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Biomedical subjects

J J Strain

Publications and source records attributed to J J Strain.

At least 271 records · Page 15Linked to original sources
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Using computer databases to predict and avoid drug-drug interactions in the cancer patient requiring psychotropics.

Psychotropic drug interactions with medical prescriptions is an essential knowledge base for the practicing oncologist as well as the psychiatrist. This paper describes a method to identify, understand, and develop a conceptual framework to codify psychotropic-medical drug interactions; a systemic approach for updating this key database, and a software system to assist in the management of this ever unfolding sphere of knowledge; and, a set of instruments to provide ongoing developments in this important area. Since many of the trials either for oncological medications or psychotropic drugs did not include studies comparing these two domains, their interactions often only become known with their utilization and subsequent reporting.

Adverse Drug Reaction Reporting Systems↗
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The sequencing of psychiatric recommendations. Concordance during the process of a psychiatric consultation.

Whether or not medical staff follow through with the recommendations of the consultation-liaison (C-L) psychiatrist, a process referred to as concordance, is an important factor that influences the outcome of C-L interventions. Previous research has demonstrated that process variables have the greatest effect on concordance. This study extends earlier research by examining the relationship of the timing of various recommendation types and concordance. In this study, the authors found that during the first two weeks of a case, psychosocial diagnostic recommendations were closely followed (most concordant) when given later in the consultation. However, concordance was better when discharge recommendations were given earlier. The findings reveal an interaction between the type of recommendation and its timing in the consultation in predicting concordance.

Cross-Cultural Comparison↗
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APM task force on psychosocial interventions in the general hospital inpatient setting. A review of cost-offset studies.

Several investigations of interventions with psychiatric and medical comorbidity (CM) in the medical inpatient setting have been reported. These studies include psychiatric liaison screening and interventions, psychosocial screening, and standard consultation. The studies had a variety of outcome variables: 1) altered psychiatric morbidity; 2) lag time to identification of CM; 3) lag time to referring to mental health disciplines; 4) cost offset; and 5) discharge placement. Methodological and design problems confound many of the results, in particular, the lack of random control procedures. However, similarity of findings of the frequency of CM in the inpatient setting and patient response to early detection and treatment should stimulate further research into the effects of psychiatric interventions in the acute inpatient medical setting.

Delivery of Health Care↗
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Composition and funding. Consultation-liaison psychiatry services.

All of the programs in the Academy of Psychosomatic Medicine directory of U.S. consultation-liaison (C-L) fellowship training (N = 49) responded to a questionnaire to document composition and funding of their staff. The mean annual budget was $324,664 (range $40,000-$550,000), with a mean of 2.4 full-time equivalents and 1.6 fellowship training positions. A significant patient cohort and C-L staff and fellows exist in these programs to launch important hypothesis-generation studies.

Budgets↗
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A survey estimate of academic liver transplant teams' selection practices for alcohol-dependent applicants.

Alcoholism itself is not a contraindication to liver transplantation. However, certain individual alcoholic applicants may pose an unacceptably high psychosocial risk of poor outcome. Transplant psychiatrists or psychologists at 14 academic liver transplant centers were asked to estimate their centers' selection practices with regard to specific problems in the more difficult alcohol-dependent applicant and with regard to hypothetical problem cases. There was impressive variability in estimated selection practice between the centers. However, the centers consistently appeared to prefer to require rehabilitation or observation in difficult situations rather than to reject applicants outright. The results provide an initial estimate of current thinking and practice with regard to the more difficult alcoholic applicant and suggest directions for further study.

Adult↗
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Organic mental disorders in the consultation-liaison psychiatry setting. A multi-site study.

Interventions recommended by consultation-liaison psychiatrists for inpatients they diagnosed as having DSM-III-R organic mental disorder (OMD) were studied to see to what extent specific variables distinguished the OMD patients and differentiated the subgroups of patients with OMD. Prospective data and Mini-Mental State Exam (MMSE) scores on 625 consecutive referrals at 3 general hospitals in Australia and the United States were collected by using the MICRO-CARES database system. The OMD group differed from the other patients because they were significantly more likely to have been referred for "organic brain syndrome" or "agitation," had less mood disorder and lower MMSE scores, and received more recommendations for antipsychotics and for ward-environment manipulation and fewer recommendations for psychological management. The many differences among the OMD subgroups were also consistent with their DSM constructs. A pilot exploration of the validity of the DSM-IV constructs of cognitive disorder and its subgroups performed on the redistributed data suggested that these constructs have similar usefulness.

Adult↗
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A prospective study of the impact of psychiatric comorbidity on length of hospital stays of elderly medical-surgical inpatients.

To determine the difference in length of hospital stay for geriatric medical-surgical inpatients with or without psychiatric comorbidity, the authors prospectively interviewed 467 admissions by using the Structured Clinical Interview for DSM-III-R and the Mini-Mental State Exam. At admission, 208 (44.5%) inpatients had a current psychiatric comorbidity, 51 (10.9%) had an anxiety disorder, 88 (18.8%) had a depressive disorder, and 126 (27%) had cognitive impairment. The patients with cognitive impairment had a significantly prolonged hospital stay compared with those without cognitive impairment (14.6 vs. 10.6 days). No difference existed in length of stay for the patients with and without anxiety disorders (11.6 vs. 11.6 days) or depressive disorders (11.0 vs 11.8 days). In view of the limited resources available for screening elderly medical-surgical inpatients for psychiatric comorbidity, this study suggests the utility of identifying cognitive impairment and targeting it for interventions to reduce the clinical burden and to decrease hospital stays.

Aged↗
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Cardiac drug and psychotropic drug interactions: significance and recommendations.

Understanding cardiac drug interactions with concurrent psychotropic prescriptions is essential for the practicing cardiologist and primary care physician, as well as for the psychiatrist. There has been an explosive use of new drugs in both psychiatry and cardiology without widespread knowledge of their potential interactions. The increasing tendency toward poly-pharmacy, the use of psychotropic medications by cardiologists and primary care physicians caring for cardiac patients, and the growth of the aging population present major challenges for the practitioner. Finally, there is a need to have models/paradigms for predicting potential drug interactions--e.g., the Cytochrome p450 schema. This paper describes a method to identify, understand, and codify the interactions between psychotropic and cardiac drugs, a systematic approach for updating this key database and specific cardiac-psychotropic drug interactions. Specifically, this paper 1) details the interactions, 2) addresses the level of their clinical significance, 3) describes the potential mechanism(s) of the interactions, and 4) offers recommendations to the clinician. Since the majority of the original clinical trials, either for cardiac medications or psychotropic drugs, do not include studies comparing these two drug domains contemporaneously, their interactions often become known only with their combined use in the clinical arena, using the patient as "guinea pig," and through subsequent reporting.

Cardiovascular Agents↗
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Further evolution of a literature database: the international use of a common software structure and methodology for the establishment of national consultation/liaison databases.

Every day there are 6000-7000 papers published in science. Since the C-L psychiatrist may be asked to consult on a patient with any medical illness, and who may be on any medical drug, methods need to be developed to review the recent literature and have an awareness of current findings. At the same time, teachers need to develop a current listing of seminal papers for trainees and practitioners of this subspecialty of psychiatry. Experts chosen because of their writings and acknowledged contributions to their subspecialty interests have sifted through thousands of articles to select the ones they regard as the most important for trainees in C-L psychiatry. In addition, certain countries--Spain, Portugal, Germany, Mexico, Australia and Brazil are developing national databases of C-L literature not only for their own use, but also to bring them to the attention of other parts of the world. This fifth iteration of the C-L literature database has especially targeted the period of 1996-1999--the millennium issue--in order to have easier access to contemporary essential studies on common problems. Part II of this issue describes the seminal cardiac drug-psychotropic drug interactions that the C-L psychiatrist may encounter in the most common medical disease in the United States--coronary heart disease--with advise to the practitioner as to their management. The use of the Internet and institutional Intranets is described.

Databases, Bibliographic↗
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Determinants of p,p-dichlorodiphenyldichloroethane (DDE) concentration in adipose tissue in women from five European cities.

To identify the determinants of p,p'-dichlorodiphenyldichloroethane (p,p'-DDE) in adipose tissue in subjects who participated in a cross-sectional study, we analyzed fatty acids, antioxidants, and p,p'-DDE in aspirates of adipose tissue of 328 postmenopausal women from 5 European countries. The overall mean of p,p'-DDE concentration was 1.66 microg/g of fatty acids (95% confidence interval = 1.46, 1.88). In a multiple-regression analysis, the main predictors of log10(p,p'DDE) were center of recruitment (p < .0001), adipose arachidic acid (p = .001), and adipose retinol (p = .04). These factors explained 14.9% of the overall variability of log10(p,p'-DDE). In our subjects, adipose tissue p,p'DDE concentrations were only weakly related with biomarkers reflecting intake of fish and other foods. This result is consistent with the notion that p,p'-DDE exists in different foods and, given the widespread contamination of the food chain, is relatively evenly distributed among foods.

Adipose Tissue↗
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Psychological reactions to acute medical illness and critical care.

The psychological stresses evoked by acute critical illness and intensive care in both patient and physician are examined and certain approaches proposed which, in our experience, can alleviate these stresses. Admittedly, these psychological concepts may appear inconsequential at first glance. We have found, however, that such intervention may facilitate the physician's efforts to provide appropriate care for his critically ill patients, including those who must die, without experiencing the psychological reactions--the guilt, shame, anguish, and despair--these patients typically arouse.

Acute Disease↗
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Models of mental health training for primary care physicians.

Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysiologic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs.

Curriculum↗
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Models of mental health training for primary care physicians: a validation study.

Since the majority of persons with alcohol, drug abuse, and/or mental disorders (19%) of Americans during any 6-month period are seen exclusively within the general health sector, it is imperative to know the quality and quantity of mental health training for primary care residents. In this study, the five program training model types previously described--Consultation, Liaison, Bridge, Hybrid, Autonomous--are validated by a random sampling technique using a structured instrument to test eight hypotheses developed before data collection to preclude post hoc interpretations. Of 250 programs, 147 responded (60%): 67 Family Practice, 42 Primary Internal Medicine, and 38 Internal Medicine. Since all eight hypotheses were supported by the data, the construct validity of the program model types is significantly substantiated. Multiple discriminant analysis revealed that the relationships between twelve training program characteristics and the five program model types were such that the former could explain 57% of the variance in the latter and correctly classify 89% of the programs.

Education, Medical, Graduate↗