Being satisfied at work does affect burnout among psychiatrists: a national follow-up study from New Zealand.

BACKGROUND: Burnout and job satisfaction in psychiatrists has been an area of considerable interest. Longitudinal studies on the subject are lacking, rendering it difficult to establish whether burnout changes with time or whether low job satisfaction may predict high burnout with time in psychiatrists. AIMS: This longitudinal study of burnout and job satisfaction in a cohort of New Zealand psychiatrists was conducted to examine if initial scores on the Job Diagnostic Survey (JDS) predicted scores on the Maslach Burnout Inventory (MBI) three years later and vice versa. METHODS: Three questionnaires (a socio-demographic questionnaire, the JDS and the MBI) were sent to all registered psychiatrists in 2008, which included all those who had participated in a study three years earlier. Scores on these three questionnaires were compared for those who had participated in both studies. RESULTS: The overall number of psychiatrists reporting a high level of emotional exhaustion (EE) did not change across the two phases. The number of psychiatrists reporting high levels of depersonalization (DP) increased from 31 (13%) to 45 (20.2%); the mean DP score for the cohort significantly increased by 17.5% (p < .01). Those reporting reduced personal accomplishment (PA) increased from 90 (37.7%) to 98 (43.9%); the mean PA score for the cohort significantly reduced by 14.5% (p < .001). Low scores on skill variety, task Identity, and feedback of the JDS were significantly correlated with high EE scores three years later, whereas low scores on skill variety were significantly correlated with high scores on DP, and low scores on task significance and feedback were correlated with low scores on PA three years later. CONCLUSIONS: Paying attention to aspects of job satisfaction may assist us in developing specific interventions for psychiatrists who may score high on different dimensions of burnout.

The utility of PET/CT in staging and assessment of treatment response of nasopharyngeal cancer.

INTRODUCTION: The aim of this study was to evaluate the impact of positron emission tomography/computerised tomography (PET/CT) as an adjunct to conventional imaging (CI) in the management of nasopharyngeal cancer (NPC) both for initial staging and assessment of post-treatment response. METHODS: All NPC cases referred to the Peter MacCallum Centre for Metabolic Imaging between January 2002 and December 2007 were identified. In patients undergoing initial staging, any differences between the pre-PET/CT management plan based on CI and that following performance of the PET/CT scan were noted. Clinical impact was scored using the Centre's published criteria: 'high' if PET/CT changed the primary treatment modality or intent, 'medium' if treatment modality was unchanged but the radiotherapy technique or dose was altered, and 'low' if there was no change in treatment modality or intent. Patients undergoing PET/CT following definitive treatment were scored according to whether or not they achieved a complete metabolic response. RESULTS: Forty-eight patients underwent a staging PET/CT. The clinical impact was high in 8%, medium in 25% and low in 66% of patients. Twenty-one patients were scanned for post-treatment response. PET/CT was less frequently equivocal than MRI (3 vs 8/21). A complete metabolic response on PET/CT was associated with a 93% negative predictive value for subsequent recurrence. CONCLUSION: PET/CT is a valuable staging tool for the detection of occult metastatic disease and defining the extent of neck nodal disease. Post-treatment, a complete metabolic response on PET/CT has a very high negative predictive value with fewer equivocal results than MRI.

CAOS contribution to understanding cultural/ethnic differences in the prevalence of bipolar affective disorder in New Zealand.

OBJECTIVE: To examine whether data on the clinical profiles of psychiatric service users can inform the claim that Maori in the New Zealand community have an increased rate of bipolar disorder. METHOD: The standardized recordings of a variety of clinical phenomena previously collected in a New Zealand study of psychiatric service users was extracted for those persons who were diagnosed with a bipolar mental disorder. The individual clinical phenomena were then compared by ethnicity. RESULTS: The most dramatic result was the increased recording of high levels of overactivity or disruptive aggressive behaviour in Maori compared with European in psychiatric service users, despite which, the rates of the disorder did not significantly differ by ethnicity. CONCLUSION: In the community survey lay raters were deciding on the presence or absence of phenomena including hyperactivity without the contextual knowledge that clinicians use. It is possible that the Composite International Diagnostic Interview decision tree was being fed an excessive amount of that criterion.

Population-based funding formulae cultural coefficients: seeking a more equitable distribution of health dollars in New Zealand.

Evidence and argument for the allocation of funds to forensic psychiatric services to take account of the ethnic disparities in the use of the Justice System is presented. This would reflect the reality of the distribution of Service demand.