Reorganization and quality management of psychiatric and substance abuse patients.

We conducted a study in the mental health and behavioral sciences program at Hines Veterans Administration Hospital to determine if a recent reorganization of the mental health services had resulted in the efficient use of treatment resources according to patients' needs. The Brief Symptom Inventory was used to assess symptomatology when patients were admitted to the inpatient psychiatry, dual diagnosis, or substance abuse lodger units. The results indicated that the groups differ significantly from one another on eight of nine symptom dimensions and on all three global indices of psychopathology. The results also reinforced the supposition that patients are receiving appropriate treatment and that resources are being used efficiently.

Cardiac retransplantation: determining limits.

OBJECTIVE: Cardiac transplantation has become an acceptable treatment option for end-stage congestive heart failure. Because of the increasing demand, there are not enough hearts to supply all patients in need of cardiac transplantation. This significant supply and demand imbalance necessitates that rationing decisions be made. This article will explore decisions made surrounding cardiac retransplantation. CONCLUSIONS: Early statistics suggest that survival for patients undergoing retransplantation is lower than first-time transplant recipients. In addition, the question of justice or fairness arises. Patients who are offered second and third heart transplants may deprive a significant number of patients who have not had their first chance at transplantation. The authors propose, based on medical suitability, respect for autonomy, and the principle of justice, that cardiac transplantation be a one-time treatment option. Retransplantation should not be allowed.

A new role for psychologists--hospital ethics committees.

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.

Do not resuscitate policies in midwestern hospitals: a five-state survey.

Hospitals in five midwestern states were surveyed regarding the presence or current development of formal Do Not Resuscitate (DNR) policies in their institutions. Responses were received from 76 percent of 986 institutions; 35.5 percent of respondents reported having DNR policies and another 24.4 percent of the institutions reported being in the process of developing such policies. 38.1 percent of respondents had ethics committees. Two variables were associated with the presence or development of DNR policies in respondent institutions: institutional size and the existence of an ethics committee. The results are discussed in terms of the need for further research in this area and in terms of recommendations and findings of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.

An MMPI scale to predict premature termination from inpatient alcohol treatment.

This study developed an MMPI scale to predict premature termination of patients from inpatient alcohol programming. MMPI responses of 93 male veterans hospitalized in a 4-week alcohol treatment program were item analyzed, and 21 items that differentiated Completers from Dropouts were selected. A classification accuracy rate of 91.36% was achieved in the standardization sample using a cut-off score of 8 and comparing only valid profiles. Classificatory accuracy of a cross validation sample (N = 90) was somewhat lower (75.34%). Face validity was absent, an indication of the scale's subtlety, and an analysis of scale items' Social Desirability Scale Values indicated that social desirability did not appear to influence item endorsement. Consistent differences between Completers and Dropouts were noted on Scales F and Sc, but not over other MMPI clinical scales, age, and race. Methodological issues and the use of the scale in alcohol treatment programming also were discussed.

Content and response-style in the construct validation of self-report inventories: a canonical analysis.

A common problem in establishing the construct validity of self-report inventories is the confounding of the purported meaning of test scores with response styles such as social desirability. Partial correlation is a traditional method of controlling such confounding effects. This paper demonstrates the analytic and interpretive advantages of using canonical correlation to remove the effects of a confounding variable. To this end, the present study examined the test protocols of 64 male inpatient alcoholics to determine whether a general measure of mental health (Sulliman Scale of Social Interest) was related to inventories that assess psychopathology (MMPI and PSI) beyond what one could expect by Ss responding in a socially desirable manner. The results of partial correlation and canonical correlation analysis were contrasted, which demonstrated the spuriousness of partial correlations in controlling for social desirability.

Further validation of the social interest index with male alcoholics.

The relationships between the Social Interest Index (SH) and other variables were explored in two studies of male alcoholics. The SH correlated positively with Achievement, Dominance, and Intraception of the Edwards Personal Preference Schedule and negatively with Abasement and Succorance. The SH failed to correlate positively with Affiliation and Nurturance and unexpectedly correlated negatively with Autonomy. The SH was also found to relate positively to Personal Orientation Inventory (POI) measures of inner-directedness, present-field time orientation, mental health, self-significance, and interpersonal contact, present-field time orientation, mental health, self-significance, and interpersonal contact. The SH was positively related to Edwards (1957) Revised Social Desirability Scale (So-R), and most partial correlations for the SH and the POH measures were significant with So-R controlled. Overall, the SH scores were not significantly related to age, marital status, and socioeconomic status but positively related to educational level. The implications of the results were discussed.

The social interest index: a study of construct validity.

Investigated the construct validity of the Social Interest Index (SII) on a sample (N = 140) of hospitalized male alcoholics. Because of the inferred properties of social interest, it was hypothesized that the SII would relate positively with measures of some social traits, mental health, intelligence, education, and internal locus of control and would relate negatively with measures of other social traits and MMPI "pathology" scales. The hypotheses generally were supported. The significant positive correlation between the SII and social desirability was discussed along with other theoretical/methodological issues raised by the data.

Personality and temperament differences between alcoholics with high and low records of traffic accidents and violations.

Significant differences on scales of the Guilford-Zimmerman Temperament Survey and the Minnesota Multiphasic Personality Inventory were found between alcoholics with high and low records of traffic accidents and violations.