Management of Serious Illness

This study examined the feasibility of a lifestyle physical activity and diet intervention designed to increase walking and decrease weight in a population of patients with serious mental illness. The researchers examined participant satisfaction, drop-out rates, and adherence to the walking program as well as health-related outcomes, including weight change, blood pressure, and mood.

The target population is thirty-nine individuals with depression or other serious mental illness who were recruited from three different mental health facilities to attend an 18-week lifestyle intervention program promoting physical activity and healthy eating.

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These individuals with serious mental illness are at high risk for chronic medical conditions, including diabetes and heart disease.

The intervention delivered consisted of nine 1-hour group sessions where in each session, participants discussed topics related to healthy lifestyle changes and participated quick warm-up followed by a group walk for 20 minutes.

The first six sessions were delivered weekly during the intensive phase of the intervention, while the final three sessions were delivered monthly during the follow-up and maintenance phase of the intervention, so that the total duration of the intervention was 18 weeks.

The findings from this study demonstrated that individuals who have depression and other serious mental illnesses can participate in a lifestyle intervention program and that they may loss weight over the course of the intervention. Hence, this study does provide evidence that lifestyle physical activity interventions targeting individuals with serious mental illness can be implemented and individuals may benefit from weight loss.

Article 2: Having a Parent With Cancer: Coping and Quality of Life of Children During

Serious Illness in the Family

This study has shown different ways of coping due to serious illness of a family member. It has shown how children’s reactions and management of such a difficult life event affect their quality of life. Specifically, how the cancer of a parent affects the children’s well-being or quality of life.

Young children, 7 to 12 years old who have a parent with cancer were the target population of this study.  The study used the explorative design, and data were collected through qualitative in-depth interviews with the children and their parents.

The researchers find out that the children in this study used various strategies including covering up difficult feelings, balancing information, and feeling good most of the time, and in light of theory on coping, it could be said that emotion-focused or dual-focused coping strategies dominated the picture.

Hence, by going “in and out” of the situation, both literally and emotionally, the children cope with the situation and maintain a balance in life.  So it may be concluded that the children, in general, report feeling good, but they put a lot of effort into it, and their quality of life is fragile. This study made us realized that it is important to be aware that the children’s well-being is especially vulnerable at the time of the diagnosis and when the illness situation changes.

Article 3: Acute Low Back Pain in the Emergency Department

This article discussed the historical and physical “red flags” that warrant a more detailed evaluation of this common chief complaint: acute low back pain.

There were no subjects in the study as it used a classic document from the National Guideline Clearinghouse from Agency for Healthcare Research and Quality (1994). Moreover, these guidelines were updated in 2004 by the Low Back Pain Guideline Team at the University of Michigan Health System.

The researchers presented how emergency department practitioners should carefully assess patients with low back pain and further evaluate those with “red flags” and refer as appropriate.  Further, this article has helped practitioners differentiate between common musculoskeletal low back pain and other more serious conditions. The treatment of common musculoskeletal acute low back pain for the patient discharged from the emergency department was also presented.

The article found out that history is the key to differentiating mechanical acute low back pain from more serious etiologies. The age, duration of pain, history of trauma, location and radiation of pain, systemic complaints, history of cancer, neurologic deficits, psychological and social risks, and functional pain are important considerations during history taking. Overall, this study is beneficial for the majority of the patients as that low back pain is just self-limiting or readily treatable condition.

Article 4:  General-Medical Conditions in Older Patients With Serious Mental Illness

This study assessed the prevalence of medical comorbidity in a large sample of patients diagnosed with serious mental illness and compared the prevalence of general-medical comorbidities between older (defined as ;=60 years old) and younger patients diagnosed with serious mental illness. We hypothesized that older patients would be more likely to be diagnosed with general-medical conditions than patients under age 60.

The researchers conducted a retrospective analysis of data from fiscal year (FY) 2001 (October 1, 2000 through September 30, 2001) from the National Patient Care Database (NPCD) of the Veterans Health Administration (VHA).

The NPCD includes all inpatient and outpatient encounters to the VHA, including primary care and specialty mental health outpatient and inpatient visits.  They included all patients with a diagnosis of any one of three serious mental illnesses (defined as schizophrenia, schizoaffective disorder, or bipolar disorder) in FY 2001.

This study found a substantial burden of medical comorbidity in patients diagnosed with serious mental illness. Moreover, older patients with serious mental illness, compared with their younger counterparts, were more likely to be diagnosed with cardiovascular, endocrine, or pulmonary conditions and were more likely to experience a greater burden of medical comorbidity overall.

Younger, compared with older patients with serious mental illness, were more likely to be diagnosed with hepatic or substance use disorders and accidents/injuries.

Based on the findings, assessing whether medical conditions are being adequately detected and treated in older patients with serious mental illness, and whether treatment models that integrate general-medical and psychiatric care could improve the quality of care for these patients, should be considered in future research endeavors.