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Biomedical subjects

J F Borus

Publications and source records attributed to J F Borus.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1984

Strangers bearing gifts: a retrospective look at the early years of community mental health center consultation.

Many early community mental health center (CMHC) consultations floundered when consultants attempted to apply Gerald Caplan 's community consultation theory, which the author describes as based on a private consultation paradigm, to the very different realities of government-mandated public paradigm consultation by CMHCs to public agencies. CMHC consultants were often perceived by consultees as "strangers bearing gifts" due to the lack of clarity concerning the rationale, contracts, roles, responsibilities, evaluation, and consultant- consultee exchanges of their public paradigm consultations. The otherwise disastrous recent losses of financial support for CMHCs are beneficially forcing them to shift their community consultation practices toward the private paradigm.

Catchment Area, Health↗
PubMed1983

Teaching residents the administrative aspects of psychiatric practice.

As the trend toward the organization and bureaucratization of professional practice increases, psychiatrists will require a better understanding of the administrative aspects of their practice. However, a survey of the American Association of Directors of Psychiatric Residency Training indicated that less than one-third of residency programs currently require core training in this area. The author presents a curricular blueprint that specifies learning objectives and a series of graduated training experiences over the course of residency in which essential teaching about the administrative aspects of psychiatric practice can be provided.

Curriculum↗
PubMed1982

Teaching psychosocial issues to medical house staff: a liaison program on an oncology service.

In a one-year controlled study, the authors assessed the impact of an active consultation-liaison teaching program on the attitudes of medical house officers toward psychosocial issues related to the care of oncology patients, consultation-liaison psychiatry, and its importance for them and their patients. Fifty medical interns, residents, and fellows, divided into a test group (N = 25) and a control group (N = 25), were followed during a one year period. A 52-item questionnaire was administered to test group subjects before and after a one- to two-month clinical rotation on the hematology/oncology service, and to the control group members at similar intervals. After their experience with consultation-liaison psychiatry, the test group members showed a significant positive change in the importance they placed upon psychiatric consultations, case presentations and the role of psychiatrists in the development of their attitudes toward the psychological care of cancer patients. The house officers also recorded significant positive changes in their attitudes toward the effectiveness and role of the consultation-liaison service in educating and assisting them in learning more about psychosocial issues. The control group demonstrated no significant change.

Attitude of Health Personnel↗
PubMed1982

The transition to practice.

Sixty-eight graduating resident physicians were interviewed during their final months of training to investigate the process and problems of selecting a practice after years of tightly structured medical education. The practice choice decision-making process commonly followed this sequence of steps: (a) acknowledging and undertaking the practice choice task; (b) defining personal, professional, and family issues; (c) establishing reward priorities and minimal requirements; (d) determining a professional presentation; (e) inquiring about practice opportunities in the professional market; (f) interviewing; (g) negotiating; (h) committing to a practice; (i) preparing for practice; and (j) using decision facilitators. The young physicians reported a characteristic pattern of affective reactions (for example, distressing anxiety when faced with the practice choice task; depression when forced to compromise among conflicting professional aspirations, personal needs, family expectations, and practice rewards; and a feeling of reconsolidation and growth upon commitment to a particular practice) accompanying the practice choice process.

Adult↗
PubMed1982

Consumer evaluation of a community mental health service, I: care delivery patterns.

There is a need for improved evaluation of community mental health services. The authors present a multidimensional consumer evaluation of the delivery system aspects of services provided at a community-run health center. The findings demonstrate that consumer evaluations can provide meaningful data to administrators concerning the ongoing delivery of care and can help them plan patterns of practice for the future.

Attitude to Health↗
PubMed1982

Training supervision as a separate faculty role.

Training supervision is a longitudinal, nonclinically focused personal relationship between a faculty member and a resident for exploring the latter's professional development. In the authors' program the training supervisor meets with the supervisee monthly over the 3-year residency. The training supervisor's role is that of a nonevaluative senior colleague who orients and advises the resident and systematically reviews training progress and problems. The authors discuss the evolution of the training supervision concept, explore potential role conflicts for the training supervisor, who may serve other functions in the residency of the supervisee, and present positive and negative resident and faculty evaluations of their program.

Adult↗
PubMed1982

Changes in children's behavior after a natural disaster.

Five months after a severe winter storm, a survey of children whose behavior had been assessed by means of a parent rating scale during a Head Start program 6 months before the disaster showed that some problem-behavior scores had increased significantly. The subgroups of children at higher risk were boys, whose Anxiety scale scores increased, and children accepted for Head Start only because their parents said they had special needs, whose Aggressive Conduct scale scores increased. For the entire group of children, school behavior improved. The findings support previous impressions that parents deny their children's problems after a natural disaster.

Aggression↗
PubMed1979

Psychotherapy in the goldfish bowl: the role of the indigenous therapist.

The therapeutic advantages and liabilities that accrue to the indigenous therapist (be he professional or paraprofessional) because of the indigenous state were explored, utilizing the five-year experience of ten indigenous therapists in Boston's North End. The current and historical proximity of therapists who live in the same neighborhood as their patients do provides both with increased access to, longitudinal knowledge about, and a blurred role concept of the other that may help or hinder the therapeutic process. Similarities in culture and values can foster alliance formation, differentiation of psychopathology, and therapeutic interventions, but also may interfere when therapy abuts culturally shared blind spots. These data are relevant to the private general psychiatrist as an indigenous therapist in non-metropolitan America.

Allied Health Personnel↗
PubMed1979

Psychiatrists and primary physicians: collaborative learning experiences in delivering primary care.

Psychiatric and primary care residents can benefit from taking part of their training together in a primary care setting such as a neighborhood health center or a health maintenance organization. The training in such organized settings can best focus on the comprehensive appraisal of patients' multiple health, mental health, and health-related social service needs; the coordination of care to devise nonfragmented treatment plans for multi-problem patients; the effective collaboration between health generalists and mental health specialists; and the efficient use of limited resources to meet a population's health care needs. Such a coordinated training experience also helps overcome interprofessional antagonisms that often inhibit collaboration between psychiatrists and other physicians.

Community Health Centers↗