Explore the vast range of titles available.

Objective: The authors evaluate an Internet virtual reality technology as an education tool about the hallucinations of psychosis. Method: This is a pilot project using Second Life, an Internet-based virtual reality system, in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients with schizophrenia. Eight hundred sixty-three self-referred users took a self-guided tour. Results: Five hundred seventy-nine (69%) of the users who toured the environment completed a survey. Of the survey responders, 440 (76%) thought the environment improved their understanding of auditory hallucinations, 69% thought it improved their understanding of visual hallucinations, and 82% said they would recommend the environment to a friend. Conclusions: Computer simulations of the perceptual phenomena of psychiatric illness are feasible with existing personal computer technology. Integration of the evaluation survey into the environment itself was possible. The use of Internet-connected graphics environments holds promise for public education about mental illness.

Physician Suicide examines the multiple risk factors that account for the higher rates of burnout, depressive symptoms, and suicide risk physicians experience compared with the general population. Suicide is typically caused by a convergence of factors, chief among these are untreated or inadequately managed mental health conditions. Physicians are less likely to seek professional help for these conditions -- in part, because of fear of professional repercussions -- and many seek to address their symptoms by self-medicating with alcohol or drugs. Burnout is especially common and is frequently due to workload, work inefficiency, lack of autonomy and meaning, and work-home conflict. The author explores these issues through the lens of a series of beautifully written and fascinating case studies that allow the reader to get inside the minds of his subjects and understand their lives and the stressors they face. The only volume of its kind, it provides an in-depth and nuanced approach to the topic of physician suicide in the context of the broader topic of physician health and wellbeing: • The book covers the full range of physician mental health issues, from lifestyle and professional expectations and burnout, through depression, anxiety, addictions, personality disorders, and aging, carefully noting the many interactions with suicide and suicidal behavior. • Prevention of these diverse problems -- at the individual and organizational level -- is addressed, with emphasis on the response of health care organizations and institutions to the issue of physician health and wellbeing, and the impact that well-organized physician well-being committees, taking on the function of a physician health program, can have on individual physicians.• The chapter-long case studies resemble short stories that realistically capture the mental health challenges doctors confront in the cultural context of medical training and professional practice. These represent the core of the book, and they succeed in making the issues discussed \"personal\" and engaging for the reader.• Accompanying each case study is a concise literature review that offers commentary and emphasizes the most important points. A detailed reference list is also offered for readers who want more extensive background material.• The author calls clearly upon the medical profession to take serious actions to improve physician health and thereby reduce the number of physicians who kill themselves each year. • \"Physician Suicide\" is a case-based textbook of physician health and wellbeing that can be used in courses teaching physicians and medical students about self-care. There is little mention in the health literature of the daily pressures inherent in the physician lifestyle, which may lead to unintended consequences, of which suicide is the most extreme. Physician Suicide is an attempt to document the pain and suffering that physicians are trained to deny, especially in front of their patients, in the hope that such discussion may improve the lives of current generations of physicians and prevent further suffering in future generations.

BACKGROUND--The associations between psychiatric caseness, denial, and self reported measures of handicap and morbidity due to asthma in patients suffering a near fatal attack of asthma have not been fully explored. METHODS--Seventy seven consecutive subjects who presented to Adelaide teaching hospitals with a near fatal attack of asthma were assessed with a validated semi-structured interview following discharge from hospital. RESULTS--43% of the patients scored > or = 5 on the GHQ-28 questionnaire. There was a positive correlation between GHQ-28 score and limitation to daily activities due to asthma, and between GHQ-28 score and days lost from work, school or usual daily activities, both of which were retained after adjusting for age and sex. Asthma severity did not show a clear association with GHQ-28 score. The asthmatic patients reported high levels of denial, 57% scoring more than 3 out of 5 on the denial scale of the Illness Behaviour Questionnaire. Presentation with a history of progressive respiratory distress was negatively associated with denial score. This persisted after adjustment for age and sex--that is, those with high denial scores were more likely to report presentation as sudden collapse than progressive respiratory distress. CONCLUSIONS--Psychiatric caseness (GHQ score > or = 5) is associated with high levels of morbidity in asthmatic patients who survive a near fatal attack of asthma. High levels of denial in asthmatic subjects may be life threatening. The link between morbidity associated with asthma and psychiatric features, along with other psychosocial issues, warrants further investigation. A broader paradigm than the traditional medical model should be considered when assessing patients with asthma.

A second-opinion child psychiatry service was piloted for six months in the northern-most two-thirds of Queensland. It provided specialist expertise by telehealth to local multidisciplinary teams of mental health staff. During the study period, 28 videoconferences were performed by the service: nine for administrative purposes, two for educational purposes, and 17 for direct and indirect clinical applications. The mean time between a referral being made and a consultation being performed was 4.7 days (range 1–13). A survey administered to referring and non-referring mental health workers showed that the major barriers to service implementation included the limited allied health applications that were offered, a perceived lack of communication during the implementation phase of the service, and the creation of a new referral network that did not conform to traditional referral patterns in the north of Queensland.

We explored the feasibility and acceptability of delivering cognitive-behavioural therapy (CBT) via videoconference to clients with depression and/or anxiety living in rural north Queensland. The study involved 15 mental health clients and their five case managers. First, each case manager was instructed in the use of telemedicine for clinical consultation, and given training in CBT. This was done via videoconference. Then the clients were introduced to telemedicine. Following six to eight intensive weekly sessions of CBT, there was improvement in certain clinical outcome measures (i.e. the Mental Health Inventory and the Health of the Nation Outcome Scale). There was a significant improvement (P<0.05 using a t-test) in the client Mental Health Inventory scores before (mean = 109) and after treatment (mean = 148). However, in the absence of a control condition, it was not possible to conclude that the treatment had a specific effect on the disorders studied. Both clients and case managers found telemedicine consultations acceptable. Clients' ratings ranged from 3 to 4.5, while case mangers' ratings ranged from 3 to 5 ('average' to 'much better than average').

Successfully developing telemedicine systems is primarily about effective change management. The literature suggests that certain principles are likely to increase the chances of success in developing a telemedicine system. These are: (1) telemedicine applications and sites should be selected pragmatically, rather than philosophically; (2) clinician drivers and telemedicine users must own the systems; (3) telemedicine management and support should follow best-practice business principles; (4) the technology should be as user-friendly as possible; (5) telemedicine users must be well trained and supported, both technically and professionally; (6) telemedicine applications should be evaluated and sustained in a clinically appropriate and user-friendly manner; (7) information about the development of telemedicine must be shared. If telemedicine is to realize its full potential, it must be properly evaluated and the results of any evaluations published, whether the results are positive or negative. Since telemedicine is about communication with colleagues and patients across large distances, it should be possible for those involved in it to do the same with their experiences.Successfully developing telemedicine systems is primarily about effective change management. The literature suggests that certain principles are likely to increase the chances of success in developing a telemedicine system. These are: (1) telemedicine applications and sites should be selected pragmatically, rather than philosophically; (2) clinician drivers and telemedicine users must own the systems; (3) telemedicine management and support should follow best-practice business principles; (4) the technology should be as user-friendly as possible; (5) telemedicine users must be well trained and supported, both technically and professionally; (6) telemedicine applications should be evaluated and sustained in a clinically appropriate and user-friendly manner; (7) information about the development of telemedicine must be shared. If telemedicine is to realize its full potential, it must be properly evaluated and the results of any evaluations published, whether the results are positive or negative. Since telemedicine is about communication with colleagues and patients across large distances, it should be possible for those involved in it to do the same with their experiences.

Objective: Simulation technologies are used to assess and teach competencies through the provision of reproducible stimuli. They have exceptional utility in assessing responses to clinical stimuli that occur sporadically or infrequently. In this article, the authors describe the utility of emerging simulation technologies, and discuss critical issues in simulator-based skills assessment and appropriate results analysis. Method: Based on literature search and expert consensus, the authors discuss three simulation technologies: standardized patients and the objective structured clinical examination; the integrated high fidelity mannequin; virtual clinical stations and the objective structured virtual examination. Results: The authors explore the current state of these technologies: uses, cost, limitations, and likely future applications. For instance, tele-standardized patients may test learners' communication/management approach to challenges during tele-consultation, such as a suicidal patient several hundred miles away. Integrated mannequins may test leadership skills during psychiatric emergencies. Case-based interactive virtual clinical assessment tools may test learners' decision-making skills or self-reflection. However, these exciting tools must be implemented systematically. Specifically, educators must define the competencies of interest precisely. Appropriate data analysis will generate dependable results, ascribing the correct proportion of outcome variability to individual learner behavior. Careful analysis and utilization of results will allow justification of the costs to major stakeholders. Conclusions: Simulation technologies offer exciting possibilities for skills evaluation and clinical practice improvement. When used creatively and appropriately, they form a useful adjunct in the armament of educators addressing the question, \"Is this physician competent?\"

OBJECTIVE: To determine the current utilisation, importance, trust and future preference for contemporary sources of health information in three different socioeconomic groups. DESIGN: A pilot study including key informant interviews and direct observation was conducted in a low socioeconomic community. From this work a survey questionnaire was designed and implemented across three different communities. PARTICIPANTS AND SETTING: Semi-structured key informant interviews and focus groups capturing 52 respondents. Paper-based surveys were left in community organisations and local health practices in a low socioeconomic (LSE) community on the outskirts of Ipswich, Queensland, a mid-high socioeconomic (MSE) community in the western suburbs of Brisbane, and at a local university. MAIN OUTCOME MEASURES: Rank of current and preferred future sources of health information, importance and trustworthiness of health information sources. RESULTS: Across all three communities the local doctor was the most currently used, important, trusted and preferred future source of health information. The most striking difference between the three communities related to the current use and preferred future use of the internet. The internet was a more currently used source of health information and more important source in the university population than the LSE or MSE populations. It was also a less preferred source of future health information in the LSE population than the MSE or university populations. Importantly, currently used sources of health information did not reflect community members' preferred sources of health information. CONCLUSIONS: People in different socioeconomic communities obtain health information from various sources. This may reflect access issues, education and awareness of the internet as a source of health information, less health information seeking as well as a reluctance by the e-health community to address the specific needs of this group. (author abstract)

Objective: This article highlights technology innovations in psychiatric and medical education, including applications from other fields. Method: The authors review the literature and poll educators and informatics faculty for novel programs relevant to psychiatric education. Results: The introduction of new technologies requires skill at implementation and evaluation to assess the pros and cons. There is a significant body of literature regarding virtual reality and simulation, including assessment of outcomes, but other innovations are not well studied. Conclusions: Innovations, like other uses of technology, require collaboration between parties and integration within the educational framework of an institution.

BACKGROUND--The reliability of information collected from close acquaintances of the deceased in studies on mortality from asthma has not been assessed. As part of a South Australian asthma mortality study, levels of agreement for information obtained directly from cases--that is, cases who had experienced near fatal asthma attacks--were compared with corresponding information concerning these cases obtained independently from close acquaintances. METHODS--The first 51 subjects presenting from the outset of the main study to hospital accident and emergency departments with near fatal asthma attacks were included to gain an early assessment of the reliability of responses. The level of agreement between self reported information and that obtained from close acquaintances was compared by means of a kappa statistic or intraclass correlation coefficient, depending on the measurement scale. Both score one for complete agreement and zero when there is no agreement. RESULTS--High levels of agreement were found for questions relating to use of hospital services, with agreement levels ranging from 0.92 for visits in the past month to accident and emergency departments, to 0.86 for prior hospital admissions and 0.78 for prior need for assisted ventilation. Levels of agreement for drug treatment ranged from 1.00 for use of beta agonists to 0.64 for corticosteroid use, and to a low 0.24 for use of sodium cromoglycate. There was moderate agreement for histories of regular use of over the counter medications without a medical consultation (0.57). Psychiatric characteristics showed moderate levels of agreement, with values of 0.44 for personal history of psychiatric consultations and 0.50 for denial score. Agreement scores were 0.66 for doctor visits in the past month, 0.66 for limitations in daily activities, 0.76 for loss of work days in the past month, 0.59 for severity of asthma, and 0.55 for frequency of asthma attacks in the past month. Poorer agreement scores were found for trends in asthma symptoms (0.21) and frequency of symptoms during the past three years (0.12). Sleep disturbance was also associated with a low agreement score (0.25). CONCLUSIONS--The more visible the asthma manifestation, and the more recent the period to which it applies, the more reliable is the information provided by close acquaintances. These factors need to be taken into account when using information from close acquaintances in asthma mortality studies.