Background. The National Institutes of Health recently recommended acupuncture as an effective tool for the treatment of various health problems. Acupuncture is an old technique but has been popular in the United States only since 1972. Its history, theories, and indications are not well known to the medical community. Methods. We reviewed the literature to gather information on the history, techniques, physiology, indications, adverse effects, and opposing views to acupuncture. Results. The mechanism by which acupuncture works involves neurotransmitters and adrenocorticotropic hormones. It appears to be effective in the treatment of pain, nausea, and drug detoxification and in stroke victims. Studies suggest acupuncture is no more effective than placebo. Acupuncture side effects have rarely been reported. Conclusions. Acupuncture appears to be a safe and effective alternative medical therapy for certain health problems. More controlled research is necessary to better understand the range of its clinical application.

Over the last 11 years, I have had the privilege of being welcomed into the tnlllsgender community in spite of my status as a psychiatrist. I say in spite 0(, not because of, largely as a result of the grave in justices many transgendered persons have suffered at the hands of some of my ill -informed and, at times, harshly judgmental colleagues. I' m disheartened to say that most of these self-identified patients would have been better served if they had been referred to someone with appropriate knowledge and training in this highly specialized area of human behavior. It was clear from my very first fo ray into the transgender community (the ~CrossPort" support group in Cincinnati, Ohio, in 1985) that cross-dressing men and their spouses (I wi!! use the shorthand notat ion "spouse" for a ll women in emotionally committed relationships with a transgendered man) were hungry for knowledge and for legit imate, open-minded inquiry into the phenomenon of cross-dressing. What they usually found when they went to a library was anything but open-minded and was often wrinen by "researchers" who had never spent so much as one evening with a support group anywhere in the country, in spite of the facr that hundreds exist (sec Appendix I for a listing of sources for information and support). Papers were written fro m the perspective of a treating health-care professional sitting behind a desk talking to a self-identified patient. Information was then generalized to the population of cross-dressers and their spouses at large, even though the majority of such individuals never seek psychiatric assistance or identify themselves as patients (Brown, 1995).

Physicians are not immune to psychosocial problems but may face unique impediments to attending to them. Self-care among physicians is not a topic generally included as a part of professional training, nor is it a topic that readily receives consideration in professional practice. The stresses of professional practice can exact a great toll, however, and self-neglect can lead to tragic consequences. In some areas, particularly suicide rates, physicians have increased vulnerability, and in other areas problems may be unrecognized (depression, substance abuse, marital problems, and other stress-related concerns). Female physicians show some particular areas of risk. In this paper, we raise questions about how and why physicians may be particularly vulnerable, review the available literature about the extent and nature of such problems in physicians, discuss possible factors related to the development of these problems in physicians, and suggest a variety of solutions to improve physician self-care.

Over the last 11 years, I have had the privilege of being welcomed into the tnlllsgender community in spite of my status as a psychiatrist. I say in spite 0(, not because of, largely as a result of the grave in justices many transgendered persons have suffered at the hands of some of my ill -informed and, at times, harshly judgmental colleagues. I' m disheartened to say that most of these self-identified patients would have been better served if they had been referred to someone with appropriate knowledge and training in this highly specialized area of human behavior. It was clear from my very first fo ray into the transgender community (the ~CrossPort" support group in Cincinnati, Ohio, in 1985) that cross-dressing men and their spouses (I wi!! use the shorthand notat ion "spouse" for a ll women in emotionally committed relationships with a transgendered man) were hungry for knowledge and for legit imate, open-minded inquiry into the phenomenon of cross-dressing. What they usually found when they went to a library was anything but open-minded and was often wrinen by "researchers" who had never spent so much as one evening with a support group anywhere in the country, in spite of the facr that hundreds exist (sec Appendix I for a listing of sources for information and support). Papers were written fro m the perspective of a treating health-care professional sitting behind a desk talking to a self-identified patient. Information was then generalized to the population of cross-dressers and their spouses at large, even though the majority of such individuals never seek psychiatric assistance or identify themselves as patients (Brown, 1995).

No description available.

No description available.

Outcome for bipolar disorder remains suboptimal despite the availability of efficacious treatments. To improve treatment effectiveness in clinical practice, a Veterans Affairs study team created a care model conceptually similar to the lithium clinics of the 1970s but augmented by principles of more recent collaborative care models for chronic medical illnesses. This intervention consists of improving patients' self-management skills through psychoeducation; supporting providers' decision making through simplified practice guidelines; and enhancing access to care, continuity of care, and information flow through the use of a nurse care coordinator. Ih this article, which is part I of a two-part report, the authors summarize the conceptual background and development of the intervention, describe the design of a three-year, 11-site randomized effectiveness trial, and report data describing its successful implementation. Trial design emphasized aspects of effectiveness to support generalizability of the findings and eventual dissemination of the intervention. Part II (see companion article, this issue) reports clinical, functional, and overall cost outcomes of the trial.

Objective: The study addressed whether a collaborative model for chronic care, described in part I (this issue), improves outcome for bipolar disorder. Methods: The intervention was designed to improve outcome by enhancing patient self-management skills with group psychoeducation; providing clinician decision support with simplified practice guidelines; and improving access to care, continuity of care, and information flow via nurse care coordinators. In an effectiveness design veterans with bipolar disorder at 11 Veterans Affairs hospitals were randomly assigned to three years of care in the intervention or continued usual care. Blinded clinical and functional measures were obtained every eight weeks. Intention-to-treat analysis (N=306) with mixed-effects models addressed the hypothesis that improvements would accrue over three years, consistent with social learning theory. Results: The intervention significantly reduced weeks in affective episode, primarily mania. Broad-based improvements were demonstrated in social role function, mental quality of life, and treatment satisfaction. Reductions in mean manic and depressive symptoms were not significant. The intervention was cost-neutral while achieving a net reduction of 6.2 weeks in affective episode. Conclusions: Collaborative chronic care models can improve some long-term clinical outcomes for bipolar disorder. Functional and quality-of-life benefits also were demonstrated, with most benefits accruing in years 2 and 3.

No description available.

BACKGROUND: Limited research suggests that rates of suicide death among transgender people may be higher than their nontransgender peers. OBJECTIVE: The objective of this study was to compare rates of suicide deaths by different means between transgender and nontransgender patients. RESEARCH DESIGN: This secondary analysis used VHA administrative and electronic health record (EHR) data from October 1, 1999 through December 31, 2016. SUBJECTS: Transgender patients (n=8981) were categorized as such based on a set of International Classification of Disease codes, and a comparison sample was selected by randomly choosing 3 nontransgender patients (n=26,924). MEASURES AND ANALYSES: Cause and date of death data are from the National Death Index. Because of low frequencies amid different methods of suicide death, we combined categories into self-poisoning; hanging, strangulation and suffocation; discharge of firearms; and self-harm by all other and unspecified means. We conducted Cox regression analyses to model time-to-event for each method of suicide, adjusted for age, sex based on EHR, race, ethnicity, marital status, and whether patients had ever been diagnosed with depression. RESULTS: Among transgender patients, 73 died by suicide (22 female EHR-based sex, 51 male EHR-based sex), and among nontransgender patients, 71 died by suicide (4 female EHR-based sex, 67 male EHR-based sex). In adjusted models, transgender patients had significantly greater hazards of death by self-poisoning and firearms than their nontransgender peers. CONCLUSIONS: Differences in methods of suicide death suggest that firearms and self-poisoning may be specific areas of concern for transgender individuals experiencing suicidal crisis, which underscore needs for examining effective delivery of evidence-based care.