Personality and risk of hospital diagnosed mental disorder: a 35 years' prospective study.

PURPOSE: The present study examined the prospective association of neuroticism, extraversion and psychoticism with risk of hospital diagnosed mental disorder, examining intelligence as a potential confounder of this association. METHODS: A total of 1118 Danish men and women completed the Eysenck personality questionnaire at the mean age of 27 years. Information on psychiatric diagnoses was obtained by linking the study population to the national Danish psychiatric registers, and risk of diagnoses associated with each personality trait was examined using multiple Cox regression in models including the three personality traits unadjusted and adjusted for intelligence. Participants with diagnosis from a psychiatric department prior to the personality assessment were excluded. RESULTS: In total, 122 participants were diagnosed with a mental disorder during follow-up. Neuroticism significantly predicted risk of anxiety-, adjustment-, personality- and alcohol and substance abuse diagnoses. Extraversion did not significantly predict any diagnosis type, while psychoticism predicted a combined category of mood and anxiety diagnoses. Despite intelligence being a significant predictor of the majority of the included diagnoses, adjusting for intelligence did not substantially influence any trait-disorder associations. CONCLUSION: The results confirm high neuroticism as a prospective vulnerability factor for mental disorder and indicate high psychoticism to be a potential risk factor for mood and anxiety disorders. These associations are not confounded by intelligence.

Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study.

BACKGROUND: Efforts to optimize the peri-operative care of hip fracture patients through multidisciplinary intervention have focused on orthopaedic-geriatric liaisons, which have not resulted in significant outcome changes. The early phase of rehabilitation could potentially be optimized through a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons. METHODS: During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing on all facets of peri-operative care. Two hours were allotted to rounds in the 14-bed unit. One hundred and twenty-six consecutive patients admitted to the unit in 2003, receiving the same well-defined care programme, were chosen as a control group. Outcome measures were morbidity and the need for visits by external specialists. RESULTS: The intervention group received 291 rounds by anaesthesiologists. Active therapeutic interventions were prescribed in 76% of all patient confrontations. The control group received 128 requested visits from internal medicine specialists, which was reduced to 50 in the intervention group (P = 0.02). There was no significant difference between post-operative morbidity and hospital stay in the control and intervention groups; in-hospital mortality was 12% in the control group and 7% in the intervention group (P = 0.24). The rounds by anaesthesiologists improved nursing care conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome aspects, providing anaesthesiological rounds 7 days per week.

Lack of postoperative pain relief after hysterectomy using preperitoneally administered bupivacaine.

BACKGROUND AND OBJECTIVES: It is well known that wound infiltration with local anesthetic can reduce postoperative pain in various degrees and with very few side effects. A previous study showed better analgesic effect when local anesthetic was applied in the subfascial, rather than the subcutaneous, layer. The present study investigated the effect of frequent bolus injections of bupivacaine (15 mL 2.5 mg/mL) preperitoneally through catheters placed intraoperatively in women who had undergone hysterectomy. METHODS: Postoperative pain and analgesic requirements were studied in a double-blind randomized trial including 41 patients. During surgery, the patients were randomized to one of two groups, and the investigators were blinded. Prior to closure of the peritoneum, the surgeon placed a catheter between the muscle layer and the peritoneum on each side of the wound. One group (n = 22) received bupivacaine (15 mL 2.5 mg/mL) every 4 hours for 48 hours via each catheter starting in the operating room. The placebo group (n = 19) received saline in a like manner. Postoperative pain was evaluated using a visual analog scale (VAS) and verbal rating scale (VRS) twice a day for 2 days at rest and on movement. Requirements of supplementary analgesics were monitored, as was wound infection after discharge. RESULTS: Bupivacaine administered preperitoneally did not improve analgesia at rest, during coughing, or during mobilization compared with saline. No difference between the groups was found regarding analgesic requirements. No complications of postoperative wound healing or toxic side effects were seen. CONCLUSION: Bolus injections of bupivacaine through intraoperative placed catheters did not improve analgesia postoperatively compared with saline injections.