo A, Subilia L, Gluzman S, Wenzel T. Environmental Stress Factors in the Treatment of Torture Survivors. Eur Psychiatry 1997. [DOI: 10.1016/s0924-9338(97)80370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kastrup M, Aadamsoo A, Subilia L, Gluzman S, Wenzel T. The Victims of Persecution and Torture: The Tactics of the Treatment in Western and Eastern Europe. Eur Psychiatry 1997. [DOI: 10.1016/s0924-9338(97)80372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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Kastrup M, Aadamsoo A, Subilia L, Gluzman S, Wenzel T. Factors of Significance in the Treatment of Victims of Persecution and Torture. Eur Psychiatry 1997. [DOI: 10.1016/s0924-9338(97)80368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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38
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Janca A, Kastrup M, Katschnig H, López-Ibor JJ, Mezzich JE, Sartorius N. The World Health Organization Short Disability Assessment Schedule (WHO DAS-S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders. Soc Psychiatry Psychiatr Epidemiol 1996; 31:349-54. [PMID: 8952375 DOI: 10.1007/bf00783424] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The World Health Organization Short Disability Assessment Schedule (WHO DAS-S) is an instrument for clinicians' assessment and rating of difficulties in maintaining personal care, in performing occupational tasks and in functioning in relation to the family and the broader social context due to mental disorders. The WHO DAS-S was developed and underwent preliminarily testing in the context of two international field trials of the multiaxial presentation of ICD-10 for use in adult psychiatry. The instrument was found to be useful, user-friendly and reasonably reliable for use by clinicians belonging to different schools of psychiatry and psychiatric traditions. Further work on the WHO DAS-S should include development of national adaptations of the instrument, studies of concurrent validity of the instrument and modification of the instrument to accommodate changes in the next edition of the International Classification of Impairments, Disabilities and Handicaps (ICIDH).
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Affiliation(s)
- A Janca
- Division of Mental Health and Prevention of Substance Abuse, World Health Organization, Geneva, Switzerland
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Saarento O, Hansson L, Sandlund M, Göstas G, Kastrup M, Muus S, Nieminen P, Zandrén T, Oiesvold T. The Nordic comparative study on sectorized psychiatry. Utilization of psychiatric hospital care related to amount and allocation of resources to psychiatric services. Soc Psychiatry Psychiatr Epidemiol 1996; 31:327-35. [PMID: 8952372 DOI: 10.1007/bf00783421] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As a part of a Nordic comparative study on sectorized psychiatry, utilization of inpatient care was related to resources and dynamic qualities of psychiatric services in seven catchment areas in four Nordic countries. One-year treated incidence cohorts were used. Each patient was followed for 1 year after first contact with the psychiatric service. Data were collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in inpatient care. Findings gave some support to the earlier reports that the utilization of inpatient care is determined by the supply of available beds. Highly staffed community services did not themselves reduce the use of inpatient services, but availability of day care services seemed to reduce utilization of inpatient care among psychotic patients.
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Affiliation(s)
- O Saarento
- Department of Psychiatry, University of Oulu, Finland
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Janca A, Kastrup M, Katschnig H, López-Ibor JJ, Mezzich JE, Sartorius N. Contextual aspects of mental disorders: a proposal for axis III of the ICD-10 multiaxial system. Acta Psychiatr Scand 1996; 94:31-6. [PMID: 8841674 DOI: 10.1111/j.1600-0447.1996.tb09821.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
After several years of development and testing, the World Health Organization (WHO) has recently completed work on the multiaxial presentation of ICD-10 for use in adult psychiatry. Axis III of the ICD-10 multiaxial system is intended for clinicians' reporting of contextual factors which may influence the diagnosis, treatment or prognosis of mental disorders that are recorded on Axis I. It was tested in two WHO-co-ordinated international field trials and found to be user-friendly, reasonably reliable and useful in routine clinical work, in the training of mental health professionals and in research on mental disorders.
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Affiliation(s)
- A Janca
- Division of Mental Health, World Health Organization, Geneva, Switzerland
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Hansson L, Oiesvold T, Göstas G, Kastrup M, Lönnerberg O, Saarento O, Sandlund M. The Nordic comparative study on sectorized psychiatry. I. Treated point prevalence and characteristics of the psychiatric services. Acta Psychiatr Scand 1995; 91:41-7. [PMID: 7754785 DOI: 10.1111/j.1600-0447.1995.tb09740.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Comparative studies relating characteristics of psychiatric services to rates of treated prevalence are scarce. As part of a Nordic comparative study on sectorized psychiatry, a point-prevalence study was performed in 5 sectorized psychiatric services with comprehensive service facilities for a defined population under responsibility. The rates of treated prevalence on a census day were related to a number of characteristics of the respective services and to accessibility of care. The results showed a great variation in one-day point prevalence in the 5 services, with almost fourfold differences. There were also marked differences in the diagnostic distribution of the cohorts. A positive correlation was found between number of beds and point prevalence, measured both as total point prevalence and impatient prevalence. The rates of beds and psychiatrists were most strongly related to the prevalence of patients with organic disorders and functional psychoses. A closed referral system was associated with a lower level of treated prevalence.
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Affiliation(s)
- L Hansson
- Department of Psychiatry, University of Lund, Sweden
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Abstract
General health assessment of refugees claiming to have been previously exposed to torture takes place in a psychological atmosphere affected by the difficult situation of the refugee. Thirty-one refugees, mainly from the Middle East and Africa, were assessed as regards their physical and mental health. Assessment took place with the help of professional interpreters and was, during each interview, performed by two medical doctors using double-blind techniques. Based on a number of highly significant (P < 0.001) correlation coefficients and Kappa values, observers agreed frequently on gradients of symptom intensity and less frequently on absolute symptom levels. However, agreement was almost complete when assessing the presence of intense symptoms and the absolute absence of a symptom. Symptom patterns were demonstrated to be consistent, clinically interpretable and, furthermore, closely associated (P < 0.0001) with self-reported global (general) health. Reliability was moderate with respect to clinical observation during interview.
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Affiliation(s)
- H D Petersen
- Amnesty International Medical Group, Copenhagen, Denmark
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Abstract
The electronic part of the nationwide Danish Psychiatric Central Register is now almost 25 years old. In this period it has proved its high value in administration, planning, treatment of patients, and not least in psychiatric research. Due to its national coverage, the register makes it easy to conduct epidemiological studies, such as analysis of trends, register linkage research, identification of representative cohorts for further analysis and follow-up studies of clinically identified cohorts. After many years of political turmoil, the register now seems to have assumed a more reasonable form, making allowance for both research interest and data protection. A proposed directive on the protection of medical data from the European Community may be a serious threat to the register and will probably eliminate all epidemiological and clinical research based on registers.
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Affiliation(s)
- P Munk-Jørgensen
- Institute of Psychiatric Demography, Aarhus Psychiatric Hospital, Risskov, Denmark
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45
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Lindegaard K, Goetz P, Kastrup M. [District psychiatry. Consumer education]. Sygeplejersken 1990; 90:22-4, 30. [PMID: 2089680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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46
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Kørner A, Nielsen BM, Eschen F, Møller-Madsen S, Stender A, Christensen EM, Aggernaes H, Kastrup M, Larsen JK. Quantifying depressive symptomatology: inter-rater reliability and inter-item correlations. J Affect Disord 1990; 20:143-9. [PMID: 2148329 DOI: 10.1016/0165-0327(90)90128-u] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study an evaluation of the inter-rater reliability of the Hamilton Depression Rating Scale, the Melancholia Scale and the Montgomery-Asberg Depression Rating Scale has been carried out. Furthermore, the inter-item correlations of these scales have been investigated in relation to diagnostic ratings. It was found that the quantitative scales had satisfactory inter-rater relationship. Only low agreement was found between the quantitative and diagnostic scales, as expected, while there was high agreement between the quantitative scales. The relevance of introducing new scales and the definition of major depression are discussed.
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Affiliation(s)
- A Kørner
- Psychiatric Department, Frederiksborg General Hospital, Hillerød, Denmark
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Hjortsø S, Butler B, Clemmesen L, Jepsen PW, Kastrup M, Vilmar T, Bech P. The use of case vignettes in studies of interrater reliability of psychiatric target syndromes and diagnoses. A comparison of ICD-8, ICD-10 and DSM-III. Acta Psychiatr Scand 1989; 80:632-8. [PMID: 2618785 DOI: 10.1111/j.1600-0447.1989.tb03036.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study is part of the ICD-10 field trials in which the use of case vignettes for interrater agreement has been examined. From our electronic database of 880 consecutively admitted inpatients we selected 24 cases that were transcribed to vignettes covering the first 5 ICD-10 target syndrome of dementia, substance use disorders, schizophrenia, mood and anxiety disorders. ICD-10 was compared with ICD-8 and DSM-III. The results showed that all 3 standard classification systems obtained an acceptable interrater agreement. Among the diagnoses, depressive disorders gave rise to most disagreement between the raters. Discrepancies between the methods of measuring interrater agreement were found when intraclass reliability was compared with consensus calculations for the individual patient.
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Affiliation(s)
- S Hjortsø
- Department of Psychiatry, Frederiksborg General Hospital, Hillerød, Denmark
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48
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Kastrup M. [Suitable for the death penalty]. Sygeplejersken 1989; 89:22-3. [PMID: 2623563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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49
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Abstract
Mentally ill people are not to be judged by the same rules as the mentally fit. Prisoners evaluated medically unfit for execution must undergo psychiatric treatment until their mental health is restored. Psychiatrists are placed in an ethical dilemma when asked to judge the mental health of prisoners on death row. A high prevalence of psychiatric and neurological disorders are reported on death row. Health professionals have an important role in implementing codes of ethics prohibiting any involvement in the execution process. Resolutions have already been passed by several associations including the World Medical Association, the American Psychiatric Association and Nordic medical associations.
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Abstract
A nation-wide cohort of all first admitted patients to all Danish psychiatric institutions over a 1 year period and aged 15 years or more was followed for 10 years in the Danish psychiatric register. Revolving door patients were defined as patients with a minimum of four admissions and 1) no admission or discharge period lasting for more than 1/4 of the observation period or 2) at least four admissions over the first 1/4 of the observation period. The revolving door population comprised 1,397 patients with an incidence rate of 0.42 males and 0.32 females per 1,000. Forty-three point five percent belonged to the same diagnostic group at first and last diagnostic assessment ranging from 28.3% in "organic psychosis" to 57.6% in "neurosis". A multiple contingency analysis showed a number of variables at first admission significantly associated with the outcome "revolving door". Many were conditioned by others and the independent variables were "age group", "main diagnosis" and "sex". Patients aged 15-24 years constituted a high risk group among schizophrenics. The 15-24 age group was further at high risk among females with personality disorder or abuse and males with manic depressive and psychogenic psychosis. Living close to a psychiatric institution was in males associated with the outcome independently of age and diagnosis, in females it was restricted to personality disorder. Revolving door patients were significantly younger than others and more likely to suffer from schizophrenia or alcohol/substance abuse.
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Affiliation(s)
- M Kastrup
- Institute of Psychiatric Demography, Risskov, Denmark
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