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Biomedical subjects

M J Lambert

Publications and source records attributed to M J Lambert.

At least 19 recordsLinked to original sources
PubMed2001

A survival analysis of clinically significant change in outpatient psychotherapy.

The number of sessions required to produce meaningful change has not been assessed adequately, in spite of its relevance to current clinical practice. Seventy-five clients attending outpatient therapy at a university-affiliated clinic were tracked on a weekly basis using the Outcome Questionnaire (Lambert et al., 1996) in order to determine the number of sessions required to attain clinically significant change (CS). Survival analysis indicated that the median time required to attain CS was 11 sessions. When current data were combined with those from an earlier investigation (Kadera, Lambert, and Andrews, 1996), it was found that clients with higher levels of distress took 8 more sessions to reach a 50% CS recovery level than clients entering with lower levels of distress. At a six-month follow-up, CS gains appeared to have been maintained. Other indices of change also were examined (reliable change, average change per session). The implications of these results for allocating mental-health benefits, such as the number of sessions provided through insurance, are discussed.

Adolescent↗
PubMed2001

Pushing the quality envelope: a new outcomes management system.

This article is based on the authors' experience in designing and implementing outcomes management systems for large managed care organizations. Topics addressed include design of instruments, use of cost-effective technology, development of computerized decision-support tools, and methods for case-mix adjustment. The case-mix-adjustment models are based on a data repository of several thousand treatment cases with multiple measurement points across the course of treatment. Data from controlled and field studies are described. These data suggest that the outcomes management methods outlined in this article can result in significantly improved clinical outcomes and a more rational allocation of behavioral health care resources.

Cost-Benefit Analysis↗
PubMed2001

Patient-focused research: using patient outcome data to enhance treatment effects.

A program of research aimed at improving the quality of psychological interventions is described. Data from over 10,000 patients were analyzed to understand the association between number of treatment sessions and clinically significant improvement. In addition to a potential dose-response relationship, typical recovery curves were generated for patients at varying levels of disturbance and were used to identify patients whose progress was less than expected ("signal" cases). The consequences of passing this information along to therapists were reported. Analyses of dose-response data showed that 50% of patients required 21 sessions of treatment before they met criteria for clinically significant improvement. Seventy-five percent of patients were predicted to improve only after receiving more than 40 treatment sessions in conjunction with other routine contacts, including medication in some cases. Identification of signal cases (potential treatment failures) shows promise as a decision support tool, although further research is needed to elucidate the nature of helpful feedback. Outgrowths of this research include its possible contribution to social policy decisions, reductions in the need for case management, use in supervision, and possible effects on theories of change.

Combined Modality Therapy↗
PubMed2000

Attacking anxiety: a naturalistic study of a multimedia self-help program.

The effects of a commercial multimedia self-help program (Attacking Anxiety) were evaluated by examining the outcome of 176 individuals who participated in the treatment. Results suggested that 62 individuals suffering from anxiety achieved clinically significant improvement. An additional 40 achieved reliable change, despite the fact that these individuals had suffered from anxiety-based problems for years prior to their participation. Only one participant experienced negative change. These results are discussed in relation to the growing literature on self-help interventions and the limitations imposed by the naturalistic nature of the investigation.

Adult↗
PubMed2000

Lower-extremity Doppler for deep venous thrombosis--can emergency physicians be accurate and fast?

UNLABELLED: Clinical diagnosis of lower-extremity (LE) deep venous thrombosis (DVT) requires confirmation by an imaging study before committing the patient to anticoagulation therapy. Studies have shown that demonstrating compressibility of leg veins under ultrasound is accurate for ruling out DVTs when performed by vascular specialists. Although LE Doppler has become the preferred test for diagnosing DVTs, it is not always available 24 hours per day. OBJECTIVES: To evaluate the accuracy and speed with which emergency physicians (EPs) could perform LE color duplex ultrasonography for the detection of DVT. METHODS: Patients presenting to an urban community emergency department (ED) between August 1, 1998, and March 3, 1999, were enrolled into this prospective study. The EPs, who underwent brief and standardized training, scanned patients at high risk for DVT with leg pain, swelling, or both. Physicians performed color duplex ultrasound examinations with compression at the common femoral and popliteal veins. The time until completion of the ED scan was recorded with a standardized method. The vascular laboratory performed a complete duplex ultrasound examination within eight hours. RESULTS: One hundred twelve patients were enrolled in the study, with 34 positive for DVT. The median examination time was 3 minutes 28 seconds (95% CI = 2 min 45 sec to 4 min 2 sec; IQR 3 min 9 sec). Times ranged from 1:02 to 18:20 minutes. The ED results had a high correlation with vascular laboratory studies, giving a kappa of 0.9 and a 98% agreement (95% CI = 95.4% to 100%). CONCLUSION: Emergency physicians can perform LE duplex ultrasound examinations accurately and quickly.

Clinical Competence↗
PubMed2000

Outcome Questionnaire: item sensitivity to change.

Although high levels of reliability are emphasized in the construction of many measures of psychological traits, tests that are intended to measure patient change following psychotherapy need to emphasize sensitivity to change as a central and primary property. This study proposes 2 criteria for evaluating the degree to which an item on a test is sensitive to change: (a) that an item changes in the theoretically proposed direction following an intervention and (b) that the change measured on an item is significantly greater in treated than in untreated individuals. Outcome Questionnaire (Lambert et al., 1996) items were subjected to item analysis by examining change rates in 284 untreated control participants and in 1,176 individuals undergoing psychotherapy. Results analyzed through multilevel or hierarchical linear modeling suggest the majority of items on this frequently used measure of psychotherapy outcome meet both criteria. Implications for test development and future research are discussed.

Adult↗
PubMed1999

Decreasing length of stay with emergency ultrasound examination of the gallbladder.

OBJECTIVE: To determine whether patients who received emergency screening ultrasound examinations (ESUEs) of the gallbladder by emergency physicians (EPs) have a shorter ED length of stay (LOS) than do those receiving ultrasound studies from radiology. METHODS: A retrospective chart review from July 1995 to August 1998 identified 1,242 patients who received gallbladder ultrasound examinations. Seven hundred fifty-three patients received ESUEs by EPs of varying levels of ultrasound experience. Four hundred eighty-nine patients received gallbladder ultrasound examinations from radiology, and were not scanned by EPs. The LOSs of the two groups were compared. Significance was evaluated using a two-tailed t-test. RESULTS: When patients received an ESUE by an EP, the median LOS was 7% (22 min) less than that for those who received an ultrasound examination by radiology (p = 0.017; 95% CI = 4 min to 41 min). When evaluated by disposition, patients discharged home and scanned by EPs had their median LOSs shortened by 11% or 32 minutes (p = 0.02; 95% CI = 5 min to 55 min). When evaluated by time of day, patients who presented after hours (6 PM-6 AM) and were scanned by EPs spent 15% (52 min) less time in the ED (p = 0.0002; 95% CI = 26 min to 89 min). Those who were seen after hours and discharged home had their LOSs shortened by 20% (1 hr, 13 min, p = 0.001; 95% CI = 28 min to 1 hr, 56 min). CONCLUSIONS: In a teaching hospital with a residency program, ESUEs decrease ED LOS for these patients. The difference was most apparent for patients presenting after hours.

Emergency Medical Services↗
PubMed1999

A qualitative examination of borderline personality disordered (BPD) patients: interpersonal dynamics and underlying paradoxes.

Theoretical conceptualizations of symptomatology in patients with borderline personality disorder (BPD) have noted an inability to integrate contradictory perceptions (splitting, or dichotomous thinking) as a hallmark of the disorder. This study investigated contradictions manifest in the thinking and behavior of BPD patients, using the concept of paradox. A paradox occurs when an apparent contradiction contains an underlying logic which makes the contradiction comprehensible. Using qualitative methods of analysis, this study explored paradoxes evident in 10 BPD patient narratives about relationship events. Specific paradoxes relating to interpersonal conflicts and self-destructiveness are presented, along with the underlying logic of each paradox as described by patients. Implications for treatment are discussed.

Borderline Personality Disorder↗
PubMed1995

Pragmatics of tracking mental health outcomes in a managed care setting.

Accountability, cost effectiveness, and continuous quality improvement are essential features of all managed health care systems. However, application of these principles to mental health treatments has lagged behind other health care services. In this article, administrative, practice, and technical issues are addressed through a joint effort between academically based researchers and administrators from two large managed health care organizations. Principles related to the measurement of outcome, instrument selection, and obstacles to the implementation of an ongoing program to assess mental health treatment outcomes are identified. Finally, principles for successfully changing mental health provider behavior toward outcome assessment and the implications of such for mental health delivery systems are discussed.

Humans↗
PubMed1995

Graduate training in psychotherapy: are therapy outcomes enhanced?

Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. Training protocols that are known to enhance trainees' skills are briefly discussed, as are conclusions of meta-analytic reviews examining relationships between therapist experience and training, and therapy outcome. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized. It is concluded that a variety of outcome sources are associated with modest effect sizes favoring more trained therapists. In many outpatient settings, therapists with more training tend to suffer fewer therapy dropouts than less trained therapists. Shortcomings of available research and speculations about possible variables influencing outcomes are discussed.

Curriculum↗
PubMed1995

Clinical significance of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data.

The clinical significance of research findings is an important issue that, until recently, was often neglected. Statistical methods are available, however, to evaluate the meaningfulness of pre- to post-treatment change. The clinical significance of the National Institute of Mental Health Treatment of Depression Collaborative Research Program Data was evaluated. A substantial number of clients receiving treatment for depression made reliable improvements and had posttreatment scores that fell within a functional distribution. A small number of clients reliably deteriorated despite undergoing 12 sessions of treatment. No differences in clinical significance rates among treatment groups existed for measures of depressive symptoms. Treatments differed in terms of clinical significance on a measure of general symptom severity. There was substantial agreement among diverse methods of measurement regarding the identification of individuals making clinically significant change.

Cognitive Behavioral Therapy↗
PubMed1995

An exploration of the relationship between interpersonal problems and psychological health.

The relationship between interpersonal distress and psychological health was investigated using a sample of 185 college undergraduates. Subjects completed the Inventory of Interpersonal Problems (a measure of interpersonal distress), the Personal Orientation Inventory (a measure of self-actualization), and the Miller Social Intimacy Scale (a measure of interpersonal closeness). The mean of scores on the Inventory of Interpersonal Problems was compared with the mean of the clinical sample reported in 1988 by Horowitz, et al. The measures of psychological health were correlated with the Inventory of Interpersonal Problems total and with the octant scales of the Inventory of Interpersonal Problems-Circumplex version. The measures were also projected onto the circumplex to summarize their interpersonal connotations.

Adaptation, Psychological↗
PubMed1995

Ethnic differences on the Outcome Questionnaire.

The Outcome Questionnaire is a 45-item inventory of client-report symptoms and distress, used to track therapeutic change on a session-by-session basis. Data collected with the cooperation of a managed care provider were analyzed to note ethnic differences on the questionnaire. 1552 first session questionnaires were selected and mean total and subscale scores were analyzed using analysis-of-variance procedures for differences by ethnicity. No significant differences were found; however, significant ethnic differences on some items were noted, and these are reported with ethnic trends in clients' problems, diagnoses, and therapists' ratings on Global Assessment of Functioning. These findings were contrasted with those of other studies reporting ethnic differences on various measures such as IQ and personality assessment.

Adaptation, Psychological↗