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Objective: Technology is rapidly shifting our day-to-day existence, education, social relationships, health care and business. Psychiatric leaders have slowly explored telepsychiatric services – but few have an approach to technology in general–due to competing clinical, educational and research demands. Technology has typically been added on, rather than integrated, to institutional functions. Method: This narrative review used a literature search of Medline, PsycNET, PsycINFO, Embase, Cochrane, SpringerLink, Scopus, ABI/Inform, Business Source Complete, and Web of Science, using subject headings and keywords along with a manual search of reference lists of articles published by November 2020. The keywords explored four areas: 1) business; 2) service delivery; 3) system change; and 4) technology. Articles were reviewed by title/abstract, full text review and review of references. They were included if they discussed integration of technology into health care and compared literature from medicine/health, psychiatry/behavioral health, business, technology, leadership and health care administration. The goal was to explore how medicine/psychiatry has integrated technology compared to business, and apply business approaches to health care and training. Results: From a total of 2,710 potential references, two authors found 327 eligible for full text review and found 69 papers directly relevant to the concepts. Business and medicine/psychiatry have similarities/differences from both historical and contemporary views. Many health care systems and companies lack a strategic plan for technology and focus only on short-term due to administrative demands. Clinical informatics is a rapidly expanding area and would be central to this process. It has started to facilitate patient-centered care as defined by quality, affordable, and timely health care. While in principle information systems use integrative approaches, electronic health records, electronic means of communications with patients and staff, behavioral health indicators and related digital advances are often added to existing systems rather than integrated. Effective businesses use integrative approaches to share domain knowledge and streamline practices to link information technology (IT) with research and development, production, financing and marketing management. A case example highlights the IT strategy and business leaders’ comments in shifting to straight through processing (STP) from the banking industry for investments. It also exemplifies a model of shared IT-business understanding, which improves performance via efficiency, quality of data/information processing/integration and managerial teamwork. Conclusion: When it is integrated into health care service delivery workflow, evaluated and quality improved, IT facilitates the translation of strategic planning into organizational change. Incremental versus strategically innovative approaches to technological integration for care, education and administration are considered. Successful implementation requires a needs and impact assessment for patients, staff, clinicians and leaders across all levels of the organization. Benefits to the mission, limited disruptions of core operational workflow and reasonable costs reduce the likelihood of failure.

Learning is no longer constrained to the classroom or lecture hall. Today's students expect teaching to be available 24/7 and on whatever device they own and to be interactive and engaging. Educators need to become familiar with computer-based teaching tools and learn how to implement them or risk losing their audience. Use of these tools is not merely converting the medium, say from a VHS (video home system) tape to a YouTube stream, but incorporating the features of the educational tools to facilitate active learning. Social media has become a force in the educational arena, providing a foundational framework.

All health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care, yet mobile health technologies may have even more promise. A scoping review examined the research question: “What are the components of culturally competent, mobile health care, and what approaches have clinicians and systems taken to implement this care, train clinicians and evaluate outcomes?” The literature search from January 2000 to March 2020 focused on keywords in four concept areas: (1) competencies; (2) mobile health; (3) culture; and (4) clinical care. Of 2471 papers, 183 papers were directly relevant to the concepts. Few studies and professional organizations’ publications specifically discuss skills or competencies for mobile health and cultural factors. Existing telehealth competency sets (i.e., video, social media, mobile health, telebehavioral health, asynchronous) have limited cultural components, and one outline of culturally competencies exists without mention of technology. The landscape of culturally competence is expanded with cultural humility and safety constructs. New sets of mobile health and cultural competencies were constructed—with integration where possible—and training and administrative approaches are suggested. Effectiveness research is needed to implement and evaluate mobile health and cultural competencies. Research is also needed to understand how these competencies align with telehealth, rural health, and unique populations (e.g., refugees, Indigenous peoples, migrant workers, gender diverse groups). Outreach and advocacy for the inclusion of people with lived and living experience is essential to this research.

The production of indium-tin oxide has increased in the past decades due to the increased manufacture of liquid crystal displays (LCD). Taiwan is one of the highest indium-consuming countries worldwide. After repeated inhalation, indium oxide (In2O3) particles would accumulate in the lungs, resulting in severe lung effects. We report two workers of an LCD producing facility with elevated serum indium level up to 149 and 73.8 μg/L (normal value 3.5 μg/L), which was much higher than that observed in previous case reports in Taiwan. We collected their detailed working history, symptoms, pulmonary function, radiologic findings, and followed up for more than one year. We also performed workplace evaluation of the facility. We observed that sandblasters who clean components of ITO thin-film production machinery by sandblasting with aluminum oxide tend to have higher indium exposure with worse pulmonary functions and HRCT findings.

Residents play a pivotal role in medical students' clinical education. From a feedback lens, the near-peer relationship between student and resident holds the potential to foster an educational alliance that could influence learning. We undertook the current qualitative study to explore medical students' perceptions of feedback experiences with residents, addressing when, how and why (and conversely when not and why not) resident feedback plays a role in their clinical education.Our methodology was qualitative interpretive description, informed by phenomenology. We conducted 24 semi-structured interviews with third and fourth year medical students at one institution. The interviews aimed to foster rich discussion about students' feedback experiences with residents during clinical rotations. Data collection and analysis proceeded iteratively. Initial interviews were independently open-coded by three investigators and then collaboratively refined. Codes were applied to subsequent interviews, and new codes were developed. During the final stages of analysis, we organised our themes by drawing on a sociocultural perspective to examine students' perceptions of relationship-building with residents and when and how this influenced feedback and learning.From the students' perspectives, when residents contributed to building interpersonal relationships with students, this in turn influenced students' receptivity to both encouraging and constructive feedback conversations. In the context of resident-student relationships that were perceived as supportive, resident feedback influenced how students approached learning and working in the clinical environment, as well as students' visions of their future selves. In unsupportive relationships, students were less inclined to engage in feedback with residents and students noted resident behaviours that they wanted to avoid in themselves.Residents are uniquely positioned to create a strong educational alliance with students in which feedback conversations can flourish. Focusing educational efforts on resident feedback conversations has the potential to significantly impact the feedback culture of our clinical environments.

The Internet is a vast expanse of information; however, search engines have made finding the proverbial needle in a haystack a simple matter. Although insurance provider databases and referrals may dominate how patients find their doctor today, one's online reputation and reviews on physician ratings sites will increasingly play a role in how prospective patients find their next provider. Social media plays a dominant role as the medium where people place and find information, blurring the boundary of professional and personal use. Privacy online has become an endangered species, requiring active strategies to keep it from going extinct.

Faculty and trainees need clinical skills, knowledge, and attitudes to ensure quality care using technology. Clinical faculty teach, supervise, and role model skills for trainees and interprofessional team members. Mobile health, smartphone/device, and app competencies may be situated within the graduate medical education milestone domains. This article outlines these competencies and aligns them with clinical care, teaching methods, and evaluation. These competencies have similarities and differences from in-person and telepsychiatric care and additional dimensions like clinical decision support, technology selection, and information flow management across an e-platform. Health systems must integrate in-person and technology-based care, while maintaining the therapeutic relationship.

Technologies like smartphones and apps are reshaping life, health care, and business. Clinicians need skills, knowledge, and attitudes to ensure quality care and to supervise the current generation of trainees, consistent with the Institute of Medicine’s Health Professions Educational Summit. Literature is integrated on patient-, learner-, competency-, and outcome-based themes from the fields of technology, health care, pedagogy, and business. Mobile health, smartphone/device, and app competencies are organized in the Accreditation Council for Graduate Medical Education (ACGME) Milestone domains of patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication. Teaching methods are suggested to align competency outcomes, learning context, and evaluation. Services by mobile health, smartphone/device, and apps have a broader scope than in-person and telehealth and telebehavioral health care. This includes clinical decision support in medicine, hybrid delivery, and integration across health systems’ e-platforms. A curriculum with seminar, case- and problem-based teaching, supervision, evaluation, and quality improvement practices is needed to achieve competency outcomes. Clinicians have to adjust assessment, triage and treatment and attend to ethical, privacy, security, and other challenges. Health systems need to manage change, proactively plan faculty development, and create a positive e-culture for learning. Research is needed on implementing and evaluating mobile health competencies for this significant paradigm shift in health care.

Learning is no longer constrained to the classroom or lecture hall. Today's students expect teaching to be available 24/7 and on whatever device they own and to be interactive and engaging. Educators need to become familiar with computer-based teaching tools and learn how to implement them or risk losing their audience. Use of these tools is not merely converting the medium, say from a VHS (video home system) tape to a YouTube stream, but incorporating the features of the educational tools to facilitate active learning. Social media has become a force in the educational arena, providing a foundational framework.

Most psychiatric care is delivered in primary care settings, where depression is the most common presenting psychiatric symptom. Given the high prevalence of depression worldwide and the well-established consequences of untreated depression, the ability of primary care clinicians to effectively diagnose and treat it is critically important. This article offers up-to-date guidance for the diagnosis and treatment of major depressive disorder, including practical considerations for delivering optimal and efficient care for these patients.

BackgroundCognitive deficits at the first episode of schizophrenia are predictive of functional outcome. Interventions that improve cognitive functioning early in schizophrenia are critical if we hope to prevent or limit long-term disability in this disorder.MethodsWe completed a 12-month randomized controlled trial of cognitive remediation and of long-acting injectable (LAI) risperidone with 60 patients with a recent first episode of schizophrenia. Cognitive remediation involved programs focused on basic cognitive processes as well as more complex, life-like situations. Healthy behavior training of equal treatment time was the comparison group for cognitive remediation, while oral risperidone was the comparator for LAI risperidone in a 2 × 2 design. All patients were provided supported employment/education to encourage return to work or school.ResultsBoth antipsychotic medication adherence and cognitive remediation contributed to cognitive improvement. Cognitive remediation was superior to healthy behavior training in the LAI medication condition but not the oral medication condition. Cognitive remediation was also superior when medication adherence and protocol completion were covaried. Both LAI antipsychotic medication and cognitive remediation led to significantly greater improvement in work/school functioning. Effect sizes were larger than in most prior studies of first-episode patients. In addition, cognitive improvement was significantly correlated with work/school functional improvement.ConclusionsThese results indicate that consistent antipsychotic medication adherence and cognitive remediation can significantly improve core cognitive deficits in the initial period of schizophrenia. When combined with supported employment/education, cognitive remediation and LAI antipsychotic medication show separate significant impact on improving work/school functioning.

The Internet and new easy-to-use software have transformed the educational paradigm from the traditional lecture and grand rounds in person to lecture attendance and learning online. Web-based education is more than just another delivery vehicle. It provides a new opportunity to provide ­distance learning, collaboration in either real time or asynchronously, incorporate rich multimedia and other visuals to illustrate teaching points, and assessment of the learner’s progress. Programming skills and computer savvy are no longer necessary but key attention to instructional design and content is critical. Many Web-based educational creations are now evaluated and promoted as scholarly activity.

OBJECTIVE To investigate health problems, especially pulmonary function, among electroplating workers exposed to nickel. METHODS We recruited 153 nickel-exposed and 74 control workers from electroplating shops in printed circuit board production plants. Questionnaires were conducted to collect basic information. Symptoms and pulmonary function were ascertained. RESULTS The average urine nickel level of the 79 high-exposure, 74 low-exposure, and 74 control workers were 7.38 ± 5.96, 5.79 ± 4.75, and 5.27 ± 3.89 μg/g Cr, respectively. Nickel-exposed workers had a significantly higher incidence of skin- and airway-based symptoms. A significant relationship between impaired pulmonary function and high (more than5.2 μg/g Cr) urine nickel level was observed. CONCLUSIONS Nickel-exposed workers had significantly higher urine nickel levels with more skin-, airway-based symptoms, as well as impaired pulmonary function. A dose-response relationship between decreased pulmonary function and nickel exposure status was observed.

Silicosis remains the most prevalent occupational disease worldwide. There have been no specific studies focusing on the association between exposure settings at work and the clinical severity in silicosis patients. In this study, we describe and compare the clinical characteristics and silicosis-associated exposure history at work among workers from several types of ceramic production facilities in Taiwan. Methods: We reviewed the medical records of 221 patients who were first diagnosed with silicosis at the Occupational Medicine Clinic of Northern Taiwan in 2012. For each patient, we collected data on demographic characteristics, smoking habits, working history, duration of exposure, and years on the first relevant job. We also retrieved clinical reports of the pulmonary function test and the baseline chest radiography used for silicosis staging. Results: As compared to other ceramic workers, sanitary ceramic workers had a worse X-ray type (p=0.044), more advanced age (p0.05). Conclusion: In this study, we found that sanitary ceramic workers were at a similar risk to other ceramic workers for moderate to severe silicosis when older age and longer working duration were accounted for.

Faculty and trainees need clinical skills, knowledge, and attitudes to ensure quality care using technology. Clinical faculty teach, supervise, and role model skills for trainees and interprofessional team members. Mobile health, smartphone/device, and app competencies may be situated within the graduate medical education milestone domains. This article outlines these competencies and aligns them with clinical care, teaching methods, and evaluation. These competencies have similarities and differences from in-person and telepsychiatric care and additional dimensions like clinical decision support, technology selection, and information flow management across an e-platform. Health systems must integrate in-person and technology-based care, while maintaining the therapeutic relationship.

Context: The mechanism of nickel-induced pathogenesis remains elusive.Objective: To examine effects of nickel exposure on plasma oxidative and anti-oxidative biomarkers.Materials and methods: Biomarker data were collected from 154 workers with various levels of nickel exposure and from 73 controls. Correlations between nickel exposure and oxidative and anti-oxidative biomarkers were determined using linear regression models.Results: Workers with a exposure to high nickel levels had significantly lower levels of anti-oxidants (glutathione and catalase) than those with a lower exposure to nickel; however, only glutathione showed an independent association after multivariable adjustment.Discussion and conclusion: Exposure to high levels of nickel may reduce serum anti-oxidative capacity.

Background To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. Objective This paper sought out competencies for mobile technologies and/or an approach to define them. Methods A scoping review was conducted to answer the following research question, “What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?” The review was conducted in accordance with the 6-stage scoping review process starting with a keyword search in PubMed/Medical Literature Analysis and Retrieval System Online, APA PsycNET, Cochrane, EMBASE, PsycINFO, Web of Science, and Scopus. The literature search focused on keywords in 4 concept areas: (1) competencies, (2) mobile technologies, (3) telemedicine mode, and (4) health. Moreover, 2 authors independently, in parallel, screened the search results for potentially relevant studies based on titles and abstracts. The authors reviewed the full-text articles for final inclusion based on inclusion/exclusion criteria. Inclusion criteria were keywords used from concept area 1 (competencies) and 2 (mobile technologies) and either 3 (telemedicine mode) or 4 (health). Exclusion criteria included, but were not limited to, keywords used from a concept area in isolation, discussion of skills abstractly, outline or listing of what clinicians need without detail, and listing immeasurable behaviors. Results From a total of 1232 results, the authors found 78 papers eligible for a full-text review and found 14 papers directly relevant to the 4 key concepts. Although few studies specifically discussed skills, the majority were clinical studies, and the literature included no lists of measurable behaviors or competency sets for mobile technology. Therefore, a framework for mobile technology competencies was built according to the review, expert consensus, and recommendations of the Institute of Medicine’s Health Professions Education Summit and Accreditation Council of Graduate Medical Education framework. This framework borrows from existing competency framework domains in telepsychiatry and social media (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication) and added domains of mHealth clinical decision support, device/technology assessment/selection, and information flow management across an electronic health record platform. mHealth Asynchronous components require additional traditional learning, teaching, supervisory and evaluation practices. Interactive curricula with case-, problem-, and system-based teaching may help faculty focus on decision making and shape skills and attitudes to complement clinical exposure. Conclusions Research is needed on how to customize implementation and evaluation of mHealth competencies and to ensure skill development is linked to the quality of care. This will require the management of organizational change with technology and the creation of a positive electronic culture in a complex policy and regulatory environment.

BACKGROUND Technology use is ubiquitous in the digital age, especially in the X, Millennial/Y and Z generations. To ensure quality care, clinicians need skills, knowledge and attitudes that can be measured. This paper proposes mobile health, smartphone/device and app competencies based on a literature review, expert consensus and recommendations of the Institute of Medicine’s Health Professions Educational Summit. OBJECTIVE Outline competencies for mH, SP/D and apps using the Accreditation Council of Graduate Medical Education (ACGME) framework. METHODS Literature is integrated on patient-, learner-, competency- and outcome-based themes from the fields of technology, healthcare, pedagogy and business. Mobile health, smartphone/device and app competencies may be situated within the graduate medical education domains of patient care, medical knowledge, practice based learning and improvement, systems based practice, professionalism, and interpersonal skills and communication. Teaching methods are suggested to align competency outcomes, learning context and evaluation. RESULTS Health care via mobile health (mH), smartphone/device (SP/D) and apps have enough similarities to in-person and telepsychiatric care that competencies can be placed in milestone domains. Additional competencies are needed since mH includes clinical decision support, device/technology assessment/selection and information flow management across an e-platform. Since care with mH may have asynchronous components – like social media – competencies for trainees and clinicians may help them shift traditional learning, teaching, supervisory and evaluation practices to achieve targeted outcomes. Clinicians have to best assess, triage and treat patients using technology in a much broader context, while maintaining the therapeutic relationship. Curricula with interactive case-, problem- and system-based teaching are suggested for faculty, along with clinical exposure to new technologies and adaptation of systems-based practice. Health systems need to manage change and create a positive e-culture. CONCLUSIONS Research is needed on implementing and evaluating mH competencies, organization change with technology and how a paradigm shift like mobile health re-contextualizes digital healthcare CLINICALTRIAL Not applicable.

With thousands of smartphone apps targeting mental health, it is difficult to ignore the rapidly expanding use of apps in the treatment of psychiatric disorders. Patients with psychiatric conditions are interested in mental health apps and have begun to use them. That does not mean that clinicians must support, endorse, or even adopt the use of apps, but they should be prepared to answer patients' questions about apps and facilitate shared decision making around app use. This column describes an evaluation framework designed by the American Psychiatric Association to guide informed decision making around the use of smartphone apps in clinical care.

Telepsychiatry (TP; video; synchronous) is effective, well received and a standard way to practice. Best practices in TP education, but not its desired outcomes, have been published. This paper proposes competencies for trainees and clinicians, with TP situated within the broader landscape of e-mental health (e-MH) care. TP competencies are organized using the US Accreditation Council of Graduate Medical Education framework, with input from the CanMEDS framework. Teaching and assessment methods are aligned with target competencies, learning contexts, and evaluation options. Case examples help to apply concepts to clinical and institutional contexts. Competencies can be identified, measured and evaluated. Novice or advanced beginner, competent/proficient, and expert levels were outlined. Andragogical (i.e. pedagogical) methods are used in clinical care, seminar, and other educational contexts. Cross-sectional and longitudinal evaluation using quantitative and qualitative measures promotes skills development via iterative feedback from patients, trainees, and faculty staff. TP and e-MH care significantly overlap, such that institutional leaders may use a common approach for change management and an e-platform to prioritize resources. TP training and assessment methods need to be implemented and evaluated. Institutional approaches to patient care, education, faculty development, and funding also need to be studied.

Context Imaging and post-mortem studies suggest that frontal lobe intracortical myelination is dysregulated in schizophrenia (SZ). Prior MRI studies suggested that early in the treatment of SZ, antipsychotic medications initially increase frontal lobe intracortical myelin (ICM) volume, which subsequently declines prematurely in chronic stages of the disease. Insofar as the trajectory of ICM decline in chronic SZ is due to medication non-adherence or pharmacokinetics, it may be modifiable by long acting injection (LAI) formulations. Objectives Assess the effect of risperidone formulation on the ICM trajectory during a six-month randomized trial of LAI (RLAI) versus oral (RisO) in first-episode SZ subjects. Design Two groups of SZ subjects (RLAI, N = 9; and RisO, N = 13) matched on pre-randomization oral medication exposure were prospectively examined at baseline and 6 months later, along with 12 healthy controls (HCs). Frontal lobe ICM volume was assessed using inversion recovery (IR) and proton density (PD) MRI images. Medication adherence was tracked. Main outcome measure ICM volume change scores were adjusted for the change in the HCs. Results ICM volume increased significantly (p = .005) in RLAI and non-significantly (p = .39) in the RisO groups compared with that of the healthy controls. A differential between-group treatment effect was at a trend level (p = .093). SZ subjects receiving RLAI had better medication adherence and more ICM increases (chi-square p Conclusions The results suggest that RLAI may promote ICM development in first-episode SZ patients. Better adherence and/or pharmacokinetics provided by LAI may modify the ICM trajectory. In vivo MRI myelination measures can help clarify pharmacotherapeutic mechanisms of action.

Background Overexposure to carbon disulfide (CS2) has been associated with an increase in coronary heart disease, but the mechanisms mediating this effect remain unclear. We aimed to examine the relationship between CS2 exposure and oxidative stress markers, in order to clarify the oxidative mechanisms involved in CS2-induced atherosclerosis. Methods A total of 89 workers from a viscose rayon plant were recruited for this study, and 111 workers not exposed to CS2 served as controls. Cholesterol, triglyceride, malondialdehyde (MDA), superoxide dismutase (SOD), catalase, GSH peroxidase, as well as total antioxidants were analyzed. Results The workers exposed to CS2 had significantly higher MDA levels and lower SOD levels than the controls. The average MDA levels were 776 ± 268.2 (240–1,220) in the high exposure (≥10 ppm; n = 38), 751.6 ± 274 (170–1,320) in the low exposure (

ACADEMIC EMERGENCY MEDICINE 2011; 18:368–373 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to determine the level of agreement between emergency physicians (EPs) and consulting psychiatrists in their diagnosis and disposition of emergency department (ED) patients with behavioral emergencies. Methods: The authors conducted a prospective study at a university teaching hospital ED with an annual census of approximately 45,000 patients. During study hours, each time a psychiatric consultation was requested, the emergency medicine (EM) and consulting psychiatry residents were asked to fill out similar short questionnaires concerning their diagnoses and disposition decisions after they consulted with their attending physicians. EM and psychiatry residents were blinded to the other’s assessment of the patient. Residents were asked about their evaluation of patients regarding: 1) psychiatric assessments, 2) if the patients presented a danger to themselves or others or were gravely disabled, and 3) the need for emergency psychiatric hospitalization. Results: A total of 408 resident physician pairs were enrolled in the study. Patients ranged in age from 5 to 92 years, with a median age of 31 years; 50% were female. The most common psychiatric assessments, as evaluated by either EPs, consulting psychiatrists, or both, were mood disorder (66%), suicidality (57%), drug/alcohol abuse (26%), and psychosis (25%). Seventy-three percent were admitted for acute psychiatric hospitalization. Agreement between EPs and psychiatrists was 67% for presence of mood disorder, 82% for suicidality, 82% for drug/alcohol abuse, 85% for psychosis, and 85% for grave disability. There was 67% agreement regarding patient eligibility for involuntary psychiatric hold. EPs felt confident enough to make disposition decisions 87% of the time; for these patients there was 76% agreement with consulting psychiatrists about the final disposition decision. Conclusions: The 67% agreement between EPs and consulting psychiatrists regarding need for involuntary hold, and 76% agreement regarding final disposition, demonstrate a substantial disagreement between EPs and psychiatrists regarding management and disposition of ED patients with psychiatric complaints. Further studies with patient follow-up are needed to determine the accuracy of the ED assessments by both EPs and consulting psychiatrists.

OBJECTIVES : Welding operations expose to metal fume. We investigated the inflammatory responses and oxidative stress from metal fume exposure in an automobile plant. METHODS : We recruited 258 automobile workers and measured the urine zinc, copper, and nickel to determine the exposure level, and examined the white blood cells, and IL-6 as inflammatory responses to the metal fume exposure. We also examined the relationship between glutathione (GSH) and metals exposure. RESULTS : There were significant association between urine metals levels and welding hours. Zinc was significantly associated with blood white cells, interleukin-6, and GSH. Copper was significantly associated with GSH, but nickel was significantly inversely associated with GSH. CONCLUSIONS : Automobile welders appear to have significant metals exposure. White blood cells and IL-6 might be involved in inflammatory process of zinc fume exposure with zinc and copper increasing GSH, but nickel depleting it.

This article describes the process of change in an academic department of psychiatry that has led to the development of a diversity initiative in teaching, research, recruitment, and services. The authors performed a literature review of diversity initiatives using PubMed. The authors then wrote a case study of the development of a diversity initiative at UC Davis. Some articles on diversity initiatives were found, but none that detailed the administrative process, funding, or sustainability of such initiatives. In 1999, the UC Davis Department of Psychiatry and Behavioral Sciences recognized the importance of issues of diversity and established the Diversity Advisory Committee, a group of department faculty and residents that explores and addresses the diversity needs of the department. In our observations, there are at least three requirements for a successful diversity initiative: a diverse patient population, a “critical mass” of interested faculty, and support of the administration. With these three factors in place, the Diversity Advisory Committee produced four Continuing Medical Education symposia focused on diversity topics, developed a 4-year cultural psychiatry curriculum and a 4-year religion and spirituality curriculum within the residency, and supported nine residents who received awards from the APA’ s Minority Fellowships in 8 years. Future plans include department-wide and medical school faculty-wide diversity training, educational research, and a postgraduate fellowship in cultural psychiatry. This article shows that a diversity initiative can be undertaken with interested minority and nonminority faculty, administrative support, and a diverse patient population. The authors hope this article will provide assistance to other academic departments in developing diversity initiatives.

Long-acting, injectable, second-generation antipsychotic medication has tremendous potential to bring clinical stability to persons with schizophrenia. However, long-acting medications are rarely used following a first episode of schizophrenia.To compare the clinical efficacy of the long-acting injectable formulation of risperidone with the oral formulation in the early course of schizophrenia.A randomized clinical trial performed at a university-based research clinic, between 2005 and 2012. Eighty-six patients with recent onset of schizophrenia were randomized to receive long-acting injectable risperidone or oral risperidone. Half of each group was simultaneously randomized to receive cognitive remediation to improve cognitive functioning or healthy-behaviors training to improve lifestyle habits and well-being. An intent-to-treat analysis was performed between October 4, 2012, and November 12, 2014.A 12-month trial comparing the long-acting injectable vs oral risperidone and cognitive remediation vs healthy-behaviors training.Psychotic relapse and control of breakthrough psychotic symptoms.Of the 86 patients randomized, 3 refused treatment in the long-acting injectable risperidone group. The psychotic exacerbation and/or relapse rate was lower for the long-acting risperidone group compared with the oral group (5% vs 33%; χ21 = 11.1; P .001; relative risk reduction, 84.7%). Long-acting injectable risperidone better controlled mean levels of hallucinations and delusions throughout follow-up (β = -0.30; t68 = -2.6, P = .01). The cognitive remediation and healthy-behaviors training groups did not differ significantly regarding psychotic relapse, psychotic symptom control, or hospitalization rates, and there were no significant interactions between the 2 medications and the 2 psychosocial treatments. Discontinuations owing to inadequate clinical response were more common in the oral group than in the long-acting risperidone group (χ21 = 6.1; P = .01). Adherence to oral risperidone did not appear to differ before randomization but was better for the long-acting risperidone group compared with the oral group (t80 = 5.3; P.001). Medication adherence was associated with prevention of exacerbation and/or relapse (χ21 =11.1; P = .003) and control of breakthrough psychotic symptoms (β = 0.2; t79 = 2.1; P = .04).The use of long-acting injectable risperidone after a first episode of schizophrenia has notable advantages for clinical outcomes. The key clinical advantages are apparently owing to the more consistent administration of the long-acting injectable. Such formulations should be offered earlier in the course of illness.clinicaltrials.gov Identifier: NCT00333177.

The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users, with opportunities to try the innovations and find them worthwhile, despite organizational resistances.The authors reviewed the literature from psychiatry, psychology, sociology, business, and technology to distill common denominators for success and failure related to implementing technology.Beneficial technological innovations that are simple to use and obviously save everyone time and effort are easy to inaugurate. However, innovations that primarily serve management rather than subordinates or front-line utilizers may fail, despite considerable institutional effort. This article reviews and outlines several of the more prominent theoretical models governing successful institutional change.Successful implementation of difficult technological changes requires visionary leadership that has carefully considered the benefits, consulted with influence leaders at all organizational levels to spot unintended consequences and sources of resistance, and developed a detailed plan and continuous quality assurance process to foster implementation over time.

This article provides a brief overview of important issues for educators regarding medical education and technology.The literature describes key concepts, prototypical technology tools, and model programs. A work group of psychiatric educators was convened three times by phone conference to discuss the literature. Findings were presented to and input was received from the 2005 Summit on Medical Student Education by APA and the American Directors of Medical Student Education in Psychiatry.Knowledge of, skills in, and attitudes toward medical informatics are important to life-long learning and modern medical practice. A needs assessment is a starting place, since student, faculty, institution, and societal factors bear consideration. Technology needs to "fit" into a curriculum in order to facilitate learning and teaching.Learning about computers and applying computer technology to education and clinical care are key steps in computer literacy for physicians.

It has been over a decade since personal digital assistants (PDAs), or handheld computers, were introduced in the early 1990s. At that time, these devices offered only basic functions, such as a calendar, an address book, and a to-do list. With increasing computer power, memory, and several additional functions, PDAs are now a mainstay in the practice of medicine. Although the medical literature on PDA use has increased dramatically in recent years, few articles exist on their use in psychiatry. Perhaps psychiatrists have yet to embrace this new technology because they do not understand how helpful these devices can be. This article reviews the many capabilities of these devices in the practice of medicine.

Providing consultation services at a medical center requires mobility, efficiency, and accurate communication between providers. At a large academic medical center, the patients seen for psychiatric consultation may be hospitalized on various floors and even in several different buildings. Most psychiatric departments have a home base of operation where consultation requests are received by telephone, fax, or mail. Consequently, physicians on the consultation service either must be available by pager or must frequently walk from their home base to the patient’s bedside. In this column we describe how the consultation service at the University of California, Davis (UC Davis) Medical Center has used Palm personal digital assistants to facilitate the provision of care. We have found these devices to be useful for a variety of purposes, including electronic signout, documentation, provision of medication information, and storage of reference materials. Background The UC Davis Medical Center is a 400-bed teaching hospital that serves as a tertiary interdisciplinary care center for numerous patients in the greater Sacramento area and northern California. The consultation service comprises three teams: two teams assess primarily adults, and one team assesses children. Each team consists of attending physicians, clinical psychologists, a psychiatric resident, two or three medical students, and a clinical nurse specialist. During the regular work week, consultation requests are fielded by administrative staff, who alert team members by pager. The resident gives the attending physician an update on the case before evaluation. Sign-out Problem During the evenings and on weekends, the consultation service is staffed by residents and on-call faculty. Requests for consultations are paged directly to the resident on call. The resident and the faculty member evaluate the patient and also follow up on patients seen during the standard work week. In the past, this weekend sign-out was performed by using a clipboard with sheets of paper containing information for the resident on call. Although this system worked, it was barely adequate. For one thing, the handwriting of many residents and attending physicians was difficult to decipher. Another problem was that there was often confusion about which patients had been seen and what care each patient needed to receive from residents on call on the weekends. With multiple sheets of paper being used to track the patients, this information was at risk of being lost.

Objective The aim of the study was to explore the extent to which initial severity of positive or negative symptoms in patients with recent-onset schizophrenia is related to medication nonadherence during the first outpatient year. Methods The study involved 64 first-episode schizophrenia patients treated with the second-generation oral antipsychotic medication, risperidone, for 12 months. Symptoms were evaluated using the SANS and SAPS completed every 3 months. Pearson correlations between medication adherence and symptoms were examined over each 3-month interval during 12 months of follow-through treatment. Possible causality was inferred from cross-lagged panel analyses. Results As expected, higher levels of adherence with antipsychotic medication were generally associated with lower levels of concurrent reality distortion (mean of SAPS delusions and hallucinations). Greater adherence during the 3-month baseline interval was generally associated with lower levels of avolition–apathy as well as alogia throughout the first outpatient year. However, medication adherence was not significantly associated with decreases in avolition–apathy or alogia over time. Cross-lagged panel analyses based on correlation coefficients are consistent with a causal relationship between initial medication adherence and lower levels of alogia. A test of mediation confirmed that an indirect path through reality distortion mediated the relationship between medication nonadherence and alogia. Conclusions The associations between greater medication adherence and lower levels of negative symptoms appeared to be accounted for by the relationship of both variables to positive psychotic symptoms. The findings suggest that the impact of second-generation antipsychotic medication on suppression of negative symptoms might be mediated via a reduction in positive symptoms.

Vinyl chloride (VC) workers are known to be at risk for development of angiosarcoma of the liver (ASL), a rare tumor. Previously, a study of p53 gene mutations in tumors of VC-exposed workers found that 50% of liver angiosarcomas contained such mutations. Mutant p53 oncoprotein and anti-p53 antibodies can also be found in the sera of ASL patients and VC-exposed workers without cancer. Workers in Taiwan have also been exposed to VC, and some have contracted liver tumors. In this study, we used enzyme-linked immunosorbent assays to detect mutant p53 protein and anti-p53 antibodies in the plasma of VC-exposed workers in Taiwan. Thirty-three of 251 (13.2%) VC-workers tested positive for the p53 overexpression (10% with positive mutant p53 protein and 3.6% with positive anti-p53) in their plasma, but only 2 of 36 controls (5.6%) tested positive (2.8% with positive mutant p53 protein and 2.8% with positive anti-p53). There was a significant association between cumulative VC exposure concentration and positive p53 expression (P = 0.032) among VC workers after we adjusted for age, hepatitis, drinking, and smoking status. In summary, P53 overexpression (mutant p53 protein or anti-p53 antibody) can be found in the plasma of VC workers in Taiwan, and a significant dose-response relationship exists between plasma p53 overexpression and VC cumulative exposure concentration.