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1.
Psychosomatics ; 51(6): 520-7, 2010.
Article in English | MEDLINE | ID: mdl-21051685

ABSTRACT

BACKGROUND: The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients. OBJECTIVE: The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services. METHOD: Program directors of seven academic Psychosomatic Medicine (PM) programs in the Northeast were surveyed to establish current staffing patterns and patient volumes. Survey data were reviewed and analyzed along with data from the literature and The Academy of Psychosomatic Medicine (APM) fellowship directory. RESULTS: Staffing patterns varied widely, both in terms of the number and disciplines of staff providing care for medical and surgical inpatients. The ratio of initial consultations performed per hospital bed varied from 1.6 to 4.6. CONCLUSION: Although staffing patterns vary, below a minimum staffing level, there is likely to be significant human and financial cost. Efficient sizing of a PM staff must be accomplished in the context of a given institution's patient population, the experience of providers, the presence/absence and needs of trainees, and the financial constraints of the department and institution. National survey data are needed to provide benchmarks for both academic and nonacademic PM services.


Subject(s)
Hospitals, General , Physicians/supply & distribution , Psychosomatic Medicine , Humans , New England , Pilot Projects , Surveys and Questionnaires , Workforce
2.
Support Care Cancer ; 16(2): 151-9, 2008 Feb.
Article in English | MEDLINE | ID: mdl-17609992

ABSTRACT

GOALS OF WORK: Fatigue, pain, and emotional distress are common symptoms among patients with cancer. We sought to learn about patient perceptions of these symptoms and their treatment. MATERIALS AND METHODS: At a baseline assessment and two monthly follow-up assessments, we asked a diverse sample of patients with solid tumor or lymphoma (N = 99) about their fatigue, pain and distress, their treatment for these symptoms, and their satisfaction with treatment via standardized questionnaires and semistructured interviews. MAIN RESULTS: In this observational study, patients reported fatigue, pain, emotional distress, and general quality of life at expected levels. Across all assessments, at least half of our sample experienced at least some fatigue, pain, or distress. On the whole, patients and providers do communicate about these concerns, and at least 75% of patients found these discussions helpful when they occurred. CONCLUSIONS: Improved symptom identification and communication may optimize the detection of those at risk of morbidity and decreased quality of life because of excess symptom burden.


Subject(s)
Fatigue/psychology , Neoplasms/psychology , Neoplasms/therapy , Pain/psychology , Adult , Aged , Aged, 80 and over , Female , Humans , Interviews as Topic , Longitudinal Studies , Male , Middle Aged , Quality of Life , Surveys and Questionnaires
3.
J Pain Symptom Manage ; 35(1): 20-30, 2008 Jan.
Article in English | MEDLINE | ID: mdl-17959345

ABSTRACT

Fatigue, pain, distress, and anorexia are four commonly encountered symptoms in cancer. To evaluate the usefulness of a single-item screening for these symptoms, 597 ambulatory outpatients with solid tumors were administered a self-report screening instrument within the first 12 weeks of chemotherapy. Patients rated the severity of each symptom on a 0-10 scale, at its worst over the past three days, with higher ratings associated with higher symptom levels. From this sample, 148 patients also completed a more comprehensive assessment of these symptoms. Two criteria were used to determine optimal cut-off scores on the screening items: 1) the sensitivity and specificity of each screening item to predict clinical cases using receiver-operating characteristics analysis and 2) the proportion of patients at each screening score who reported that some relief of the target symptom would significantly improve their life. Optimal cut-off scores ranged from 4 to 6 depending on the target symptom (area under the curve range=0.68-0.88). Use of single-item screening instruments for fatigue, pain, distress, and anorexia may assist routine clinical assessment in ambulatory oncology practice. In turn, such assessments may improve identification of those at risk of morbidity and decreased quality of life due to excess symptom burden.


Subject(s)
Anorexia/diagnosis , Fatigue/diagnosis , Neoplasms/complications , Pain/diagnosis , Stress, Psychological/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Care , Anorexia/etiology , Data Interpretation, Statistical , Fatigue/etiology , Female , Humans , Male , Neoplasms/psychology , Pain/etiology , Quality of Life , ROC Curve , Stress, Psychological/etiology , Surveys and Questionnaires
5.
Prog Neuropsychopharmacol Biol Psychiatry ; 31(2): 574-7, 2007 Mar 30.
Article in English | MEDLINE | ID: mdl-17234318

ABSTRACT

There is growing evidence that atypical antipsychotics may be effective in the treatment of acute bipolar depression. Results from randomized, placebo-controlled trials support the use of quetiapine monotherapy and a combination of olanzapine-fluoxetine in the depressed phase of bipolar disorder, while only limited data exists regarding the use of aripiprazole in this population. To assess the potential effectiveness of aripiprazole in treating acute bipolar depression, a chart review was conducted on 12 patients with treatment-resistant bipolar disorder (I, II, and not otherwise specified [NOS]) who received aripiprazole augmentation for the relief of an acute major depressive episode. After 8 weeks of treatment, 4 of 12 (33%) patients demonstrated a response, defined as a 50% reduction in the Montgomery-Asberg Depression Rating Scale (MADRS) score. In addition, 5 of 12 (42%) patients newly developed akathisia. This report, though limited by its small sample size and naturalistic design, suggests that the usefulness of aripiprazole in the treatment of bipolar depression may be limited by akathisia.


Subject(s)
Akathisia, Drug-Induced/etiology , Antipsychotic Agents/adverse effects , Piperazines/adverse effects , Quinolones/adverse effects , Adult , Antidepressive Agents/adverse effects , Aripiprazole , Bipolar Disorder/drug therapy , Drug Synergism , Female , Humans , Male , Middle Aged
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