Evaluating the Proactive C-L Model: Insights and Unanswered Questions From the UK HOME Study.

The HOME Study is the largest and among the most important trials in the history of consultation-liaison psychiatry, and its study team is to be commended for this landmark study. In this article, we provide context for the HOME Study and consider several aspects of the study critical to understanding the nature of the intervention and interpreting its results. First, we compare the model of proactive integrated consultation-liaison psychiatry as implemented in the HOME Study with versions of proactive consultation-liaison psychiatry as commonly practiced in the US.

An Observational Study of Proactive and On-Request Psychiatry Consultation Services: Evidence for Differing Roles and Outcomes.

Background: Proactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce the length of stay and improve staff satisfaction. However, in some settings, it is impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future.

Role Distinctions and Role Overlap Among Behavioral Health Providers.

Integrated behavioral health care (IBHC) models are a growing trend for health care delivery, particularly in the primary setting. Clinicians working within IBHC contexts provide a spectrum of behavioral health services, including screening, prevention and health promotion, assessment, and treatment services. Integration of behavioral health providers into primary and specialty medical settings addresses the significant need for behavioral health services, improves care quality, improves patient experience, and reduces costs of care, access issues, and delays in service provision.

Differences in Demographic and Clinical Characteristics of Patients With Depressive vs. Manic First Episode of Bipolar Disorder.

Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.

An evaluation of proactive psychiatric consults on general medical units.

Objective: Recent studies have shown an association between proactive psychiatric consultation on medical units and shorter length of stay. The aim of this study was to assess the impact of implementing a proactive psychiatric consult service on general medical units in an urban teaching hospital on length of stay and qualitative measurement of satisfaction of adequacy of psychiatric services.

Methods: Bivariate and multivariate analyses of demographic, clinical and outcome data were performed comparing patients seen by the proactive psychiatric consult team, patients seen contemporaneously on other general medical units by a traditional, reactive consult team and patients seen the prior year on the proactive intervention units by the reactive consult team.

Lung cancer incidence in patients with schizophrenia: meta-analysis.

Background: Lung cancer risk factors, like tobacco smoking, are highly prevalent in patients with schizophrenia. Whether these patients have a higher risk of lung cancer remains unknown.

Aims: We aimed to investigate whether patients with schizophrenia have a higher incidence of lung cancer compared with general population, in a meta-analysis.

Association of Schizophrenia With the Risk of Breast Cancer Incidence: A Meta-analysis.

Importance: Patients with schizophrenia are considered to have many risk factors for the development of cancer. However, the incidence of breast cancer in women with schizophrenia compared with the general population remains uncertain.

Objective: To perform an updated meta-analysis to evaluate the association between schizophrenia and the risk of breast cancer.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

Background: Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care.

Objectives: Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost.

Design: Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers.

Psychiatry and the meaningful use of electronic health records.

Use of electronic health records (EHRs) for psychiatric care is on the rise, although the software and the workflow patterns on which the software has been built are often based on non-psychiatric practices. For providers, the transition from paper psychiatric records to electronic ones requires the development of a new set of skills that includes accommodating the physical presence of the computer and performing various forms of data entry, while still managing to carry out the tasks required for psychiatric practice. These changes alter the dynamic of communication, including elements of assessment and treatment that occur between the psychiatrist and patient.

The Intensive Treatment Unit: A brief inpatient detoxification facility demonstrating good postdetoxification treatment entry.

Inpatient detoxification is frequently used to treat substance use disorders, despite consistent findings that drug use soon after detoxification is the norm. A number of lines of evidence suggest the most rational means of improving outcomes after detoxification is to improve postdetoxification treatment entry. This report presents outcomes from the Intensive Treatment Unit (ITU), a brief inpatient detoxification unit in Baltimore, MD, found to have good postdischarge treatment entry outcomes.

Content of advance directives for individuals with advanced dementia.

Objective: To examine how people with end-stage dementia have conveyed their wishes for end-of-life care in advance directives.

Method: The documents of 123 residents of three Maryland nursing homes, all with end-stage dementia, were reviewed.

Results: More years of education and White race were significantly associated with having an advance directive.