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Background: Many studies have looked at sources of stress in psychiatrists, yet the role played by different factors in the causation of burnout in psychiatrists remains unclear. We had two aims, first, to develop a predictive model for the onset of burnout. Second, we aimed to study the differences in the perception of what caused stress between psychiatrists who rated themselves high on Emotional Exhaustion compared to those who rated themselves as low on Emotional Exhaustion.Methods: A previously described questionnaire that identified stressors relevant to consultant psychiatrists was mailed out to 426 psychiatrists, with 240 replies. Scores on the Emotional Exhaustion dimension of the Maslach Burnout Inventory were available for 131 respondents.Results: Based on an earlier literature review, the Sources of Stress Questionnaire (SOS-Q) used in the study had 45 factors, categorized into predisposing, precipitating, perpetuating and protective factors for burnout in psychiatrists. Of these, factor analysis identified 11 non-correlated factors which were used in the final analysis of this study. Four factors emerged as associated with burnout in psychiatrists in New Zealand: too much work; working long hours; an aggressive administrative environment; and lacking support from management. Two factors negatively correlated with Emotional Exhaustion were a high level of job satisfaction and/or enjoyment, and low pay compared to other countries.Conclusions: Most factors associated with burnout are preventable and can be managed jointly between psychiatrists and administrators. Service providers need to address burnout seriously. [ABSTRACT FROM PUBLISHER]

Objectives: The aim of this study was to ascertain the workload for rural general practitioners providing palliative care and to identify barriers to care for patients living in rural areas of New Zealand. Design and methods: This was a cross-sectional survey of rural general practitioners using a postal questionnaire. Results: One hundred eighty-six questionnaires were returned. Of respondents, 98% provided palliative care. The estimated mean number of patients cared for in the previous 12 months was 7.3. Specialist medical advice from a hospice or palliative care consultant was accessed by 77% of respondents. District and community nursing was available to over 90% of respondents but this was not universally available 24 hours a day in all areas. Forty-seven percent of rural palliative care patients died at home. Conclusions: Commitment of general practitioners to palliative care appeared high although the workload was a relatively small part of their activity. There seems to be a need for wider availability of specialist advice, 24-hour nursing cover, and some support services. A commitment to supporting domiciliary services is needed if large increases in institutional care are to be avoided in the future. [ABSTRACT FROM AUTHOR]

Mobile phone images might be useful in after-hours triage of primary care. We conducted a study to identify population access to mobile phone cameras and to assess the clinical usefulness of mobile phone cameras. The survey was conducted among 480 patients attending two rural New Zealand practices. There were significantly more Maori owners compared to non-Maori (P =0.002). Age was a significant factor influencing the ownership of mobile phones. We also conducted a clinical quiz among health professionals to assess how the provision of images on a mobile phone and on CD-ROM (to simulate the image that would be seen if email was used to transmit the images) influenced diagnostic confidence. Ten photographable clinical conditions were used to quiz 30 health professionals who were randomized into three groups of 10 each on diagnostic confidence. Images were found to significantly increase diagnostic confidence in all cases except one. It appears that mobile phone cameras are generally acceptable to patients and likely to be of practical use to rural practitioners in a range of clinical scenarios. [ABSTRACT FROM AUTHOR]

Objective: The present accepted classificatory systems (ICD-10 and DSM-IV) represent the culmination of 100 years of post-Kraepelinian evolution. The present paper reports on a study to ascertain the views of New Zealand psychiatrists on their requirements of a classificatory system, and their opinions on those currently in use. Method: An anonymous postal survey of 542 psychiatrists and trainees was undertaken in New Zealand. Results: A total of 235 questionnaires were returned, completed. New Zealand psychiatrists primarily use DSM-IV and do so because that is what they were taught on. They make relatively limited use of the multiaxiality. The purposes of classificatory systems that they value most highly are reliable interclinician communication, and to inform patient management planning. The two purposes they valued least were usefulness for a national statistical base, or to indicate prognosis. Conclusions: New Zealand psychiatrists' views are consistent with some of the stated objectives of ICD-10 and DSM-IV, but there is significant diversity in the former and over-ambition in the latter, with much to be resolved. [ABSTRACT FROM AUTHOR]

Background: Burnout and job satisfaction in psychiatrists has been an area of considerable interest. Longitudinal studies on the subject are lacking, rendering it difficult to establish whether burnout changes with time or whether low job satisfaction may predict high burnout with time in psychiatrists., Aims: This longitudinal study of burnout and job satisfaction in a cohort of New Zealand psychiatrists was conducted to examine if initial scores on the Job Diagnostic Survey (JDS) predicted scores on the Maslach Burnout Inventory (MBI) three years later and vice versa., Methods: Three questionnaires (a socio-demographic questionnaire, the JDS and the MBI) were sent to all registered psychiatrists in 2008, which included all those who had participated in a study three years earlier. Scores on these three questionnaires were compared for those who had participated in both studies., Results: The overall number of psychiatrists reporting a high level of emotional exhaustion (EE) did not change across the two phases. The number of psychiatrists reporting high levels of depersonalization (DP) increased from 31 (13%) to 45 (20.2%); the mean DP score for the cohort significantly increased by 17.5% (p < .01). Those reporting reduced personal accomplishment (PA) increased from 90 (37.7%) to 98 (43.9%); the mean PA score for the cohort significantly reduced by 14.5% (p < .001). Low scores on skill variety, task Identity, and feedback of the JDS were significantly correlated with high EE scores three years later, whereas low scores on skill variety were significantly correlated with high scores on DP, and low scores on task significance and feedback were correlated with low scores on PA three years later., Conclusions: Paying attention to aspects of job satisfaction may assist us in developing specific interventions for psychiatrists who may score high on different dimensions of burnout.

Background: Family (whanau) and other carers can play a central part in the natural history of psychiatric service users. Diagnoses or the classification of mental disorders play a significant role in communications between clinicians, psychiatric service users, and family. Despite that centrality, the views and experiences of family on the utility of the present classification systems have been little studied., Aims: This study aimed to document the understanding and opinions of families/whanau on the utility of diagnostic labels as they observed them being applied to their family members., Method: This is a qualitative study. The families of two cultural groups (New Zealand Maori and non-Maori) of psychiatric service users were interviewed using a structured approach., Results: A number of themes on the utility of the diagnostic systems emerged. The single most powerful message being that how the diagnostic labels were communicated, and how they were utilized in the patient management planning, were of paramount importance. There were some cross-cultural differences. From Maori, there was a particular plea for a greater incorporation of culturally syntonic concepts., Conclusion: Family/whanau had positive views of the contributions current diagnostic practices make to patient care. The study elicited the view that more contextual issues, and not just phenomenology, should be taken into account in the development of diagnostic systems.

Background: Primary percutaneous coronary intervention (PPCI) has evolved, including the introduction of stents and platelet glycoprotein IIb/IIIa receptor inhibitors (GPI). The effects of these changes and other variables on long-term survival for a single-centre service were studied., Methods: A prospective database of clinical and angiographic variables were kept for patients treated with PPCI in Waikato Hospital from 1996 to 2006 (n=527). This was analysed with long-term mortality data. Survival was recorded using Kaplan-Meier curves. Multivariate analysis of factors at presentation, including ethnicity was performed., Results: 5, 8 & 10-year survival rates were 76.5% (n=274), 72.7% (n=125) & 71.0% (n=19) respectively. Increased stent (42.8% vs. 84.1%, p<0.001) and GPI (39.6% vs. 73.3%, p<0.001) use was seen between early and late stages of the study. Stent use was associated with greater 5-year survival (80.5% vs. 70.8%, p=0.02), but GPI use was not. Multivariate analysis showed stent use independently predicted reduced mortality. Age, Maori ethnicity, renal failure and cardiogenic shock predicted higher mortality., Conclusions: Survival after PPCI remains high long-term. Stent and GPI use significantly increased. Stent, but not GPI, use was associated with improved survival. Maori ethnicity was under-represented in the study and is associated with worse long-term outcomes after myocardial infarction (MI)., (Copyright (c) 2009 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. All rights reserved.)

Objective: To examine whether data on the clinical profiles of psychiatric service users can inform the claim that Māori in the New Zealand community have an increased rate of bipolar disorder., Method: The standardized recordings of a variety of clinical phenomena previously collected in a New Zealand study of psychiatric service users was extracted for those persons who were diagnosed with a bipolar mental disorder. The individual clinical phenomena were then compared by ethnicity., Results: The most dramatic result was the increased recording of high levels of overactivity or disruptive aggressive behaviour in Māori compared with European in psychiatric service users, despite which, the rates of the disorder did not significantly differ by ethnicity., Conclusion: In the community survey lay raters were deciding on the presence or absence of phenomena including hyperactivity without the contextual knowledge that clinicians use. It is possible that the Composite International Diagnostic Interview decision tree was being fed an excessive amount of that criterion.

Evidence and argument for the allocation of funds to forensic psychiatric services to take account of the ethnic disparities in the use of the Justice System is presented. This would reflect the reality of the distribution of Service demand.