The Overall Diagnosis: Psychodynamic Psychiatry, Six-Minute Psychotherapy, and Patient-Centered Care.

Optimal patient care in psychiatry necessitates attention to the treatment relationship and to the patient's experience as an individual. The growth of patient-centered medicine has led to an increased appreciation of the importance of the biopsychosocial formulation, the personhood of both the patient and the physician, the autonomy and authority of the patient, and the therapeutic alliance. Patient-centered medicine, developed by the seminal psychoanalytic theorist Michael Balint, has its roots in psychodynamic concepts. A psychodynamic approach to psychopharmacology improves psychiatric prescribing, and guides the psychiatrist in providing brief, limited psychotherapy, similar to that which the Balints recommended in primary care practice.

Integrative multidisciplinary treatment in the public sector: a pilot study.

Integrative Multidisciplinary Treatment (IMT) emphasizes factors common to evidence-based treatments for borderline personality disorder (BPD) and is suitable for implementation in a public sector setting staffed by clinicians with diverse theoretical backgrounds. Preliminary results suggested decreases in psychiatric disturbance, depression, suicidality, hospitalizations, and emergency room visits, and increases in quality of relationships and quality of life. Results generalized across patients with and without BPD, with two exceptions: hospitalizations and suicidality.

Sexual assault nurse examiners' application of statutory rape reporting laws.

INTRODUCTION: The objective of this study was to compile a list of current state laws that mandate medical providers' reporting of statutory rape and assess the subjective interpretation of such laws by sexual assault nurse examiners (SANEs) throughout the country. METHODS: We contacted an SANE representative from each state by use of the International Association of Forensic Nurses' Web site to obtain information on his or her interpretation of the respective state's statutory rape reporting laws. We compared current state laws and SANE interpretation of such laws with legal interpretation of state laws 5 years previously. RESULTS: According to practitioners, the number of states that legislate mandatory reporting has increased over the past 5 years. State law routinely mandates reporting in 26 states and does not mandate reporting in 10 states. In 3 of those 10, the law prohibits reporting. The law requires reporting only under certain conditions in 14 states. DISCUSSION: Practitioner interpretation of state laws regarding definitions and mandatory reporting of statutory rape varies widely from state to state, and these laws have changed significantly in many states over the past 5 years. Practitioners wishing to comply with state reporting laws require updated legislation information.

Change in "resolved plans" and "suicidal ideation" factors of suicidality after participation in an intensive outpatient treatment program.

BACKGROUND: This study aims to investigate factors related to suicide in a unique clinical population with more chronic psychopathology than many outpatient samples. METHOD: One hundred and five adult outpatients were included in the current study. We predicted that higher scores on the resolved plans and preparation (RPP) factor of the Beck Suicide Scale [Beck, A.T., Kovacs, M., Weissman, M., (1979). Assessment of suicidal intention: The scale for suicidal ideation. Journal of Consulting and Clinical Psychology 47, 343-352] would predict multiple attempter status even after accounting for co-morbid diagnoses and suicidal ideation (SI) factor scores. Additionally, we predicted that the scores on the RPP factor would decrease less over time than scores on the SI factor. RESULTS AND CONCLUSIONS: Results were consistent with both hypotheses, suggesting that RPP factor scores were uniquely predictive of status as a multiple attempter and were more stable over time. LIMITATIONS: Mental health diagnoses were rendered without the use of a structured interview and therefore no reliability data were collected.

Clinical considerations in breast cancer sentinel lymph node mapping: a Moffitt review.

Lymphatic mapping redefined the clinical significance of axillary lymph nodes in the treatment of breast cancer. Current literature supports the concept that any patient diagnosed with invasive breast cancer should in fact have their sentinel lymph nodes evaluated. However, there are many cases of " special situations in lymphatic mapping " . These special situations mark an important point that should be considered: When and who should undergo lymphatic mapping? A summary of these considerations/cases will be the focus of this report.

Local recurrence in lumpectomy patients after imprint cytology margin evaluation.

BACKGROUND: This is a follow-up study to our previously reported data on local recurrence rates in patients whose lumpectomy margins were evaluated by intraoperative imprint cytology (IIC(M)). The purpose of this study was to compare local recurrence rates for patients whose lumpectomy margins were evaluated with IIC(M) with local recurrence rates of those not evaluated by IIC(M). METHODS: A total of 1713 patients underwent lumpectomy treatment for breast cancer from 1988 to 2001 were prospectively entered into a computerized database and subsequently included in this study. Of the patients, 520 (group 1) had their surgery performed at an outside institution where conventional margin analysis was performed. Another 1193 (group 2) had their surgery performed at our institution where margins were evaluated by IIC(M). For each histologic type and for the overall sample, probabilities of recurrence with time were estimated using the method of Kaplan and Meier. RESULTS: IIC(M) overcomes sampling error inherent in the frozen section analysis and results in a diminished incidence of overall 5-year local recurrence from 8.8% to 2.8% (P <0.0001). The recurrence rates for each respective histologic subtype are reported for both absolute recurrences and probability of recurrence with time. CONCLUSIONS: IIC(M) provides an accurate evaluation of lumpectomy margins for patients undergoing breast-conservation treatment. IIC(M) was associated with an overall lower local recurrence rate. This series defined the utility of intraoperative imprint cytology for evaluation of margins in patients undergoing breast-conservation treatment.

The influence of gender of the surgeon on surgical procedure preference for breast cancer.

There are few data in the literature with regard to the influence of surgeon gender and the treatment of breast cancer. In this retrospective review we propose to test the hypothesis that male surgeons are just as likely as female surgeons to provide breast-conservative treatment. From 1990 through 1997 2271 women with breast cancer in Cincinnati, Ohio were operated on by surgeons within the TriHealth Corporation. We compared the performance rate of breast conservation therapy (BCT) with the rate of mastectomy in early-stage breast cancer patients between male and female surgeons. Male surgeons were significantly more likely to provide their patients with breast-conserving treatment than their female colleagues for stages 0 and IIb (P < 0.05). Although male surgeons performed more BCT than female surgeons for stages I and IIa the difference was not statistically significant. For the three stages combined there was a 30 per cent greater chance of a patient receiving breast-conserving treatment if she went to a male surgeon (P < 0.05). We conclude that in our institution male surgeons are no more likely to select mastectomy than their female colleagues and there appears to be an increased use of BCT by male surgeons.