Physician staffing for the practice of psychosomatic medicine in general hospitals: a pilot study.

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.

Smoking and depression.

The relationship between smoking and depression is bidirectional. Recent research has focused on nicotine's neurobiologic impact on the brain as it relates to depression. Genetic factors are also important and may account for up to 67% of smoking initiation, maintenance, and dependence. Because nicotine withdrawal may mimic and induce depression, appropriate clinical evaluation and treatment are essential to reduce the high morbidity and mortality associated with smoking and depression and maximize smoking cessation rates.

How do delirium and dementia increase length of stay of elderly general medical inpatients?

The purpose of this study was to identify the proximate causes through which dementia and delirium extend length of stay (LOS) in elderly general hospital patients. Among 93 patients age >/=65 years admitted to a tertiary-care teaching hospital through the emergency department, admission ratings of cognitive impairment, delirium, and dementia predicted the emergence of mental and behavioral manifestations of delirium and dementia in the hospital and greater LOS. Mental and behavioral manifestations also predicted greater LOS. On average, mental manifestations appeared first and were followed by behavioral manifestations, and the appearance of both types of manifestations occurred before the mean LOS. The results suggest that elderly patients with dementia and/or delirium who become symptomatic after admission to a general hospital first show mental signs and symptoms, then show behavioral disturbances, which appear to be the proximate causes of greater LOS.

Two-year evaluation of the logic model for developing a psycho-oncology service.

OBJECTIVE: The objective of this study was to test whether reorganizing a psycho-oncology service in a planned and focused manner would maximize the achievement of coherent developmental goals. METHODS: The logic model, a strategic program development tool, was used in the context of a public psychiatry fellowship to analyze and plan the organizational objectives of a psycho-oncology service. To assess the efficacy of the logic model, a two-year prospective evaluation of the model's outcome measures was performed. RESULTS: The psycho-oncology service was systematically reorganized through use of the logic model. Qualitative and quantitative data identified the degree of goal achievement. Most of the short- and medium-term clinical, educational, and research goals, as measured by outcome measures, had been realized at the two-year point. CONCLUSIONS: The logic model facilitated the effective reorganization of a psycho-oncology program by analyzing the existing service, developing pertinent goals, and then measuring goal attainment. These findings will be useful to psychiatric services interested in rational program development and service delivery, especially in small and medium hospitals with limited resources.