Biomedical subjects
Publications and source records attributed to J S Lyons.
Four hundred nineteen consecutive consult cases were studied to determine the relationship of the timing of the consult to hospital length of stay. Results indicated that earlier consultations predicted shorter lengths of stay. Applications of the present methodology to more complex evaluations of psychiatric consultation are discussed.
We report a study of occupational stress in 374 paramedics. Results indicate that this profession experiences a high degree of job-related stress relative to other medical personnel. In a component analysis of this stress the results show that job stress manifests itself as job dissatisfaction, organizational stress, and negative patient attitudes, but not as frequently as somatic distress.
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.
The present study details the development of a stress scale for medical personnel. The Medical Personnel Stress Scale is a 48-item subjective stress measure capable of assessing both organizational and individual dimensions of stress. It demonstrated both the ability to discriminate between divergent medical emergency room organizations and to predict self reported on-the-job difficulties.
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.
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.
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Three varieties of patterned dystrophies of the retinal pigment epithelium have been described in the literature: They are reticular dystrophy, macroreticular dystrophy, and butterfly-shaped pigment dystrophy of the fovea (macula). They are all inherited and are bilateral and symmetric. Results of retinal-function tests in all three varieties were essentially normal, except for the electro-oculogram in the butterfly-shaped pigment dystrophy. We have observed within a single family one member manifesting butterfly-shaped pigment dystrophy, one member with macroreticular dystrophy, and one member with probable reticular dystrophy. Electrophysiologic studies of the retina in these patients were in accord with those already reported, except for supernormal scotopic responses in the latter two patients. This family demonstrates the linkage necessary to tie together a number of entities heretofore considered as separate.
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Alcohol is an increasingly abused substance among psychiatric inpatients, and the extent to which alcohol dependence history is documented and the alcoholism subsequently treated is a compelling issue. This study is a retrospective review of the extent to which alcohol dependence history was obtained, and if applicable, whether a diagnosis and/or treatment plan were made, for acute psychiatric inpatients. For these purposes, an original instrument was constructed. Our results indicate that the predominant focus for acute inpatients is on diagnostic assessment of the severity of the alcohol problem, reflecting the need to deal with those issues requiring the most immediate attention. For patients with schizophrenia, attention to alcoholism diagnosis and treatment was less than that for nonschizophrenic patients. The implications of these findings are discussed with reference to the evaluation and treatment of dually diagnosed patients, along with further directions for research.
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.
The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational purposes. First, a feasibility study (N = 21 patients) was conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Averaged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes; as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study 1 revealed that on most items there was considerable agreement; some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was more susceptible to differences. Some improvements--mainly of the anchor points--were specified which may further enhance interrater reliability. The INTERMED proves to be a reliable method for classifying patients' care needs, especially when used by experienced raters scoring by patient interview. It can be a useful tool in assessing patients' care needs, as well as the level of needed adjustment between general and mental health service delivery. The INTERMED is easily applicable in the clinical setting at low time-costs.
The validity and clinical use of a recently developed instrument to assess health care needs of patients with a physical illness, called INTERMED, is investigated. The INTERMED combines data reflecting patients' biological, psychological, and social characteristics with information on health care utilization characteristics. An example of a patient population in which such an integral assessment can contribute to the appropriateness of care, are patients with low back pain of degenerative or unknown origin. It supports the validity and the clinical usefulness of the INTERMED when clinically relevant subgroups in this heterogeneous population can be identified and described based on their INTERMED scores. The INTERMED was utilized in a group of patients (N = 108) having low back pain who vary on the chronicity of complaints, functional status, and associated disability. All patients underwent a medical examination and responded to a battery of validated questionnaires assessing biological, psychological, and social aspects of their life. In addition, the patients were assessed by the INTERMED. It was studied whether it proved to be possible to form clinically meaningful groups of patients based on their INTERMED scores; for this, a hierarchical cluster analysis was performed. In order to clinically describe them, the groups of patients were compared with the data from the questionnaires. The cluster analysis on the INTERMED scores revealed three distinguishable groups of patients. Comparison with the questionnaires assessing biological, psychological, and social aspects of disease showed that one group can be characterized as complex patients with chronic complaints and reduced capacity to work who apply for a disability compensation. The other groups differed explicitly with regard to chronicity, but also on other variables. By means of the INTERMED, clinically relevant groups of patients can be identified, which supports its use in clinical practice and its use as a method to describe case mix for scientific or health care policy purposes. In addition, the INTERMED is easy to implement in daily clinical practice and can be of help to ease the operationalization of the biopychosocial model of disease. More information on its validity in different patient populations is necessary.
The authors examined the timing of patient referrals to a psychiatric consultation-liaison service in relation to the patient's social vulnerability and level of psychiatric dysfunction. One hundred consecutive patients were assessed with the INTERMED, a method to document biopsychosocial and health care-related aspects of disease. Although 30% of patients were referred within the first day of admission, 19% of requests for referrals were made after 2 weeks. Late referral was associated with high social vulnerability and early referral with severe psychiatric dysfunction. The authors illustrate the disadvantages of a psychiatric liaison model focusing on psychopathology alone and demonstrate the need for an integrated patient assessment in the general hospital, focusing on detecting frail elderly patients.
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