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Biomedical subjects

P Solomon

Publications and source records attributed to P Solomon.

At least 55 records · Page 3Linked to original sources
PubMed1996

Perspectives concerning consumers as case managers.

Consumer and non-consumer case managers participating in a randomized trial of consumer case management were interviewed regarding their perceptions of consumer and non-consumer case managers, their work and their clients. Consumer case managers were concerned about how they were accepted by other mental health professionals. The consumer team maintained less collateral contact with other professionals and more interpersonal contact with clients than the non-consumer team. Consumer case managers did not show any greater signs of stress, diminished self esteem, or burnout than non-consumer case managers.

Burnout, Professional↗
PubMed1996

Case manager alliance with clients in an older cohort.

It was hypothesized that members of an older cohort of seriously mentally ill community mental health clients would develop stronger alliances with intensive case managers. Eighty-six clients participating in a study of case management services completed a measure of working alliance and structured interviews. It was found that older cohort clients, those age 45 or older, showed much stronger alliances with their case managers than younger clients.

Adult↗
PubMed1996

Unintentional intraoperative awareness during sufentanil anaesthesia for cardiac surgery.

PURPOSE: The aim of this clinical report is to describe a case of unintentional intraoperative awareness during sufentanil anaesthesia in a patient undergoing elective aortocoronary bypass grafting. CLINICAL FINDINGS: After premedication with morphine (5 mg) and scopolamine (0.2 mg), this 51-yr-old woman received sufentanil (10 micrograms.kg-1), midazolam (4 mg) and isoflurane (0.3-0.4% end-tidal). The patient recalled specific events and discussions which took place in the operating room during surgery. This patient's report was clear and corroborated by operating room personnel. The patient denied having felt pain, anxiety or emotional distress. CONCLUSION: Although awareness during opioid anaesthesia has been previously described with morphine and fentanyl, as far as we know this is the first clinical report of awareness with sufentanil. Given that recent efforts of early extubation in cardiac surgery patients may involve a reduction in the amount of opioid administered, this report serves as a reminder of the ever present potential for this disturbing complication.

Anesthesia, General↗
PubMed1996

Defining the minimum level of detectable change for the Roland-Morris questionnaire.

BACKGROUND AND PURPOSE: The Roland-Morris Questionnaire (RMQ) is a self-administered disability measure in which greater levels of disability are reflected by higher numbers on a 24-point scale. The RMQ has been shown to yield reliable measurements, which are valid for inferring the level of disability, and to be sensitive to change over time for groups of patients with low back pain. Little is known about the usefulness of this instrument in aiding decision making regarding individual patients. The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients. SUBJECTS: The study sample consisted of 60 outpatients with low back pain. METHODS: The RMQ was administered at the subjects' initial visit and again 4 to 6 weeks later. Conditional standard errors of measurement (CSEMs) were computed for initial and follow-up RMQ scores, and these values were used to estimate the minimum level of detectable change. Results. Minimum levels of detectable change at the 90% confidence level varied from 4 to 5 RMQ points. CONCLUSION AND DISCUSSION: The magnitude of CSEMs is sufficiently small to detect change in patients with initial scores in the central portion of the scale (4-20 RMQ points); however, the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20.

Adolescent↗
PubMed1996

Impact of brief family psychoeducation on self-efficacy.

One hundred eighty-three relatives of people with serious mental illnesses were randomly assigned to receive individualized consultation or group psychoeducation or were placed on a 9-month wait list. Analysis of variance and multiple regression revealed that the individualized consultation increased the family members' sense of self-efficacy regarding mentally ill relatives. Group psychoeducation was helpful in increasing self-efficacy of family members who had never participated in a support or advocacy group for relatives of psychiatrically disabled individuals.

Adult↗
PubMed1996

Moving from psychoeducation to family education for families of adults with serious mental illness.

The number of psychosocial interventions for relatives of adults with serious and persistent mental illness has increased significantly in recent years. Psychoeducational interventions combine educational and therapeutic objectives, offering didactic material about the ill relative's disorder and therapeutic strategies to enhance the family's communication and coping skills with the goal of reducing the patient's rate of relapse. The more recent development of family education differs from psychoeducation in that its primary goals are didactic and supportive rather than therapeutic. Interventions are focused on improving family members' quality of life by reducing stress and burden and only secondarily on benefiting the ill relative. The author reviews the conceptual and empirical basis of both psychoeducation and family education, discusses the distinctions between these two approaches in program structure and effectiveness, and suggests future policy, program, and research directions for family interventions.

Adult↗
PubMed1995

Consumer case management and attitudes concerning family relations among persons with mental illness.

Data from 91 clients participating in a clinical trial of consumer case management services were analyzed to determine if there is a relationship between client satisfaction with family relations and the amount of community treatment services, including case management. It was found that clients' greater face to face contact with case managers was related to less satisfaction with family relations after one year of service. The analysis provides some support for the hypothesis that case managers may be serving some of the functions that have traditionally been served by the families of mentally ill clients. Another conclusion that could be supported by this analysis is that the degree of intensity of case management services has an impact on family relations.

Adult↗
PubMed1995

The working alliance and consumer case management.

The Working Alliance Inventory was used to measure the strength of the therapeutic relationship between seriously mentally disabled case management clients and their case managers in a randomized trial of consumer-provided case management services. It was found that while there was no difference in the strength of the alliance between the consumer and nonconsumer teams of case managers, there were positive relationships between alliance and some outcomes, including quality of life, symptomatology, attitudes toward medication compliance, and satisfaction with mental health treatment.

Assertiveness↗
PubMed1995

The efficacy of a consumer case management team: 2-year outcomes of a randomized trial.

This article reports the results of a randomized trial of a team of case managers who are mental health consumers compared to a team of nonconsumer. Using a repeated measures MANOVA design, consumer case managers were found to be as effective as a team of nonconsumer case managers in maintaining the stability of severely mentally disabled clients served over a 2-year period. Implications for the employment of consumers in mental health services and the vocational capacity of persons with mental illness are discussed.

Administrative Personnel↗
PubMed1995

Subjective burden among family members of mentally ill adults: relation to stress, coping, and adaptation.

Among 225 family members participating in a study of psychoeducational interventions, 39% of the variance in subjective burden was explained by the severity of stressors related to the relative's illness and by mediators related to social support and coping capabilities. Interventions directed toward improving self-efficacy and coping strategies may be important mediators of subjective burden.

Adaptation, Psychological↗
PubMed1995

Jail recidivism in a forensic case management program.

This article explores the factors related to jail recidivism among clients receiving case management services who were seriously mentally ill, homeless, and former inmates in a large urban jail. The authors interviewed six case managers about 51 clients and examined the use of treatment stipulations as a condition of probation, clients' major diagnostic and behavioral problems, and case management strategies. Clients whose case managers actively sought legal stipulations to case management as a condition of probation and parole were more likely to return to jail. Implications for service planning and future research are discussed.

Case Management↗
PubMed1995

Adaptive coping among family members of persons with serious mental illness.

OBJECTIVE: This study sought to describe factors associated with adaptive coping by family members with a psychiatrically disabled relative. METHODS: A total of 225 family members of persons with serious mental illness were interviewed. Hierarchical regression analysis using five variables that may have contributed to adaptive coping was conducted. The five factors were demographic characteristics of the family member, severity of the relative's illness, the family member's subjective burden and grief, social support, and personal coping resources (self-efficacy and mastery). RESULTS: More extensive adaptive coping was associated with increased social support as measured by the density of the social network, the extent of affirming social support, and participation in a support group for families. Better coping was also associated with a greater sense of self-efficacy in dealing with the relative's mental illness. Adaptive coping was not associated with the severity of the relative's illness. CONCLUSIONS: The findings suggest that mental health professionals should encourage family members to use the support provided by community-based support groups and to form such groups if none are available.

Activities of Daily Living↗
PubMed1995

Interaction of the criminal justice system and psychiatric professionals in which civil commitment standards are prohibitive.

Three case studies are the basis for a discussion of the criminalization hypothesis as it may apply to psychiatric probationers and parolees in the criminal justice system. In each of these cases, the treating psychiatrist faced the problems of noncompliance with treatment and/or restrictive civil commitment standards. The patient's status as a probationer or parolee played a pivotal role in strategies for ensuring treatment through the criminal justice system as opposed to the mental health system or civil commitment process.

Adult↗
PubMed1995

Issues in serving the forensic client.

In the course of a study of a team model of intensive case management for people with serious mental illness who are homeless and leaving Philadelphia jails, several issues regarding the interaction of mental health and jail systems have arisen. Among these issues are continuity of care in an unpredictable jail system, extensive involvement of family members in the charges brought against clients, and the use of legal sanctions toward therapeutic outcomes. This article discusses these issues both as they have appeared in the literature and as they have affected the progress of the study. Implications for community mental health system interactions with jails in serving forensic clients are explored.

Community Mental Health Services↗
PubMed1994

Family perceptions of consumers as case managers.

Family members of clients participating in a randomized trial of consumer delivered case management services were found to be satisfied with the service, without regard to whether or not their ill relative was served by a consumer case management team. While family members did not necessarily know that their ill relative's case manager was a consumer, the attitude toward the capabilities of consumers serving as case managers was positive.

Adult↗
PubMed1994

Designing psychoeducational services for spouses of persons with serious mental illness.

Psychoeducational and support groups for families of mentally ill adults may not be adequately addressing the needs of spouses with mentally ill partners. This paper describes a group psychoeducational approach which has been developed and implemented through collaboration between professionals and well spouses. The high attrition of spouses in a general family psychoeducational group was dramatically reduced in this spouse psychoeducational group. Significant improvements were found in well spouse knowledge about the illness and coping strategies, personal distress, and negative attitudes towards the ill spouse over the 3-month intervention and at 1-year followup. Implications for practitioners and researchers are discussed.

Adaptation, Psychological↗
PubMed1994

Assessing change over time in patients with low back pain.

BACKGROUND AND PURPOSE: This study compared the ability of the Roland-Morris (RM), Oswestry (OSW), and Jan van Breemen Institute (JVB) pain and function questionnaires to detect change over time. SUBJECTS: The sample consisted of 88 patients with mechanical low back pain who were referred by physicians to the outpatient physical therapy department of a teaching hospital. METHODS: Questionnaires were completed by the subjects at their initial visit and 4 to 6 weeks later. Clinically important change was estimated by having the subject and the clinician independently complete two rating scales. Sensitivity to change was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: The ROC curve areas for the RM (0.79), OSW (0.78), and JVB pain (0.79) questionnaires were significantly greater than for the JVB function questionnaire (0.66). Blank and multiple responses per item were present on approximately 20% of the OSW questionnaires and 14% of the JVB questionnaires. Words rather than checks were evident on 3% of the RM questionnaires. CONCLUSION AND DISCUSSION: Based on the latter finding, we believe the RM questionnaire may be the preferred instrument for assessing change over time in patients with low back pain.

Activities of Daily Living↗