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J S Lyons

Publications and source records attributed to J S Lyons.

At least 19 recordsLinked to original sources
PubMed2001

A systematic review of the quality of homeopathic clinical trials.

BACKGROUND: While a number of reviews of homeopathic clinical trials have been done, all have used methods dependent on allopathic diagnostic classifications foreign to homeopathic practice. In addition, no review has used established and validated quality criteria allowing direct comparison of the allopathic and homeopathic literature. METHODS: In a systematic review, we compared the quality of clinical-trial research in homeopathy to a sample of research on conventional therapies using a validated and system-neutral approach. All clinical trials on homeopathic treatments with parallel treatment groups published between 1945-1995 in English were selected. All were evaluated with an established set of 33 validity criteria previously validated on a broad range of health interventions across differing medical systems. Criteria covered statistical conclusion, internal, construct and external validity. Reliability of criteria application is greater than 0.95. RESULTS: 59 studies met the inclusion criteria. Of these, 79% were from peer-reviewed journals, 29% used a placebo control, 51% used random assignment, and 86% failed to consider potentially confounding variables. The main validity problems were in measurement where 96% did not report the proportion of subjects screened, and 64% did not report attrition rate. 17% of subjects dropped out in studies where this was reported. There was practically no replication of or overlap in the conditions studied and most studies were relatively small and done at a single-site. Compared to research on conventional therapies the overall quality of studies in homeopathy was worse and only slightly improved in more recent years. CONCLUSIONS: Clinical homeopathic research is clearly in its infancy with most studies using poor sampling and measurement techniques, few subjects, single sites and no replication. Many of these problems are correctable even within a "holistic" paradigm given sufficient research expertise, support and methods.

Clinical Trials as Topic↗
PubMed2001

Needs-based planning for persons with serious mental illness residing in intermediate care facilities.

This study examined the association of clinical status to mental health service use among persons with mental illness living in residential care. Two hundred residents with a chart diagnosis of schizophrenia were randomly selected from four intermediate care facilities. The severity of psychiatric illness-community mental health (SPI-CMH) scale was used to assess clinical status and symptom severity according to three dimensions: symptoms and functioning, risk behaviors, and complication to illness. Lower levels of severity of psychiatric illness were associated with participation in workshops, family contact, and admitting to mental health problems. Results suggest that residents of the intermediate care facilities have clinical needs consistent with habilitation and rehabilitation services. While residents infrequently engage in high-risk behavior such as suicide and violence, they have considerable living skills and vocational needs. Future research should consider the relationship over time of mental health service utilization, severity of psychiatric illness, and psychosocial factors.

Adult↗
PubMed2001

Evaluation of the LKC stimulator for focal ERG testing.

Numerous studies have demonstrated the ability of focal ERGs to diagnose abnormally functioning maculae in the absence of funduscopic and angiographic signs, as well as to confirm diagnoses of clinically suspected macular disease. We present normative data on the second commercially available focal ERG stimulator (FCS-500, LKC Technologies), which may be added to the standard full field ERG systems currently used in many laboratories. The stimulator uses a monocular indirect ophthalmoscope to present a 5 degrees white stimulus flickering at 31.25 Hz in a 20 degrees background field. We have established a range of normal amplitudes (747-3000 nV) and implicit times (30.5-37.5 ms) for the instrument based on tests of 45 eyes of 45 normal patients. To confirm the validity of this test for diagnosis of ocular dysfunction we compared these normals to 46 eyes of 46 patients with macular disease and decreased acuity, and to 49 eyes of 49 patients with retinitis pigmentosa. Using Focal ERG amplitude alone, we found overall accuracy of 85% in diagnosing macular disease associated with decreased acuity. These findings confirm the validity and efficacy of the system we have evaluated.

Adolescent↗
PubMed2001

The prediction of mental health service use in residential care.

The purpose of this study was to characterize the clinical and psychosocial factors of residents living in psychiatric nursing homes, assess residents' levels of mental health service utilization, and examine the factors that predict the utilization of mental health services. Data were collected from 200 randomly selected residents with schizophrenia living in four intermediate care facilities. Fewer than 60% of residents received mental health services beyond medication and nearly one-half of the residents were readmitted to the hospital in the course of a year. Family contact and involvement in activities were associated with mental health service utilization. Hospital readmission was predicted, not by substance use, but rather by not using substances. There is a growing need among service providers to better identify relevant factors that are important in treatment planning and service delivery. Attention to these issues may impact treatment provision and outcomes for persons with schizophrenia and their families.

Activities of Daily Living↗
PubMed2001

Dissociation as a mediator of psychopathology among sexually abused children and adolescents.

OBJECTIVE: This study investigated the role of dissociation as a mediator of mental health outcomes in children with a history of sexual abuse. METHOD: The study group consisted of 114 children and adolescents (ages 10-18 years) who were wards of the Illinois Department of Children and Family Services and were living in residential treatment centers. Interviews, provider ratings, and chart reviews were used to assess the relationship of childhood abuse history, dissociative responses, and psychopathology. RESULTS: Sexual abuse history was significantly associated with dissociation, whereas a history of physical abuse was not. Both sexual abuse and dissociation were independently associated with several indicators of mental health disturbance, including risk-taking behavior (suicidality, self-mutilation, and sexual aggression). Severity of sexual abuse was not associated with dissociation or psychopathology. Analysis of covariance indicated that dissociation had an important mediating role between sexual abuse and psychiatric disturbance. These results were replicated across several assessment sources and varied perspectives. CONCLUSIONS: The findings suggest a unique relationship between sexual abuse and dissociation. Dissociation may be a critical mediator of psychiatric symptoms and risk-taking behavior among sexually abused children. The assessment of dissociation among children may be an important aspect of treatment.

Adolescent↗
PubMed2001

An emergency housing program as an alternative to inpatient treatment for persons with severe mental illness.

OBJECTIVE: This study evaluated the feasibility and effectiveness of an emergency housing program as a step-down program after inpatient care, as a step-up program from community-based living, and as an alternative to inpatient care for individuals with serious mental illness who sought treatment at an urban medical center. METHODS: One hundred sixty-one persons admitted consecutively to an emergency housing program were assessed retrospectively with the Severity of Psychiatric Illness scale and the Acuity of Psychiatric Illness scale at admission and again at discharge. Analyses of covariance were used to evaluate the change in residents' clinical acuity and psychosocial status between admission and discharge. RESULTS: Residents who had been admitted to the emergency housing program from inpatient psychiatric treatment showed a significant decline in acuteness of psychiatric symptoms. Psychiatric symptoms also improved for residents who were admitted to the program from community-based service programs and for residents admitted as an alternative to inpatient treatment, although the differences for these two groups were less prominent. CONCLUSIONS: The findings suggest that an emergency housing program is a feasible mode of extended community-based care for many persons with serious and persistent mental illness.

Acute Disease↗
PubMed2001

Understanding costs of home and community based services.

With detailed cost information, home and community-based services (HCBS) providers can make intelligent choices that reduce costs without compromising quality and outcomes. Using cost and utilization data from a large HCBS program, monthly costs are estimated and related to demographic and clinical variables. HCBS costs are positively related to disability and cognitive impairment, but not to available social support. Costs vary significantly across the nursing home-eligible population, indicating that caution is warranted when seeking to capitate HCBS services. Per capita costs are strongly related to program volume and experience, falling from $508 to $423 (16.7 percent) over the course of the program.

Aged↗
PubMed2000

Specialized substance abuse treatment for women and their children: an analysis of program design.

In the present study, 36 specialized substance abuse treatment programs for women and their children were identified and chosen for review. These programs provide a wide range of services including substance abuse, mental health and medical treatment, life skills training (i.e. vocational and parenting training), and social services (i.e. child care and transportation). A cluster analysis was conducted, and three distinct patterns of program design were identified. Results suggest that programs vary considerably regarding the extent to which comprehensive services are provided and to whom they are offered. Many programs that appear to be comprehensive fail to provide the full range of services to all those who need them. In particular, many programs for pregnant women seem to focus almost exclusively on pregnancy-related issues. As such, specialized substance abuse treatment for women may be at risk for becoming too specialized. Recommendations are made for future substance-related program planning for women and their children.

Child↗
PubMed2000

Strengths of children and adolescents in residential settings: prevalence and associations with psychopathology and discharge placement.

OBJECTIVE: During the past few years there has been growing interest in developing strength-based approaches to services, particularly for children and adolescents. METHOD: This study assesses the prevalence of 30 strengths for a random sample of children and adolescents in residential placements in Florida. In addition, the relationship between strengths and clinical and functional characteristics is studied. RESULTS: Results suggest that there is substantial variation across individuals on the presence of strengths and the potential for development. Strengths were associated with symptoms, risk behaviors, and functioning. Level of strengths predicted success in the reduction of risk behaviors during the child/adolescent's stay. In addition, the level of strengths was independently associated with good dispositional outcomes. CONCLUSIONS: The findings provide further empirical support for the importance of strengths and the utility of an integrated model that considers both psychopathology and strengths in planning for children's services.

Adolescent↗
PubMed2000

Evaluating the use of psychiatric hospitalization by residential treatment centers.

OBJECTIVE: To examine differences in risk levels of psychiatric hospital referrals received from residential treatment centers (RTCs) as a measure of service quality. METHOD: This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were wards of the state from the 10 largest RTCs in one metropolitan county and were screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI. RESULTS: Referrals were placed into 1 of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed moderate or severe levels of suicidality, dangerousness to others, or psychotic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the 10 RTCs. In addition, RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients. CONCLUSIONS: The residential treatment providers in our sample are expected to provide intensive treatment to children and adolescents with serious emotional and behavioral problems. Our finding that some RTCs are making low-risk referrals suggests that they are struggling to meet the needs of some of their clients. Our findings can be used to inform quality improvement efforts at RTCs that are currently struggling.

Adolescent↗
PubMed2000

Variations in the clinical presentations of children and adolescents at eight psychiatric hospitals.

OBJECTIVE: Clinical presentations of children and adolescents admitted to eight psychiatric hospitals were examined to determine variation in symptoms and severity of illness. METHODS: A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI) scale, a reliable measure of psychiatric severity and factors thought to affect decision making about mental health services. The CSPI was completed by mobile crisis workers after interviews with 875 children and adolescents to assess whether hospitalization was appropriate. All the children were wards of the state in Cook County, Illinois, and all were subsequently hospitalized. RESULTS: A factor analysis of the CSPI revealed three distinct factors: caregiver problems, externalizing symptoms, and internalizing symptoms. Children were classified as having mild, moderate, or severe problems or symptoms in the areas covered by the three factors. Chi square analyses revealed that significant variation existed between hospitals in the proportions of children with problems or symptoms in the three factor areas and in the severity of their problems or symptoms. CONCLUSIONS: The major finding of variation among the eight hospitals on measures of severity of children's psychiatric illness and caregiver problems empirically supports the importance of adjusting for severity before implementing initiatives to manage performance and outcome across a system of hospitals.

Adolescent↗
PubMed1999

INTERMED--an assessment and classification system for case complexity. Results in patients with low back pain.

STUDY DESIGN: Cross-sectional investigation and follow-up of patients with low back pain. OBJECTIVES: To evaluate the capacity of the INTERMED--a biopsychosocial assessment and classification system for case complexity--to identify patients with a chronic, disabling course of low back pain and to predict treatment outcome. SUMMARY OF BACKGROUND DATA: An impressive number of biologic and nonbiologic factors influencing the course of low back pain have been identified. However, the lack of a concise, comprehensive, reliable and validated classification system of this heterogeneous patient population hampers preventive and therapeutic progress. METHODS: The INTERMED was used to assess patients with low back pain, who participated in a functional rehabilitation program (n = 50) and patients with low back pain who applied for disability compensation (n = 50). Patients of the rehabilitation program were observed to assess the effects of treatments. RESULTS: The INTERMED distinguished between patients in different phases of disability and provided meaningful information about the biopsychosocial aspects of low back pain. In hierarchical cluster analysis two distinct clusters emerged that differed in the degree of case complexity and treatment outcomes. CONCLUSIONS: This first application of the INTERMED indicates its potential utility as a classification system for patients with low back pain.

Adult↗
PubMed1999

Impact of comorbid affective and alcohol use disorders on suicidal ideation and attempts.

The effect of concurrent affective and alcohol use disorders on suicidal ideation and behavior was investigated. The Diagnostic Interview Schedule Version III-R (DIS) was administered to 307 adult veteran men ranging in age from 23 to 78. Participants were classified into one of four groups based on their final DIS diagnosis-lifetime unipolar depression and lifetime bipolar I disorder with or without a lifetime alcohol use disorder. Logistic regression analyses indicated that veterans with a major affective disorder were at greater risk for suicidality than veterans without an affective disorder. However, veterans with unipolar depression were at no greater risk for suicidality than those with bipolar I disorder. Unipolar and bipolar I disorders with a concurrent alcohol use disorder were always associated with an increased risk for suicidality.

Adult↗
PubMed1999

Clinical trials versus mental health services research: contributions and connections.

The growing emphasis on using empirical data to guide mental health policy decision making has contributed, in part, to a developing dichotomy along the continuum of research on mental health interventions. At one end of the continuum is research on the efficacy of mental health interventions, traditionally referred to as clinical trials research. The goal of clinical trials research is to determine whether or not a specific intervention can be shown to be efficacious for a specific problem. At the other end of the continuum is research on the implementation and evaluation of mental health interventions, traditionally referred to as mental health services research. The goals of mental health services research are to understand the access to, organization and financing of, and outcomes of mental health interventions. The conceptual, methodological, and measurement features of both types of research are presented and suggestions are offered to bridge the gap between the two paradigms. The purpose of this article is to highlight each discipline's unique contributions to mental health research and, in so doing, facilitate a discussion that fosters scientific integration and collaboration between clinical trials and mental health services investigators.

Clinical Trials as Topic↗
PubMed1999

Psychiatric hospital service utilization of children and adolescents in state custody.

OBJECTIVE: To examine factors related to psychiatric hospitalization decision and length of stay of wards of the illinois Department of Child and Family Services. METHOD: A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI), a reliable, quantitative measure of psychiatric severity and its mediating factors. The CSPI was completed by hospital screeners upon conclusion of their crisis interviews. In addition to completing the CSPI, workers reported on demographic information, DSM-IV diagnoses, prescreening living arrangements, and length of hospital stay. RESULTS: CSPI variables could effectively predict decision to admit versus deflect. The overall accuracy of this statistically significant prediction model was 77.9%, which was replicated on a new sample. Factors associated with decision to hospitalize are clinical in nature; ratings of suicidality, dangerousness, and impulsivity contributed the most to the model. Predicting length of stay was only moderately successful. Despite achieving significance, the model accounted for just 15.1% of length of stay variance using a multiple regression. Factors associated with length of stay were largely nonclinical in nature: living arrangement stability, region of the hospitalization, and age. CONCLUSIONS: These results can be used to assess how decisions regarding level and duration of care are currently being made as a point of departure for quality improvement efforts.

Adolescent↗
PubMed1998

Characteristics of short-stay admissions to a psychiatric inpatient service.

Since the rapid expansion of managed care coupled with dramatic reductions in lengths of inpatient stay, there is widespread concern that the emphasis on cost containment is eclipsing attention to patient care. The present study was undertaken to evaluate speculations that the majority of short-stay (less than 48 hours) admissions to a psychiatric inpatient service at a large teaching hospital in the midwestern United States consisted of public pay patients who were rapidly transferred to area state hospitals. Using two cases mix measures, severity of illness and changes in acuity and clinical outcomes of a sample of short-stay (n = 77) and longer stay (n = 145) admissions were compared. Short-stay admissions, although similar to longer stay patients in terms of demographics, Axis I diagnosis, payer status, and appropriateness of admission, are clinically distinct. The use of nonhospital alternatives in treating a subsample of suicidal patients and the implications for improved mental health services delivery are discussed.

Adult↗