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Biomedical subjects

J F Borus

Publications and source records attributed to J F Borus.

At least 19 recordsLinked to original sources
PubMed1989

Child psychiatry fellowship training: a crisis in recruitment and manpower.

Eighty-three percent (104 of 126) of the accredited child psychiatry fellowships in the United States responded to a survey of current manpower and training problems facing child psychiatry. Thirty-five percent of the respondents were having trouble filling their classes with highly qualified fellows, and 45% were having difficulty recruiting faculty child psychiatrists. Other significant problems included developing faculty interest in research, providing didactic seminars in new areas such as developmental neurobiology and infant psychiatry, and funding fellow and faculty positions and research. The authors examine this crisis in manpower, recruitment, and training and suggest solutions on local and national levels.

Accreditation↗
PubMed1988

Primary health care providers' recognition and diagnosis of mental disorders in their patients.

Primary care physicians and nurse practitioners are the initial casefinders of mental health problems and major providers of mental health treatment in the United States. However, past studies suggest that such primary care providers often neither recognize nor correctly diagnose their patients' mental disorders. This study compared an HMO's primary providers' direct assessments of the current emotional disorders of patients just seen for an outpatient medical visit with those of mental health professionals assessing the same patients with the Structured Clinical Interview for DSM III R (SCID). Using the SCID-derived diagnosis as the standard, the primary providers failed to recognize almost two-thirds of their patients with a current mental disorder. Although confident in their assessments, the primary providers were also able to correctly identify very few of the specific mental disorders most prevalent in primary medical care practice; they identified only one of the seven depressions, three of the 18 anxiety disorders, and none of the four alcohol or drug abuse disorders. Reasons for these diagnostic discrepancies, comparisons with past studies, and training to improve primary providers' diagnosis of mental disorders in their patients are discussed.

Affective Symptoms↗
PubMed1988

Developing minimal national standards for clinical experience in psychiatric training.

There are no minimum standards for the clinical training of psychiatrists with regard to the type and number of patients evaluated or treated. Interest in establishing such standards derives from a need for greater accountability, a high fail rate on the clinical portion of the American Board of Psychiatry and Neurology examinations, and an increasing demand for precise documentation of competence in specific areas by hospital privileging committees. Although considerable disagreement exists as to what the overall requirements should be, some minimum requirements can be agreed on. The authors discuss concerns about minimal standards and make suggestions for further development of standards.

Clinical Competence↗
PubMed1987

Performance of screening and diagnostic tests. Application of receiver operating characteristic analysis.

Evaluation of psychiatric screening and diagnostic tests has benefited from the application of sensitivity, specificity, the kappa-statistic, and predictive values. These measures derive their meaning from a single criterion threshold. Receiver operating characteristic (ROC) analysis extends assessment of test performance by providing information about all possible pairs of achievable sensitivity and specificity values. The ROC analysis offers a comprehensive means for comparing different tests or different scoring procedures for one test. As a demonstration we used the ROC analysis to evaluate three types of scoring rules for one psychiatric test, the Health Opinion Survey. The demonstration indicated that ROC analysis can profitably take a place among the standard methods for test evaluation in psychiatric research. In addition, ROC analysis can assist clinicians in selecting appropriate test procedures for particular patient populations.

Borderline Personality Disorder↗
PubMed1987

The influence of newspaper reports on outbreaks of mass hysteria.

A previous study suggested that newspaper reports contributed to the generation and propagation of a recent epidemic of "mysterious gas poisoning" among Arab schoolgirls. To further explore the role of the press in mass hysteria, the authors reviewed newspaper reports related to two separate outbreaks of hysteria among schoolchildren. Despite extensive coverage of both epidemics, only one questionably related new outbreak and no relapses of illness in the original settings occurred following these reports. The variable influence the media may have on mass hysteria and the multitude of other factors that can affect such outbreaks are discussed.

Child↗
PubMed1987

Substance use, eating behaviors, and social impairment of medical students.

Self-report instruments assessing substance use, eating behaviors, social adjustment, and depression were distributed to all 329 first- and second-year medical students at a private northeastern university. Two-hundred students (61 percent) completed the questionnaires. Thirty-five students (17.5 percent) were found to be at risk for substance (alcohol and psychoactive drugs) abuse, of whom 13 were found to be at high risk. Thirty-three students (16.5 percent) were found to be at risk for an eating disorder, of whom only one was at high risk. Risk for eating disorders was greater for the female students, but risk for substance abuse was not related to gender. Psychosocial impairment and depression were associated with risk for either eating disorders or substance abuse.

Adaptation, Psychological↗
PubMed1987

Are we training too many psychiatrists?

In contrast to the past decade's concerns about an undersupply of psychiatric manpower, the authors point out that the profession may soon be facing the prospect of an oversupply of psychiatrists. Given the present rate of producing psychiatrists, shifts in demands for psychiatric services, changing payment and access patterns regarding specialty medical care, increasing numbers of nonpsychiatrist mental health professionals, and a probable surfeit of primary care physicians, underemployment of psychiatrists may become commonplace. Future psychiatrists will likely be used more as consultants, and the profession will need fewer, but better trained, graduates. The authors present alternative proposals to deal with service needs related to such reductions.

Community Psychiatry↗
PubMed1987

[Identifying mental health service needs of persons with schizophrenia].

The present study aimed to identify the needs and describe the use of twenty mental health services in a population of chronic schizophrenic patients living in two regions in Quebec (Estrie and Centre-Sud). An attempt was also made to determine the principal reasons for which some services were not being used when they were identified as clinically required. The population considered was composed of the patients (N = 88) who had been discharged from the psychiatric care units of five general hospitals over a period of five months in 1982, and for whom the attending psychiatrist could confirm with certainty a diagnosis of chronic schizophrenia in accordance with the criteria of DSM-III. Medical files of these patients were reviewed, and the patients and psychiatrists themselves were interviewed separately regarding the patients' needs and use of twenty mental health services over the period from the seventh to the twelfth month after discharge from hospital. Results of the study show that services which were most often identified as clinically required were: 1) taking of neuroleptics, 2) organization of leisure activities, 3) case management, and 4) individual supportive therapy. At the same time, results indicate a poor fit between needs and use for most of rehabilitation and psychosocial services. The main reasons for non-use of services which were identified as clinically required are also presented. The implications of these results for the organization of mental health services for persons suffering from chronic schizophrenia are discussed, especially the importance of case management services.

Adult↗
PubMed1986

A reexamination of the psychiatric resident's experience in the general hospital.

The authors discuss three phases of psychiatric residency training: the beginning psychiatry training syndrome, the professional and psychologic changes associated with the second year, and the senior resident year, characterized by transition to practice issues. Since most residency training experiences occur in general hospital settings, it is imperative that general hospital psychiatrists be aware of the professional and emotional changes that residents experience as they move from inpatient to outpatient settings and assume more administrative responsibilities in departments of psychiatry. The authors recommend preventive steps that residency training directors in general hospitals might take to reduce residents' adverse emotional responses to stresses associated with each training period in the general hospital.

Career Choice↗
PubMed1986

Ongoing evaluation in psychiatry: the first step toward quality.

Concern about quality control in psychiatric training has been heightened by the lack of standardized assessment within residencies to ensure that graduates reach a level of competence commensurate with the ability to practice independently and the high failure rate on the American Board of Psychiatry and Neurology examination. An APA task force explored the paucity of evaluation of both training programs and residents and made 10 recommendations for improving the quality of residency training. The authors describe the evaluative components of these recommendations and the political steps taken to gain professional consensus for their requirement in all training programs.

Accreditation↗
PubMed1985

The 'offset effect' of mental health treatment on ambulatory medical care utilization and charges. Month-by-month and grouped-month analyses of a five-year study.

The five-year ambulatory medical care experience of 400 patients with mental disorders was studied to test the "offset" hypothesis that patients receiving timely mental health specialist treatment have lower subsequent utilization of, and charges for, care than patients not receiving such specialist treatment. Specialist treatment was associated with significant offset savings in utilization and charges for the non-psychiatric medical care of treated patients with either severe or less severe mental disorders. However, the visits and charges for such specialist treatment boosted the overall (nonpsychiatric plus mental health specialist) care utilization and charges of the specialist-treated patients above those of patients treated solely by their nonpsychiatric physicians; this overall increase was especially pronounced for patients with severe mental disorders. The findings suggest the need for randomized prospective offset studies comparing utilization, cost, and clinical outcomes.

Ambulatory Care↗
PubMed1984

Marital and family therapy for troubled physicians and their families. A bridge over troubled waters.

Because individual therapy for troubled physicians has been notoriously difficult and often ineffective, we report our experience using a treatment--marital therapy--newly applied to such problems in the medical community. The sample involved 13 male physicians and their spouses with emotional difficulties in themselves and/or their relationships. After marital treatment, there was substantial improvement in more than 92% (12/13) of the physicians, their spouses, and/or their marital relationships.

Adult↗
PubMed1984

Consumer evaluation of a community mental health service, II: Perceptions of clinical care.

Using patient self-report and therapist questionnaires, the authors investigated the perceptions of patients at a community mental health service about several aspects of their clinical care: what they expected from treatment, what they found helpful about treatment, how they thought treatment could be improved, their therapist preferences, and their perceptions of their treatment outcome. The patients' desire for advice and the perceived helpfulness of the advice given in therapy, the patients' limited preference for a therapist of their own ethnicity, and other findings are discussed, as is the usefulness of such consumer evaluations in mental health care delivery.

Attitude of Health Personnel↗