Sickle cell disease is characterized by acute pain crises. Pain, chronic medical problems, utilization and coping were compared in younger vs older patients using questionnaires and medical record review. Groups reported similar pain intensity and medical conditions. The pattern of utilization differed such that older patients attended outpatient clinic, and younger patients went to the Emergency Department. Younger patients were more likely to cope by ignoring pain, or by using heat, cold or massage. Older patients were more likely to pray and hope. We conclude that age plays an important role in the utilization and coping of sickle cell patients.

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The psychotherapy skills of psychiatry residents were assessed by using a structured-response supervisor inventory, the Supervisor Report (SR). Longitudinal data on the same resident across time showed a small but positive trend toward the acquisition of skill in doing psychodynamic psychotherapy. Mixed cross-sectional and longitudinal comparisons between ratings of the beginning residents and advanced residents demonstrated a significant, but small, increase in skill over the course of outpatient training. SR score changes also corroborated observational data on individual residents. While these findings suggest the utility of the SR in measuring changes in psychotherapy skill, the results must be considered in light of the relatively poor interrater reliability and only somewhat better test-retest reliability.

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