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J S Lyons

Publications and source records attributed to J S Lyons.

At least 73 records · Page 4Linked to original sources
PubMed1991

Main effects analysis in clinical research: statistical guidelines for disaggregating treatment groups.

Treatment outcome research generally relies on main effects analysis of variance to determine whether treatments are differentially effective. Bryk and Raudenbush (1988) developed a decision strategy for disaggregating treatment groups under conditions of heterogeneity of variance. There is, however, reason to consider disaggregating main effects even when this assumption is not violated. The potential statistical significance of disaggregation can be shown to be a function of the reliability of the dependent measure. With this reliability, residual variance can be partitioned into a systematic (individual differences) component and a random error component. It is then possible to calculate an F test of the ratio of these variances. When this F is statistically significant and the proportion of within-cell systematic variance to total variance is large, disaggregation should be undertaken to search for important individual or treatment difference variables (i.e., interactions).

Adult↗
PubMed1991

Expenditures for psychotropic medications in the United States in 1985.

OBJECTIVE: Psychotropic medications have seldom been included in estimates of the costs of mental health services. In the infrequent case that these costs have been assessed, they have been estimated by using national surveys of consumers of health services. The objective of this study was to estimate the costs of prescriptions for psychotropic medications in the United States in 1985 and to assess the difference with the most recent cost estimate from a health services survey (1977). METHOD: Study data were based on retail costs of psychotropic medications reported to the Pharmaceutical Data Service Alpha National Prescription and Sales Audit. The data come from a computerized survey panel of 2,250 pharmacies representative of the more than 14,000 pharmacies nationwide. The database includes all medication prescriptions filled, whether paid with cash or Medicaid or reimbursed by third-party payment. Analyses were limited to psychotropic medication prescriptions. RESULTS: In 1985, $1.45 billion was spent on outpatient psychotropic medications. Nearly $868 million (60% of the total) was spent on antianxiety and sedative-hypnotic medications, while approximately $263 million (18%) was spent on antipsychotic medications, $240 million (17%) on antidepressants, and $84 million (5%) on combination psychotropic medications. These expenditures were much higher than would have been expected given the most recent health services estimate of $513 million. CONCLUSIONS: These results demonstrate the substantial cost of psychotropic medications in 1985. The finding that the cost of psychotropic medications was so high, in contrast to the lower estimate from the 1977 survey, demonstrates the importance of obtaining more frequent cost estimates and basing future estimates on medication databases.

Costs and Cost Analysis↗
PubMed1991

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients.

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.

Aged↗
PubMed1991

Assessment of coping strategies, social support, and general health status in individuals with diabetes mellitus.

This study examined 51 individuals (30 men, 21 women) who participated in an outpatient diabetes education program. Participants with higher perceived support by friends and problem-solving coping strategies were healthier, while those exhibiting a wish-fulfillment coping style were less healthy. Perceived family social support was much greater for Type II (noninsulin-dependent) individuals than for Type I (insulin-dependent) individuals. Men perceived greater family support, were more likely to use problem-solving coping, and were healthier than women; however, both wish fulfillment and detachment coping were more prevalent in women. Perceived support from family and friends increased with education. Implications for diabetes education programs are also introduced.

Adaptation, Psychological↗
PubMed1990

Capitation payment systems and public mental health care: implications for psychotherapy with the seriously mentally ill.

The evolution, rationale, and implications of capitation payment systems in public mental health are discussed. These systems will unify the clinical, administrative, and fiscal structures of state and community mental health providers. Psychotherapeutic practice may shift to more action-oriented, problem-focused, brief and crisis interventions. The diminishing prospects for long-term intensive psychotherapy and the need to demonstrate its clinical efficacy and economic feasibility are discussed.

Capitation Fee↗
PubMed1990

Supplier-induced demand for pastoral care services in the general hospital: a natural experiment.

Assesses the effects the elimination of a pastoral care training program and a reduction in staff had on referral rates for pastoral care. Results showed a decrease in referrals initiated by pastoral care staff but an increase in pastoral care referrals initiated by medical staff and patients. Notes that when pastoral care staff were less available, the demand for their services became more apparent.

Chaplaincy Service, Hospital↗
PubMed1989

A proposed value matrix for the evaluation of psychiatric consultations in the general hospital.

A strategy of determining the value of psychiatric consultation services in the general hospital is presented. Value analysis, a theoretically driven model for establishing the worth of mental health services from multiple perspectives, is used to propose a value matrix for consultation psychiatry. Based on an integration of decision theory and evaluation science, the goal of value analysis is to establish a range of outcomes that might be viewed as important from various perspectives. This hypothesized matrix of economic and clinical values for patients, families, medical staff, providers, payors, and society provides a framework for evaluating outcomes of psychiatric consultation services.

Cost-Benefit Analysis↗
PubMed1989

Health services research in nursing homes: a systematic review of three clinical geriatric journals.

This article presents the results of a systematic review of five years of health services research found in nursing home studies published in three major geriatric journals. This review indicates that very little services research has been undertaken in nursing home settings. The small amount of quantitative, empirical research that has been published has suffered from research design, method, and analytic shortcomings. Nursing home research in at least one federal agency has experienced worse than average funding and disapproval rates. The implications of this review are discussed, and recommendations are made for advancing this important area of study.

Aged↗
PubMed1989

Religious affiliations in mental health research samples as compared with national samples.

Religious affiliations of patients in research samples in four major psychiatric journals for the years 1978-1982 were compared with those reported in national samples. Protestants and the unaffiliated were underrepresented, whereas Jewish persons were overrepresented. Catholics used mental health services in proportions similar to their presence in the population at large. These findings suggest that religious affiliation may influence the use of mental health services.

Catholicism↗
PubMed1989

Effect of a psychiatric liaison program on consultation rates and on detection of minor psychiatric disorders in cancer patients.

Because only 2% of the 47% of cancer patients with psychiatric disorders receive psychiatric consultations, the authors investigated the impact of a psychiatric liaison program on improving consultation rates on a gynecologic oncology unit. Consultation rates for gynecologic cancer patients before and after introduction of the program were compared to rates from other cancer patients in the same hospital during the same 7-year period. Rates for the gynecologic patients were higher after the program (9%) than before (4%), as were rates for follow-up consultations, and the detection of minor DSM-III disorders improved. The authors conclude that liaison improves access to psychiatric treatments that often enhance the quality of life for seriously ill patients.

Female↗
PubMed1989

The construct validity of the ischemic score of Hachinski for the detection of dementias.

Two hundred forty-one nursing home patients from the National Nursing Home Survey Pretest were assessed using the Ischemic Score of Hachinski. Medical chart diagnoses were used to classify those with and without dementia. The Mini-Mental State Examination was used to assess the accuracy of the medical-chart diagnoses of dementia. The Ischemic Score failed to differentiate multi-infarct dementia from other types of dementias. Instead, the difference between the two dementia groups was in the direction opposite that predicted by Hachinski.

Aged↗