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Concern about the potential of medical and surgical residents making errors when fatigued has led to a reduction in resident duty hours. However, this reduction in duty hours, coupled with a lack of, or inadequate training in dealing with fatigue, may result in decreased opportunities for residents to learn how to provide safe care when fatigued. We conducted structured interviews with 18 senior residents completing their residency programs to investigate existing fatigue training programs and their experiences in coping with fatigue as physicians. Most reported receiving some lectures on fatigue, and use of one or more strategies to cope with fatigue while providing patient care. Respondents reported moderate to high concern about their ability to provide safe patient care when fatigued once residency training was completed. Further research is needed related to fatigue awareness and training.

As reviewed by Bettencourt and colleagues,1 a number of studies have considered psychosocial issues as they relate to the experiences of rural dwelling women who have been treated for breast cancer. While many concerns reported by rural women are commensurate with those identified by urban women (eg, body image, effects of cancer diagnosis and treatment on family members), some differences seem to be emerging. In general, women living in rural areas may be more likely to experience distress than women living in urban communities.2 In addition to a recognized shortage of mental health care in rural communities,3 issues of stigma related to mental health care and expectations of self-sufficiency may limit acceptance of mental health services in rural areas.4 Among rural women living with cancer, high levels of depression and hopelessness/helplessness have been noted.5 Rural women living with cancer report lower than average quality of life6 and may have particular concerns about being stigmatized within their communities as a result of their cancer diagnosis.7 One way in which rural and urban areas may differ is in the availability of community-based social support. The importance of social support as a buffer to emotional distress has been widely studied among a variety of medical populations8 including individuals living with cancer.9 Potential effects of rural versus urban residence have been noted, although findings are somewhat equivocal, as both benefits and hindrances to well-being have been identified. For example, given the shortage of mental health care providers in rural communities,3 geographic distance may limit availability of professional social support for rural women.10 On the other hand, several characteristics of rural communities may be of benefit to individuals coping with cancer. Rural communities often value close relationships with family, community members and religious institutions,4,11 all of which can be excellent sources of social support. In fact, studies have highlighted the perceived benefit of increased community support experienced by female cancer survivors living in rural compared to urban areas.12 Thus, while there may be limited cancer-specific support services in many rural communities, women living in rural areas may have community networks which make general social support readily available.13 Due to unanswered questions regarding whether rurality may affect quality of life among cancer survivors, and recognizing the importance of social support in quality of life outcomes regardless of residence, analyses presented herein were conducted to examine the extent to which rural residence and social support seeking affect quality of life among breast cancer survivors in the early post-treatment period.

PURPOSE Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.

Missouri's traumatic brain injury (TBI) early referral programme connects individuals with TBI to state services in the acute stages of recovery. This study evaluated the impact of this programme on service utilization and functional outcomes.Sixty-seven individuals in the Early Referral (ER) programme were compared with 31 individuals who received services later in their recovery (controls) in terms of their functioning upon programme enrollment and programme services received. Telephone surveys were then completed with 29 ER and 22 later-referred controls assessing social/emotional and vocational functioning, as well as satisfaction with programme services.The ER group had greater functional limitations than controls upon enrollment. Despite this, at follow-up the ER group evidenced significantly better social integration, emotional well-being and vocational functioning than the control group. Individuals in the ER group did not require/receive more programme resources to achieve these better outcomes. Across both groups, 91% reported feeling the programme is valuable for individuals with TBI.Missouri's TBI early referral programme provides efficacious and cost-effective targeted support for individuals with TBI. Contact with clients and their families during or shortly after acute rehabilitation appears to be associated with better functional outcomes without an increase in the level of services rendered.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program thatmatched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients.

As demographics shift to include more elderly populations and those living with chronic medical conditions, costs for health care services continue to escalate. As a result, health care systems around the world increasingly struggle to provide cost-effective, coordinated, and quality health care to those they serve. Significant policy, procedural, and practice changes are essential in solving these growing problems. With experience in interdisciplinary teams, rehabilitation psychologists and other psychological providers have a clear vantage point from which to help guide movement toward an integrated health care model that values health promotion, prevention, and collaborative care. Psychologists can be an integral part of this new “interdisciplinary team,” but, as a profession, we must advocate for this inclusion and position ourselves to take on this new role through education and training.

This study examined how breast cancer diagnosis influences underlying cognitions and explicit worries about death, and their roles in health-related quality of life (QOL). Forty-two women who underwent surgery for the removal of either a cancerous or benign breast mass indicated their worries about dying, and completed measures of death-thought accessibility and QOL. Women with cancer reported lowered physical, emotional, and functional well-being. Further, although they did not differ in explicit worry about death, women with cancer (compared to those with a benign mass) evidenced greater death thought accessibility, which in turn mediated the effect of cancer diagnosis on well-being.

Objective: To examine the effects of a 10-week Tai Chi (TC) program on neuropsychological, psychological, and physical health of female cancer survivors. Design: Twenty-three women with a history of cancer participated in 60-min TC classes two times/week for 10-weeks. Main Outcome Measures: Before and after the intervention, participants completed neuropsychological tests (memory, executive functioning, language, and attention); 5 tests of balance; and self-report questionnaires of neuropsychological complaints, stress and mood, and fatigue. Results: After the 10-week session, participants evidenced fewer neuropsychological complaints and enhanced neuropsychological functioning. They also demonstrated improved balance and reported better psychological functioning. Conclusions: Results suggest that TC may promote gains in neuropsychological functioning, in addition to previouslydemonstratedimprovementsinphysicalandpsychologicalhealth.These findingssupporttheneed for controlled trials examining the potential benefits of TC on neuropsychological functioning after cancer.

Legislative advocacy is a prerequisite for the development of research and community services benefiting individuals with traumatic brain injury (TBI). Dr Mitchell Rosenthal and other leaders in rehabilitation began the process of advocating for TBI services more than 25 years ago, before many in the field fully appreciated the necessity of these efforts. Since that time, substantial gains have been made through advocacy efforts on behalf of individuals with TBI and their families. This article provides an overview of the TBI advocacy movement, highlighting federal legislation resulting in appropriations for TBI services and protecting the rights of individuals with TBI. Key government entities engaged in developing states' TBI infrastructure and providing services to individuals with TBI and their families are also discussed. In addition to celebrating some of the successes that were initiated by the efforts of Dr Rosenthal and other visionaries, select shortcoming of current legislation is noted to provide insights regarding future advocacy needs.