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Humensky JL, Fattal O, Feit R, Mills SD, Lewis-Fernández R. Factors Associated With Outpatient Visit Attendance After Discharge From Inpatient Psychiatric Units in a New York City Hospital. Psychiatr Serv 2017; 68:624-627. [PMID: 28196463 PMCID: PMC5481167 DOI: 10.1176/appi.ps.201600150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A class action lawsuit in New York (Koskinas v. Cuomo) established the right of psychiatric inpatients to receive discharge planning, including arranging outpatient treatment. The attendance rate of the initial outpatient appointment after discharge from inpatient treatment in one city hospital was examined to determine whether rates varied by inpatient unit type. METHODS The authors performed retrospective chart review of 1,884 discharges to outpatient care. Multivariate regression models were used to examine the odds of attending the initial appointment. RESULTS Eighty-four percent of patients attended the initial appointment. Higher odds of attendance were associated with case management, living in a shelter or being homeless, general medical comorbidity, and inpatient treatment in a co-occurring disorders unit. Lower odds were associated with being non-Latino black. Inpatient treatment in a Latino unit had no significant effect. CONCLUSIONS Hospital characteristics, patient population, and availability of local outpatient services may influence continuity of care.
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Affiliation(s)
- Jennifer L Humensky
- Dr. Humensky and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, New York (e-mail: ). Dr. Humensky is also with the Division of Behavioral Health Services and Policy Research and Dr. Lewis-Fernández is also with the Center of Excellence for Cultural Competence, both at the New York State Psychiatric Institute, New York. Dr. Fattal is with the Department of Psychiatry, NYC Health+Hospitals/Bellevue, and with the Department of Psychiatry, New York University (NYU) School of Medicine, both in New York. Ms. Feit is with the Department of Psychiatry, NYU Langone Medical Center, New York. Ms. Mills is with the Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Omar Fattal
- Dr. Humensky and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, New York (e-mail: ). Dr. Humensky is also with the Division of Behavioral Health Services and Policy Research and Dr. Lewis-Fernández is also with the Center of Excellence for Cultural Competence, both at the New York State Psychiatric Institute, New York. Dr. Fattal is with the Department of Psychiatry, NYC Health+Hospitals/Bellevue, and with the Department of Psychiatry, New York University (NYU) School of Medicine, both in New York. Ms. Feit is with the Department of Psychiatry, NYU Langone Medical Center, New York. Ms. Mills is with the Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Rachel Feit
- Dr. Humensky and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, New York (e-mail: ). Dr. Humensky is also with the Division of Behavioral Health Services and Policy Research and Dr. Lewis-Fernández is also with the Center of Excellence for Cultural Competence, both at the New York State Psychiatric Institute, New York. Dr. Fattal is with the Department of Psychiatry, NYC Health+Hospitals/Bellevue, and with the Department of Psychiatry, New York University (NYU) School of Medicine, both in New York. Ms. Feit is with the Department of Psychiatry, NYU Langone Medical Center, New York. Ms. Mills is with the Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Sarah D Mills
- Dr. Humensky and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, New York (e-mail: ). Dr. Humensky is also with the Division of Behavioral Health Services and Policy Research and Dr. Lewis-Fernández is also with the Center of Excellence for Cultural Competence, both at the New York State Psychiatric Institute, New York. Dr. Fattal is with the Department of Psychiatry, NYC Health+Hospitals/Bellevue, and with the Department of Psychiatry, New York University (NYU) School of Medicine, both in New York. Ms. Feit is with the Department of Psychiatry, NYU Langone Medical Center, New York. Ms. Mills is with the Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
| | - Roberto Lewis-Fernández
- Dr. Humensky and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University, New York (e-mail: ). Dr. Humensky is also with the Division of Behavioral Health Services and Policy Research and Dr. Lewis-Fernández is also with the Center of Excellence for Cultural Competence, both at the New York State Psychiatric Institute, New York. Dr. Fattal is with the Department of Psychiatry, NYC Health+Hospitals/Bellevue, and with the Department of Psychiatry, New York University (NYU) School of Medicine, both in New York. Ms. Feit is with the Department of Psychiatry, NYU Langone Medical Center, New York. Ms. Mills is with the Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego
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Steinman SA, Ahmari SE, Choo T, Kimeldorf MB, Feit R, Loh S, Risbrough V, Geyer MA, Steinglass JE, Wall M, Schneier FR, Fyer AJ, Simpson HB. PREPULSE INHIBITION DEFICITS ONLY IN FEMALES WITH OBSESSIVE-COMPULSIVE DISORDER. Depress Anxiety 2016; 33:238-46. [PMID: 26878422 PMCID: PMC4806386 DOI: 10.1002/da.22474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Deficits in sensorimotor gating have been hypothesized to underlie the inability to inhibit repetitive thoughts and behaviors. To test this hypothesis, this study assessed prepulse inhibition (PPI), a measure of sensorimotor gating, across three psychiatric disorders (obsessive-compulsive disorder [OCD], social anxiety disorder [SAD], and anorexia nervosa [AN]) whose clinical presentations include repetitive thoughts and behaviors METHODS We tested acoustic PPI in unmedicated individuals with OCD (n = 45), SAD (n = 37), and AN (n = 26), and compared their results to matched healthy volunteers (n = 62). All participants completed a structured clinical interview and a clinical assessment of psychiatric symptom severity. RESULTS Percent PPI was significantly diminished in females with OCD compared to healthy female volunteers (P = .039). No other differences between healthy volunteers and participants with disorders (male or female) were observed. Percent PPI was not correlated with severity of obsessions and compulsions, as measured by the Yale-Brown Obsessive Compulsive Scale. CONCLUSIONS This is the first study to assess PPI in participants with SAD or AN, and the largest study to assess PPI in participants with OCD. We found PPI deficits only in females with OCD, which suggests that the cortico-striato-pallido-thalamic and pontine circuitry (believed to underlie PPI) differs between males and females with OCD. Given that PPI deficits were only present in females with OCD and not related to repetitive thoughts and behaviors, our results do not support the hypothesis that sensorimotor gating deficits, as measured by PPI, underlie the inability to inhibit repetitive thoughts and behaviors in individuals with OCD, SAD, and AN.
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Affiliation(s)
- Shari A. Steinman
- New York State Psychiatric Institute, Division of Clinical Therapeutics,Columbia University Medical Center, Department of Psychiatry
| | - Susanne E. Ahmari
- University of Pittsburgh, Department of Psychiatry, Center for Neural Basis of Cognition
| | - Tse Choo
- Columbia University Medical Center, Department of Psychiatry
| | | | - Rachel Feit
- New York State Psychiatric Institute, Division of Clinical Therapeutics
| | - Sarah Loh
- New York State Psychiatric Institute, Division of Clinical Therapeutics
| | - Victoria Risbrough
- Veterans Administration Health Care System, San Diego,University of California San Diego, Department of Psychiatry
| | - Mark A. Geyer
- Veterans Administration Health Care System, San Diego,University of California San Diego, Department of Psychiatry
| | - Joanna E. Steinglass
- New York State Psychiatric Institute, Division of Clinical Therapeutics,Columbia University Medical Center, Department of Psychiatry
| | - Melanie Wall
- Columbia University Medical Center, Department of Psychiatry
| | - Franklin R. Schneier
- New York State Psychiatric Institute, Division of Clinical Therapeutics,Columbia University Medical Center, Department of Psychiatry
| | - Abby J. Fyer
- New York State Psychiatric Institute, Division of Clinical Therapeutics,Columbia University Medical Center, Department of Psychiatry
| | - H. Blair Simpson
- New York State Psychiatric Institute, Division of Clinical Therapeutics,Columbia University Medical Center, Department of Psychiatry
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Miller-Matero LR, Dubaybo F, Ziadni MS, Feit R, Kvamme R, Eshelman A, Keimig W. Embedding a Psychologist Into Primary Care Increases Access to Behavioral Health Services. J Prim Care Community Health 2014; 6:100-4. [DOI: 10.1177/2150131914550831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Patients commonly report psychological issues during primary care visits; however, few patients will follow through with a referral for behavioral health services at an outside facility. Therefore, patients may benefit from having psychologists embedded into primary care clinics. The purpose of this study was to determine who saw a primary care psychologist and to investigate which patient characteristics predicted who was more likely to attend subsequent visits with behavioral health services. Methods: There were 96 patients referred to a primary care psychologist by their primary care physician. Chart reviews were conducted to obtain patient characteristics and to determine whether the patients attended a subsequent visit with behavioral health services after the initial evaluation. Results: There were 84.4% of patients who completed an initial evaluation with a psychologist and 15.6% either cancelled or did not show for this evaluation. Of those who completed the initial evaluation, more than half had never received treatment from a behavioral health specialist. Of the 70.4% patients recommended to attend additional behavioral health treatment, 54.4% of patients attended a subsequent visit. Gender, age, race, years of education, and whether a patient had previous behavioral treatment did not predict who was more likely to attend a subsequent behavioral health visit after the initial evaluation. Conclusions: Embedding a psychologist in a primary care clinic leads to increased access to behavioral health services, especially among patients who may not seek out these services themselves or follow through with a physician’s referral to an outside behavioral health clinic.
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Taneri S, Feit R, Azar DT. Safety, efficacy, and stability indices of LASEK correction in moderate myopia and astigmatism. J Cataract Refract Surg 2004; 30:2130-7. [PMID: 15474826 DOI: 10.1016/j.jcrs.2004.02.070] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the visual outcomes and complications in low to moderate levels of myopia and astigmatism treated with laser-assisted subepithelial keratectomy (LASEK) with a focus on postoperative recovery. SETTING Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. METHODS A retrospective analysis of a case series of eyes treated with LASEK from 1996 to July 2002 with a follow-up of 2 years was performed. The LASEK technique involved creating an epithelial flap with 25 to 45 seconds of exposure to 20% alcohol, ablating the corneal surface using 3 different excimer lasers and nomogram adjustment, and repositioning the flap and applying a bandage contact lens. The main outcome measures were uncorrected visual acuity (UCVA), efficacy index, manifest refraction, best spectacle-corrected visual acuity (BSCVA), safety index, retreatment rate, and complications. RESULTS One hundred seventy-one eyes (85 right eyes and 86 left eyes) of 105 patients were studied. Preoperatively, the mean spherical equivalent was -2.99 diopters (D) +/- 1.43 (SD) (range -0.38 to -7.75 D) and the mean cylinder, -0.78 +/- 0.73 D. The UCVA ranged from 20/800 to 20/32, and the BSCVA ranged from 20/63 to 20/16; the median was 20/20. One week postoperatively, 96% of eyes had a UCVA of 20/40 or better but definitive visual recovery took more than 4 weeks in some eyes. Approximately 95% of eyes were within +/-1.0 D of emmetropia after 4 to 52 weeks; the remaining 5% did not show major deviations. At 4 to 52 weeks, only 1 eye was overcorrected by more than 1.0 D of manifest refraction. The safety index remained close to 1.0 for the follow-up after 4 weeks. The efficacy index displayed a plateau at 0.9 from 1 month to 1 year. No serious complication (including recurrent erosion syndrome) was encountered. The mean follow-up was 31 weeks, and the retreatment rate was 2.9% up to 2 years of follow-up. CONCLUSIONS The long-term safety and effectiveness of LASEK for the correction of low to moderate myopia and astigmatism were demonstrated. The treatment effect stabilized after 4 weeks.
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Affiliation(s)
- Suphi Taneri
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and the Schepens Eye Research Institute, Harvard Medical School, Boston, MA 02114, USA
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Abstract
Laser subepithelial keratomileusis (LASEK) has become a viable alternative to photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in selected patients. LASEK may decrease the complications associated with PRK, including postoperative pain and slow visual rehabilitation. In this article, the authors present the visual outcomes and complication rates of LASEK based on the retrospective case review of 101 consecutive patients (163 eyes) treated with LASEK surgery over the past 6 years. Seventy-eight percent of these eyes showed complete epithelial healing by day 3, and there were no incidents of recurrent erosions. As with LASIK, the achieved correction for LASEK was greater than the treatment dose (requiring undercorrection nomogram adjustments). Mean logMAR UCVA was 0.03 (20/20) at 1 year. LASEK seems to be a safe and effective option for patients who request refractive surgery.
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Affiliation(s)
- Rachel Feit
- Cornea and Refractive Surgery Service, Massachussets Eye and Ear Infirmary, Schepens Eye Research Institute, Harvard Medical School, 243 Charles Street, Boston, MA 02155, USA
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Feit R, Boyarsky S, Buettner JB. Aortic aneurysm presenting as ureteral obstruction, case report. Mo Med 1981; 78:187-192. [PMID: 7254169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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