Respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) modulates brain response to stress in major depression.

Background: Negative stress significantly impacts major depressive disorder (MDD), given the shared brain circuitry between the stress response and mood. Thus, interventions that target this circuitry will have an important impact on MDD. The aim of this study was to evaluate the acute effects of a novel respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) technique in the modulation of brain activity and connectivity in women with MDD in response to negative stressful stimuli.

Impact of a Rapid-Access Ambulatory Psychiatry Encounter on Subsequent Emergency Department Utilization.

The authors sought to determine whether providing a rapid-access ambulatory psychiatry encounter correlated with emergency department utilization during a 6-month follow-up period. Electronic medical records of patients who accessed ambulatory psychiatric care through an urgent care psychiatry clinic that offers treatment exclusively on a walk-in basis over a 1-year period (N = 157) were reviewed retrospectively to track emergency department encounters with and without a psychiatric chief complaint in the 6 months before and after the initial psychiatry evaluation. Among patients who had not previously received ambulatory psychiatric care (N = 88), emergency department utilization decreased from 0.

A Successful Walk-In Psychiatric Model for Integrated Care.

Purpose: Accommodating walk-in psychiatry visits in primary care can improve access to psychiatric care for patients from historically underserved groups. We sought to determine whether a walk-in psychiatry model embedded within an integrated care practice could be sustained over time, and to characterize the patients who accessed care through it.

Methods: We reviewed electronic health records linked to 811 psychiatry encounters in an integrated care practice between October 1, 2015 and September 30, 2017.

Longitudinal Urgent Care Psychiatry as a Unique Access Point for Underserved Patients.

Objective: The authors sought to determine whether a walk-in psychiatry model with longitudinal follow-up capability could improve access for patients who traditionally miss appointments.

Methods: An urgent care clinic that offers treatment exclusively on a walk-in basis was opened within an adult psychiatry practice to accommodate patients who missed prior scheduled appointments. Electronic health records for patients who received an initial psychiatry evaluation at the practice during a 6-month period (N=355) were reviewed retrospectively to track the clinic's productivity and patient demographic characteristics.

Hospital Length of Stay With a Proactive Psychiatric Consultation Model in the Medical Intensive Care Unit: A Prospective Cohort Analysis.

Background: Previous studies have demonstrated that proactive psychiatric consultation reduces hospital length of stay (LOS) in the general medical setting; however this model has not been studied in the intensive care unit (ICU).

Objective: To compare outcomes between a conventional consultation model and a proactive psychiatric consultation model.

Methods: Two medical ICUs (MICUs) were randomized to proactive psychiatric consultation vs conventional consultation psychiatric models.

The Psychiatry Morbidity and Mortality Incident Reporting Tool Increases Psychiatrist Participation in Reporting Adverse Events.

Objectives: Although the reporting of adverse events (AEs) is widely thought to be a key first step to improving patient safety in hospital systems, underreporting remains a common problem, particularly among physicians. We aimed to increase the number of safety reports filed by psychiatrists in our hospital system.

Methods: We piloted an online survey for psychiatry-specific AE reporting, the Psychiatry Morbidity and Mortality Incident Reporting Tool (PMIRT) for a 1-year period.

Quality of Life and Psychosocial Functioning 2 Years Following Facial Transplantation.

Background: Face transplantation is a novel option for patients with severe facial disfigurement. Quality of life (QoL) outcomes of face transplantation remain poorly understood.

Objectives: We sought to evaluate psychosocial functioning among 6 patients undergoing facial transplantation.

Consultation-Liaison Psychiatry vs Psychosomatic Medicine: What's in a name?

Background: In November of 2017, The Academy of the Psychosomatic Medicine voted to change its name to the Academy of Consultation-Liaison Psychiatry. It followed a similar change in which the American Board of Medical Specialties voted to change the name of the field to Consultation-Liaison Psychiatry.

Objective: The authors, all instrumental in bringing about this change, discuss the history and rationale for this name change.

The role of face transplantation in the self-inflicted gunshot wound.

Background: Facial self-inflicted gunshot wounds (SIGSWs) cause a devastating midfacial defect and pose a challenging problem to the reconstructive surgeon. Face transplantation (FT) has the potential for near-normal restoration in otherwise non-reconstructible defects. Two out of 7 FT recipients at Brigham and Women's Hospital (BWH) sustained SIGSWs.

The walk-in clinic model improves access to psychiatry in primary care.

Objective: Missed appointments decrease clinic capacity and negatively affect health outcomes. The objective of this study was to increase the proportion of filled initial psychiatry appointments in an urban, hospital-based primary care practice.

Methods: Patients were identified as having a high or low risk of missing their initial psychiatry appointments based on prior missed medical appointments.

Do Consultation Psychiatrists, Forensic Psychiatrists, Psychiatry Trainees, and Health Care Lawyers Differ in Opinion on Gray Area Decision-Making Capacity Cases? A Vignette-Based Survey.

Background: Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in "gray area" cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds.

Method: Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying "yes/no" question regarding capacity and a certainty scale for each vignette.

Tissue Expansion Technique for Desyndactylization of Toes Using an External Fixator.

We present an alternative technique for desyndactylization of toes using soft tissue traction with an external fixator. This method allows for tissue expansion for subsequent skin plasty, thereby avoiding the need for a graft or complicated local skin rearrangement. The use of the conventional acute correction technique can create more scarring and might increase the potential for complications, especially if the graft is obtained from a remote site.

Readings on psychosomatic medicine: survey of resources for trainees.

Background: As systems of care become more complex and comorbid medical and psychiatric illness becomes more evident, it is essential to prepare psychiatric trainees for practice in more integrated models of care.

Objective: We sought to identify readings available for residency training in consultation-liaison (C-L) psychiatry/psychosomatic medicine with the intent to help educators and trainees identify appropriate and essential learning resources within the field.

Methods: We reviewed readings available to the residents (including commonly used textbooks in C-L psychiatry and C-L training programs' required reading lists) and identified areas of consensus regarding the topics germane to the care of patients with comorbid medical and psychiatric illness (namely depression, dementia, and delirium) and the education of trainees.

Psychiatry department response to the Boston Marathon bombings within a level-1 trauma center.

In this article we present how the consultation-liaison and psychology divisions of an academic medical center's Department of Psychiatry responded in the first week after the Boston Marathon bombings, specifically in the context of disaster response guidelines and evidence-based approaches to acute trauma. Since the department had to address several complicated matters at multiple levels within the hospital system, we highlight unexpected issues unique to this particular event as they arose within the primary domains of our involvement. This article aims to (1) provide a descriptive analysis of how we enacted disaster and trauma guidelines and evidence-based care within a hospital setting, (2) shed light on the unique and unexpected administrative and systemic issues encountered in our response, and (3) discuss lessons learned, including opportunities to improve trauma-related care.

Psychosomatic medicine training as a bridge to practice: training and professional practice patterns of early career psychosomatic medicine specialists.

Background: The number of interested candidates for psychosomatic medicine (PM) training programs has not matched the growing need for psychiatrists trained to care for complex medically ill patients. The reasons for this lack of growth may be found in the experience of new entrants into the subspecialty.

Objective: To investigate this issue, we conducted a survey of early career psychiatrists (ECPs) practicing PM to identify the personal and professional characteristics of ECP PM specialists and to examine the relevance of PM training to professional practice.

Recommendations for training psychiatry residents in psychosomatic medicine.

Background: The Accreditation Council of Graduate Medical Education (ACGME) mandates that residents in psychiatry training programs learn to provide psychiatric consultation to other medical and surgical services. The ACGME, however, offers little information to instruct academic faculty and institutions to what constitutes a quality educational experience in psychosomatic medicine/consultation-liaison psychiatry for the resident trainee.

Methods: These recommendations were developed through a collaborative process between educators in C-L psychiatry and members of the Academy of Psychosomatic Medicine's Residency Education Subcommittee.

Patient- and practice-related determinants of emergency department length of stay for patients with psychiatric illness.

Study Objective: To identify patient and clinical management factors related to emergency department (ED) length of stay for psychiatric patients.

Methods: This was a prospective study of 1,092 adults treated at one of 5 EDs between June 2008 and May 2009. Regression analyses were used to identify factors associated with ED length of stay and its 4 subcomponents.