REACTIONNAIRES

Book reviewed in this article:
The Termination of Intensive Psychotherapy Marshdl Edelson, M.D., Ph.D.
The Management of the Anxious Patient Ainslie Meares, M.D., B. Agr. Sc., D.P.M.     

Driving with Roadmaps and Dashboards: Using Information Resources to Structure the Decision Models in Service Organizations

This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in community services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured decision making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support decisions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underlying this system—mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels—can be implemented to support clinical practice in a wide variety of settings. The Research Network on Youth Mental Health is a collaborative network funded by the John D. and Catherine T. MacArthur Foundation. Network Members at the time this work was performed included: John Weisz, Ph.D. (Network Director), Bruce Chorpita, Ph.D., Robert Gibbons, Ph.D., Charles Glisson, Ph.D., Evelyn Polk Green, M.A., Kimberly Hoagwood, Ph.D., Peter S. Jensen, M.D., Kelly Kelleher, M.D., John Landsverk, Ph.D., Stephen Mayberg, Ph.D., Jeanne Miranda, Ph.D., Lawrence Palinkas, Ph.D., Sonja Schoenwald, Ph.D.     

Books—New and Not So New

Book reviewed in this article:
The Borderland of Embryology and Pathology : R. A. Willis, D.SC., M.D., F.R.C.P.
Recent Advances in Paediatrics : Edited by Dr. Douglas Gairdner, F.R.C.P.
The History and Philosophy of Knowledge of the Brain and its Functions : Edited by Dr. F. N. L. Poynter, PH.D., F.L.A.
The Cranial Nerves : Alf Brodal, M.D.
The Birth of Normal Babies : Lyon P. Strean, PH.D., D.D.S.     

Books—New and Not So New

Book reviewed in this article:
Recent Advances In Cerebral Palsy. Edited by Prof. R. S. Illingworth, M.D., F.R.C.P. with a foreword by Prof. N. B. Capon, M.D., F.R.C.P.
Sauvegarde De L'Enfance. Nos. 1–4, 1957.     

BOOK REVIEWS

Book reviewed in this article:
Voth D. & Glees P. (Eds) in collaboration with Lorber J. Spina Bifida—Neural Tube Defects
Betz E. H. & Reznik M. Anatomie Pathologique Spéciale
Delgado-Escueta A. V., Ward A. A., Woodbury D. M. & Porter R. J. (Eds) Basic Mechanisms of the Epilepsies. Molecular and Cellular Approaches     

Book Reviews

Book reviewed in this article:
Tuckwell H. C. Introduction to Theoretical Neurobiology: Volumes 1&2
Kozlowski P. B., Snider D. A., Vietze P. M. & Wisniewski H. M. Brain in Pediatric AIDS Karger
Sudarsky L. Pathophysiology of the Nervous System Little Brown
Samii M. (Ed.) Peripheral Nerve Lesions
Groen J., Smit E. & Eijsvoogel J. (Eds) The Discipline of Curiosity Science in the World Elsevier     

Overview Of Publicly Funded Managed Behavioral Health Care

Using MEDLINE and other Internet sources, the authors perform a systematic review of published literature. A total of 109 articles and reports are identified and reviewed that address the development, implementation, outcomes, and trends related to Managed behavioral health care (MBHC). MBHC remains a work in progress. States have implemented their MBHC programs in a number of ways, making interstate comparisons challenging. While managed behavioral health care can lower costs and increase access, ongoing concerns about MBHC include potential incentives to under-treat those with more severe conditions due to the nature of risk-based contracting, the tendency to focus on acute care, difficulties assuring quality and outcomes consistently across regions, and a potential cost-shift to other public agencies or systems. Success factors for MBHC programs appear to include stakeholder involvement in program and policy development, effective contract development and management, and rate adequacy.Mardi Coleman, B.A., is a Research Associate at the UMass Center for Health Policy and Research. William Schnapp, Ph.D., is a Professor at the University of Texas Medical School at Houston. Debra Hurwitz, M.B.A., B.S.N., R.N., is the Director, Sabine Hedberg, M.A., M.P.A., is a Project Director, Linda Cabral, M.M., is a Project Director, and Aniko Laszlo, M.A., M.B.A., is a Research Associate, all at the UMass Center for Health Policy and Research. Jay Himmelstein, M.D., M.P.H., is a Professor of Family Medicine and Community Health.Material for this article was developed in part to support a comprehensive evaluation of the MassHealth Primary Care Clinician Plan behavioral health carve-out, conducted by the University of Massachusetts Center for Health Policy and Research at the request of Phyllis Peters, M.B.A., Deputy Assistant Secretary for the MassHealth Office of Acute and Ambulatory Care.Address for correspondence: Mardi Coleman, B.A., UMass Center for Health Policy and Research, 222 Maple Avenue, Shrewsbury, MA 01545. E-mail: mardia.coleman@umassmed.edu.     

Book Reviews

Book reviewed in this article:
Narabayashi H., Nagatsu T., Yanagisawa N. and Mizuno Y. (Eds) Parkinson's Disease: From Basic Research to Treatment (Advances in Neurology, volume 60)
Brant-Zawadzki M., Boyko O. B., Jensen M. C. and Gillian G. D. MR Angiography: A Teaching File
Eisenberg R. L. Skull and Spine Imaging: An Atlas of Differential Diagnosis
Carlson L. A., Gottfries C. G. and Winblad B. Vascular dementia Karger.     

Book reviews

Book reviewed in this article:
Chase T. N., Friedhoff A. J., and Cohen D. J. (Eds) Tourette syndrome: genetics, neurobiology and treatment, Advances in Neurology
Aminoff M. J. Brown-Séquard: a visionary of science
Boulton A. A., Baker G. B. and Taylor C. W. (Eds) Intracellular messengers: neuromethods 20
Corain B., Iqbal K., Nicolini M., Winblad B., Wisniewski H. and Zatta P. (Eds) Alzheimer's disease: advances in clinical and basic research     

Books—New and Not So New

Book reviewed in this article:
The Educability of Cerebral Palsied Children. M. I. Dunsdon.
The Infantile Cerebral Palsies. Eirene Collis, W. R. F. Collis, W. Dunham, L. T. Hilliard, D. Lawson. Foreword by Sir Francis Walshe.
A Psychological Study of a City's Cerebral Palsied Children. Ella B. Floyer, M.A., Dipl.Ed. Formerly Educational Psychologist, Liverpool Education Committee.
Cerebral Palsy. Advance in Understanding and Care. Viola E. Cardwell.
Management of the Handicapped Child. Diagnosis, Treatment and Rehabilitation. H. Michal-Smith. Foreword by Arnold Gesell.
The Young Handicapped Child. Educational Guidance for the Young. Blind, Cerebral Palsied and Deaf Child. Agatha H. Bowley, Ph.D., F.B.Psy.S. With a section on The Young Deaf Child by L. Gardner, B.Sc., D.Ed., D.Psy.
Educating Spastic Children. E. Eleanor Schonell, M.A., Ph.D.     

The changing role of the state hospital director: Restructuring the top management team

This article analyzes turnover in the position of state hospital director. It examines the relationship between role structure, job stress and burnout. Based on this analysis, recommendations are made for the restructuring of a top management team. Buffalo Psychiatric Center, a 750-bed facility operated by the New York State Office of Mental Health, provides the setting for this case study.Diane M. Pinchoff, M.A., is Associate Director of the Buffalo Psychiatric Center, 400 Forest Avenue, Buffalo, N.Y. 14213. Mahmud Mirza, M.D., is Director of the Buffalo Psychiatric Center. Reprint requests should be directed to Diane M. Pinchoff at the above address.     

The symbolic and object play of children with autism: A review

The unique characteristics of autistic children's symbolic and object play are presented and discussed in the context of a literature review covering research since 1964. Several theoretical issues are highlighted: the relationship of play in facilitating language and cognition, play as an intervention, and play as an assessment tool. Difficulties in research methodology due to pooling autistic and schizophrenic subject are raised, as well as possible difficulties inherent in ignoring severity levels within the autistic population. The appropriateness of play therapy is questioned, and evidence is presented to provide encouragement for further inquiry into the study of autistic play.This article was written in partial fulfillment of the requirements for a master's degree in psychology at the University of Colorado at Denver under the direction of Carolyn Simmons, Ph.D. The author wishes to thank Gordon Farley, M.D., Eben Ingram, Ph.D., Carolyn Simmons, Ph.D., and Graham Sterritt, Ph.D., for their wisdom, patience, encouragement, and good humor.     

The Environment and Staff of Residential Facilities: Findings from the Italian ‘Progres’ National Survey

We administered structured interviews to managers and staff of a random sample of 265 Italian psychiatric Residential Facilities (RFs). Most are independent buildings, located in urban and suburban areas. The median number of residents is 10. The few RFs (5.7%) with more than 20 beds have a higher rate of drop-outs and escapes. The average indoor space per resident is 36 square meters, there is often a garden, and residents generally live in two-bed rooms. Most facilities are located within walking distance of shopping centers or recreational facilities. Three-quarters have 24-hour staff coverage. On average, each facility has about 10 full-time equivalent workers, with a staff:resident ratio of 0.92. Most of the professional input is provided by nurses and auxiliary staff. Critical issues to be considered in planning facilities include the physical environment, the size, and the staffing patterns. Angelo Picardi, Giovanni de Girolamo, and Pierluigi Morosini are affiliated with the National Mental Health Project, Italian National Institute of Health, Rome, Italy.Giovanni Santone is affiliated with the Psychiatric Clinic, United Hospitals of Ancona and University of Marche, Ancona, Italy.Ian Falloon is affiliated with the University of Auckland, Auckland, New Zealand.Angelo Fioritti is affiliated with the Program on Mental Health and Pathological Dependence, AUSL of Rimini, Rimini, Italy.Rocco Micciolo is affiliated with the Chair of Biostatistics, University of Trento, Trento, Italy.Enrico Zanalda is affiliated with the Department of Mental Health, Turin, Italy.The PROGRES Group includes: National Coordinators: G. de Girolamo, M.D., A. Picardi, M.D., P. Morosini, M.D. (National Mental Health Project, National Institute of Health, Rome); Biostatistician: R. Micciolo, M.D. (University of Trento); Regional Coordinators: P. Argentino, M.D., G. Borsetti, M.D., M. Casacchia, M.D., P. Ciliberti, M.D., G. Civenti, M.S.W., A. Colotto, M.D., G. Dell’Acqua, M.D., W. Di Munzio, M.D., G. Fagnano, D.Psyc., A. Fioritti, M.D., N. Longhin, M.D., M. Miceli, M.D., M. Nicotera, M.D., M. Pisetta, R. Putzolu, E. Rossi, M.D., M.E. Rotunno, M.D., D. Semisa, M.D., R. Tomasi, M.D., P. Tulli, D.Psyc., E. Zanalda, M.D.     

Strike action at the major teaching psychiatric facility

This article reviews the literature on strikes at psychiatric facilities and describes one such experience. The need in labor contracts to define a crisis in patient care and to protect the non-striking staff from extra-professional liability is highlighted.N. el-Guebaly, M.D. is Associate Professor and Head of the Department of Psychiatry, St. Boniface General Hospital, 409 Tache Ave., Winnipeg, Manitoba, Canada. R2H 2A6. J. Toews, M.D. is Associate Professor and Assistant Clinical Head of the Department of Psychiatry, Health Sciences Centre. Requests for reprints should be addressed to Dr. el-Guebaly at the above address.     

Physical activity, self-esteem, and self-efficacy relationships in older adults: A randomized controlled trial

A randomized controlled trial examined the growth and form of multidimensional self-esteem over a 12-month period (6-month exercise intervention and 6-month follow-up) in 174 older adults engaged in either a walking or stretching/toning program. The extent to which changes in physical fitness parameters and physical self-efficacy were related to changes in perceptions of attractive body, strength, physical conditioning, and physical self-worth was also determined. Latent growth curve analyses showed a curvilinear pattern of growth in esteem with significant increases at all levels of self-esteem upon completion of the intervention followed by significant declines at 6 months poistintervention in both groups. Frequency of activity and changes in physical fitness, body fat, and self-efficacy were related to improvements in esteem perceptions relative to attractive body, strength, and physical condition. Model fitting procedures suggested that the best fit of the data was to a model in which the influence of changes in efficacy and physical parameters on physical self-worth were mediated by perceptions of attractive body and physical conditions. This study was supported by the National Institute on Aging (Grant #AG 12113). We are indebted to the assistance provided by the following individuals at various stages of this endeavor: Jane Nelson, M.S., Richard Boileau, Ph.D., Greg Dykstra, Ph.D., Dimitri Demetriou, M.S., Heidi-Mai Talbot, M.S., Erin Dunn, M.S., Melissa Pena, M.S., Eric Hall, M.S., Chris Uchacz, M.S., Julie Lowery, R.N., Naveen Devabhaktuni, M.D., Angelo Pascale, M.S., and Chakang Pongurgson, M.S.     

BOOK REVIEWS

Book reviewed in this article: Reuben J.P., Purpura D.P., Bennett M.V.L. & Kandel E.R. Electrobiology of nerve, synapse and muscle Lenman J.A.R. & Ritchie A.E. Clinical Electromyography Brazier M.A.B. & Coceani F. (eds) Brain dysfunction in infantile febrile convulsions Brazier M.A.B. Electrical Activity of the Nervous System     

Damn the Torpedos! A Treatment Memoir*†

A former patient reflects on her treatment with Martin Cooperman, M.D., director of psychotherapy at Chestnut Lodge from 1958 to 1968. As noted in the short introduction by Jay S. Kwawer, Ph.D., who obtained this memoir for us, Cooperman left the Lodge to join Otto Will, M.D., at the Austen Riggs Center, where the author encountered him in his private practice.     

Book reviews

Book reviewed in this article:
Kidd G., Lawes N. and Musa I. Understanding Neuromuscular Plasticity
Hume Adams J. and Duchen L. (Eds) Greenfield's Neuropathology, 5th Edition
Hasso A. N., Shakudo M. and Chadrycki E. MRI of the Brain. The Raven MRI Teaching File III Neoplastic Disease
Cecconi L., Pompili A., Caroli F. and Squillaci E. MRI Atlas of Central Nervous System Tumours
Altschuler R. A., Bobbin R. P., Clopton B. M. and Hoffman D.W., Eds Neurobiology of Hearing: The Central Auditory System     

Medical nutrition therapy for hypercholesterolemia positively affects patient satisfaction and quality of life outcomes

Following a heart-healthy diet to lower cholesterol levels is often assumed to be difficult, to be burdensome, and to have a negative impact on quality of life (QOL). The purpose of this study was to evaluate the impact of medical nutrition therapy (MNT) versus usual care (UC) for hypercholesterolemia on patient satisfaction and QOL. Ninety ambulatory care patients (6 men and 30 women), age 28 to 66, were randomly assigned to receive either MNT from dietitians using a National Cholesterol Education Program-based protocol or UC from their physicians. Patients who received MNT reported no difference in QOL related to the taste or enjoyment of food compared with UC patients. However, the MNT group reported initial improvements in QOL related to the convenience and cost of following a low-fat diet when compared with the UC group. The MNT group also reported significant and lasting improvements in perceived QOL related to self-care compared with the UC group. MNT patients were more satisfied with the interaction at visits, knowledge and ability to manage their cholesterol, eating habits, appearance, time spent exercising, and life in general. Moreover, MNT patients did not report any negative impact related to following a low-fat diet in regard to feeling restricted by diet; interference with lifestyle activities; or difficulty planning, purchasing, or preparing meals or eating away from home. Contrary to popular belief, there is no apparent reduction but rather an improvement in some measures of QOL and patient satisfaction with MNT for hypercholesterolemia. This article was supported by a research grant from the American Dietetic Association Foundation and the E.P. Charlton Charitable Foundation and by the Massachusetts General Hospital (MGH) General Clinical Research Center (GCRC) (M01RR01066). We are grateful for the advice of Mark Schneider, Ph.D. and the help of MGH GCRC staff: Ellen J. Anderson, M.S., R.D., Jane Hubbard, M.S., R.D., Deborah Cioffi, and Nursing staff Vicki Turbini, and Kathleen Egan, for their assistance in data collection. We are most grateful to the MGH Ambulatory Nutrition Service dietitians (Lillian Sonnenberg, D.Sc., R.D., Catie Hanley, M.S., R.D., Mary McGehee, M.S., R.D., Lois Kiley, M.S., R.D.) for their implementation of the intervention, to the MGH Department of Dietetic Interns for their assistance in recruitment and data collection, and to Elina Levina, B.S. for data entry.     

BOOK REVIEWS

Book reviewed in this article:
Advances in Anatomy, Embryology and Cell Biology Ziles K.J.
Clinical Neuroimmunology Rose F.C. (ed.)
A History of Microtechniques Bracegirdle B.
Maturation of the Nervous System. Progress in Brain Research, Vol. 48 Corner M.A., Baker R.E., van de Poll N.E., Swaab D.F. & Uyling H.B.M. (eds)