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J J Strain

Publications and source records attributed to J J Strain.

At least 217 records · Page 12Linked to original sources
PubMed1987

Consortium-based consultation/liaison research: commentary and perspective.

Although a consortium approach for clinical trials is a common research strategy which has made important contributions in other disciplines in medicine, to date it has not been employed for research efforts in the consultation/liaison setting. There are several reasons for this: the relative newness of the field, lack of administrative control over patient care, and the unavailability of a standard methodology that could be adapted to multiple sites. Four basic research strategies can be employed within the framework of a research consortium to advance scientific knowledge in consultation/liaison psychiatry: 1) prevalence studies of psychiatric morbidity in medical settings; 2) interrelationship among psychiatric and medical conditions; 3) the outcome of psychiatric interventions within medical milieu; and, 4) cost-benefit evaluation. A field-tested computerized database protocol and a software system usable on an office-based microcomputer were employed to obtain standardized data across multiple training sites. The advantages and disadvantages of consortium studies are described.

Clinical Trials as Topic↗
PubMed1986

Psychiatric emergencies in the general hospital.

Using a psychiatric consultation data base, 1257 referrals were classified into "stat" (14%), "today" (44%), and "routine" (42%) status of urgency. "Stat" referrals compared to the "today" and "routine" group were more likely to be male, highly educated, and 20-39 years old or over 80 years of age. The "stat" group was referred more often for the management of behavior and suicide risk evaluation, and received more diagnoses of organic mental disorders than the other referrals. An increased number of "stat" patients required constant observation on the medical/surgical ward, narcotic or neuroleptic administration, and inpatient psychiatric treatment.

Emergencies↗
PubMed1986

The role of psychiatry in the training of primary care physicians.

The question of psychiatry's role in medicine, and in particular its role in the training of primary care physicians (PCPs), is heightened by the knowledge that 60% of the 15% of patients who have DSM-III diagnosable alcohol, drug abuse, and mental health (ADM) disorders are seen exclusively in the general health sector. In addition, although PCPs have a low recognition rate of ADM disorders and are pessimistic about their outcome even with treatment, they prescribe the majority of tricyclic and anxiolytic medications. Models of mental health training for PC residents in training are examined, with particular emphasis on competencies taught, pedagogic vehicles, disciplines of the mental health teacher, and the relationship to departments of psychiatry. A computerized approach to assist the mental health training of primary care physicians developed at the Mount Sinai School of Medicine and Northwestern is presented. Finally, critical policy issues with regard to psychiatry's future role in training is described.

Computers↗
PubMed1986

The problem of alcohol in the medical/surgical patient.

The authors report the results of a computerized data-based study of 845 general hospital patients seen by a consultation-liaison psychiatry service in a major urban hospital. The findings indicate that only 5.2% of the referrals were for the problem of alcohol. Furthermore, the detection rate of an alcohol problem by both the referring physicians and the psychiatric consultants was low (8.3%) as compared with the literature's reported prevalence rate of alcoholism in the general hospital (8.7%-55%). The problem of recognition of an alcohol problem in the medical/surgical patient is explored with particular emphasis on the obstacles to diagnosis--masking of alcoholism by other major psychiatric disease, the categorization of patients by symptom rather than underlying causation, and the lack of sufficient employment of useful diagnostic screening devices.

Adolescent↗
PubMed1986

Mental health education in three primary care specialties.

The authors used a questionnaire to examine the characteristics of the mental health components of residency training in traditional internal medicine, primary care internal medicine, and family practice. Traditional internal medicine programs relied almost exclusively on the consultation method and inpatient facilities, offered little formal instruction, used the psychiatrist as the primary teacher, and spent considerably less per resident for mental health training than the other programs. Psychologists and social workers as a group were the primary mental health teachers in family medicine residencies. Traditional internal medicine programs emphasized psychophysiological reactions and simple pharmacotherapy, while primary care internal medicine and family practice programs concentrated on life cycle issues, psychosocial awareness, and simple psychosocial management techniques. None of the three types of residencies focused on complex psychiatric disorders or management techniques. The three specialties differed significantly (F = 13, p = .0001) in the total amount of time on average the resident spent in formal mental health instruction. The need for evaluation of the outcome of training is also discussed.

Faculty, Medical↗
PubMed1985

A minicomputer approach to consultation-liaison data basing: Pedagog-Admin-CLINFO.

Minicomputer systems have been designed for researchers who have no prior computer experience and, therefore, require no computer training, that is, programming knowledge. Such systems allow immediate access to the data, their retrieval, reduction, and analysis, and the retention of direct control over the data base by the researcher. In addition, CLINFO offers a wide range of calculations and statistical procedures. The three-dimensional, time-oriented data-base format of CLINFO allows for a longitudinal study of a particular variable, and its repeated measure over time in the same patient. This system has been adapted for use in the consultation-liaison setting to provide pedagogic, research, and administrative functions from a field-tested data base.

Computers↗
PubMed1985

Microcomputers and consultation psychiatry in the general hospital.

The microcomputer allows for the design of a system that functions integrally with both the day-to-day and long-term needs of a consultation-liaison psychiatric service. This article describes a microcomputer system and data structure that can accomplish many of the same research tasks as a minicomputer system. In addition, the same data item inputs can be used to develop management reports that can facilitate the administrative as well as the pedagogic needs of a consultation-liaison service. Because of the daily availability and review of output reports, supervisors' corrections are made that enhance the reliability of the data. The program format provides 1) an intake form with pertinent identifying demographic data; 2) an activity file that contains every encounter between the consultant and the patient as well as research, supervisory, and liaison activities (which permit cost-effectiveness analysis); 3) a master clinical data base containing 255 variables for each case seen; 4) a computer-generated chart note; 5) letters to referring physicians; 6) clinical activity descriptions for billing; and 7) a file for pertinent literature searches. Since certain analyses may be limited in the microsystem, its interactive capacity with mainframe computers allows for complex functions. The microsystem described presently emphasizes flexibility, accessibility, and step-by-step development of files as needed by a particular consultation-liaison service. Finally, microcomputers are available at a fraction of the cost of the minicomputer or mainframe systems.

Adult↗
PubMed1985

Consultation-liaison psychiatry and cost-effectiveness research. A review of methods.

In light of the increasing emphasis on cost-effectiveness evaluations of consultation-liaison interventions, it becomes important for researchers to be cognizant of the available statistical methods. With this in mind, the present article reviews eight strategies of cost-effectiveness research and discusses their relative strengths and liabilities.

Cost Control↗
PubMed1985

Toward the integration of psychosocial services in the general hospital. The human services department.

This article describes an innovative administrative organization for the delivery of psychologic care in the contemporary teaching hospital that, by combining services under medical leadership, takes an evolutionary beyond multidisciplinary team approaches. The long-range goal of this organization is to provide cost-effective psychosocial services in the general hospital while maintaining the unique role contributions of the participating disciplines. To allow for informed decision making in this process, the initial step has been to establish a collaborative data base for patient and staff tracking, program planning, and evaluation.

Home Care Services↗
PubMed1985

Informed consent--mandating the consultation.

This article illustrates how a mandatory consult procedure identified treatable psychiatric problems. Using a computerized data-based format, 372 (37.4%) patients (the "judgment" group) of 996 psychiatric consultations were identified as referred to assess the patient's capacity to execute a consent form for a medical or surgical procedure. One hundred twenty-nine (35%) of the 372 patients thus referred by hospital mandate were given psychiatric diagnoses (DSM-II) by the consultant and received recommendations for primary psychiatric treatment. The "judgment" group had significantly more organic brain syndrome and psychoses associated with CNS conditions (p less than 0.001), whereas the "nonjudgment" group was diagnosed as exhibiting significantly more neurosis, alcoholism, psychophysiologic disorders, transient situational reactions, and personality disorders (p less than 0.001). Without a required psychiatric consultation sanctioned by administrative hospital mandate, the majority of the "judgment" cases with major psychopathology would not have been identified. The use of the mandated psychiatric consultation in the general hospital is discussed.

Aged↗
PubMed1985

Medical and surgical inpatients who referred themselves for psychiatric consultation.

Medical and surgical inpatients who referred themselves for psychiatric consultation are characterized. The 25 "self-referred" compared to 787 "others" referred to the Consultation-Liaison Psychiatry Division were more likely to state depression (52%/25%) and anxiety (36%/11%) as reasons for referral. "Self-referrals" were less likely to be referred by physicians for behavior management (8%/23%), general diagnosis (4%/22%) or suicide evaluation (4%/25%). The "self-referral" represents a challenge to the current medical model referral mechanism in which the physician controls access to consultants. The data indicate that there should be a mechanism for the patient's contribution to the referral process and that increased sensitivity to psychologic difficulties in coping with medical illness would improve the use of psychiatric consultation in the medical setting.

Adult↗
PubMed1985

L-tryptophan does not increase weight loss in carbohydrate-craving obese subjects.

Eight subjects, aged 26 to 50 years, who had long histories of carbohydrate (CHO) craving and were more than 45 kg above desirable body weight participated in a randomized, double-blind, crossover pilot study on the effects of L-tryptophan on weight loss and mood state. One g of tryptophan with 10 g of CHO was administered three times a day, 30 min before meals, as an adjunct to a weight-loss protocol that included nutritional consultation teaching low fat, high fiber diets ranging from 1200-1600 kcals/day, behavior modification, and supportive therapy. During the pretreatment period, body weight and plasma tryptophan levels were measured and the Beck Depression Inventory, SCL 90 rating, and Profile-of-Mood State (POMS) were used to assess mood. During the treatment periods, subjects kept daily records of food intake and the timing of medication. All patients were seen at least biweekly. After six weeks on medication, baseline measurements were repeated and the crossover between tryptophan and placebo was implemented. After an additional six weeks on placebo or tryptophan, the same measurements were repeated. For the eight patients who completed the three-month protocol, the mean weight loss for six weeks on placebo was 1.14 kg and for six weeks on tryptophan was 2.3 kg. Mean Beck scores were 8.8 during the control period, 8.3 on placebo, and 10.9 on tryptophan. Mean SCL 90 ratings were 69.2 during the control, 54.6 on placebo, and 64.2 on tryptophan. Mean scores for total mood disturbance on the POMS were 48 during the control period, 43 on placebo, and 52 on tryptophan.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗