Factors affecting engagement of dual diagnosis patients in outpatient treatment

This study examined factors associated with engagement in outpatient treatment of patients with dual diagnoses of psychiatric disorder and substance use disorder. The charts of all 57 patients referred to a dual diagnosis treatment program during a six-month period were reviewed, and data on patients' substance use diagnosis, psychiatric diagnosis, sex, ethnicity, and referral source were collected. Patients referred from inpatient treatment were more likely to attend three or more appointments at the dual diagnosis program than those referred from outpatient treatment. Substance of abuse interacted with both referral source and sex in predicting engagement.     

A human-centered approach to medical informatics for medical students, residents, and practicing clinicians

The authors have developed a curriculum in medical informatics that focuses on practical problems in clinical medicine, rather than on the details of informatics technologies. Their development of this human-centered curriculum was guided by the identification of six key clinical challenges that must be addressed by practitioners in the near future and by an examination of the failures of past informatics efforts to make a significant difference in the everyday practice of clinical medicine. Principles of human factors engineering--the body of knowledge about those human abilities, limitations, and characteristics that are relevant to design--are an essential part of this curriculum. Human factors engineering also provides the necessary perspective, as well as the concrete knowledge and methods, that can enable practitioners to properly evaluate their clinical information needs, weight the merits of proposed technology-based solutions, and understand their own inherent performance limitations.     

Attitude change in college students and chronic patients: A dual perspective.

Assessed both initial attitudes and attitude change among 30 college students and 320 chronic patients participating in a hospital companionship program. Student attitudes toward a number of mental health concepts were initially similar to 2 student control groups (N = 30 each). Patient expectations of college students likewise were similar to patient controls. At the conclusion of the program, students manifested significantly more favorable attitudes toward patients and less favorable attitudes toward the mental hospital; patients saw the students as more nurturant than they had initially expected. A social hierarchy hypothesis is advanced to partially account for the reported success of similar companionship programs. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the treatment of dual diagnosis clients who have chronic mental illness.

Examines several issues relevant to treating dual diagnosis clients who have coexisting chronic mental illness and substance abuse diagnoses. The development of various theoretical viewpoints on the relationship between substance abuse and mental illness is described along with a critical review of current research efforts. Suggestions are made for professionals to devote more attention to coordinating services and resources within mental health systems, adjusting academic training and professional development, and developing research efforts that will provide practical guidelines for clinicians. Until more definitive research is available, administrators, clinicians, and professional training programs are advised to adopt a broad clinical perspective of work with dual diagnosis clients that incorporates both mental health and substance abuse treatment modalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress in medical students

The object of this study was to examine the main stressors experienced by students in an Irish medical school and their effects on the attitude of the students towards their training. It also determined the students' knowledge of how they could receive help and their attitudes towards seeking such help. Data was collected by an anonymous self-report questionnaire distributed to a fifth year medical school class in the Hilary Term of the academic year. These 63 students had chosen medicine as a career mainly because of vocational and academic factors and almost two thirds of them had always wanted to do medicine. However four were no longer happy with that choice. Fifty-four percent of them had felt like making a complaint on at least one occasion, but did not do so. The perceived problems were mainly verbal in nature. 41% said that this had affected their attendance. The main source of perceived mistreatment was consultant staff. Rates of perceived racial and sexual discrimination were low. Other stressors included examinations, financial issues and family issues. 52% of students did not know the process by which they could make a complaint and 30% felt that seeking help or advice from staff would be damaging to their future career. This study analyses these issues and suggests ways of addressing them.     

Trends in the residential (inpatient) treatment of individuals with a dual diagnosis.

Clinical trends are discussed with respect to the inpatient treatment of individuals with dual diagnosis. Identified operant trends include the increased attention on functionally derived treatments and treatments designed for infrequent behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching smoking-cessation counseling to medical students using simulated patients

The controversy continues over the appropriate use of vaginal hysterectomy for many indications that were previously treated only with abdominal or laparoscopic methods. Current outcomes data have pointed up the need for established guidelines to ensure that patients receive appropriate surgical treatment that is most cost-effective and that meets the standard of quality care. Dr Kovac reviews recent data regarding the various surgical options for hysterectomy and offers guidelines based on objective pathologic criteria.     

Methods in the evaluation of medical students]

BACKGROUND: Delayed diagnosis, a high rate of histologically undifferentiated types of tumors, and rapid disease progression are frequently cited as the main reasons for the poor prognosis of gastric cancer in young patients. An improved prognosis has been anticipated for young gastric cancer patients because of recent improvements in digestive tract diagnostic techniques. This retrospective study was designed to determine whether these trends have had an impact on young Japanese patients with gastric cancer, and to further elucidate differences in clinicopathologic features between elderly and young patients. METHODS: From 1984 to 1995, 1654 patients with gastric cancer were admitted to our hospital. Of these, 86 patients (5.2%) were less than 40 years of age (young group). The clinicopathologic features of this young group were reviewed retrospectively, using hospital records, and compared with those of older patients (n = 499 [29.4%], 60 to 69 years of age). RESULTS: The young group contained significantly higher percentages of female patients, epigastric pain symptoms, depressed superficial type lesions, mucosal invasion, and poorly differentiated histology; percentages of hepatic metastasis and venous invasion were lower. Survival rates for all patients and for the resected cases were significantly better in the young group (p = 0.035 and 0.017 respectively). The percentage of early stage stomach cancers for the group less than 40 years of age was 49.0% in 1984-89, but had risen to 60.9% by 1990-95. CONCLUSIONS: Early diagnosis has improved the prognosis of young gastric cancer patients. Furthermore, these data show a recent shift in stage distribution; additional prognostic improvement is anticipated for young patients with early gastric cancer.     

Black students in medical schools

This paper presents an assessment and comparison of two groups of black medical students and the problems they confronted in medical school. Data were obtained from a sample of blacks who attended medical school during the years 1971 to 1974 and from black physicians who graduated from medical school in 1970 or before. A comparison of the two groups revealed statistically significant differences in the impact of others on the decision to enter medicine and in the sources of financial support; also the data suggest differences in perceived discrimination and in the time at which the individual decided to become a physician. The information from the 1971-1974 group illuminates the type and intensity of problems they encountered and the importance of various programs designed to aid black medical students. Overall, the findings of this study indicate a need for new efforts to recruit and to retain black students in medical schools.     

For Children's Sake: Training students in the treatment of child witnesses of domestic violence.

The authors describe For Children's Sake, an innovative program at Illinois State University focused on serving children who have witnessed domestic violence and on training graduate students in working with this special population. Unique aspects of the program including its funding source, child maltreatment focus, and training model in complete program delivery, are highlighted. Additionally, a multilevel integration of the For Children's Sake program into the School Psychology doctoral program is discussed. Challenges, dilemmas, and successes that faculty and graduate students involved with For Children's Sake have experienced are mentioned to assist and encourage trainers in developing other innovative programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use by surgical residents and students entering surgery

It has been known that the sensitive period for ocular dominance column plasticity is prolonged in animals raised under light deprivation. We tested whether this prolongation is related to a developmental change in Mg2+ block of N-methyl-D-aspartate (NMDA) receptors. Synaptic potentials were recorded intracellularly from visual cortex slices of rats whose optic nerves were blocked bilaterally by tetrodotoxin injected into the eyes for 2-4 weeks of age. In cells from normal rats, the amplitude of NMDA receptor-mediated synaptic potentials became smaller at more negative membrane potentials, and larger at more positive potentials, even at 0.1 mM [Mg2+]o. In cells from tetrodotoxin-treated rats, the voltage-dependence was significantly weaker than in cells from normal rats at 0.1 mM [Mg2+]o. Thus, Mg(2+)-block of synaptic NMDA receptors in the visual cortex may be regulated by optic nerve activity, and may thereby control the sensitivity to synaptic plasticity in an activity-dependent manner.     

Assessing medical care of dying residents in nursing homes

A rational approach to hemodialysis access in the patient with renal failure requires an understanding of many factors. The initial approach to such patients and subsequent decisions have a significant impact on quality of life as well as the morbidity of access choices. Autogenous vascular access remains the gold standard in the care of these patients. Alternatives are less desirable but are necessary in an increasing number of situations. Careful thought before embarking on a procedure will provide better long-term function and preserve the patient's options for the future.     

Dual diagnosis: approaches to the treatment of people with dual mental health and drug abuse problems

The author reports his personal experience of allergy to antibiotics following anaesthesia. Over a period of four years, corresponding to 5,500 patients who had consulted for reasons of allergy, 32 patients presented per-operative anaphylactic accident of which 5 were attributed to antibiotics (about 15%). Three of these accidents were attributed to cephalosporin, 1 to vancomycin and 1 to erythromicin.     

Asthma training in third-year medical students

In response to the increasing use of children's trade books in school reading programs, this article reviews the use of real text, drawing on the application and interaction of two distinct perspectives: reader response theory and comprehension instruction. The authors propose the need to combine knowledge of instruction with the new focus on the role of the reader within response theory and within comprehension research. This article suggests how comprehension instruction and response to literature activities can intersect in the classroom for students who are deaf or hard of hearing. Explicit models and instructional strategies are discussed in the framework of this bimodal approach to reading. A sample list of high quality children's books, including several trade books that feature deaf or hard of hearing characters and issues, is provided as a resource for teachers.     

Recent developments in assessing medical students

Most medical schools in the UK are revising their undergraduate courses in response to the recommendations published by the General Medical Council Education Committee in Tomorrow's doctors. However, achievement of the objectives of curricular change is attendant on revision of the assessment process. This paper reviews traditional and more recently developed methods for assessment of medical education in the light of the General Medical Council's recommendations which relate specifically to summative assessment of the core curriculum. The importance of reliability and validity is highlighted, and the case for criterion-referenced assessment is examined.     

Theories of dual diagnosis in mental retardation.

Provides a historical review of theory development in the field of dual diagnosis. Dual diagnosis, defined in this instance as the co-occurrence of mental health disorders with mental retardation, has become a major area of clinical practice and research in the past 10 yrs. Whereas areas such as differential diagnosis, assessment, and prevalence have been major focuses of research, etiologies of dual diagnosis have received less attention. Current etiological theories have practical implications for the treatment and prevention of dual diagnoses and suggest important directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)