A Prospective Study of the Relationship between Medical Knowledge and Professionalism among Internal Medicine Residents

Background: Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized in internal medicine departments could help better prognosticate patients in the realm of internal medicine. Methods: During a 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood alanine-amino transferase (ALT) activity, and mid-arm muscle circumference (MAMC) measurements. Results: We recruited 980 consecutive patients upon hospital admission (median age 72 years (IQR 65–79); 56.8% males). According to the FRAIL questionnaire, 106 (10.8%) patients were robust, 368 (37.5%) pre-frail, and 506 (51.7%) were frail. The median ALT value was 19IU/L (IQR 14–28). The median MAMC value was 27.8 (IQR 25.7–30.2). Patients with low ALT activity level (<17IU/L) were frailer according to their FRAIL score (3 (IQR 2–4) vs. 2 (IQR 1–3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30 days readmission in the whole cohort was 17.4%. Frail patients, according to the FRAIL score (FS), had a higher risk for 30 days readmission (for FS > 2, HR = 1.99; 95CI = 1.29–3.08; p = 0.002). Frail patients, according to low ALT activity, also had a significantly higher risk for 30 days readmission (HR = 2.22; 95CI = 1.26–3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥4 days (for FS > 2, HR = 1.87; 95CI = 1.39–2.52; p < 0.001). Frail patients, according to low ALT activity, were also at higher risk for LOS ≥4 days (HR = 1.87; 95CI = 1.39–2.52; p < 0.001). MAMC values were not correlated with patients’ LOS or risk for re-admission. Conclusion: Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

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Factors Associated with Pathological Dissociation in the General Population

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2005.01586.x ◽

2005 ◽

Vol 39 (5) ◽

pp. 387-394 ◽

Cited By ~ 61

Author(s):

Päivi Maaranen ◽

Antti Tanskanen ◽

Kirsi Honkalampi ◽

Kaisa Haatainen ◽

Jukka Hintikka ◽

...

Keyword(s):

Alcohol Consumption ◽

General Population ◽

Prospective Study ◽

Population Sample ◽

Dissociative Experiences Scale ◽

Factors Associated ◽

Dissociative Experiences ◽

A Prospective Study ◽

Prospective Study Design ◽

The Relationship

Objective: This study assessed the prevalence of pathological dissociation in the general population, and the relationship between pathological dissociation and sociodemographic and several psychiatric variables. Method: The stratified population sample consisted of 2001 subjects. The study questionnaires included the Dissociative Experiences Scale, the Dissociative Experiences Scale-Taxon, the Toronto Alexithymia Scale, the Beck Depression Inventory, and sociodemographic background. Results: The prevalence of pathological dissociation (DES-T ≥ 20) was 3.4% in the general population and did not differ significantly between genders. Men scored higher than women in the amnesia subscale, and women in the absorption and imaginative involvement subscale. The relationship between pathological dissociation, alexithymia, depression and suicidality was strong. The likelihood of pathological dissociation was nearly nine-fold higher among depressive subjects, more than seven-fold higher among alexithymic subjects, and more than four-fold higher among suicidal subjects than among the others. Frequent alcohol consumption also associated significantly with pathological dissociation. Conclusions: A significant relationship between pathological dissociation, depression, alexithymia, and suicidality was found in the general population. The importance of these factors should be examined in a prospective study design to determine causality.

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