An integrated model for measuring management performance.

A model of organizational performance measurement that compels attention to the proper balance among quality, cost, and access; takes into account patient perceptions; produces clear targets for continual quality improvement (CQI); yields easily understood graphical displays; and captures health care organizations in simultaneous operation across the functions of cost, quality, and access was designed for the 22 medical treatment facilities of the Strategic Air Command. Such a tool provides practitioners, payers, and patients a range of information--from systemwide, facility, clinical service, and practitioner-specific insights on current performance to resource forecasts and easily understood targets for CQI. This case study shows that integrated performance modeling may be useful in examining many health management and reform issues.

Double-blind placebo-controlled multicenter evaluation of the efficacy and safety of nomifensine in depressed outpatients.

Outpatients with primary affective disorder-depression who scored at least 20 on the Hamilton Depression Rating Scale (HDRS) were randomly assigned to treatment for 1 month with nomifensine (100-200 mg/day) or placebo. Clinical laboratory and physical evaluations, including ECGs when feasible, revealed no clinically significant changes over the course of treatment. Nomifensine patients showed improvement compared to placebo on the HDRS total score endpoint analysis (p = .06) and the Cognitive Disturbance and Retardation factors (p less than or equal to .05). A better rate of improvement was seen with nomifensine on the Clinical Global Impressions severity of illness (p less than or equal to .05) and therapeutic index (p less than or equal to .05) components. No differences were seen between groups in the incidence of overall or specific side effects. Nomifensine thus appeared safe and superior to placebo on several key measures of depressive symptomatology in this multicenter study of depressed outpatients.

The physician's determination of personnel reliability in sensitive occupations.

The Air Force Medical Officer through AFR 35-99 (Personnel Reliability Program) is responsible for the medical evaluation, psychological assessment, and surveillance of persons who will work in sensitive occupations. This paper addresses various personality factors which indicate poor personnel reliability and suggest an interviewing technique of open-ended questions and developmental history assessment to help determine reliability. Once a person is selected into a Personnel Reliability Program, the physician must be alert to the importance of social stress on personnel reliability and performance.

Minimizing the psychological effects of a wartime disaster on an individual.

In this paper, the psychological reactions of individuals and groups to a wartime disaster, such as nuclear explosion, are presented. The psychological literature on disasters is discussed. The presentation attempts to emphasize viewing the victims of a disaster as individuals responding in a normal way to an overwhelming experience, rather than labeling them as psychiatric patients. The various phases of a disaster are discussed with particular emphases on the preventive measures and leadership roles which may be taken by the physician. The development and treatment of situational psychoses, as well as neurotic reactions, are examined and the dynamics especially of long-lasting neurotic problems explored. The paper concludes by making specific recommendations regarding the establishment of disaster plans and training programs at each military facility. It is suggested that the use of such plans may help minimize the psychological effects of a wartime disaster on the individual.

Psychotherapy with wives of sexual deviants.

The authors presents three case histories of wives of sexual deviants--two pedophilics and one exhibitionist. Each of these women felt responsible for the deviance of her husband and attempted to control her husband's acts through sexual activity. The authors suggest that these women derived some psychologic gain through the deviant acts of their husbands, having remained with these men during trying times. The ego defense mechanisms utilized by them included denial, intellectualization, isolation of affect and undoing. The wife is recognized as an integral part of the dynamic system involving the man, and as such, the necessity for her participation in the treatment is recognized. By encouraging change in the wives, a measure of change could be induced in their husbands. Myths about these women fitting a stereotype of cold, sexually unresponsive persons, as described in the literature and by their spouses, were not substantiated.

Kansas: a survey of state hospital admissions from an area served by a mental health center.

The authors made a survey of all admissions to Topeka (Kans.) State Hospital from a three-county catchment area over an 11-year period during which a private psychiatric clinic in the area assumed the functions of a comprehensive community mental health center. The center's activities brought a significant decrease in the number of direct admissions to the hospital from the catchment area. However, the center consistently referred more patients with psychotic disorders to the state hospital than would be expected on the basis of over-all state hospital admissions. Similarly, a high proportion of patients with organic brain syndromes were admitted directly to the hospital from the three-county area. The authors say the findings suggest that the public mental hospital still has an important role to play on the delivery of mental health services.